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1.
Artigo em Inglês | MEDLINE | ID: mdl-32701180

RESUMO

The catalytic oxidation of CO on transition metals, such as Pt, is commonly viewed as a sharp transition from the CO-inhibited surface to the active metal, covered with O. However, we find that minor amounts of O are present in the CO-poisoned layer that explain why, surprisingly, CO desorbs at stepped and flat Pt crystal planes at once, regardless of the reaction conditions. Using near-ambient pressure X-ray photoemission and a curved Pt(111) crystal we probe the chemical composition at surfaces with variable step density during the CO oxidation reaction. Analysis of C and O core levels across the curved crystal reveals that, right before light-off, subsurface O builds up within (111) terraces. This is key to trigger the simultaneous ignition of the catalytic reaction at different Pt surfaces: a CO-Pt-O complex is formed that equals the CO chemisorption energy at terraces and steps, leading to the abrupt desorption of poisoning CO from all crystal facets at the same temperature.

2.
J Shoulder Elbow Surg ; 28(12): 2259-2271, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31500986

RESUMO

BACKGROUND: Proximal humeral fractures (PHFs) are among the most common fractures in elderly patients, but there is insufficient evidence from randomized controlled trials (RCTs) to determine which interventions are the most appropriate for their management. To date, no RCT has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for 3- or 4-part PHFs in elderly patients. METHODS: This was a prospective RCT. The primary objective was to compare pain and function 12 months after fracture using the Constant score in patients aged 80 years or older with 3- and 4-part PHFs, treated by either RSA or nonoperative treatment. Secondary outcome measures included Disabilities of the Arm, Shoulder and Hand, visual analog scale (VAS), Short Form 12 (SF-12), EuroQol 5 Dimensions, and EQ-VAS scores. RESULTS: We analyzed 30 nonoperative and 29 RSA patients with mean ages of 85 years and 82 years, respectively. No differences between the nonoperative and RSA groups were noted for any patient-reported outcomes at 12 months' follow-up except the VAS pain score. The Constant scores were 55.7 in the nonoperative group and 61.7 in the RSA group (P = .071); the Disabilities of the Arm, Shoulder and Hand scores were 29 and 21, respectively (P = .075); the VAS scores were 1.6 and 0.9, respectively (P = .011); the physical SF-12 scores were 36 and 37, respectively (P = .709); the mental SF-12 scores were 43 and 42, respectively (P = .625); the EuroQol 5 Dimensions scores were 0.89 and 0.92, respectively (P = .319); and the EQ-VAS scores were 65 and 67, respectively (P = .604). CONCLUSIONS: This study yields important evidence for the treatment of complex PHFs in elderly patients suggesting minimal benefits of RSA over nonoperative treatment for displaced 3- and 4-part PHFs. At short-term follow-up, the main advantage of RSA appeared to be less pain perception.


Assuntos
Artroplastia do Ombro , Tratamento Conservador , Fraturas do Ombro/terapia , Articulação do Ombro/fisiopatologia , Dor de Ombro/etiologia , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Epífises/cirurgia , Feminino , Humanos , Úmero/cirurgia , Masculino , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Fraturas do Ombro/complicações , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/fisiopatologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
3.
Trials ; 20(1): 387, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262366

RESUMO

PURPOSE: The purpose of the study was to compare the safety and efficacy of autologous mesenchymal stem cells (MSCs) embedded in a xenogenic scaffold for repairing the supraspinatus tendon. METHODS: This was a randomized, double-blind and placebo-controlled trial evaluating patients with full-thickness rotator cuff tears (Eudra-CT, 2007-007630-19). Effectiveness was evaluated using the Constant score and a visual analogue pain scale (VAS). Constant score has four domains including pain (15 possible points), activities of daily living (20 possible points), mobility (40 possible points), and strength (25 possible points). Scores range from 0 points (most disability) to 100 points (least disability). The structural integrity of the repaired tendon was assessed by magnetic resonance imaging (MRI) according to Patte and Thomazeau classification criteria. The primary study end point was an improvement in the Constant score by 20 points at one year compared to initial assessment. RESULTS: The trial was stopped due to adverse effects observed in both groups. Only thirteen patients were included and analyzed. The Constant questionnaire showed a significant improvement in the MSC treatment group compared with the preoperative data (p = 0.0073). Secondary outcome measures were similar in both groups. CONCLUSIONS: Our study showed preliminary inconclusive clinical outcomes in the patients treated with MSCs. Adverse events revealed the need for further approaches using scaffolds of a different nature or perhaps no scaffolds, in the context of small joints. TRIAL REGISTRATION: Eudra-CT, 2007-007630-19 . Registered on 30 January 2008. LEVEL OF EVIDENCE: A Level 1 of evidence treatment study.


Assuntos
Transplante de Células-Tronco Mesenquimais/efeitos adversos , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Tecidos Suporte/efeitos adversos , Idoso , Fenômenos Biomecânicos , Pesquisa Comparativa da Efetividade , Avaliação da Deficiência , Método Duplo-Cego , Término Precoce de Ensaios Clínicos , Feminino , Xenoenxertos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Recuperação de Função Fisiológica , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
4.
Int Orthop ; 43(7): 1701-1708, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30116870

RESUMO

BACKGROUND AND PURPOSE: There is no consensus on the optimal surgical procedure for treating Neer type-2 distal clavicle fractures. Hook plates provide better stability than other fixation methods for small fragments but have been related to multiple complications. METHODS: Retrospective study on patients operated for Neer type-2 fractures using a hook plate. At the time of the study, we performed functional (UCLA and Constant scales) and radiographic (coracoclavicular distance CCD) evaluation and ultrasound assessments of the condition of the rotator cuff. RESULTS: Twenty-four patients were included in the study, with a mean age of 43 years (18-81) and a mean follow-up of 40.4 months (22-67). All the fractures healed, except one. The plate was removed at a mean of five  months (3-13). The Constant score was 85.7 and the UCLA score was 32. The mean increase in CCD at final follow-up was 9.6% ± 7.2% (range 1.9-54.3%) compared with the uninjured side. Nine patients showed acromioclavicular arthrosis (only one case was symptomatic), and 12% showed subacromial osteolysis. No acromion fractures were recorded. The implant failed in three cases due to medial movement of the material, and we found one peri-plate fracture. CONCLUSIONS: The use of hook plates in this particular type of fracture provides high consolidation rates and good functional outcomes, irrespective of the fracture subtype. However, it is essential to select the correct length and depth of the hook to prevent complications such as medial movement of the implant. Ultrasound assessment showed that rotator cuff injury is not a common complication if the implant is removed as soon as the fracture has consolidated.


Assuntos
Placas Ósseas/efeitos adversos , Clavícula/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Clavícula/lesões , Feminino , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
5.
Injury ; 49 Suppl 2: S22-S26, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30219143

RESUMO

BACKGROUND: This study evaluates the clinical outcomes in patients with proximal humerus fractures (PHF) treated with reverse total shoulder arthroplasty (RTSA) as a revision procedure for failed fixation that have more than 5 years of follow-up. MATERIALS AND METHODS: This is a retrospective study of 270 RTSA. The inclusion criteria for this study consisted of patients initially treated with either open reduction and plate fixation (ORIF) or fixation using an intramedullary nail (IMN), who were managed with a single-stage revision to a RTSA, and had a minimum of 24 months clinical and radiological follow-up. Six patients with failed fixation of displaced PHF were revised with RTSA. One patient was excluded from the study because she died. Five shoulders were reviewed for the purpose of this study. The patients were evaluated using Constant score, relative Constant score and visual analogue scale for pain. RESULTS: The mean follow-up was 89 months (65-108). The mean absolute Constant score improved from 31, 81 to 44, 2 and the relative Constant score improved from 31,81% to 67,2%. Mean VAS improved from 6, 8 to 2. One patient rated their outcome excellent, 1good, 1 satisfied and 2 poor. CONCLUSION: RTSA is an appropriate treatment as a revision surgery for failed fixation of PHF. Patients should be adequately warned that they will improve their function but may have complications following this salvage procedure.


Assuntos
Artroplastia do Ombro , Fixação Interna de Fraturas/efeitos adversos , Amplitude de Movimento Articular/fisiologia , Reoperação , Fraturas do Ombro/cirurgia , Articulação do Ombro/cirurgia , Idoso , Feminino , Humanos , Radiografia , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia , Falha de Tratamento
6.
Chem Commun (Camb) ; 54(73): 10260-10263, 2018 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-30152499

RESUMO

Achieving the Ag(001)-supported synthesis of heptacene from two related reactants reveals the effect of the presence of Br atoms on the reaction process. The properties of reactants, intermediates and end-products are further characterized by scanning tunneling microscopy and spectroscopy.

7.
J Shoulder Elbow Surg ; 27(7): 1275-1282, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29475786

RESUMO

BACKGROUND: Neurologic pre- and postoperative injuries to the axillary and/or suprascapular nerve (SSN) have a higher incidence than expected and may lead to significantly decreased functional outcomes and increased risk of reverse shoulder arthroplasty (RSA) failure. METHODS: Patients who underwent a RSA for rotator cuff tear arthropathy (RCTA) were included from December 2014 to December 2015. This study focused on the clinical (Constant score), radiographic, and pre- and postoperative electromyographic evaluations at 3 and 6 months. RESULTS: Twenty patients met the inclusion criteria. One was lost to follow-up. Preoperatively, 15 patients showed changes on electromyography (9 SSN and 15 axillary nerve lesions); all of them were chronic and disuse injuries. The mean preoperative relative Constant score (rCS) of all included patients was 39 ± 9 (range, 19-64). At 3 months postsurgery, the prevalence of acute injuries for both nerves was 31.5%. At 6 months postsurgery, 2 axillary nerve injuries and 6 SSN injuries remain unchanged, and the rest improved or normalized. The mean postsurgery rCS of the entire cohort at 6-month follow-up was 78 ± 6.5. Mean postoperative rCS for acute postoperative nerve injury was 71 ± 3 for the axillary nerve and 64 ± 5 for SSN. CONCLUSIONS: Axillary and SSN injuries in RCTA have a much higher incidence than expected. Most of these axillary lesions are transient, with an almost complete recovery seen on electromyography at 6 months and with scarce functional impact. However, SSN lesions appear to behave differently, with poor functional results and having a lower potential for a complete recovery.


Assuntos
Artroplastia do Ombro/efeitos adversos , Axila/inervação , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Artropatia de Ruptura do Manguito Rotador/cirurgia , Articulação do Ombro/inervação , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletromiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Reoperação , Artropatia de Ruptura do Manguito Rotador/etiologia , Artropatia de Ruptura do Manguito Rotador/fisiopatologia , Resultado do Tratamento
8.
J Shoulder Elbow Surg ; 26(9): 1581-1588, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28408254

RESUMO

BACKGROUND: Large glenoid defects are a difficult reconstructive problem for shoulder surgeons. The purpose of this study was to determine the complications, rate of healing, and functional results of glenoid bone grafting in primary or revision surgery with reverse shoulder arthroplasty. METHODS: We retrospectively reviewed 23 patients with glenoid bone loss who underwent primary or revision surgery using a glenoid bone graft with a minimum follow-up of 2 years. Range of motion and the Constant, American Shoulder and Elbow Surgeons, and visual analog scale scores were obtained from preoperative assessment and the latest follow-up visit. Radiographic evaluation included analysis of plain radiographs as well as preoperative and follow-up computed tomography. RESULTS: Three patients were excluded from the study. Allografts were used in 13 cases and autografts in 7 cases. The mean Constant score improved from 30.7 ± 9.4 to 51.3 ± 13.4 (P < .001). At a mean follow-up of 26 months, computed tomography imaging revealed that the glenoid bone graft was fully incorporated in 95% of cases. No statistically significant differences were found on analysis of the clinical and radiographic outcomes related to the graft source. There was a 20% postoperative complication rate: 1 case of aseptic glenoid component loosening, 1 surgical wound hematoma, 1 acromial fracture, and a symptomatic grade 3 scapular notching. CONCLUSIONS: The use of bone grafts in glenoid defects is a useful technique by which, in the majority of cases, single-stage reconstruction surgery may be performed, even in the presence of severe bone loss. Incorporation rates are high, with satisfactory clinical outcome.


Assuntos
Artroplastia do Ombro/efeitos adversos , Transplante Ósseo , Cavidade Glenoide/cirurgia , Complicações Pós-Operatórias/etiologia , Articulação do Ombro/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Aloenxertos , Artroplastia do Ombro/métodos , Autoenxertos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Injury ; 47 Suppl 3: S29-S34, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27692103

RESUMO

INTRODUCTION: At present, surgical treatment of comminuted radial head fractures without associated instability continues to be controversial. When anatomical reconstruction is not possible, radial head excision is performed. However, the appearance of long-term complications with this technique, along with the development of new radial head implants situates arthroplasty as a promising surgical alternative. The purpose of the present study was to compare the mid-term functional outcomes of both techniques. MATERIALS AND METHODS: A retrospective study was performed between 2002 and 2011 on 25 Mason type-III fractures, 11 patients treated with primary radial head resection and 14 who received treatment of the fracture with metal prosthesis. At the end of follow-up, patients were contacted and outcomes evaluated according to: Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand score (DASH) and strength measurement. Radiographic assessment (proximal migration of the radius, osteoarthritic changes, and signs of prosthesis loosening) was also performed. RESULTS: The average age of the sample was 53.7 years in the resection group, and 54.4 years in the replacement group, with a mean follow-up of 60.3 and 42 months respectively. According to the MEPS scale, there were 6 excellent cases, 3 good and 2 acceptable in the resection group, and 6 excellent cases, 3 good, 3 acceptable, and 2 poor in the prosthesis group. The mean DASH score were 13.5, and 24.8 for the resection and the replacement group respectively. We found one postoperative complication in the resection group (stiffness and valgus instability) and 6 in the replacement group: 3 of joint stiffness, 1 case of prosthesis breakage, and 2 neurological injuries. CONCLUSIONS: Although this is a retrospective study, the high complication rate occurring after radial head replacement in comparison with radial head resection, as well as good functional results obtained with this last technique, leads us to recommend it for comminuted radial head fractures without associated instability.


Assuntos
Articulação do Cotovelo/cirurgia , Fraturas Cominutivas/cirurgia , Instabilidade Articular/cirurgia , Complicações Pós-Operatórias/cirurgia , Implantação de Prótese/métodos , Radiografia , Fraturas do Rádio/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Feminino , Seguimentos , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/fisiopatologia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Próteses e Implantes , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Espanha , Resultado do Tratamento
10.
J Shoulder Elbow Surg ; 25(3): 369-75, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26927432

RESUMO

BACKGROUND: The aim of this study was to describe the fracture patterns of capitellum coronal fractures and to evaluate the complications and functional and radiographic outcomes of open reduction and internal fixation in patients older than 65 years. METHODS: A retrospective study of 23 patients with a mean follow-up of 48 months (36-105) was performed. Fractures were classified according to the Dubberley classification. All patients were evaluated by the Mayo Elbow Performance Index (MEPI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS: Three patients were lost to follow-up. There were 16 type 1 and 4 type 2 fractures. The mean age was 71 years (66-79), and 65% were women. The mean MEPI score was 92 (60-100), and the mean DASH score was 9 (0-75). Either a concomitant fracture or an elbow dislocation was present in 50% of the patients. Mean sagittal plane range of motion at last follow-up was 122° ± 8°, with lower extension in type 2 and worse scores on MEPI (91 vs. 97) and DASH (3 vs. 0) scales. Placement of the screws in the posteroanterior direction was associated with better range of motion in flexion (130° vs. 122°) and better outcomes in functional scores (MEPI, 97 vs. 89; QuickDASH, 0 vs. 4). Complications were post-traumatic osteoarthritis in 3 patients, avascular necrosis in 1 patient, and heterotopic ossification in 5 patients. One patient required reoperation. CONCLUSIONS: Patients older than 65 years have no substantial risk of complex fracture patterns, but they have a large number of concomitant injuries. Open reduction and internal fixation with cannulated screws allow stable fixation and provide satisfactory functional results with a lower complication rate.


Assuntos
Articulação do Cotovelo/lesões , Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Fraturas do Úmero/cirurgia , Idoso , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Fraturas do Úmero/fisiopatologia , Masculino , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
11.
J Bone Joint Surg Am ; 98(6): 441-8, 2016 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-26984911

RESUMO

BACKGROUND: Spinal fusion with the use of autograft is a commonly performed procedure. However, harvesting of bone from the iliac crest is associated with complications. Bone morphogenetic proteins (BMPs) are extensively used as alternatives, often without sufficient evidence of safety and efficacy. The purpose of this study was to investigate non-inferiority of osteogenic protein-1 (OP-1, also known as BMP-7) in comparison with iliac crest bone graft in posterolateral fusions. METHODS: This study was a randomized, controlled multicenter trial. Patients who underwent a single-level instrumented posterolateral fusion of the lumbar spine for degenerative or isthmic spondylolisthesis with symptoms of neurological compression were randomized to receive OP-1 combined with local bone (OP-1 group) or autologous bone graft from the iliac crest combined with local bone (autograft group). The primary outcome was overall success, defined as a combination of clinical success and evidence of fusion on computed tomography (CT) scans, at one year postoperatively. RESULTS: One hundred and nineteen patients were included in the study, and analysis of the overall outcome was performed for 113. Non-inferiority of OP-1 compared with iliac crest autograft was not found at one year, with a success rate of 40% in the OP-1 group versus 54% in the autograft group (risk difference = -13.3%, 90% confidence interval [CI] = -28.6% to +2.10%). This was due to the lower rate of fusion (the primary aim of OP-1 application) seen on the CT scans in the OP-1 group (54% versus 74% in the autograft group, p = 0.03). There were no adverse events that could be directly related to the use of OP-1. CONCLUSIONS: OP-1 with a collagen carrier was not as effective as autologous iliac crest bone for achieving fusion and cannot be recommended in instrumented posterolateral lumbar fusion procedures. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Proteína Morfogenética Óssea 7/uso terapêutico , Ílio/transplante , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Descompressão Cirúrgica , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/instrumentação , Espondilolistese/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Transplante Autólogo , Resultado do Tratamento
12.
Int Orthop ; 40(4): 771-81, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26780717

RESUMO

PURPOSE: Reverse shoulder arthroplasty (RSA) in fractures is especially indicated in patients of advanced age, although the influence of age on functional outcomes, health-related quality of life (HRQoL) and complication rate is unknown. We hypothesized that complication rate would decrease in the geriatric population because of their reduced activity, improving the perceived HRQoL. METHODS: Retrospective study of 42 patients with proximal humeral fractures treated with RSA, divided into two groups: <80 years (<80y)(n = 16) and ≥80 years (≥80y)(n = 26). The assessment tools used were radiological images (functional outcome) with the Constant-Murley score(CMS); disabilities of the arm, shoulder and hand (DASH) score; and HRQoL with the EQ-5D index. Mean follow-up time was 32.6 months. RESULTS: Mean CMS adjusted for age and sex (R-CMS) was 68 % ± 29 %. Patients in the ≥80y group had a lower total CMS, 33 vs 64 (p = 0.027). Mean active range of motion at 24 months <80y/≥80y was: forward flexion: 126°/110°; abduction: 117°/105°; external rotation: 22°/20°; and internal rotation: L3/sacrum. Mean EQ-VAS was 74 ± 16 in the <80y group, and 63 ± 12.6 in the ≥80y group. Mean DASH was 29.5 ± 9.2. The EQ-5D "self-care" item in the >80y group was the most affected. The "pain/discomfort" item was lower for the two age groups than for the reference population. There were 9.5 % complications: one prosthesis dislocation, one periprosthetic fracture and two surgical wound haematoma. CONCLUSIONS: Our results indicate that age is a critical factor for RSA success. Lower functional outcomes have been obtained in patients older than 80y, although the EQ-5D results in our sample were similar or even better than the referred population. LEVEL OF EVIDENCE: Level III.


Assuntos
Artroplastia de Substituição/métodos , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Fraturas do Ombro/cirurgia , Articulação do Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Substituição/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
13.
Rev. Esp. Cir. Ortop. Traumatol. (Ed. Impr.) ; 59(5): 318-325, sept.-oct. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-140872

RESUMO

Introducción-objetivos. Describir la incidencia, factores etiológicos, repercusión funcional y actitud terapéutica de las fracturas de acromion y espina de la escápula tras artroplastia invertida por artropatía de manguito rotador. Material y método. Análisis retrospectivo de 126 artroplastias inversas entre los años 2009-2011. Se identificaron 4 fracturas que se compararon con un grupo control de 40 pacientes. Se analizan variables relacionadas con el proceso quirúrgico, funcionales y de calidad de vida (escala Constant, EQ-5D). Resultados. La incidencia de la fractura fue 3,28% (4 pacientes), edad media 74,7 años y tiempo medio hasta el diagnóstico 11,9 meses. El Constant preoperatorio del grupo control fue de 37,3% y de los pacientes con fractura 34,7% (p > 0,05); el postoperatorio 81,2% y 66,5%, respectivamente (p < 0,001). La anteversión y abducción en los pacientes con fractura descendieron en 39° (p = 0,02) y 34° (p = 0,057) respectivamente con respecto al grupo control. La calidad de vida percibida (EQ-VAS) es inferior en el grupo de fractura (60 vs 76) (p = 0,002). En ninguno de los casos de fractura se observó inestabilidad, no precisando cirugías de revisión. La tasa de consolidación fue de un 50% tras un seguimiento medio de 39,6 meses. Conclusiones. La fractura de escápula tras artroplastia invertida es una complicación poco frecuente. A pesar de su aparición los resultados funcionales y de calidad de vida de estos pacientes son superiores a los presentes preoperatoriamente, sin embargo, resultan inferiores a los de los pacientes intervenidos en los que no se encuentra dicha complicación. Son necesarios más estudios prospectivos que nos ayuden a definir las pautas de actuación terapéutica ante esta complicación (AU)


Introduction-objectives. To describe the incidence, etiological factors, functional impairment and therapeutic management of scapular fractures after reverse shoulder arthroplasty (RSA) in rotator cuff arthropathy. Material and method. A retrospective study was conducted on 126 RSA between 2009 and 2011, in which 4 fractures were identified that were compared with a control group of 40 patients. An analysis was performed on the variables related to the surgical technique, functional results, and quality of life (Constant scale, EQ-5D). Results. The fracture incidence was 3.28% with a mean age of 74.7 years. The mean time until diagnosis was 11.9 months. The preoperative Constant score in the control group was 37.3%, and 34.7% in the fracture group (P > .05); postoperative Constant score: 81.2 and 66.5%, respectively (P > .001). Forward elevation and abduction in fracture patients decreased by 39° (P = .02), and 34° (P = .057) respectively. The perceived quality of life (EQ-VAS) was lower in the fracture group (60 vs. 76) (P = .002). There were no instability cases, and no revision surgery was required. The union rate was 50% after a mean follow-up 39.6 months. Conclusions. Scapular fracture after RSA is a rare complication. Despite its presence, the functional outcomes and quality of life of these patients are higher than preoperatively; however, they are lower than that obtained in patients with RSA without this complication. More prospective studies are needed to define guidelines for therapeutic action against this complication (AU)


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escápula/lesões , Escápula , Artroplastia/métodos , Acrômio/lesões , Acrômio/cirurgia , Acrômio , Manguito Rotador/lesões , Manguito Rotador/cirurgia , Manguito Rotador/fisiopatologia , Manguito Rotador , Qualidade de Vida , Estudos Prospectivos , Seguimentos , Pseudoartrose/complicações , Coluna Vertebral/cirurgia , Coluna Vertebral
14.
Int Orthop ; 39(10): 1965-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26318881

RESUMO

PURPOSE: The purpose of this study was to record the incidence and management of periprosthetic humeral fractures (PHF) using reverse total shoulder arthroplasty (RTSA) in our institution. METHODS: We performed a retrospective study of 203 RTSA implanted in 200 patients between 2003 and 2014. The mean follow-up was 78.82 months (range, 12-141). Mean age of the study cohort was 75.87 years (range, 44-88). There were only 25 male patients (12.5 %). We assessed the presence of periprosthetic humeral fractures studying the medical files and X-rays of all patients. RESULTS: We identified seven periprosthetic humeral fractures in 203 RTSA (3.4 %): three intra-operative (1.47 %) and four post-operative (1.97 %). The average age at the time of the fracture was 75.14 years (59-83). All patients were women (100 %). Three patients with post-operative fractures type B were treated by osteosynthesis, and one patient with post-operative fracture type A was treated conservatively. All intra-operative fractures needed cerclage wire and in one case long cemented stem. All our periprosthetic fractures healed. CONCLUSIONS: Surgical treatment with osteosynthesis in type B post-operative fractures with a stable stem is recommended. Conservative treatment is sufficient in non-displaced type A post-operative fracture. Special attention should be paid to bone quality patients using non-cemented stems in primary surgery but especially in revision shoulder surgery.


Assuntos
Artroplastia de Substituição/efeitos adversos , Fraturas do Úmero/cirurgia , Artropatias/cirurgia , Fraturas Periprotéticas/cirurgia , Articulação do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/epidemiologia , Fraturas do Úmero/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/epidemiologia , Fraturas Periprotéticas/etiologia , Reoperação , Estudos Retrospectivos , Articulação do Ombro/lesões
15.
Rev Esp Cir Ortop Traumatol ; 59(5): 318-25, 2015.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25818527

RESUMO

INTRODUCTION-OBJECTIVES: To describe the incidence, etiological factors, functional impairment and therapeutic management of scapular fractures after reverse shoulder arthroplasty (RSA) in rotator cuff arthropathy. MATERIAL AND METHOD: A retrospective study was conducted on 126 RSA between 2009 and 2011, in which 4 fractures were identified that were compared with a control group of 40 patients. An analysis was performed on the variables related to the surgical technique, functional results, and quality of life (Constant scale, EQ-5D). RESULTS: The fracture incidence was 3.28% with a mean age of 74.7 years. The mean time until diagnosis was 11.9 months. The preoperative Constant score in the control group was 37.3%, and 34.7% in the fracture group (P>.05); postoperative Constant score: 81.2 and 66.5%, respectively (P>.001). Forward elevation and abduction in fracture patients decreased by 39° (P=.02), and 34° (P=.057) respectively. The perceived quality of life (EQ-VAS) was lower in the fracture group (60 vs. 76) (P=.002). There were no instability cases, and no revision surgery was required. The union rate was 50% after a mean follow-up 39.6 months. CONCLUSIONS: Scapular fracture after RSA is a rare complication. Despite its presence, the functional outcomes and quality of life of these patients are higher than preoperatively; however, they are lower than that obtained in patients with RSA without this complication. More prospective studies are needed to define guidelines for therapeutic action against this complication.


Assuntos
Artroplastia do Ombro , Fraturas de Estresse/etiologia , Complicações Pós-Operatórias , Lesões do Manguito Rotador/cirurgia , Escápula/lesões , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/métodos , Estudos de Casos e Controles , Feminino , Seguimentos , Fixação de Fratura , Fraturas de Estresse/epidemiologia , Fraturas de Estresse/fisiopatologia , Fraturas de Estresse/cirurgia , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Qualidade de Vida , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Escápula/cirurgia , Resultado do Tratamento
16.
J Shoulder Elbow Surg ; 23(3): 369-76, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24291047

RESUMO

BACKGROUND: Intramedullary nailing of displaced proximal humerus fractures is an attractive option in the elderly patient. However, in recent reports, some existing intramedullary nails have shown high rate of complications, so new designs are being developed. The objective of the present study is to report on outcomes and complications when comparing a straight to a curvilinear nail design. METHODS: We prospectively include 54 patients with Neer's 2- or 3-part proximal humerus fractures. Two were lost to follow-up, 26 were surgically treated with a new straight humeral nail (MultiLoc, Synthes) mean age 69 (range, 47-87 years), and 26 with a curvilinear nail (Polarus, Acumed) mean age 71 (range, 38-89 years). At final follow-up (average 14 months), patients underwent a clinical and radiographic evaluation. Clinical outcome was assessed with the adjusted Constant score. RESULTS: All but 1 fracture went on to radiographic union. Mean Constant score in the Polarus nail was 72.7 ± 16.0 and 83.3 ± 16.7 in the MultiLoc (P = .246). Symptoms related with rotator cuff disease were present in 19/26 patients (73%) and in 9/26 (34.6%), respectively (P = .001). The mean neck-shaft angle at final follow-up was 135° in the MultiLoc group and 130° in the Polarus group (P > .05). Reoperation rate was 42% for Polarus and 11.5% for MultiLoc. CONCLUSION: Straight intramedullary nails had a comparable union rate to an accepted curvilinear design, with a much lower incidence of complications. Rotator cuff pain and dysfunction can be minimized with the use of newer generation straight nails.


Assuntos
Pinos Ortopédicos/classificação , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Úmero/cirurgia , Úmero/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos/efeitos adversos , Desenho de Equipamento , Feminino , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Humanos , Fraturas do Úmero/diagnóstico por imagem , Úmero/diagnóstico por imagem , Fixadores Internos , Lacerações/etiologia , Lacerações/prevenção & controle , Masculino , Pessoa de Meia-Idade , Radiografia , Reoperação , Lesões do Manguito Rotador , Resultado do Tratamento
17.
Eur. j. anat ; 16(3): 184-189, sept. 2012. ilus
Artigo em Inglês | IBECS | ID: ibc-109227

RESUMO

New humeral nailing systems appear constantly in the market, but few anatomical studies assessing the potential risks of neurovascular injury, exist. The aim of this study is to determine the potential risk of neurovascular injury during proximal and distal locking. An anatomical analysis was carried out in cadavers where a new straight proximal humeral nail had been inserted. The nail entry point was always located medially to the myotendinous junction of the supraspinatus muscle, therefore affecting only muscle fibres. The nail entry point was surrounded by articular cartilage of the humeral head. The axillary nerve and the posterior humeral circumflex artery were at safe distances (>2cm) from all proximal and distal locking screws. The radial nerve and its accompanying artery, the profunda brachii artery, were at risk whenever medial cortex violation happened, as they were located within 1cm of the exit point of the most distal locking screw. The straight humeral nail analysed in the current study seems to be more secure in relation to the neurovascular injury potential when compared to previously reported ones. Only the incorrect selection of the length of the most distal locking screw may lead to injury of the radial nerve and/or profunda brachii artery; therefore, close monitorisation during the insertion of this distal locking screw is recommended (AU)


No disponible


Assuntos
Humanos , Ombro/anatomia & histologia , Fraturas do Ombro/cirurgia , Fixação Interna de Fraturas/métodos , Úmero/anatomia & histologia , Pinos Ortopédicos , Cadáver
18.
Injury ; 43 Suppl 2: S12-9, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23622986

RESUMO

INTRODUCTION: There is no controversy about the need for surgical treatment of the displaced surgical neck fractures of the humerus, but there are few studies comparing the results of the three preferred types of surgical treatment. To expand the knowledge needed in decision making, a patient series is reviewed using health related quality of life (HRQoL), functional and radiographic data from patients treated with percutaneous pinning, locking plates or intramedullary nails. MATERIALS AND METHODS: Retrospective observational cohort study of patients who underwent internal fixation of fractures of the surgical neck of the humerus between 2004 and 2009 (mean follow-up 40.67 ± 17.93 months). Fifty patients fulfilled the inclusion criteria (mean age 70.04 ± 13.15 years). Nine had been treated by percutaneous pinning, fifteen with locking plates and twenty-six with intramedullary nails. We compared the results between the three groups of the HRQoL with the EuroQol5D questionnaire; the functional capacity of the operated and non-operated shoulder with the Constant score; and the radiographic result with plain X-rays. RESULTS: Forty-eight patients had achieved fracture healing. The plating and nailing groups had a better fracture reduction compared with the pinning group (p <0.05). The EuroQol-5D did not discriminate between groups (mean 0.65 ± 0.26; p >0.05). The mean Constant score of the K-wire group (47.67 ± 22.42) was lower than those of the plating (82.45 ± 17.69) and nailing groups (72.72 ± 15.96) (p = 0.001), with no differences between plates and nails. There was positive correlation between the EuroQol-5D result and the Constant score (r = 0.490; p <0.005). The fractured shoulder was worse in each item of the Constant score than the non-operated one in patients treated with pins and nails. Patients treated with plates achieved similar results between operated and non-operated shoulder in three items: arm positioning, internal and external rotation. Seventeen patients (six re-operated) had some kind of complication during follow-up. CONCLUSION: Patients treated with pinning achieved a worse radiographic and Constant score than patients treated with plates or nails. Although we did not find differences between the plating and nailing groups, patients treated with plates got a Constant score more similar to the non-operated shoulder.


Assuntos
Fixação Interna de Fraturas/métodos , Complicações Pós-Operatórias/cirurgia , Fraturas do Ombro/cirurgia , Idoso , Pinos Ortopédicos , Placas Ósseas , Fios Ortopédicos , Feminino , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Qualidade de Vida , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/epidemiologia , Fraturas do Ombro/fisiopatologia , Espanha/epidemiologia , Inquéritos e Questionários , Resultado do Tratamento
19.
J Arthroplasty ; 26(8): 1570.e9-12, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21474273

RESUMO

We report on a 68-year-old woman with gonarthrosis who underwent total knee arthroplasty. Having initially achieved a satisfactory result, she developed at 5 months postoperation an irreducible flexion contracture necessitating revision surgery; but no pathological findings were discovered. In the immediate postoperative period, the patient developed a severe spasm of the hamstring muscles and a paralysis of the external popliteal sciatic nerve with a posterior dislocation of the knee. After reduction, an electromyography study showed an alteration in medullary sensitive conduction; and the magnetic resonance image showed a lesion compatible with meningioma. This complication has not been previously described as a consequence of spinal tumor. Technical considerations are described for this rare complication, which remains a serious challenge for the orthopedic surgeon.


Assuntos
Artroplastia do Joelho/instrumentação , Luxação do Joelho/etiologia , Prótese do Joelho , Neoplasias Meníngeas/complicações , Meningioma/complicações , Falha de Prótese , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Luxação do Joelho/diagnóstico por imagem , Luxação do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Laminectomia , Imagem por Ressonância Magnética , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/patologia , Meningioma/cirurgia , Osteoartrite do Joelho/cirurgia , Radiografia , Recidiva , Reoperação , Resultado do Tratamento
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