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1.
Rev Esp Cir Ortop Traumatol ; 66(3): 215-222, 2022.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-35590439

RESUMO

OBJECTIVE: To evaluate the clinical and radiological results of a series of patients with a glenoid bone defect treated by reverse total shoulder arthroplasty associated with a bone graft stabilized with a trabecular titanium glenoid component (Axioma SMR Lima®). MATERIAL AND METHODS: Retrospective descriptive study of 16 consecutive patients with an average age of 68.2years. In 13 cases they were primary arthroplasties and in 3 revision ones. The data included in the study were obtained by reviewing the clinical history. The glenoid defect was classified according to Gupta et al. The pre- and postoperative clinical assessment included the score on the visual analogue pain scale (VAS), the result of the Constant score and the active joint balance. Radiographically, the integration of the bone graft and the fixation of the components were assessed. RESULTS: The average follow-up was 42.1months. The average VAS score improved from 7.5 preoperative points to 2.5 points in the last control (P=.006) and on the Constant score from 35.8 pre-surgical points to 64.4 points (P=.001). The average joint balance went from 54° of abduction, 54° of antepulsion, 24° of external rotation and internal rotation to preoperative trochanter to 120° of abduction (P=.001), 124° of antepulsion (P=.001), 63° of external rotation (P=0.001) and internal rotation at L5 in the last clinical control. In all patients, graft integration and the absence of component loosening were observed. The incidence of complications was 6.2%. DISCUSSION: The treatment of glenoid defects by reverse total shoulder arthroplasty and a bone graft stabilized by trabecular titanium metaglene presents good clinical and radiological results and a low rate of short-term complications.

2.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 66(3): 215-222, May-Jun 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-204979

RESUMO

Objetivo: Evaluar los resultados clínicos y radiológicos de una serie de pacientes con defecto óseo glenoideo tratados mediante artroplastia total inversa de hombro asociada a injerto óseo estabilizado mediante componente glenoideo de titanio trabecular (Axioma SMR Lima®). Material y métodos: Estudio descriptivo retrospectivo de 16 pacientes consecutivos con una edad media de 68,2años. En 13 casos se trataba de artroplastias primarias y en 3, de revisión. Los datos incluidos en el estudio se obtuvieron mediante revisión de la historia clínica. El defecto glenoideo se clasificó de acuerdo con Gupta et al. La valoración clínica pre- y postoperatoria incluyó la puntuación en la escala visual analógica de dolor (EVA), el resultado de la escala Constant y el balance articular activo. Radiográficamente se valoró la integración del injerto óseo y la fijación de los componentes. Resultados: El seguimiento medio fue de 42,1meses. La puntuación media en la escala EVA mejoró de 7,5 puntos preoperatorios a 2,5 puntos en el último control (p=0,006) y en la escala de Constant de 35,8 puntos prequirúrgicos a 64,4 puntos (p=0,001). El balance articular activo pasó de 54° de abducción, 54° de antepulsión, 24° de rotación externa y rotación interna a trocánter preoperatorios a 120° abducción (p=0,001), 124° antepulsión (p=0,001), 63° rotación externa (p=0,001) y rotación interna a L5 en el último control clínico. En todos los pacientes se objetivó integración del injerto y la ausencia de aflojamiento de los componentes. La incidencia de complicaciones fue del 6,2%. Discusión: El tratamiento de defectos glenoideos mediante artroplastia inversa e injerto óseo estabilizado mediante metaglena de titanio trabecular presenta buenos resultados clínicos, radiológicos y una baja tasa de complicaciones a corto plazo.(AU)


Objective: To evaluate the clinical and radiological results of a series of patients with a glenoid bone defect treated by reverse total shoulder arthroplasty associated with a bone graft stabilized with a trabecular titanium glenoid component (Axioma SMR Lima®). Material and methods: Retrospective descriptive study of 16 consecutive patients with an average age of 68.2years. In 13 cases they were primary arthroplasties and in 3 revision ones. The data included in the study were obtained by reviewing the clinical history. The glenoid defect was classified according to Gupta et al. The pre- and postoperative clinical assessment included the score on the visual analogue pain scale (VAS), the result of the Constant score and the active joint balance. Radiographically, the integration of the bone graft and the fixation of the components were assessed. Results: The average follow-up was 42.1months. The average VAS score improved from 7.5 preoperative points to 2.5 points in the last control (P=.006) and on the Constant score from 35.8 pre-surgical points to 64.4 points (P=.001). The average joint balance went from 54° of abduction, 54° of antepulsion, 24° of external rotation and internal rotation to preoperative trochanter to 120° of abduction (P=.001), 124° of antepulsion (P=.001), 63° of external rotation (P=0.001) and internal rotation at L5 in the last clinical control. In all patients, graft integration and the absence of component loosening were observed. The incidence of complications was 6.2%. Discussion: The treatment of glenoid defects by reverse total shoulder arthroplasty and a bone graft stabilized by trabecular titanium metaglene presents good clinical and radiological results and a low rate of short-term complications.(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Artroplastia do Ombro , Transplante Ósseo , Avaliação de Processos e Resultados em Cuidados de Saúde , Radioterapia , Lesões do Ombro/cirurgia , Lesões do Ombro/terapia , Estudos Retrospectivos , Ortopedia , Traumatologia
3.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 66(3): T215-T222, May-Jun 2022. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-204980

RESUMO

Objective: To evaluate the clinical and radiological results of a series of patients with a glenoid bone defect treated by reverse total shoulder arthroplasty associated with a bone graft stabilized with a trabecular titanium glenoid component (Axioma SMR Lima®). Material and methods: Retrospective descriptive study of 16 consecutive patients with an average age of 68.2years. In 13 cases they were primary arthroplasties and in 3 revision ones. The data included in the study were obtained by reviewing the clinical history. The glenoid defect was classified according to Gupta et al. The pre- and postoperative clinical assessment included the score on the visual analogue pain scale (VAS), the result of the Constant score and the active joint balance. Radiographically, the integration of the bone graft and the fixation of the components were assessed. Results: The average follow-up was 42.1months. The average VAS score improved from 7.5 preoperative points to 2.5 points in the last control (P=.006) and on the Constant score from 35.8 pre-surgical points to 64.4 points (P=.001). The average joint balance went from 54° of abduction, 54° of antepulsion, 24° of external rotation and internal rotation to preoperative trochanter to 120° of abduction (P=.001), 124° of antepulsion (P=.001), 63° of external rotation (P=0.001) and internal rotation at L5 in the last clinical control. In all patients, graft integration and the absence of component loosening were observed. The incidence of complications was 6.2%. Discussion: The treatment of glenoid defects by reverse total shoulder arthroplasty and a bone graft stabilized by trabecular titanium metaglene presents good clinical and radiological results and a low rate of short-term complications.(AU)


Objetivo: Evaluar los resultados clínicos y radiológicos de una serie de pacientes con defecto óseo glenoideo tratados mediante artroplastia total inversa de hombro asociada a injerto óseo estabilizado mediante componente glenoideo de titanio trabecular (Axioma SMR Lima®). Material y métodos: Estudio descriptivo retrospectivo de 16 pacientes consecutivos con una edad media de 68,2años. En 13 casos se trataba de artroplastias primarias y en 3, de revisión. Los datos incluidos en el estudio se obtuvieron mediante revisión de la historia clínica. El defecto glenoideo se clasificó de acuerdo con Gupta et al. La valoración clínica pre- y postoperatoria incluyó la puntuación en la escala visual analógica de dolor (EVA), el resultado de la escala Constant y el balance articular activo. Radiográficamente se valoró la integración del injerto óseo y la fijación de los componentes. Resultados: El seguimiento medio fue de 42,1meses. La puntuación media en la escala EVA mejoró de 7,5 puntos preoperatorios a 2,5 puntos en el último control (p=0,006) y en la escala de Constant de 35,8 puntos prequirúrgicos a 64,4 puntos (p=0,001). El balance articular activo pasó de 54° de abducción, 54° de antepulsión, 24° de rotación externa y rotación interna a trocánter preoperatorios a 120° abducción (p=0,001), 124° antepulsión (p=0,001), 63° rotación externa (p=0,001) y rotación interna a L5 en el último control clínico. En todos los pacientes se objetivó integración del injerto y la ausencia de aflojamiento de los componentes. La incidencia de complicaciones fue del 6,2%. Discusión: El tratamiento de defectos glenoideos mediante artroplastia inversa e injerto óseo estabilizado mediante metaglena de titanio trabecular presenta buenos resultados clínicos, radiológicos y una baja tasa de complicaciones a corto plazo.(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Artroplastia do Ombro , Transplante Ósseo , Avaliação de Processos e Resultados em Cuidados de Saúde , Radioterapia , Lesões do Ombro/cirurgia , Lesões do Ombro/terapia , Estudos Retrospectivos , Ortopedia , Traumatologia
4.
Acta Ortop Mex ; 35(1): 33-39, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480437

RESUMO

INTRODUCTION: Loss of bone stock and anatomical alteration of the proximal femur make femoral revision surgery a complex procedure in which the choice of implant will be critical. Our goal is to assess the clinical and radiological results of complete coating Monoblock stems. MATERIAL AND METHODS: Retrospective study of 78 consecutive cases of femoral review surgery intervened by our unit. RESULTS: The average follow-up was 122 months. The average score on the Harris Hip Score was 81.2 ± 11.4 points. An age of less than 65 years, a minor femoral defect according to Paprosky classification (I, II and IIIA), the existence of a single previous surgery and the non-occurrence of intra or postoperative complications, was associated with better clinical and functional outcomes (p < 0.05).Cumulative survival was 96.7% at age 10 if we consider as failure the removal of the stem by aseptic loosening and 92% if we consider withdrawal for any cause to fail. CONCLUSION: Despite the current tendency to use modularity in femoral review surgery and given the results presented, we consider that complete coating monoblock stems provide a firm and stable fixation. However, the worst results in patients with major defects have led to other options being considered.


INTRODUCCIÓN: La pérdida de stock óseo y la alteración anatómica del fémur proximal hacen de la cirugía de revisión femoral un procedimiento complejo en la que la elección del implante será fundamental. Nuestro objetivo es valorar los resultados clínicos y radiológicos de los vástagos monobloque de recubrimiento completo. MATERIAL Y MÉTODOS: Estudio retrospectivo de 78 casos consecutivos de cirugía de revisión femoral intervenidos por nuestra unidad. RESULTADOS: El seguimiento medio fue de 122 meses. La puntuación media en la escala de Harris Hip Score fue de 81.2 ± 11.4 puntos. Una edad menor de 65 años, un defecto femoral menor según la clasificación de Paprosky (I, II y IIIA), la existencia de una única cirugía previa y la no aparición de complicaciones intraoperatorias o postoperatorias se asoció con mejores resultados clínicos y funcionales (p < 0.05). La supervivencia acumulada fue de 96.7% a los 10 años si consideramos como fracaso la retirada del vástago por aflojamiento aséptico y de 92% si consideramos como fracaso la retirada por cualquier causa. CONCLUSIÓN: Pese a la tendencia actual al uso de la modularidad en cirugía de revisión femoral y dados los resultados presentados, consideramos que los vástagos monobloque de recubrimiento completo proporcionan una fijación firme y estable. Sin embargo, los peores resultados obtenidos en pacientes con defectos óseos mayores han provocado que se valore otro tipo de opciones.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Idoso , Criança , Fêmur/cirurgia , Humanos , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
5.
Int J Obes (Lond) ; 45(1): 45-55, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32884101

RESUMO

BACKGROUND/OBJECTIVES: In Samoa, where 80% of the adult population is living with obesity, understanding the determinants of adiposity and growth during infancy may inform prevention efforts. We examined the association of a missense variant, rs373863828, in the CREBRF gene with body composition in Samoan infants. Adults with one or more copies of the rs373863828 minor allele (A) have higher odds of obesity, based on body-mass index (BMI), but paradoxically decreased odds of diabetes compared to those without the allele. Our study may offer novel insight into the natural history and pathogenesis of this unexpected relationship. SUBJECTS/METHODS: In a prospective study, we measured body composition in early infancy, and at 2- and 4-months of age using anthropometry and dual-energy x-ray absorptiometry (DXA). We genotyped subjects at the CREBRF rs373863828 locus and compared infants with (AA/AG) and without (GG) the variant. In longitudinal analyses, we calculated the absolute change in each outcome from the early infant to the 4-month assessment, adjusting for baseline and other covariates. RESULTS: In cross-sectional analyses, there was no significant difference in infant BMI or fat mass by genotype. After adjusting for covariates, infants with the variant had 4.0 ± 1.8 g more bone mass (p = 0.026) and 210.9 ± 79.6 g more lean mass (p = 0.009) at 4-months and accumulated 176.9 ± 73.0 g more lean mass between the early infant and 4-month assessment (p = 0.017). CONCLUSIONS: The CREBRF rs373863828 minor allele (A) was not associated with increased BMI or adiposity in Samoan infants, but instead with increased lean and bone mass. Our findings suggest that lean (i.e., muscle) and bone mass accretion should be explored as pathways to explain the "protective" effect of the CREBRF variant against diabetes.


Assuntos
Composição Corporal/genética , Mutação de Sentido Incorreto/genética , Havaiano Nativo ou Outro Ilhéu do Pacífico , Proteínas Supressoras de Tumor/genética , Adulto , Estudos Transversais , Feminino , Genótipo , Humanos , Lactente , Recém-Nascido , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico/genética , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Polimorfismo de Nucleotídeo Único/genética , Estudos Prospectivos , Samoa/epidemiologia , Adulto Jovem
6.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29523412

RESUMO

OBJECTIVE: To evaluate the results of surgical treatment of intraarticular calcaneal fractures, and also to analyze the variables that influence the final clinical and radiological outcomes as well as the complications. MATERIAL AND METHODS: We retrospectively analyzed 86 intraarticular calcaneal fractures in 78 patients, who underwent surgery with an extended lateral approach and reconstruction plate. The mean age was 48 years (16-74 years) and the mean follow-up was 4.6 years (9-99 months); 54 patients (69.2%) suffered falls from less than 3m in height or banal injuries and 24 patients (30.8%) falls from more than 3m in height or high energy-accidents. According to the Sanders classification we operated 12 (15%) typeII, 54 (62.8%) typeIII and 20 (23.2%) typeIV fractures. RESULTS: The postoperative mean AOFAS score was 73.9 points, with good or excellent results in 57% of the patients. Twelve cases (14%) suffered surgical wound complications and 11 (12.8%) required subtalar arthrodesis. Significantly better results were obtained in the patients younger than 30 years old, patients that fell from less than 3m in height and patients with Sanders fractures types II and III compared to typeIV, which were associated with higher rate of subtalar arthrodesis. CONCLUSIONS: We consider that open reduction and internal fixation of intraarticular fractures of the calcaneus with reconstruction plate is a valid treatment alternative. Given the complications described and the secondary subtalar arthrodesis rate, we recommend a meticulous technique carried out by experienced surgeons.

7.
Rev. Esp. Cir. Ortop. Traumatol. (Ed. Impr.) ; 61(1): 43-50, ene.-feb. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-159400

RESUMO

Introducción. El tratamiento de las fracturas en 3 y 4 fragmentos de húmero proximal en el paciente anciano resulta controvertido. La frecuente coexistencia de un hueso de mala calidad y la afección del manguito rotador con dificultades para el tratamiento rehabilitador en pacientes pluripatológicos conlleva, en muchas ocasiones, resultados clínicos decepcionantes, aun cuando el resultado radiológico sea aceptable. Objetivo. Evaluar los resultados clínicos, radiológicos y funcionales obtenidos en el tratamiento de las fracturas de húmero proximal complejas con prótesis inversa en pacientes mayores de 65 años de nuestro servicio. Material y métodos. Revisión prospectiva en la que incluimos a 30 pacientes con fractura de húmero proximal intervenidos en nuestro servicio con prótesis total inversa de hombro. De ellos, 26 eran mujeres y 4 hombres. La edad media fue de 74,9 años (DE=6,6). El seguimiento medio fue de 34,5 meses (DE=19,3). Resultados. El resultado clínico y funcional ha sido aceptable, con una antepulsión activa media de 124° y una rotación externa media de 13°. La puntuación media en la escala abreviada de Constant fue de 49,1 puntos (DE=14,1), en la escala UCLA fue de 27 puntos (SD=6,3) y en el cuestionario QuickDASH de 32,2 puntos (DE=19,2). El 80% de los pacientes están libres de dolor sin precisar analgesia para la realización de sus actividades habituales. El 95% de los pacientes estaban satisfechos o muy satisfechos tras la intervención. La tasa de complicaciones fue del 13,3%. Conclusiones. Consideramos la artroplastia total inversa como una opción válida en el tratamiento de las fracturas en 3 y 4 fragmentos de húmero proximal en pacientes mayores de 65 años. Los objetivos de la cirugía deben incluir la reconstrucción anatómica de las tuberosidades, evitando incrementos de la longitud del miembro intervenido superiores a 2cm (AU)


Introduction. The treatment of 3 and 4 part proximal humeral fractures in elderly patients is still controversial. The frequent co-existence of poor quality bone and rotator cuff abnormalities in patients with multiple clinical conditions and with difficulties for physical rehabilitation leads to disappointing clinical results, even when the radiological images are acceptable. Objective. To evaluate the clinical, radiological, and functional results in patients over 65 years old with complex proximal humerus fractures treated with reverse shoulder arthroplasty. Material and methods. A prospective review was carried out on 30 patients (26 women and 4 men) with proximal humeral fractures treated with reverse shoulder arthroplasty in our department. The mean age was 74.9 years (SD=6.3), and the mean follow-up was 34.5 months (SD=19.3). Results. Clinical and functional results were acceptable, with a mean forward flexion of 124° and a mean external rotation of 13°. The mean abbreviated Constant abbreviated score was 49.1 (SD=14.1), 27 (SD=6.3) in the UCLA scale, and 32.2 (SD=19.2) in the QuickDASH questionnaire. The large majority (80%) of the patients are pain free, and they do not need medication to do daily activities. The complication rate was 13.3%. Conclusions. We consider that reverse shoulder arthroplasty is a valid option to treat 3and 4 part proximal humeral fractures in elderly patients. The surgical goals should include the anatomical reconstruction of the tuberosities, avoiding enlargement of the operated arm greater than 2cm (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Fraturas do Úmero/cirurgia , Fraturas do Úmero , Alongamento Ósseo/métodos , Artroplastia/instrumentação , Artroplastia/métodos , Fixação Interna de Fraturas/métodos , Procedimentos Ortopédicos/métodos , Estudos Prospectivos , 28599 , Análise de Variância
8.
Epidemiol Infect ; 145(1): 41-45, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27609054

RESUMO

The risk of malaria outbreak surfaced in Vanuatu after Tropical Cyclone (TC) Pam in March 2015. In June and July 2015 we conducted malariometric surveys on the islands of Tanna, Aneityum, and Erromango in Tafea Province, where malaria elimination had been targeted, to determine if malaria incidence had increased after TC Pam. No Plasmodium infection was detected by microscopy and PCR in 3009 survey participants. Only 6·3% (190/3007) of participants had fever. Spleen rates in children aged ⩽12 years from Aneityum and Tanna were low, at 3·6% (14/387) and 5·3% (27/510), respectively. Overall bed net use was high at 72·8% (2175/2986); however, a significantly higher (P < 0·001) proportion of participants from Aneityum (85·9%, 796/927) reported net use than those from Tanna (67·1%, 751/1119) and Erromango (66·8%, 628/940). A recent decrease in malaria incidence in Tafea Province through comprehensive intervention measures had reduced the indigenous parasite reservoir and limited the latter's potential to spur an outbreak after TC Pam. The path towards malaria elimination in Tafea Province was not adversely affected by TC Pam.


Assuntos
Tempestades Ciclônicas , Surtos de Doenças , Malária/epidemiologia , Animais , Criança , Pré-Escolar , Testes Diagnósticos de Rotina , Monitoramento Epidemiológico , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Microscopia , Reação em Cadeia da Polimerase , Vanuatu/epidemiologia
9.
Rev Esp Cir Ortop Traumatol ; 61(1): 43-50, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27818189

RESUMO

INTRODUCTION: The treatment of 3and 4 part proximal humeral fractures in elderly patients is still controversial. The frequent co-existence of poor quality bone and rotator cuff abnormalities in patients with multiple clinical conditions and with difficulties for physical rehabilitation leads to disappointing clinical results, even when the radiological images are acceptable. OBJECTIVE: To evaluate the clinical, radiological, and functional results in patients over 65 years old with complex proximal humerus fractures treated with reverse shoulder arthroplasty. MATERIAL AND METHODS: A prospective review was carried out on 30 patients (26 women and 4 men) with proximal humeral fractures treated with reverse shoulder arthroplasty in our department. The mean age was 74.9 years (SD=6.3), and the mean follow-up was 34.5 months (SD=19.3). RESULTS: Clinical and functional results were acceptable, with a mean forward flexion of 124° and a mean external rotation of 13°. The mean abbreviated Constant abbreviated score was 49.1 (SD=14.1), 27 (SD=6.3) in the UCLA scale, and 32.2 (SD=19.2) in the QuickDASH questionnaire. The large majority (80%) of the patients are pain free, and they do not need medication to do daily activities. The complication rate was 13.3%. CONCLUSIONS: We consider that reverse shoulder arthroplasty is a valid option to treat 3and 4 part proximal humeral fractures in elderly patients. The surgical goals should include the anatomical reconstruction of the tuberosities, avoiding enlargement of the operated arm greater than 2cm.


Assuntos
Artroplastia do Ombro/métodos , Fraturas do Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Radiografia , Recuperação de Função Fisiológica , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/fisiopatologia , Resultado do Tratamento
10.
Case Rep Infect Dis ; 2015: 626917, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26356072

RESUMO

The incidence of skin infections caused by Serratia marcescens is extremely low and such infections are typically observed in immunocompromised patients. The clinical manifestations of these infections include cellulitis, abscesses, fluctuant nodules, or granulomatous lesions. Infections caused by S. marcescens are very difficult to treat due to their resistance to many antibiotics, which often leads to specific and prolonged treatment. Infections after receiving a tattoo are very rare and are caused by unhygienic conditions or the inexperience of the tattooist. In this paper we present the case of a 32-year-old male with no comorbidity, who presented an abscess caused by S. marcescens in a area that was tattooed one month earlier. The case was resolved with surgery and antimicrobial therapy that was based on the antibiogram. To our knowledge, this is the first reported case of a S. marcescens skin infection following a tattoo, in the absence of immunosuppression.

11.
Rev Esp Cir Ortop Traumatol ; 56(1): 17-23, 2012.
Artigo em Espanhol | MEDLINE | ID: mdl-23177938

RESUMO

OBJECTIVE: To evaluate the results of surgical treatment of displaced acetabular fractures, and to discern which variables influence the final radiological and clinical outcome. METHODS: We retrospectively analyzed 23 patients who underwent open reduction and internal fixation of acetabular fracture with a mean age of 40.4 years (17-72 years). Mean follow-up was 4 years (1.5-7.5 years). According to Judet and Letournel classification, we operated 10 simple fractures (43.5%) and 13 complex (56.5%), with both-column fractures being the most common type (8 hips). We evaluated the quality of reduction achieved, the clinical results and the occurrence of coxarthrosis. RESULTS: We obtained anatomic reduction of the lesion in 12 cases (52%), in 7 (30%) residual displacement was less than 2mm, and in 4 patients (17%) greater than 2mm. According to Harris' score, the clinical outcome was excellent or good in 18 cases (78%) and fair or poor in 5 (22%), getting worse in complex fractures and when we do not reach an anatomic reduction of the injury. Six patients (26%) developed moderate or severe degenerative changes during follow-up. The degree of postoperative reduction obtained was identified as the main predictor of the development of post-traumatic osteoarthritis. DISCUSSION AND CONCLUSIONS: The acquisition by open reduction and internal fixation of an accurate congruence between the femoral head and acetabulum is essential to achieve good long-term results.


Assuntos
Acetábulo/lesões , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Adolescente , Adulto , Idoso , Feminino , Fixação de Fratura/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/etiologia , Complicações Pós-Operatórias/etiologia , Radiografia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 56(1): 17-23, ene.-feb. 2012.
Artigo em Espanhol | IBECS | ID: ibc-96530

RESUMO

Objetivo. Evaluar los resultados del tratamiento quirúrgico de las fracturas desplazadas de acetábulo. Discernir que variables influyen en el resultado clínico y radiológico final. Material y métodos. Analizamos de forma retrospectiva 23 pacientes intervenidos de fractura acetabular mediante reducción abierta y fijación interna, con una edad media de 40,4 años (17-72 años). El seguimiento medio fue de 4 años (1,5-7,5 años). Según la clasificación de Judet y Letournel intervinimos 10 fracturas simples (43,5%) y 13 complejas (56,5%), siendo la fractura de ambas columnas la más frecuente (8 casos). Valoramos la calidad de la reducción obtenida, los resultados clínicos y la aparición de coxartrosis. Resultados. Obtuvimos una reducción anatómica de la lesión en 12 casos (52%), en 7 (30%) el desplazamiento residual fue menor de 2mm y en 4 pacientes (17%) mayor de 2mm. Según la escala de Harris, el resultado clínico fue excelente o bueno en 18 casos (78%) y aceptable o pobre en 5 (22%), obteniendo peores resultados en fracturas complejas y cuando no alcanzamos una reducción anatómica de la lesión. Seis pacientes (26%) habían desarrollado cambios degenerativos moderados o severos al final del seguimiento. El grado de reducción postquirúrgica obtenida fue identificado como el principal predictor de desarrollo de coxartrosis postraumática. Discusión y conclusiones. La obtención mediante reducción abierta y fijación interna de una correcta congruencia entre la cabeza femoral y el acetábulo es esencial para lograr buenos resultados a largo plazo (AU)


Objective. To evaluate the results of surgical treatment of displaced acetabular fractures, and to discern which variables influence the final radiological and clinical outcome. Methods. We retrospectively analyzed 23 patients who underwent open reduction and internal fixation of acetabular fracture with a mean age of 40.4 years (17-72 years). Mean follow-up was 4 years (1.5-7.5 years). According to Judet and Letournel classification, we operated 10 simple fractures (43.5%) and 13 complex (56.5%), with both-column fractures being the most common type (8 hips). We evaluated the quality of reduction achieved, the clinical results and the occurrence of coxarthrosis. Results. We obtained anatomic reduction of the lesion in 12 cases (52%), in 7 (30%) residual displacement was less than 2mm, and in 4 patients (17%) greater than 2mm. According to Harris’ score, the clinical outcome was excellent or good in 18 cases (78%) and fair or poor in 5 (22%), getting worse in complex fractures and when we do not reach an anatomic reduction of the injury. Six patients (26%) developed moderate or severe degenerative changes during follow-up. The degree of postoperative reduction obtained was identified as the main predictor of the development of post-traumatic osteoarthritis. Discussion and conclusions. The acquisition by open reduction and internal fixation of an accurate congruence between the femoral head and acetabulum is essential to achieve good long-term results (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Avaliação de Resultado de Intervenções Terapêuticas/métodos , Avaliação de Resultados em Cuidados de Saúde , Acetábulo/lesões , Acetábulo/cirurgia , Osteoartrite do Quadril/classificação , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/cirurgia , Osteoartrite/complicações , Cabeça do Fêmur/lesões , Avaliação de Resultados em Cuidados de Saúde/métodos , Acetábulo/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Avaliação de Resultados em Cuidados de Saúde/normas , Estudos Retrospectivos , Cabeça do Fêmur/cirurgia , Cabeça do Fêmur
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