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1.
J Am Acad Orthop Surg ; 28(20): e878-e887, 2020 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-33030854

RESUMEN

The talus is unique in having a tenuous vascular supply and 57% of its surface covered by articular cartilage. Fractures of the head, neck, or body regions have the potential to compromise nearby joints and impair vascular inflow, necessitating surgical treatment with stable internal fixation in many cases. The widely preferred approach for many talar neck and body fractures is a dual anterior incision technique to achieve an anatomic reduction, with the addition of a medial malleolar osteotomy as needed to visualize the posterior talar body. Percutaneous screw fixation has also demonstrated success in certain patterns. Despite this modern technique, osteonecrosis and osteoarthritis remain common complications. A variety of new treatments for these complications have been proposed, including vascularized autograft, talar replacement, total ankle arthroplasty, and improved salvage techniques, permitting some patients to return to a higher level of function than was previously possible. Despite these advances, functional outcomes remain poor in a subset of severely injured patients, making further research imperative.


Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Procedimientos Ortopédicos/métodos , Astrágalo/lesiones , Tobillo/cirugía , Artroplastia de Reemplazo , Autoinjertos/irrigación sanguínea , Tornillos Óseos , Fracturas Óseas/complicaciones , Humanos , Osteoartritis/etiología , Osteoartritis/terapia , Osteonecrosis/etiología , Osteonecrosis/terapia , Osteotomía/métodos , Pronóstico , Recuperación de la Función , Astrágalo/irrigación sanguínea
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1346-1351, 2020 Oct 15.
Artículo en Chino | MEDLINE | ID: mdl-33063503

RESUMEN

Objective: To review the research progress in the diagnosis and treatment of distal tibiofibular syndesmosis injury. Methods: The recent literature about distal tibiofibular syndesmosis injury was reviewed and analyzed. Results: Distal tibiofibular syndesmosis injury is commonly seen in ankle joint injury, the anatomical complexities make diagnosis and treatment difficult. Preoperative physical examination, radiologic evaluation, and intraoperative stress-testing are important for the diagnosis. Aggressive treatment is also recommended for these injuries to prevent long-term chronic instability. Internal fixation is the main treatment, including metal screw, degradable screw, elastic fixation, and hybrid techniques. Metal screw fixation is still the current mainstream, but elastic fixation represented by Suture-button is more in line with the physiological characteristics of ankle joint, and the rate of secondary operation is low while the clinical outcome is satisfactory. The application prospect of elastic fixation is worthy of expectation. Conclusion: It's crucial for patient with ankle fracture to repair the distal tibiofibular syndesmosis injury. How to diagnose the injury more accurately and simply, how to increase the success rate of reduction, and how to reduce the complications of surgery are still worthy for further exploration.


Asunto(s)
Traumatismos del Tobillo , Fracturas Óseas , Traumatismos del Tobillo/diagnóstico , Traumatismos del Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Tornillos Óseos , Fijación Interna de Fracturas , Humanos
3.
Medicine (Baltimore) ; 99(40): e21755, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019385

RESUMEN

RATIONALE: The objective of the present study was to evaluate the accuracy, effectiveness, and safety of screw view model of navigation (SVMN) guided minimal invasive percutaneous pelvic screws (PPSs) insertion for lateral compression pelvic ring injuries (PRI). PATIENT CONCERNS: A female patient experienced a high falling injury, and presented with pain, swelling, deformity, and movement limitation of the left hip for 3 hours. DIAGNOSES: She was diagnosed with pelvic fractures, left iliac fracture, left pubic branch fracture, left ischial branch fracture, and lumbar transverse process fracture. INTERVENTIONS: We used a SVMN technique to guide PPSs insertion, including a percutaneous anterior inferior iliac spine screw, a percutaneous iliac screw (PIS), and a percutaneous sacroiliac screw (PSIS). OUTCOMES: In total, 3 PPSs were inserted and all were presented with excellent position postoperatively. The designing time of all screws was 11.7 minutes, the time of all guide needles insertion was 18.1 minutes, the time of all screws insertion was 32.8 minutes, blood loss was 21 mL, and the time of radiation exposure lasted 7.2 minutes. Moreover, surgical complications, including neurovascular compromise, wound infection, fracture nonunion, and screw loosening, were not observed during the 12 months follow up visit. LESSONS: SVMN technique guided PPSs insertion is an effective and safety approach for the treatment of PRI in selected patients. Besides, it is necessary for surgeons to master the rationale of computer navigation, to familiar with the anatomy of pelvis and to select suitable patients.


Asunto(s)
Tornillos Óseos , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Huesos Pélvicos/lesiones , Adulto , Lesiones por Aplastamiento/cirugía , Femenino , Fracturas Óseas/diagnóstico por imagen , Humanos
4.
Medicine (Baltimore) ; 99(40): e22186, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019393

RESUMEN

This study aimed to verify the relationship between the number of fusion level and the risk of screw loosening by using cortical bone trajectory (CBT) screws in patients with lumbar degenerative disease.We retrospectively reviewed the serial plain radiograph images of lumbar degenerative disease patients who had undergone posterior fixation and fusion surgery with CBT from 2014. All included patients should have been followed-up with computed tomography scan or plain radiograph for at least 6 months after operation. We individually evaluated the prevalence of screw loosening according to each vertebral level. We also determined whether the number of screw fixation affected the prevalence of screw loosening and whether S1 fixation increased the risk of screw loosening.The screw-loosening rates were high at the S1 level. Moreover, although fixation involved to S1, the loosening rates evidently increased (Fisher exact test, P = .002). The screw-loosening rate was 6.56% in 2 level fusion. However, it increased with the number of fusion levels (3 level: 25.00%, 4 level: 51.16%, and 5 level: 62.50%). To investigate if the number of fusion level affected the S1 screw loosening, we classified the cohort of patients into either involving S1 (S1+ group) or not (S1- group) according to different fusion levels (). The screw loosening between 2 group in 2 (5.56% vs 6.98%) and 3 fusion level (26.32% vs 22.73%) did not exhibit any significant difference. Interestingly, significantly high screw loosening was found in 4 fusion level (60.00% vs 15.38%), indicating that the higher fusion level (4 level) can directly increase the risk of S1 screw loosening.Our data confirmed that the screw-loosening rate increases rate when long segment CBT fixation involves to S1. Therefore, in case of long-segment fixation by using CBT screw, surgeons should be aware of the fusion level of S1.


Asunto(s)
Tornillos Óseos , Degeneración del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/cirugía , Fusión Vertebral/instrumentación , Hueso Cortical/diagnóstico por imagen , Análisis de Falla de Equipo/métodos , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
5.
Zhonghua Yi Xue Za Zhi ; 100(35): 2763-2767, 2020 Sep 22.
Artículo en Chino | MEDLINE | ID: mdl-32972057

RESUMEN

Objective: To evaluate the precision of the robot-assisted sacroiliac screw placement for posterior pelvis injury and the impacting factors. Methods: The clinical data of twenty-four cases of posterior pelvic fractures treated by percutaneous sacroiliac screw placement in Yantai shan Hospital from August 2016 to May 2018 were studied retrospectively. There were 17 males and 7 females with a mean age of 44.1 years (ranged from 17 to 71 years). According to AO classification, 17 cases were type B fractures (9 cases of type B1 and 8 type B2), and 7 cases were type C factures (3 cases of type C1, 2 type C2 and 2 type C3). All cases were treated by robot-assisted percutaneous sacroiliac screw placement (AO cannulated screws with a diameter of 7.3 mm). In the posterior pelvic surgeries for the 24 cases, 26 S(1) sacroiliac screws fixations and 18 S(2) sacroiliac screw fixations were placed in total, with single S(1) segmental fixation in 8 cases, single S(2) segmental fixation in 3 cases, S(1) and S(2) combined fixation in 13 cases, S(1) unidirectional one-sided fixation in 18 cases, S(1) bidirectional two-sided fixation in 3 cases, S(2) unidirectional one-sided fixation in 14 cases, S(2) bidirectional two-sided fixation in 2 cases and S(1) unidirectional double screws fixation in 2 cases. X-ray and CT examinations were taken for all 24 cases after operation. The visual analogue scale (VAS) of pain were performed before and after the operation. Results: All the sacroiliac screws were successfully implanted at once as planned with the assistance of the robot. The postoperative X-ray films and CT showed that none of the sacroiliac screws broke through the sacral body and the contralateral sacral wing's frontal cortex nor did they stray into the sacral canal and the intervertebral space. In 3 cases, the sacroiliac screws went closely against and wore out the front edge of iliac cortical density line and sacral alar slope and finally re-entered the sacral body. In 3 cases, sacroiliac screws touched upon the sacral nerve canals but did not break through the nerve canals. The mean VAS of pain was improved from 7.1 points (4-10 points) before the operation to 1.9 points (0-3 points) after. Conclusions: The robot-assisted sacroiliac screw placement shows high precision, and hence is worthy of clinical promotion; however the primary role of the surgeon could not be replaced.


Asunto(s)
Huesos Pélvicos , Robótica , Adolescente , Adulto , Anciano , Tornillos Óseos , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sacro , Adulto Joven
6.
Bone Joint J ; 102-B(9): 1242-1247, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32862682

RESUMEN

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


Asunto(s)
Tornillos Óseos , Coxa Valga/cirugía , Placa de Crecimiento/cirugía , Parálisis Cerebral/complicaciones , Niño , Coxa Valga/etiología , Femenino , Humanos , Masculino , Procedimientos Ortopédicos/instrumentación , Procedimientos Ortopédicos/métodos , Estudios Retrospectivos , Resultado del Tratamiento
7.
Braz Dent J ; 31(4): 374-379, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32901712

RESUMEN

The aim of this study was to verify the effect of the implant volume loss, vertical misfit between abutment and prosthetic platform, prosthetic screw loosening torque, and screw stress distribution in titanium and zirconia abutments. Ten CAD/CAM system custom abutments of each material were milled and attached to the titanium implants. The implant volume loss was evaluated by microtomography, the vertical misfit with optical microscopy, and digital torque wrench measured the prosthetic screw loosening. All experimental analyses were performed before and after mechanical cycle (1,000,000 cycles, 100 N/2 Hz). Virtual models of the structures were created for finite element analysis, and the stress on the screw obtained with von Mises procedure. Data were analyzed using an independent t-test, two-way ANOVA for repeated measures, and Tukey's HSD test (a=0.05). There was no significant difference in the implant volume loss for the two abutment materials (p=0.662). Titanium abutments provided higher loosening torque values after mechanical cycling (p<0.001). Lesser marginal misfit was obtained with titanium abutments before and after mechanical cycling (p<0.001). The stress distribution on the screw was similar between abutment materials. In conclusion, CAD/CAM custom titanium abutment reduced the marginal misfit and increased the torque maintenance of prosthetic screws when compared to CAD/CAM custom zirconia abutment.


Asunto(s)
Pilares Dentales , Titanio , Tornillos Óseos , Circonio
8.
Int J Oral Implantol (Berl) ; 13(3): 269-277, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32879931

RESUMEN

PURPOSE: To compare the short-term clinical and radiographic outcomes of angulated screw-retained and cemented implant crowns following flapless immediate implant placement. MATERIALS AND METHODS: The study was designed as a prospective cohort study with 1-year follow-up. Eligible patients were divided into two groups according to restoration type: the angulated screw group (AG) and the cemented group (CG). Implant survival, marginal bone loss, mechanical complications, probing depth, bleeding on probing% and pink aesthetic score were evaluated. RESULTS: After 1 year of loading, the implant survival rate was 100% in both groups (AG, n = 23; CG, n = 20). A significantly lower bleeding on probing% was found in the AG than in the CG (11.6 ± 19.1% vs. 33.3 ± 33.8%, P = 0.04). No significant differences in marginal bone loss, probing depth and mechanical complication rates were found between the two groups (P = 0.53, 0.48, 0.41, respectively). The overall pink aesthetic score value was 8.96 ± 0.88 in the AG and 8.98 ± 0.62 in the CG at 1-year examination (P = 0.96). The percentage of excellent pink aesthetic scores (≥ 9) value increased from 48% at baseline to 83% at 1 year in the AG, and from 45% at baseline to 85% at 1 year in the CG. CONCLUSION: Based on the 1-year results, both treatment options provide high implant survival, a stable marginal bone level and excellent aesthetic outcomes in the short term. Angulated screw-retained crowns might benefit the long-term peri-implant conditions.


Asunto(s)
Implantes Dentales de Diente Único , Implantes Dentales , Tornillos Óseos , Coronas , Estética Dental , Estudios de Seguimiento , Humanos , Estudios Prospectivos
9.
Zhonghua Yi Xue Za Zhi ; 100(33): 2628-2632, 2020 Sep 08.
Artículo en Chino | MEDLINE | ID: mdl-32892611

RESUMEN

Objective: To evaluate the stress status of femoral head and neck, screws and acetabulum caused by femoral neck shortening after internal fixation of femoral neck fracture with finite element method, and to analyze the stress of proximal femoral neck and acetabulum from the mechanical point of view. Methods: CT scan data of hip of a healthy adult female were collected. Three-dimensional reconstruction MICs and related module function simulation was used to establish the postoperative shortening model of femoral neck fracture with Pauwells angle>50°, which was treated with cannulated screws. The models were divided into four groups: normal femoral neck without shortening, shortening for 2.5 mm, shortening for 7.5 mm and shortening for 12.5 mm. The finite element analysis software MSC. Nastran2012 was used to do the mechanical analysis. The acetabulum surface, femoral head surface, proximal femur and the maximum stress, stress nephogram and other relevant data were collected. Results: The maximum tensile stress and the maximum stress at the fracture site of the femoral neck increased gradually with the increasing of shortening of femoral neck, however, the maximum compressive stress under the femoral neck and the medial cortex decreased gradually; the maximum stress on the surface of the femoral head was 14.9, 15.0, 16.3 and 16.3 MPa, respectively; the maximum stress on the surface of the acetabulum was 10.1, 10.1 and 10.5,11.7 MPa, respectively. Conclusion: The mechanical environment of the hip joint changes with femoral neck shortening. With the increasing of femoral neck shortening, the peak stress of the acetabulum increases continuously. When the femoral neck is shortened seriously, the load distribution is uneven and the complex mobility of hip joint is decreased. In addition, the change of shortening might play a role in the necrosis of femoral head.


Asunto(s)
Fracturas del Cuello Femoral , Adulto , Tornillos Óseos , Femenino , Cuello Femoral , Análisis de Elementos Finitos , Fijación Interna de Fracturas , Articulación de la Cadera , Humanos
10.
Zhonghua Wai Ke Za Zhi ; 58(9): 707-712, 2020 Sep 01.
Artículo en Chino | MEDLINE | ID: mdl-32878418

RESUMEN

Objective: To evaluate the feasibility of placement of S(2) alar iliac screw (S(2)AI) using free-hand technique for sacrapelvic fusion in lumbar degenerative scoliosis. Methods: Eighteen patients with Lumbar Degenerative Scoliosis treated by S(2)AI screw fixation at Department of Orthopedics, General Hospital of Southern Theater Command of People's Liberation Army and Department of Orthopedics, 89th hospital of People's Liberation Army from August 2014 to October 2018 were analyzed retrospectively. There were 5 males and 13 females, aged 63.2 years old (range:55 to 71 years old).Parameters of spine including: Cobb Angle, C(7) plumb line -center sacral vertical line (C(7)PL-CSVL), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slope (SS) and pI-LL were measured on the whole spine X-ray before operation and at final follow-up. Pelvic CT scan was performed postoperatively to assess the accuracy of S(2)AI placement. Oswestry disability Index (ODI) was also recorded. The data were compared by paired t test or Wilcoxon tests. Results: All patients were followed up for 23.7 months (range: 12~62 months).At the last follow up, Cobb Angle decreased from (32.28±4.97) °preoperative to (6.56±3.20) ° (t=41.142, P<0.01) and C(7)PL-CSVL deceased from (1.11±2.07) cm preoperative to (0.18±1.08) cm (t=41.142, P=0.06) .LL improved from (-22.39±13.07) °preoperative to (-36.39±4.29) ° (t=4.470, P<0.01) , PI-LL decreased from (26.83±14.83)°preoperative to (13.72±8.3)° (t=4.396, P<0.01) , PT decreased from (27.94±4.26) °to (23.39±6.08) ° (t=2.680, P=0.02) , and SS increased from (22.22±6.36) °to (26.28±7.24) ° (t=-2.178, P=0.04) .SVA decreased from (6.54±4.51) cm preoperative to (2.62±1.29) cm (t=3.052, P=0.01) .ODI decreased from 0.58(0.40) (M(Q(R))) to 0.18 (0.15) (Z=-4.567, P<0.01) .No complications such as nerve and blood vessel injury occurred during the operation. A total of 32 S(2)AI screws were placed, 3 screws were placed with mild to moderate cortical breaches, 2 were perforated the pelvis ventrally, 1 was perforated posteriorly, with no clinically notable neurovascular or visceral complications. Eight patients finished the SRS-22 questionnaire, with mean score of 4.4 in terms of satisfaction with management. Conclusions: Free-hand technique of S(2)AI screw placement for sacrapelvic fusion in degenerative lumbar scoliosis is safe and feasible.S(2)AI fixation in DLS can provide great correction of deformity, maintain the stability of lumbo-pelvic area and improve the clinical symptoms.


Asunto(s)
Ilion/cirugía , Sacro/cirugía , Escoliosis/cirugía , Fusión Vertebral/métodos , Anciano , Animales , Tornillos Óseos , Estudios de Factibilidad , Femenino , Humanos , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fusión Vertebral/instrumentación , Resultado del Tratamiento
11.
Handchir Mikrochir Plast Chir ; 52(5): 413-418, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32992392

RESUMEN

Scaphoid nonunion has traditionally been treated by open surgery where the pseudarthrosis has been cleaned while either a structural wedged bone graft, or chips of cancellous bone has been used to fill the defect. K-wires or a screw has been used to stabilize the bone. Using the arthroscopic technique for treatment of nonunion of the scaphoid gives us small exposure to the joint, however with an excellent view of the bones, the articular surfaces and the intraarticular ligaments. The results from arthroscopic treatment for scaphoid nonunion with bone grafting using chips of cancellous bone are as good as from the open technique. The arthroscopic treatment, though, helps us to diagnose and treat concomitant lesions. There is less damage of blood supply, nerves and capsule, which might lead to a faster recovery and rehabilitation. The technique will be described and discussed.


Asunto(s)
Fracturas no Consolidadas/diagnóstico por imagen , Fracturas no Consolidadas/cirugía , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/cirugía , Tornillos Óseos , Hilos Ortopédicos , Fijación Interna de Fracturas , Humanos
12.
Medicine (Baltimore) ; 99(35): e22001, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32871954

RESUMEN

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.


Asunto(s)
Implantes Absorbibles , Tornillos Óseos , Articulación del Codo/lesiones , Fijación de Fractura/instrumentación , Fracturas del Húmero/cirugía , Adolescente , Niño , Femenino , Humanos , Masculino , Estudios Retrospectivos
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1091-1095, 2020 Sep 15.
Artículo en Chino | MEDLINE | ID: mdl-32929899

RESUMEN

Objective: To explore the changes of bone and risk of micro-fracture in femoral head after removal of cannulated screws following femoral neck fracture healing under the impact force of daily stress. Methods: A total of 42 specimens of normal hip joint were collected from 21 adult fresh cadaveric pelvic specimens. Wiberg central-edge (CE) angle, bone mineral density, diameter of femoral head, neck-shaft angle, and anteversion angle of femoral neck were measured. Then, the 3 cannulated screws were implanted according to the AO recommended method and removed to simulate the complete anatomical union of femoral neck fracture. The morphology of screw canal in the femoral head was observed by CT. Finally, the specimens were immobilized vertically within the impact device in an upside-down manner, and the femoral heads were impacted vertically. Every specimen was impacted at 200, 600, and 1 980 N for 20 times with the impacting device. After impact, every specimen was scanned by CT to observe the morphology changes of screw canal in the femoral head. Micro-fractures in the femoral head could be confirmed when there was change in the morphology of screw canal, and statistical software was used to analyze the risk factors associated with micro-fractures. Results: After impact at 200 and 600 N, CT showed that the morphology of screw canal of all specimens did not change significantly compared with the original. After impact at 1 980 N, there were protrusion and narrowing in the screw canal of the 22 femoral head specimens (11 pelvic specimens), showing obvious changes compared with the original screw canal, indicating that there were micro-fractures in the femoral head. The incidence of micro-fracture was 52.38% (11/21). logistic regression results showed that there was correlation between micro-fracture and bone mineral density ( P= 0.039), but no correlation was found with CE angle, diameter of femoral head, neck-shaft angle, and anteversion angle ( P>0.05). Conclusion: The micro-fractures in the femoral head may occur when the femoral head is impacted by daily activities after removal of cannulated screws for femoral neck fractures, and such micro-fractures are associated with decreased bone density of the femoral head.


Asunto(s)
Fracturas del Cuello Femoral , Fracturas por Estrés , Adulto , Tornillos Óseos , Cabeza Femoral , Fijación Interna de Fracturas , Humanos
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1106-1113, 2020 Sep 15.
Artículo en Chino | MEDLINE | ID: mdl-32929902

RESUMEN

Objective: To evaluate the effectiveness of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in pubic branch fractures. Methods: The clinical data of 42 patients with pubic branch fractures treated by hollow screw fixation between March 2008 and March 2019 were analyzed retrospectively. According to the operation method, they were divided into the traditional operation group (20 cases in group A, fixed with traditional retrograde pubic screws) and the modified operation group (22 cases in group B, fixed with percutaneous retrograde pubic screws assisted by hollow pedicle opener). There was no significant difference ( P>0.05) between the two groups in terms of gender, age, cause of injury, fracture classification, comorbidity, and time from injury to operation. The operation time, blood loss, incision length, screw length, and complications were recorded and compared between the two groups. The fracture reduction was evaluated according to Matta standard on the next day after operation, and the function was evaluated by Majeed score at 12 months after operation. Results: The operation was successfully completed in both groups. The operation time, blood loss, and incision length of group B were significantly less than those of group A ( P<0.05); there was no significant difference in screw length between the two groups ( t=0.793, P=0.437). All patients were followed up 8-24 months, with an average of 16.8 months. There was no complication in the two groups, such as injury of blood vessels and nerves, fracture of internal fixation, screw entering into joint cavity, and nonunion of fracture. There was no significant difference in the fracture healing time between the two groups ( t=-1.068, P=0.299). There were 2 cases of incision infection, 1 case of incision fat liquefaction, 2 cases of lower extremity deep vein thrombosis in group A, the incidence of complications was 25.0%; there was only 1 case of lower extremity deep vein thrombosis in group B, the incidence of complication was 4.5%, which was lower than that in group A, but the difference was not significant ( χ 2=2.104, P=0.147). In group A, 1 case was found to be dislocated, but in group B, there was no dislocated fracture. There was no significant difference between the two groups in the evaluation of Matta imaging on the next day after operation and the evaluation of Majeed function at 12 months after operation ( P>0.05). Conclusion: Percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener is effect for the pubic branch fractures with the advantage of smaller incision, shorter operation time, and less bleeding compared with traditional methods.


Asunto(s)
Fracturas Óseas , Tornillos Pediculares , Fracturas de la Columna Vertebral , Tornillos Óseos , Fijación Interna de Fracturas , Humanos , Estudios Retrospectivos , Resultado del Tratamiento
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1149-1157, 2020 Sep 15.
Artículo en Chino | MEDLINE | ID: mdl-32929909

RESUMEN

Objective: To investigate the surgical method for primary malignant osseous tumors in the craniovertebral junction (CVJ) and its effectiveness. Methods: The clinical data of 7 patients with primary malignant osseous spinal tumors in CVJ, which collected between September 2010 and April 2019, were retrospectively analyzed. There were 5 males and 2 females, aged 23 to 75 years (median, 56 years). All patients were diagnosed as chordoma in 4 cases, plasmacytoma in 2 cases, and fibrosarcoma in 1 case. The disease duration ranged from 0.7 to 36.0 months, with an average of 12.2 months. Lesion location: 1 case of C 0, 1, 3 cases of C 2, 1 case of C 1, 2, 1 case of C 2, 3, and 1 case of C 0-2. Preoperative visual analogue scale (VAS) score was 6.7±2.1, the Japanese Orthopaedic Association (JOA) score was 15.6±2.4. According to American Society of Spinal Cord Injury (ASIA) grading system, there was 1 case of grade C, 1 case of grade D, and 5 cases of grade E. According to Enneking stage of spinal malignant tumor, there was 1 case of stage ⅠB, 2 cases of stage ⅡB, and 4 cases of stage Ⅲ. According to Weinstein-Boriani-Biagini (WBB) stage, there was 1 case of 5-8/A-D, 1 case of 4-9/A-D, 1 case of 6-7/B-D, 1 case of 6-7/A-D, 2 cases of 1-12/A-D, and 1 case of 3-10/A-D. All these patients were treated with tumor extended resection, bone graft fusion, and internal fixation via posterior cervical approach, as well as tumor (stage Ⅰ or stage Ⅱ) boundary resection via transoral or submandibular approach. Meanwhile, anterior reconstructive fusion was procedured with bone grafting Cage needed to place the internal fixation. Results: The operation time was 307-695 minutes (mean, 489.57 minutes), and the intraoperative blood loss was 400-2 000 mL (mean, 1 107.14 mL). There was no intraoperative injury in vertebral artery and spinal cord or any related postoperative complications, including incision infection, intracranial infection, and pulmonary infection. All the patients were followed up 3-57 months (mean, 21 months). Postoperative X-ray film and CT showed that the internal fixation screw was firm and in a satisfactory position, and the bone graft was fused at 3-6 months after operation. Symptoms such as neck pain, limb numbness, and fatigue relieved to different degrees after operation. At 3 months after operation, the VAS score improved to 1.7±0.8 ( t=7.638, P=0.000); while the JOA score improved to 16.1±1.5, but no significant difference was found when compared with preoperative score ( t=1.549, P=0.172). According to ASIA grading system, 1 patient with grade C had upgraded to grade D after operation, while the remaining patients had no change. There were 4 cases of recurrence after operation, in which those patients were with high malignancy of tumors before the first surgery. Their tumors also affected a wide range of slope or surrounding soft tissues and could not be completely removed. Among the 4 cases, 1 patient underwent transoral tumor removal operation again, while the other 3 cases gave up further treatment. There was no recurrence among the remaining 3 cases. Conclusion: Primary malignant osseous tumors in the CVJ can be completely exercised via means of trabsoral or submandibular approach. Meanwhile the anterior reconstruction can be achieved by placing special Cage specimen. These two methods together with postoperative adjuvant treatments such as radiotherapy and chemotherapy can improve the survival time of patients and reduce tumor recurrence.


Asunto(s)
Fusión Vertebral , Adulto , Anciano , Tornillos Óseos , Vértebras Cervicales , Femenino , Fijación Interna de Fracturas , Humanos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Vértebras Torácicas , Resultado del Tratamiento , Adulto Joven
16.
Medicine (Baltimore) ; 99(39): e22324, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-32991442

RESUMEN

RATIONALE: Coracoid processes (CPs) fracture with acromioclavicular (AC) joint dislocation are extremely rare. This combined injury has brought many challenges to surgeons, and the mechanism underlying the injury is still not fully understood. There is no clear consensus on its treatment. PATIENT CONCERNS: Here, we describe a CP fracture with AC joint dislocation in a middle-aged manual worker. DIAGNOSIS: Radiographs showed a fracture of the base of the CP and a third-degree AC joint separation. INTERVENTIONS: The patient was treated surgically with open reduction and internal fixation of the AC joint by LCP clavicle hook plate, and the CP was fixed with a 3.5 mm diameter cannulated screw. OUTCOMES: Three months after the operation, shoulder function was completely restored, and the affected shoulder had full mobility with no tenderness. Plain film radiography showed anatomical indications of the healing of these combined injuries. LESSONS: Although AC joint dislocation with CP fractures is extremely rare in adults, it is important to remind and remember that this possibility exists. In unclear cases, special radiographic films and CT are necessary. Surgical treatment of AC joint dislocation with CP fractures can provide solid stability and restore normal shoulder function with an excellent prognosis.


Asunto(s)
Articulación Acromioclavicular/lesiones , Apófisis Coracoides/lesiones , Fracturas Óseas/cirugía , Luxaciones Articulares/cirugía , Articulación Acromioclavicular/diagnóstico por imagen , Articulación Acromioclavicular/patología , Cuidados Posteriores , Placas Óseas/normas , Tornillos Óseos/normas , Apófisis Coracoides/patología , Fijación Interna de Fracturas/métodos , Fracturas Óseas/diagnóstico por imagen , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Reducción Abierta/métodos , Radiografía/métodos , Resultado del Tratamiento
17.
Clinics (Sao Paulo) ; 75: e1824, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32935824

RESUMEN

OBJECTIVES: The recent advancements in spine fixation aid in the treatment of complex spinal pathologies. Both the iliac screw (IS) and the S2-alar-iliac (S2AI) screw provide adequate stability in the fixation of complex lumbosacral spine pathologies, leading to a significant increased rate of using these techniques in the daily practice of the spine surgeons. This study aims to analyze, describe, and compare the insertion and positioning parameters of the S2AI screw and IS techniques in children without spinal deformities. METHODS: An observational retrospective study was conducted at a university hospital in 2018, with 25 computed tomography (CT) images selected continuously. Mann-Whitney-Shapiro-Wilk tests were performed. The reliability of the data was assessed using the intraclass correlation. The data were stratified by age group only for Pearson's correlation analysis. RESULTS: The mean age was 11.7 years (4.5 SD). The mean IS length was 106.63 mm (4.59 SD). The mean length of the S2AI screw was 104.13 mm (4.22 SD). The mean skin distance from the IS entry point was 28.13 mm (4.27 SD) and that for the S2AI screw was 39.96 mm (4.54 SD). CONCLUSIONS: Through CT, the S2AI screw trajectory was observed to have a greater bone thickness and skin distance than the IS. There was a linear correlation between age and screw length for both techniques. A similar relationship was observed between skin distance and age for the S2AI screw technique. In children, the S2AI screw technique presents advantages such as greater cutaneous coverage and implant thickness than the IS technique.


Asunto(s)
Tornillos Óseos , Fijación Interna de Fracturas/instrumentación , Sacro , Fusión Vertebral/métodos , Columna Vertebral/diagnóstico por imagen , Niño , Humanos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Fusión Vertebral/instrumentación , Columna Vertebral/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
19.
Rev. méd. panacea ; 9(2): 135-140, mayo-ago. 2020.
Artículo en Español | LILACS, LIPECS | ID: biblio-1121237

RESUMEN

Introducción: El tratamiento quirúrgico de las fracturas intertrocantericas presenta complicaciones postquirúrgicas múltiples debido a varios factores, el índice punta-ápex o "TAD" es uno de los principales predictores del desanclaje del tornillo femoral o "cut out". Objetivo: Realizar una revisión bibliográfica del "TAD" en los estudios científicos más actuales. Materiales y métodos: Estudio descriptivo de búsqueda bibliografíca en páginas científicas como Scielo, Elsevier, Pubmed, Medline y bibliotecas virtuales nacionales e internacionales. Resultados: Las fracturas intertrocantericas representan el 50% de todas las fracturas del fémur proximal, mayor incidencia en mujeres (2:1 hasta 8:1) y personas mayores de 65 años, las complicaciones postquirúrgicas representan el 17%, el desanclaje de tornillo o "cut out" se describe como la complicación más común. El "TAD" es usado desde 1995; la migración del tornillo deslizante en la cabeza femoral se observa inclusive en pacientes con TAD menor de 25 mm, debido a la implicancia de factores (asociados al implante, mal posicionamiento del tornillo deslizante y mala calidad ósea), dando un umbral óptimo del TAD más bajo (<20 mm) que el corte tradicional(<25 mm); por cada milímetro que aumenta el TAD, el riesgo de corte aumenta aproximadamente 1.1. El TAD presenta una especificidad significativamente mayor que el CalTAD y TAD + CalTAD (59.1 vs 49.2%, p <0.001; 59.1 vs 54.1%, p <0,001). Conclusiones: El "TAD", sigue siendo el mayor predictor de "cut out" en la actualidad inclusive por encima de los nuevos predictores. (AU)


Introduction: Surgical treatment of intertrochanteric fractures involves multiple post-surgical complications due to several factors. The tip-apex distance or "TAD" is one of the main predictors of femoral screw displacement or "cutout". Objective: perform a bibliographic review of the "TAD" in the most current scientific studies. Materials and methods: Descriptive study of bibliographic searches in scientific sites such as Scielo, Elsevier, Pubmed, Medline and national and international virtual libraries. Results: Intertrochanteric fractures account for 50% of all fractures of the proximal femur, higher incidence in women (2:1 to 8:1) and people over 65 years, post-surgical complications account for 17%, screw displacement or "cutout" is described as the most common complication. The TAD has been used since 1995; migration of the sliding screw in the femoral head is observed even in patients with a cut out of less than 25 mm, due to the implication of factors (associated with the implant, poor positioning of the sliding screw and poor bone quality), giving an optimal threshold of cut out lower (<20 mm) than the traditional cut out (<25 mm); for every millimeter that the cut out increases, the risk of cut out increases approximately 1.1. TAD has a significantly higher specificity than CalTAD y TAD + CalTAD (59.1 vs 49.2%, p <0.001; 59.1 vs 54.1%, p <0,001). Conclusions: The "TAD", is still the biggest predictor of "cut out" at present even above the new predictors. (AU)


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Tornillos Óseos , Fracturas de Cadera/cirugía , Fracturas de Cadera/terapia , Epidemiología Descriptiva
20.
Lancet ; 396(10248): 390-401, 2020 08 08.
Artículo en Inglés | MEDLINE | ID: mdl-32771106

RESUMEN

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.


Asunto(s)
Moldes Quirúrgicos , Fijación Interna de Fracturas , Fracturas Óseas/terapia , Hueso Escafoides/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Tornillos Óseos , Femenino , Fijación de Fractura , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Fracturas no Consolidadas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Evaluación del Resultado de la Atención al Paciente , Hueso Escafoides/cirugía , Tiempo de Tratamiento , Adulto Joven
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