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1.
Medicine (Baltimore) ; 99(21): e20276, 2020 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-32481306

RESUMEN

RATIONALE: The most common fractures of the spine are associated with the thoracolumbar junction (T10-L2). And burst fractures make up 15% of all traumatic thoracolumbar fractures, which are often accompanied by neurological deficits and require open surgeries. Common surgeries include either anterior, posterior or a combination of these approaches. Here, we report the first attempt to treat thoracolumbar burst fracture (TLBF) with severe neurologic deficits by percutaneous pedicle screw fixation (PPSF) and transforaminal endoscopic spinal canal decompression (TESCD). PATIENT CONCERNS: A 46-year-old Chinese woman suffered from severe lower back pain with grade 0 muscle strength of lower limbs, without any sensory function below the injury level, with an inability to urinate or defecate after a motor vehicle accident. Imaging studies confirmed that she had Magerl type A 3.2 L1 burst fracture. DIAGNOSES: Burst fracture at L1. INTERVENTIONS: The patient underwent PPSF at the level of T12 to L2, but her neurological function did not fully recover after the operation. One week after the injury, we performed TESCD on her. OUTCOMES: There was an immediate improvement in her neurological function in just 1 day after 2-stage operation. During the 6-month follow-up period, her neurological functions gradually recovered, and she was able to defecate and urinate. At the last follow-up visit, her spinal cord function was assessed to be at Frankel grade D. LESSONS: PPSF plus TESCD can achieve complete spinal cord decompression, promote neurological recovery, and is therefore an effective method for the treating lumbar burst fractures with severe neurologic deficits.


Asunto(s)
Endoscopía/métodos , Fijación Interna de Fracturas/métodos , Dolor de la Región Lumbar/etiología , Vértebras Lumbares/lesiones , Tornillos Pediculares , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/lesiones , Descompresión Quirúrgica/métodos , Femenino , Fracturas por Compresión/complicaciones , Fracturas por Compresión/diagnóstico , Fracturas por Compresión/cirugía , Humanos , Laminectomía/métodos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/cirugía , Imagen por Resonancia Magnética , Persona de Mediana Edad , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/diagnóstico , Tomografía Computarizada por Rayos X
2.
Medicine (Baltimore) ; 99(21): e20015, 2020 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-32481269

RESUMEN

The purpose of this study is to define the rate of implant failure and risk factors for failure in patients treated operatively for displaced medial epicondyle fractures.Patients <18 years of age with medial epicondyle humerus fractures that were treated with screw or k-wire fixation between 2005 and 2015 were eligible. Inclusion criteria included follow-up until radiographic union and no known medical conditions that could impair healing.Thirty four patients with 35 fractures were identified with an average age of 12 years old. 11.4% (n = 4/35) of fractures were treated using K-wires, 25.7% (n = 9/35) were treated using a screw and washer construction, and 62.9% (n = 22/35) were treated using screw alone. There were 16 reported complications (46%) including implant prominence requiring reoperation (6), implant failure (1), and fracture displacement (1). Other complications included non-union/delayed union (4), new ulnar nerve palsy (2), and decreased range of motion (2). Rates of complications were not different between the types of fixation (P = 1.0). Those who developed complications were younger than those who did not (P = 0.05). 91.4% of patients returned to full activity including weight bearing and throwing sports.Although 25% of patients experienced implant complications and the overall complication rate approached 50%, nearly all reported return to full activity.


Asunto(s)
Fijación Interna de Fracturas/efectos adversos , Fracturas del Húmero/cirugía , Complicaciones Posoperatorias/etiología , Adolescente , Tornillos Óseos/efectos adversos , Hilos Ortopédicos/efectos adversos , Niño , Falla de Equipo , Femenino , Fijación Interna de Fracturas/métodos , Humanos , Masculino , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos
3.
Bone Joint J ; 102-B(6): 744-748, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32475231

RESUMEN

AIMS: The aim of this study was to compare patient-reported outcome measures (PROMs) and the Single Assessment Numerical Evaluation (SANE) score in patients treated with a volar locking plate for a distal radial fracture. METHODS: This study was a retrospective review of a prospective database of 155 patients who underwent internal fixation with a volar locking plate for a distal radial fracture between August 2014 and April 2017. Data which were collected included postoperative PROMs (Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and Patient-Rated Wrist Evaluation (PRWE)), and SANE scores at one month (n = 153), two months (n = 155), three months (n = 144), six months (n = 128), and one year (n = 73) after operation. Patients with incomplete data were excluded from this study. Correlation and agreement between PROMs and SANE scores were evaluated. Subgroup analyses were carried out to identify correlations according to variables such as age, the length of follow-up, and subcategories of the PRWE score. RESULTS: The Pearson correlation coefficient (r) between PROMs and SANE scores was -0.76 (p < 0.001) for DASH and -0.72 (p < 0.001) for PRWE, respectively. Limits of agreement between PROMs and '100-SANE' scores were met for at least 93% of the data points. In subgroup analysis, there were significant negative correlations between PROMs and SANE scores for all age groups and for follow-up of more than six months. The correlation coefficient between PRWE subcategories and SANE score was -0.67 (p < 0.001) for PRWE pain score and -0.69 (p < 0.001) for PRWE function score, respectively. CONCLUSION: We found a significant correlation between postoperative SANE and PROMs in patients treated with a volar locking plate for a distal radial fracture. The SANE score is thus a reliable indicator of outcome for patients who undergo surgical treatment for a radial fracture. Cite this article: Bone Joint J 2020;102-B(6):744-748.


Asunto(s)
Placas Óseas , Autoevaluación Diagnóstica , Fijación Interna de Fracturas/instrumentación , Medición de Resultados Informados por el Paciente , Fracturas del Radio/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Correlación de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Adulto Joven
4.
Orthop Clin North Am ; 51(3): 317-324, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32498950

RESUMEN

Percutaneous reduction and fixation of pelvic ring fractures is now widely accepted as a safe and effective treatment method. The only exception remains reduction and fixation of pubic symphyseal injuries. Several units from China and one from Spain have published clinical and biomechanical studies supporting percutaneous reduction and fixation of the pubic symphysis with various screw configurations. The initial clinical results are promising. Biomechanical data show there is little difference between plate and screw fixation. We review the current literature and also present a case performed by ourselves using this novel technique.


Asunto(s)
Fijación Interna de Fracturas/tendencias , Fracturas Óseas/cirugía , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Óseas/diagnóstico por imagen , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/tendencias , Huesos Pélvicos/diagnóstico por imagen , Sínfisis Pubiana/diagnóstico por imagen , Sínfisis Pubiana/lesiones , Sínfisis Pubiana/cirugía
5.
Orthop Clin North Am ; 51(3): 325-338, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32498951

RESUMEN

Minimally invasive surgical techniques are increasingly used for definitive treatment of displaced intra-articular calcaneal fractures. These approaches have been shown to minimize soft tissue injury, preserve blood supply, and decrease operative time. These methods can be applied to all calcaneal fractures and have particular advantages in patients with higher than usual risks to the soft tissues. The literature suggests that results of limited soft tissue dissection approaches provide equivalent outcomes to those obtained with the extensile lateral approach. We predict that as imaging and other techniques continue to improve, more calcaneal fractures will be treated by these appealing safer techniques.


Asunto(s)
Calcáneo/lesiones , Calcáneo/cirugía , Traumatismos de los Pies/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Fracturas Intraarticulares/cirugía , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Posicionamiento del Paciente
6.
Orthop Clin North Am ; 51(3): 339-343, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32498952

RESUMEN

Pediatric spine trauma presents unique management challenges. These injuries are often the result of high-energy mechanisms and are associated with other serious injuries that can complicate surgical and nonsurgical approaches. The pediatric population presents a host of challenges related to patient compliance, healing challenges, and patient tolerance of therapy. Percutaneous pedicle screw instrumentation, temporary fixation without fusion, continues to expand in its role of pediatric spine fracture treatment. Compared with open instrumentation and fusion, this technique addresses many of the previously mentioned challenges. Additional study is needed to evaluate the clinical utility of this approach in pediatric spinal fractures.


Asunto(s)
Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Adolescente , Niño , Femenino , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Humanos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Tornillos Pediculares , Resultado del Tratamiento
7.
Indian J Dent Res ; 31(2): 331-333, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32436919

RESUMEN

In the treatment of mid-facial fractures circum-zygomatic suspension wiring is one of the treatment modality. Earlier zygomatic awls were used to pass wire, which used to cause conspicuous trauma. In the present case we have used 16 gauge lumbar puncture needle for the suspension wiring for Lefort 1 fracture, which is inconspicuous as compared to an awl. The needle was passed in close proximity to bone to prevent soft tissue impaction between the wire and bone as it might lead to the necrosis of soft tissue, and the wire was twisted around the maxillary arch bar. The fragments were stable and occlusion was maintained. Six weeks post-operatively the bone healing was satisfactory, and the wires and arch bar were removed.


Asunto(s)
Fracturas Maxilares , Fracturas Cigomáticas , Hilos Ortopédicos , Fijación Interna de Fracturas , Humanos , Maxilar , Punción Espinal
8.
Gene ; 751: 144766, 2020 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-32413481

RESUMEN

Approximately 10-15% of fracture patients suffer impaired healing, which is either delayed or even results in non-union. We performed a Systematic Review, aiming to examine the types and frequency of specific genetic abnormalities in patients experiencing bone fracture and to ascertain whether a genetic association exists regarding the tendency for some patients to suffer fracture non-union or postoperative non-union events. GO and KEGG analyses were used to identify the likely function of the genes involved. Furthermore, we evaluated the functional significance of single nucleotide polymorphisms using RegulomeDB and GTEx. Seven eligible studies involving 29 genes and 89 SNPs were analyzed in this review. We found that the polymorphisms in gene NOS2, NOG, BMP4, CYR61, IL1ß and FGFR1 apparently predisposed patients to fracture non-union, while the polymorphisms in gene MMP13, BMP6 and FAM5C appeared to provide protection from non-union. Bioinformatics analysis suggested that these genes were enriched in inflammatory pathways, suggesting that inflammation may be a potential factor involved in fracture non-union. Three SNPs (rs17563, rs3753793 and rs2853550) had smaller RegulomeDB scores, indicating significant biological function. In conclusion, we have identified a number of genes and their polymorphisms that might contribute to a genetic susceptibility to fracture non-union. Further studies with larger cohorts will enhance our understanding of fracture non-union and may inform and direct early interventions.


Asunto(s)
Fracturas no Consolidadas/genética , Citocinas/genética , Fijación Interna de Fracturas , Fracturas no Consolidadas/cirugía , Predisposición Genética a la Enfermedad , Humanos , Polimorfismo de Nucleótido Simple
9.
Bone Joint J ; 102-B(5): 632-637, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32349595

RESUMEN

AIMS: Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients' long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques. METHODS: In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired t-test. RESULTS: Patient-reported functional outcomes as assessed by overall SMFA were statistically significantly improved at five years (p < 0.001) compared with one-year data from the same patients. Patients additionally reported an improvement in the Standardized Mobility Index (p < 0.001), Standardized Emotional Index (p < 0.001), as well as improvement in Standardized Bothersome Index (p = 0.003) between the first year and latest follow-up. Patient-reported pain and knee ROM were similar at five years to their one-year follow-up. In total, 15 of the patients had undergone subsequent orthopaedic surgery for their knees at the time of most recent follow-up. Of note, only one patient had undergone knee arthroplasty following plateau fixation related to post-traumatic osteoarthritis (OA). CONCLUSION: Knee pain following tibial plateau fracture stabilizes at one year. However, PROs continue to improve beyond one year following tibial plateau fracture, at least in a statistical sense, if not also clinically. Patients displayed statistical improvement across nearly all SMFA index scores at their minimum five-year follow-up compared with their one-year follow-up. Cite this article: Bone Joint J 2020;102-B(5):632-637.


Asunto(s)
Fijación Interna de Fracturas/métodos , Reducción Abierta/métodos , Medición de Resultados Informados por el Paciente , Fracturas de la Tibia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Rango del Movimiento Articular , Recuperación de la Función
10.
Medicine (Baltimore) ; 99(18): e20153, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358405

RESUMEN

At present, the posterior cervical approach with open reduction and internal fixation (ORIF) remains a commonly effective treatment for unstable Atlas fracture. However, the inserted screws into the C1 lateral mass of some unstable atlas fracture are very difficult, so that the operation is forced to change into C0 to C2 fusion. In order to improve the successful rate of lateral mass screw placement, we introduced a method of fixing lateral mass with a towel clamp in posterior transpedicular fixation, and explore the efficacy and feasibility.Twenty-one consecutive patients with unstable atlas fracture were treated via this method from October 2012 to July 2017. All cases had neck pain and restricted motion of neck movement on admission. Electronic medical records and pre- and postoperative radiographs were reviewed. Screw and rod placement, bone fusion, and spinal cord integrity were assessed via long-term follow-up with anteroposterior and lateral radiographs and computed tomography. Follow-up included clinical assessment of neurological function, assessment of pain using the visual analog scale (VAS), and assessment of the activities of daily living using the neck disability index (NDI).The mean follow-up duration was 22.1 months (range: 12-54 months). No screw loosening or breakage, plate displacement, neurovascular injury, and severe complications occurred during follow-up. The mean operative time was 112.4 ±â€Š14.9 min (range: 82-135 min), and mean blood loss was 386.2 ±â€Š147.9 mL (range: 210-850 mL). One patient experienced continuous neck pain postoperatively, but this gradually disappeared with analgesic administration. At final follow-up, all patients had bone fusion, the VAS scores and NDI were significantly improved compared with preoperatively.Fixing the C1 lateral mass with a towel clamp during posterior transpedicular fixation for unstable atlas fracture appears to be a safe and reliable method, with the advantages of being a simple technique with few complications.


Asunto(s)
Atlas Cervical/lesiones , Atlas Cervical/cirugía , Fijación Interna de Fracturas/métodos , Fracturas de la Columna Vertebral/cirugía , Actividades Cotidianas , Pérdida de Sangre Quirúrgica , Placas Óseas , Tornillos Óseos , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Rango del Movimiento Articular , Estudios Retrospectivos
11.
Acta Chir Orthop Traumatol Cech ; 87(2): 101-107, 2020.
Artículo en Checo | MEDLINE | ID: mdl-32396510

RESUMEN

PURPOSE OF THE STUDY Comparison of the outcomes of clavicle midshaft fractures using two different surgical techniques, namely intramedullar osteosynthesis using elastic stable intramedullary nailing (ESIN) with medial cap and extramedullar plate osteosynthesis. MATERIAL AND METHODS The prospective randomized trial was conducted at the Department of Trauma Surgery of the Department of Surgery of the University Hospital Hradec Králové in the Czech Republic at the Level I Trauma Center between 2014 and 2018 and compared two types of osteosynthesis of clavicle midshaft fractures. 60 patients were enrolled in the study and were randomly assigned to one of the two groups. In Group 1, the participants were treated by ESIN and in Group 2 by plate osteosynthesis. The operative technique was chosen by the sealed envelope method. According to the randomization list created by a specialised statistical company, every envelope was marked with a unique number and contained the intramedullar "IM", or the extramedullar "EM" sign. RESULTS The observation of statistical parameters by unpaired t test detected significantly different results: a shorter incision using ESIN osteosynthesis (median = 2.9 cm) compared with plate osteosynthesis (median 14 cm, p < 0.001), longer X-ray exposure using ESIN (median = 325 s) compared with plate osteosynthesis (median = 16.5 s, p < 0.001) and radiation dose using ESIN (median = 996 cGy/cm2) compared with plate osteosynthesis (median = 4 cGy/cm2, p < 0.001). The difference in other parameters such as operative time, in-patient length of stay and duration of rehabilitation was not statistically significant. The time to clavicle fracture repair was comparable in both the surgical arms, i.e. approximately 3 months. Also, the duration of incapacity for work was not statistically different. Functional Constant Shoulder Score at a one-year followup is comparable in both the two arms (p = 0.268). The Dunn s method necessitated a longer operative time when treating multifragmental midshaft clavicle fracture by the ESIN compared to simple fractures. No statistically significant difference was detected in the operative time of different procedures and in the number of bone fragments. The functional outcome was excellent in 25 patients (83%) in each method. DISCUSSION Most midshaft clavicle fractures are still treated non-operatively with good outcomes. The indication for surgical treatment is the dislocation of fragments greater than the width of the clavicle bone, the shortening of fragments greater than 2 cm and the angulation of more than 30°. Patient after operative treatment profits from bone healing by absolute or relative stability. In recent years, new intramedullar techniques other than open plate reduction and fixation have emerged. For example, elastic stable intramedullary titan nailing. Both the methods are full-fledged without functional differences in longterm follow-up. CONCLUSIONS We consider the intramedullar osteosynthesis to be the most appropriate surgical approach for simple midshaft spiral, oblique and transverse clavicle fractures and also wedge oblique fractures. Plate osteosynthesis is useful for all types of fractures. No statistically significant difference in the rate of bone healing was observed after intramedullar or extramedullar ostesynthesis, but multifragmentary fractures healed faster when plate osteosynthesis was used. The determining factor for the received radiation dose is solely the surgical method, not the type of fracture. There is a statistically significant difference in shorter X-ray exposure and lower received radiation dose in plate fixation and reduction. The complication rate is comparable in both the methods. Key words: elastic stable intramedullary nailing, midshaft clavicle fracture, ESIN, TEN, titan elastic nail, clavicle plate osteosynthesis, 3.5 LCP clavicular plate, indication for midshaft fracture treatment.


Asunto(s)
Clavícula/lesiones , Clavícula/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Clavos Ortopédicos , Placas Óseas , Fijación Interna de Fracturas/instrumentación , Curación de Fractura , Humanos , Estudios Prospectivos , Resultado del Tratamiento
12.
Acta Chir Orthop Traumatol Cech ; 87(2): 114-119, 2020.
Artículo en Checo | MEDLINE | ID: mdl-32396512

RESUMEN

PURPOSE OF THE STUDY MIPO (Minimally Invasive Plate Osteosynthesis) technique is currently a commonly used method to treat fractures of the distal third of tibia diaphysis. At the same time, it is just like other methods accompanied by a relatively high complication rate. The purpose of this study was to determine whether the use of this technique at our department is effective and whether the complication rate does not differ considerably from values reported by literature. MATERIAL AND METHODS In the period 2014-2016, minimally invasive plate osteosynthesis was performed in a total of 42 patients, who had suffered a fracture of the distal third of tibia diaphysis. They sustained a low-energy trauma. The mean age of patients was 50 years (range 27-86 years) and the mean follow-up period was 11.8 months (range 1.5-38 months). All the patients were treated with a minimally invasive technique with the use of subcutaneous LCP. In 41 patients (98%) it was inserted via anteromedial approach. In one patient only (2%), the LCP was inserted via anterolateral approach due to the unfavourable local finding on the medial side of the distal lower limb. RESULTS Of the total number of operated patients, 35 patients (83%) underwent surgery within 24 hours of injury, including two patients in whom an external fixator was used. The mean operative time was 61 minutes (range of 30-150 minutes). The primary healing occurred in 93% of patients with radiological signs of healing within 5.6 months on average (range of 1.5-16 months). Time to full weight bearing was 4.2 months on average (range of 1.5-16 months). Delayed healing was observed in four patients. In three patients, a non-union developed, necessitating revision surgery. Infectious complications were reported in seven patients, in three of whom deep wound infection developed. In one case, the chronic infection resulted in a lower limb amputation. In five patients mal-union occurred. DISCUSSION The outcomes achieved by the authors in treating fractures of the distal third of tibia diaphysis with a minimally invasive technique do not considerably differ from the outcomes reported by other authors in literature. In terms of the outcomes and the complication rate, the MIPO method is comparable to the treatment of these fractures with the use of nails. Limiting for fracture healing is the vascular supply. Therefore, in treating these injuries it is necessary to proceed with minimum invasiveness and carefulness and to seek to limit any additional trauma to soft tissues, thus also to vascular supply. In case of syndesmosis failure, the concurrent treatment of distal fibula fractures is clearly indicated. In case of intact syndesmosis, fibular osteosynthesis and the sequence of procedures are to be decided by the surgeon. At present, rigid osteosynthesis is being abandoned for potential slower healing up to development of non-unions. CONCLUSIONS The treatment of fractures of the distal third of tibia diaphysis remains an unsolved issue despite the development of stateof-the art materials, implants and surgical techniques. The MIPO technique can be considered an effective method of treatment of these types of fractures, achieving a high success rate of healing and acceptable rate of complications. Key words: minimally invasive plate osteosynthesis (MIPO), distal third of tibia diaphysis, locking compression plate (LCP).


Asunto(s)
Diáfisis/cirugía , Fijación Interna de Fracturas/métodos , Fracturas de la Tibia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Placas Óseas , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/instrumentación , Curación de Fractura , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del Tratamiento
15.
Medicine (Baltimore) ; 99(19): e19830, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384428

RESUMEN

BACKGROUND: Optimal treatments for ulnar coronoid fracture have yet to be determined. We aimed to systematically review treatment efficacy assessed by functional outcomes of patients with isolated ulnar coronoid fracture. METHODS: Medline, Cochrane Library, EMBASE, and Google Scholar were searched for studies reporting quantitative outcomes data after surgical treatment for isolated ulnar coronoid fractures up to July 16, 2019. Functional outcomes determined using disabilities of the arm, shoulder and hand score; Mayo elbow performance score (MEPS); and range of motion were systematically reviewed. RESULTS: Six studies with a total of 65 patients with isolated coronoid fracture who had received surgical treatment were included. All studies were of good quality according to a modified Delphi checklist. Most patients had Type II fractures based on Regan-Morrey or O'Driscoll classification. Disabilities of the arm, shoulder and hand scores were reported by 2 studies (mean range 5-17). Four studies reported MEPS (mean range 89-98). One study reported Broberg-Morrey scores, in which 93% patients achieved excellent or good outcomes. Five studies reported range of motion, with mean flexion ranging from 122 to 137 and mean extension ranging from 4.0 to 21 degrees. Quantitative analyses revealed that lateral, medial, or posterior approaches in treating Type II fractures are associated with higher postoperative MEPS and flexion scores than the anteromedial approach. CONCLUSIONS: Treatment efficacy assessed by functional outcomes for isolated ulnar coronoid fractures is overall satisfactory. Whether lateral, medial, or posterior approaches lead to more favorable outcomes than the anteromedial approach is inconclusive. Further prospective studies are warranted.


Asunto(s)
Artroscopía/métodos , Desbridamiento/métodos , Fijación Interna de Fracturas/métodos , Fracturas del Cúbito/fisiopatología , Fracturas del Cúbito/cirugía , Adolescente , Adulto , Femenino , Humanos , Masculino , Periodo Posoperatorio , Rango del Movimiento Articular , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento , Cúbito/fisiopatología , Cúbito/cirugía , Adulto Joven
16.
JAMA ; 323(18): 1792-1801, 2020 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-32396179

RESUMEN

Importance: Humeral shaft fractures traditionally have been treated nonsurgically, but there has been a steady increase in the rate of surgery over the past 2 decades without high-quality evidence to justify the trend. Objective: To compare the effectiveness of surgical treatment with open reduction and internal plate fixation to nonsurgical treatment with functional bracing in the treatment of closed humeral shaft fractures. Design, Setting, and Participants: Randomized clinical trial conducted at 2 university hospital trauma centers in Finland, enrollment between November 2012 and January 2018 with a final follow-up of January 2019. A total of 82 adult patients with closed, unilateral, displaced humeral shaft fracture met criteria for inclusion. Patients were excluded if they had cognitive disabilities preventing them from following the protocol or had multimorbidity or multiple trauma. Interventions: Patients were randomly assigned to surgical treatment with open reduction and internal plate fixation (n = 38) or to nonsurgical treatment with functional bracing (n = 44). Main Outcome and Measure: The primary outcome was Disabilities of Arm, Shoulder and Hand (DASH) score at 12 months (range, 0 to 100 points, 0 denotes no disability and 100 extreme disability; minimal clinically important difference, 10 points). Results: Among 82 patients who were randomized (mean age, 48.9 years; 38 women [46%]; 44 men [54%]), 78 (95%) completed the trial. Thirteen (30%) of the patients assigned to functional bracing underwent surgery during the 12-month follow-up period to promote healing of the fracture. At 12 months, the mean DASH score was 8.9 (95% CI, 4.2 to 13.6) in the surgery group and 12.0 (95% CI, 7.7 to 16.4) in the bracing group (between-group difference, -3.1 points; 95% CI, -9.6 to 3.3; P = .34). Eleven patients (25%) allocated to functional bracing developed fracture nonunion. Three patients (8%) allocated to surgery developed a temporary radial nerve palsy. Conclusions and Relevance: Among patients with closed humeral shaft fracture, internal fixation surgery, compared with nonoperative functional bracing, did not significantly improve functional outcomes at 12 months. However, the substantial amount of treatment crossover from nonoperative to surgical treatment should be considered when interpreting the trial results. Trial Registration: ClinicalTrials.gov Identifier: NCT01719887.


Asunto(s)
Tirantes , Reducción Cerrada , Fijación Interna de Fracturas , Fracturas del Húmero/terapia , Adulto , Anciano , Anciano de 80 o más Años , Placas Óseas , Reducción Cerrada/efectos adversos , Reducción Cerrada/métodos , Evaluación de la Discapacidad , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Fracturas no Consolidadas/etiología , Humanos , Fracturas del Húmero/cirugía , Masculino , Persona de Mediana Edad , Reducción Abierta/métodos , Recuperación de la Función
17.
Zhongguo Gu Shang ; 33(3): 203-8, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32233244

RESUMEN

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.


Asunto(s)
Traumatismos del Tobillo , Calcáneo , Fracturas de la Tibia , Adulto , Estudios de Casos y Controles , Fijadores Externos , Femenino , Fijación de Fractura , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Tracción , Resultado del Tratamiento , Adulto Joven
18.
Zhongguo Gu Shang ; 33(3): 230-4, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32233249

RESUMEN

OBJECTIVE: To explore clinical effect of open reduction and internal fixation through a single lateral approach for Pilon fractures. METHODS: From January 2016 to May 2017, 28 patients with Pilon fractures were treated with open reduction and internal fixation through a single lateral approach. Among them, including 17 males and 11 females, aged from 25 to 59 years old with an average of (39.2±12.2) years old; 13 patients on the left side and 15 patients on the right side; according to Rüedi-Allgöwer classificaton, 7 patients were typeⅠ, 11 patients were typeⅡ, 10 patients were type Ⅲ. All patients were performed external fixation or calcaneal traction within 24 h of emergency, and open reduction and internal fixation was performed after swelling of soft tissue. Healing of incision and fracture, postoperative complications were observed, and AOFAS score at 1 year after operation was used to evaluate ankle joint function. RESULTS: Twenty-eight patients were followed up from 12 to 25 months with an average of (16.4±7.2) months. Two patients occurred superficial wound infection caused delayed wound healing, 1 patient occurred partial skin necrosis and healed after wound dressing change. The healing time of incision ranged from 11 to 25 days with an average of (15.2±8.4) days. All patients got bone union and the time ranged from 12 to 18 weeks with an average of (15.2±3.4) weeks. Two patients suffered from ankle pain after walking postoperatively and X-ray showed traumatic arthritis, the pain got better with the treatment of non steroidal anti inflammatory drugs. No cases of deep infection, nonunion, delayed union, malunion, loosening of internal fixation occurred after operation. AOFAS score at 1 year after operation was 89.6±5.7, 14 patients got excellent results, 12 good, and 2 fair. CONCLUSION: The single lateral approach for surgical treatment of Pilon fractures could provide sufficient exposure, reduction and fixation with less soft tissue application and the clinical curative effect is satisfied. However, for Pilon fracture with varus deformity or comminuted fracture on the medial side of tibial, it is difficult to place the main plate on the medial side of tibial. Instead, anteromedial incision or extensive anterior incision is more suitable.


Asunto(s)
Fracturas de Tobillo , Fracturas de la Tibia , Adulto , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
19.
Zhongguo Gu Shang ; 33(3): 252-6, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32233254

RESUMEN

OBJECTIVE: To explore changes of inflammatory factors on prognosis of tibia plateau Schatzker Ⅲ fractures treated under arthroscopic or open reduction and internal fixation. METHODS: From November 2013 to November 2016, clinical data of 30 patients with tibia plateau Schatzker Ⅲ fractures were retrospectively analyzed, and divided into minimally invasive group and control group according to different surgical methods 15 patients in each group. Minimally invasive group were treated by arthroscopic internal fixation, including 8 males and 7 females, aged from 20 to 50 years old with an average of (35.0± 14.6) years old, the time from injury to operation ranged from 7 to 15 days with an average of (11.0±4.1) days. Control group were treated by open reduction and internal fixation, including 7 males and 8 females, aged from 18 to 48 years old with an average of (33.0±13.6) years old, the time from injury to operation ranged from 6 to 14 days with an average of (10.0±3.4) days.Operation time, length of incision, blood loss, postoperative loading time and fracture healing time, complications were compared between two groups. Level of IL-1ß, IL-6, TNF-α were detected at 3 days, 6 months and 12 months after operation, Lysholm knee function score at 6 and 12 months were compared between two groups. RESULTS: Allpatients were followed up, but there was no significant difference in following up between two groups. Operation time, length of incision, blood loss, postoperative loading time, fracture healing time and cases of complications in minimally invasive group were (80.3±9.7) min ,(4.2± 1.0) cm ,(102.2±26.4) ml ,(30.0±10.0) d ,(70.0±5.0) d and 0 case respectively; while in control group were (90.3±9.1) min, (10.5±1.1) cm ,(221.1±46.8) ml ,(50.0±15.0) d ,(90.0±6.0) d and 2 cases respectively; there were significant difference between two groups. Lysholm score in minimally invasive group 89.2±5.1 was higher than that of control group 80.1±3.1; and score of swelling, squat and pain in minimally invasive group was higher than that of control group at 6 months after opertaion. While there were no significant difference in each items and total score of Lysholm score between two groups at 12 months after operation. Level of IL-1ß, IL-6, and TNF-α in minimally invasive group at 3 days and 6 months were [(52.1±20.1) pg/L, (0.9±0.1) pg/L ],[(56.1±20.1) pg/L ,(1.1±1.3) pg/L ] and [(28.3±2.5) pg/L ,(8.4±1.5) pg/L ] respectively; while in control group were [(64.8±9.1) pg/L ,(8.1±2.1) pg/L ],[(65.8±12.3) pg/L ,(9.1±5.3) pg/L ] and [(38.5±2.3) pg/L ,(26.5± 1.4) pg/L ] respectively; there were statistically difference in level IL-1ß, IL-6 and TNF-α between two groups at 3 days and 6 months after operation; while there was no difference at 12 months after operation (P>0.05) . Inflammatory cytokines level at 3 days after operation IL-1ß [OR=1.279, 95%CI (1.047, 1.512), P<0.05 ], IL-6 [OR=1.687, 95%CI (1.478, 1.888), P<0.05 ], TFN-α [ OR=2.096, 95%CI (1.863, 2.316), P<0.05 ] was an independent risk factor for Lysholm knee function score at 6 months after operation. CONCLUSION: Arthroscopic surgery and open surgery also could obtain good clinical effects in treating tibia plateau Schatzker Ⅲ fractures. Arthroscopic internal fixation could shorten operation time, lessen the mount of blooding with minimally invasive, lower occurrence of postoperative complications, faster recovery of knee function.


Asunto(s)
Tibia , Fracturas de la Tibia , Adulto , Femenino , Fijación Interna de Fracturas , Humanos , Inflamación , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Fracturas de la Tibia/cirugía , Resultado del Tratamiento , Adulto Joven
20.
Zhongguo Gu Shang ; 33(3): 257-60, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32233255

RESUMEN

OBJECTIVE: To explore clinical effect of delayed internal fixation through anteromedial and posterolateral approach of ankle joint in treating Pilon fracture combined with fibula fracture. METHODS: From December 2016 to December 2018, 18 patients with Pilon and fibula fracture treated by internal fixation through anteromedial and posterolateral approach of ankle joint with three plates, including 12 males and 6 females, aged from 38 to 51 years old with an average of (44.00±3.45) years old. According to classification of Rüedi and Allgöwer, 9 patients were typeⅡand 9 patients were type Ⅲ. All patients were closed fractures. Burnell Charnley standard was used to evaluate reduction of articular surface fracture at 7 days after operation, and Mazur ankle evaluation grading system was used to compare the improvement of ankle function between 9 and 12 months after operation. RESULTS: All patients were followed up for 12 to 18 months with an average of (14.00± 1.57) months. According to standard of Burwell Charnley at 7 days after operation, 13 patients got excellent results and 5 patients good. All fracture healed well from 9.5 to 15 months with an average of (12.00±1.43) months. No infection, skin necrosis, loosen and broken of internal fixation, loosing of fracture reduction occurred. Mazur ankle joint score at 12 months (92.11± 5.28) scores was higher than 9 months (89.33±5.20) scores (t=7.976, P<0.001) . CONCLUSION: Delayed internal fixation through anteromedial and posterolateral approach of ankle joint for Pilon fracture combined with fibula fracture has advantages of simple operation, satisfied reduction, stable fixation, less postoperative complications and satisfied ankle joint function.


Asunto(s)
Fracturas de Tobillo , Fracturas de la Tibia , Adulto , Fracturas de Tobillo/cirugía , Femenino , Peroné , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fracturas de la Tibia/cirugía , Resultado del Tratamiento
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