Assuntos
Guias de Prática Clínica como Assunto , Tromboembolia Venosa/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Hospitalização , Humanos , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia Venosa/etiologia , Adulto JovemRESUMO
This article presents a unified clinical theory that links established facts about the physiology of bone and homeostasis, with those involved in the healing of fractures and the development of nonunion. The key to this theory is the concept that the tissue that forms in and around a fracture should be considered a specific functional entity. This 'bone-healing unit' produces a physiological response to its biological and mechanical environment, which leads to the normal healing of bone. This tissue responds to mechanical forces and functions according to Wolff's law, Perren's strain theory and Frost's concept of the "mechanostat". In response to the local mechanical environment, the bone-healing unit normally changes with time, producing different tissues that can tolerate various levels of strain. The normal result is the formation of bone that bridges the fracture - healing by callus. Nonunion occurs when the bone-healing unit fails either due to mechanical or biological problems or a combination of both. In clinical practice, the majority of nonunions are due to mechanical problems with instability, resulting in too much strain at the fracture site. In most nonunions, there is an intact bone-healing unit. We suggest that this maintains its biological potential to heal, but fails to function due to the mechanical conditions. The theory predicts the healing pattern of multifragmentary fractures and the observed morphological characteristics of different nonunions. It suggests that the majority of nonunions will heal if the correct mechanical environment is produced by surgery, without the need for biological adjuncts such as autologous bone graft. Cite this article: Bone Joint J 2016;98-B:884-91.
Assuntos
Consolidação da Fratura/fisiologia , Fraturas Ósseas/cirurgia , Fraturas não Consolidadas/fisiopatologia , Osso e Ossos/fisiologia , Fixação Interna de Fraturas , Fraturas Ósseas/fisiopatologia , Fraturas não Consolidadas/cirurgia , Homeostase/fisiologia , Humanos , Técnica de Ilizarov , Estresse MecânicoAssuntos
Traumatismos do Braço/terapia , Traumatismos da Perna/terapia , Ferimentos por Arma de Fogo/terapia , Antibacterianos/uso terapêutico , Traumatismos do Braço/cirurgia , Bandagens , Árvores de Decisões , Transferência de Energia , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Humanos , Traumatismos da Perna/cirurgia , Lesões dos Tecidos Moles/cirurgia , Lesões dos Tecidos Moles/terapia , Infecção dos Ferimentos/cirurgia , Infecção dos Ferimentos/terapia , Ferimentos por Arma de Fogo/fisiopatologia , Ferimentos por Arma de Fogo/cirurgiaRESUMO
Use of the patient's hand to estimate percentage body surface area (BSA) of injury is well established in the management of burns. Exactly what constitutes "the palm of the hand' and how large an area this is, depends on whether you follow Advanced Trauma Life Support teaching. United Kingdom teaching, or use a "Lund and Browder chart'. A study was designed to measure the areas in question to find which was most accurate. The conclusions challenge standard teaching and show a sex difference. The area of the palm alone is 0.5 per cent BSA in males and 0.4 per cent BSA in females, whereas the area of the palm plus the palmar surface of the five digits is 0.8 per cent BSA in males and 0.7 per cent BSA in females. Therefore if a hand alone is used to assess the size of a burn the per cent BSA could be overestimated.