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1.
Medicine (Baltimore) ; 100(1): e22393, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429725

RESUMO

ABSTRACT: Calcaneal fractures are rare in pediatric population, with more displaced intra-articular fractures encountered due to the increasing number of high-energy trauma. Operative interventions are gaining popularity because of the unsatisfactory outcomes of traditional conservative methods. This study investigated the clinical outcomes of a minimally invasive technique using the sinus tarsi approach and external fixator in the treatment of intra-articular calcaneal fractures in pediatric patients.Patients who underwent open reduction between January 2010 and January 2018 at our institute were included in this study and reviewed retrospectively. Radiological and clinical parameters were all recorded and analyzed.Overall, 29 patients were included in the study, including 23 boys and 6 girls (10.2 ±â€Š2.2 years old). The average follow-up was 29.5 months postoperatively (range, 26-72 months). Bohler angle was 15.2 ±â€Š3.3° preoperatively, and 34.0 ±â€Š3.8° postoperatively (P < .001); Gissane angle was 101.8 ±â€Š6.2 degrees preoperatively, and 129.7 ±â€Š6.2° postoperatively (P < .001). The average length of incision was 3.4 ±â€Š0.7 cm. At the last follow-up, all patients showed satisfactory clinical outcomes and the score was 90.0 ±â€Š2.3 according to American Orthopedic Foot and Ankle Society Scale.Minimally invasive approach with external fixator is an effective method for treating displaced intra-articular calcaneal fractures in pediatric patients, with a lower incidence of wound-related complications and good cosmetic outcomes.


Assuntos
Calcâneo/lesões , Calcâneo/cirurgia , Fixadores Externos/normas , Adolescente , Criança , Pré-Escolar , Fixadores Externos/efeitos adversos , Fixadores Externos/tendências , Feminino , Pé/cirurgia , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/cirurgia , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Resultado do Tratamento
2.
J Orthop Surg Res ; 15(1): 581, 2020 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-33267906

RESUMO

BACKGROUND: The optimal dosage and administration approach of tranexamic acid (TXA) in primary total knee arthroplasty (TKA) remains controversial. In light of recently published 14 randomized controlled trials (RCTs), the study aims to incorporate the newly found evidence and compare the efficacy and safety of intra-articular (IA) vs. intravenous (IV) application of TXA in primary TKA. METHODS: PubMed, Embase, Web of Science, and Cochrane Library were searched for RCTs comparing IA with IV TXA for primary TKA. Primary outcomes included total blood loss (TBL) and drain output. Secondary outcomes included hidden blood loss (HBL), hemoglobin (Hb) fall, blood transfusion rate, perioperative complications, length of hospital stay, and tourniquet time. RESULT: In all, 34 RCTs involving 3867 patients were included in our meta-analysis. Significant advantages of IA were shown on TBL (MD = 33.38, 95% CI = 19.24 to 47.51, P < 0.001), drain output (MD = 28.44, 95% CI = 2.61 to 54.27, P = 0.03), and postoperative day (POD) 3+ Hb fall (MD = 0.24, 95% CI = 0.09 to 0.39, P = 0.001) compared with IV. There existed no significant difference on HBL, POD1 and POD2 Hb fall, blood transfusion rate, perioperative complications, length of hospital stay, and tourniquet time between IA and IV. CONCLUSION: Intra-articular administration of TXA is superior to intravenous in primary TKA patients regarding the performance on TBL, drain output, and POD3+ Hb fall, without increased risk of perioperative complications. Therefore, intra-articular administration is the recommended approach in clinical practice for primary TKA.

3.
BMC Public Health ; 20(1): 1905, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33317486

RESUMO

BACKGROUND: The aim of this study was to determine the knowledge, attitude and practice (KAP) regarding the COVID-19 among frontline healthcare workers (F-HCWs) working at different hospitals in Nepal and to identify the factors significantly associated with KAP. METHODS: We used a web-based survey, and a convenience sampling method was adopted to collect data from 603 F-HCWs working at different hospitals in Nepal during the first week of June 2020. A self-administered questionnaire was utilized to assess the KAP perceived by the F-HCWs. It was divided into 4-parts consisting of 30-items, demographic characteristics (10-items), knowledge (10-items), attitude (5-items), and practice (5-items). It consisted of both multiple-choice questions and Likert scale items questionnaire. RESULTS: Among the participants, 76% reported adequate knowledge, 54.7% reported positive attitude, and 78.9% reported appropriate practice. Statistically significant differences regarding the perceived level of knowledge among F-HCWs were observed among independent variables, including age, gender, level of education, marital status, profession, work experience, source of information, infection prevention and control (IPC) training, and online course(p < 0.05). Similarly, statistically significant differences regarding the attitude among F-HCWs were observed among independent variables, including age, gender, level of education, profession, and online course(p < 0.05). Moreover, only 2-independent variables, including the profession and online course, showed statistically significant differences with practice(p < 0.05). Pearson correlation analysis showed a significant association between knowledge, attitude and practice at the level of p = 0.01. The factors significantly associated with adequate knowledge were male gender, nurse and doctor, websites and IPC training. Similarly, factors significantly associated with positive attitude were online course related to COVID-19 only. Moreover, factors significantly associated with appropriate practice were master's degree or above and online course related to COVID-19. CONCLUSIONS: F-HCWs reported adequate overall knowledge with a positive attitude and adopted the appropriate practice. The experienced F-HCWs with higher education and who received IPC training and online course regarding COVID-19 had better KAP. So, the stakeholders must arrange the educational programs and training for F-HCWs for better preparedness tackling with COVID-19.


Assuntos
/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Recursos Humanos em Hospital/psicologia , Adolescente , Adulto , Feminino , Hospitais , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Nepal , Recursos Humanos em Hospital/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
4.
Medicine (Baltimore) ; 99(45): e23146, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157997

RESUMO

An interest in the fixation of posterior malleolus via the posterolateral approach has gained popularity recently. Most surgeons choose prone or lateral position during the surgery, and this study proposes an additional radiolucent table for easier access to the posterolateral anatomic structure of ankle joint, and compares it with traditional positioning.From September 2014 to September 2018, 21 patients with trimalleolar fractures and 28 patients with posterior malleolus and fibular fractures receiving open reduction and internal fixation (ORIF) using the posterolateral approach with the utilization of an additional radiolucent table were included in Additional Table group. Patients of matched sex, age, and injury type using the same surgical approach with the traditional positioning were selected from the hospital database and included in the Traditional group. Baseline information and clinical parameters were recorded.No significant differences existed concerning age, sex, or operative side between the 2 groups in patients with trimalleolar fractures. The time for positioning was significantly longer in the Traditional group (20.5 ±â€Š6.45 minutes) than the Additional Table group (12 ±â€Š3.5 minutes) (P < .001). Besides, the operative time in the Traditional group (75.28 ±â€Š5.45 minutes) was significantly longer than the Additional Table group (58 ±â€Š5.95 minutes) (P < .001). There was no case of nonunion and malunion in both groups. At 12-month follow-up, the American Orthopedic Foot and Ankle Society Scale (AOFAS) score showed no significant difference between the 2 groups (P = .46). In patients with fibular fracture and posterior malleolus fracture, no significant differences existed concerning age, sex, operative side between the 2 groups. The time for positioning was significantly longer in the Traditional group (16.5 ±â€Š3.45 minutes) than the Additional Table group (11 ±â€Š3.5 minutes) (P < .001). Besides, the operative time in the Traditional group (55.28 ±â€Š8.45 minutes) was significantly longer than the Additional Table group (44 ±â€Š7.95 minutes) (P < .001). There was no case of nonunion and malunion in both groups. At the 12-month follow-up, the AOFAS score showed no significant difference between the 2 groups (P = .26).The novel positioning with an additional table is an excellent choice for trimalleolar fracture, posterior malleolus fracture, with/without distal fibular fracture.


Assuntos
Fraturas do Tornozelo/cirurgia , Fixação Interna de Fraturas , Redução Aberta , Posicionamento do Paciente/métodos , Adulto , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta/métodos , Estudos Retrospectivos
5.
BMC Musculoskelet Disord ; 21(1): 735, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176748

RESUMO

BACKGROUND: The clinical outcome of open reduction and internal fixation (ORIF) for delayed lateral condylar fracture of the humerus (LCFH) varies in different studies, but ORIF for LCFH with an early-delayed presentation usually resulted in significant improvement of elbow function. Early delayed presentation is defined as a period of 3 to 12 weeks from the injury. This study aims to compare the clinical outcomes of biodegradable pin (BP) vs. Kirschner wire (KW) in the treatment of LCFH with an early delayed presentation. METHODS: LCFH with an early-delayed presentation treated with KW or BP were retrospectively reviewed in our hospital. The patients were divided into two groups KW (n = 17) and BP group (n = 26). Baseline information, including sex, age, operative side, duration from injury to surgery, and implant choice, was reviewed. Radiographs and medical records were collected from the Hospital Database. RESULTS: In all, 17 patients (male/female, 9/8) in KW and 26 patients (male/female,13/13) in the BP group were included. The age showed no statistically significant difference between the KW (52.3 ± 10.2, month) and the BP (56.1 ± 10.7, month), (P = 0.258). At the last follow-up, there existed no statistically significant difference between the two groups concerning Baumann's angle (P = 0.272) and carrying angle (P = 0.911). The MEPS at the last follow-up was better in the KW group (91.1 ± 2.7) than the BP group (89.2 ± 3.0), (P = 0.048). There was no case of nonunion or malunion in both groups. The incidence of fishtail deformity was (8/17, 47.1%) in KW and (13/26, 50%) in the BP group. The incidence of lateral prominence was (5/17, 29.4%) in the KW and (7/26, 26.9%) in the BP group. Furthermore, the incidence of implant prominence was higher in KW (12/17, 70.6%) than BP (0) (P <  0.001). CONCLUSION: Open reduction and internal fixation for LCFH with an early-delayed presentation produced satisfactory outcomes. Biodegradable pin is a good alternative to Kirschner wire, with comparable clinical outcomes.

6.
Medicine (Baltimore) ; 99(35): e22001, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871954

RESUMO

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.


Assuntos
Implantes Absorvíveis , Parafusos Ósseos , Articulação do Cotovelo/lesões , Fixação de Fratura/instrumentação , Fraturas do Úmero/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 99(33): e21696, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872043

RESUMO

INTRODUCTION: Lateral condylar fracture (LCF) of the humerus in children is one of the commonest elbow injuries in children. Early recognition of the problem and appropriate management usually yields satisfactory outcomes. Closed or open reduction with Kirschner-wire (KW) is a cost-effective choice of fixation method for displaced fracture. However, various other methods, including partially threaded cannulated cancellous screw and biodegradable pin (BP), have also been used. This study aimed to investigate the efficacy of BP and compare its clinical outcomes with KW. MATERIAL AND METHODS: Patients with LCF admitted from January 2008 to January 2016 at our institute were reviewed retrospectively. Baseline information and clinical data were collected from Hospital Database. Patients were divided into the KW group and BP group. RESULTS: In all, 85 patients (male 50, female 35) in the KW group and 76 patients (male 47, female 29) in the BP group were included in this study. The average age of patients in the KW group was 5.2 years, and that of BP was 5.9 years. No nonunion or malunion was observed in either group. At the last follow-up visit, there was no statistically significant difference between the 2 groups with regard to elbow function and appearance. The incidence of long-term complications, including avascular necrosis, fishtail deformity, and lateral prominence, showed no significant difference between both the groups. The incidence of hardware prominence was higher in the KW (13/85, 15.6%) than BP (2/76, 2.6%) group (P < .001). CONCLUSIONS: Both KW and BP are safe and effective choices for LCF of the humerus in children. Both the implant designs produce satisfactory and comparable clinical outcomes. However, BP has the advantage of less hardware prominence, no need for hardware removal, and fewer long-term complications.


Assuntos
Implantes Absorvíveis , Fios Ortopédicos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Criança , Pré-Escolar , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Fraturas do Úmero/diagnóstico por imagem , Masculino , Estudos Retrospectivos
8.
Medicine (Baltimore) ; 99(39): e22364, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991454

RESUMO

Pathological fracture of the proximal femur represents a challenging situation for orthopedic surgeons because of the high risk of non-union, varus union, and avascular necrosis (AVN) of the femoral head. This study aims to investigate the efficacy of ESINs for the treatment of proximal femoral fractures caused by simple bone cysts (SBCs).All the patients with a diagnosis of proximal femoral fracture secondary to SBC treated with ESINs combined with bone grafting between January 2008 and January 2018, were analyzed retrospectively.In all, 11 patients were included in the Double ESINs group (5.1 ±â€Š0.8 years, 5 male, 6 female) and 27 patients were included in the Triple ESINs group (9.1 ±â€Š2.1 years, 11 male, 16 female). There was no significant difference between the 2 groups concerning the patients demographic parameters, including sex and affected side. However, the age in the Double group was significantly younger than those in the Triple group (P < .001). All patients in both groups displayed excellent outcomes according to the Musculoskeletal Tumor Society Score (MSTS), and there was no significant difference between the 2 groups at a 12-month follow-up evaluation (P = .10). As for the Capanna classification (1 + 2), there was no significant difference between these 2 groups (P = .24). In the Triple ESINs group, 24 (88.9%) patients were categorized in Capanna 1 and 2, whereas all patients in Double ESINs were Capanna 1 and 2. Overall, the success rate was 92%.ESINs combined with bone grafting is a successful strategy for proximal femoral fractures caused by SBCs in the pediatric population.


Assuntos
Cistos Ósseos/complicações , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas , Criança , Pré-Escolar , Feminino , Fraturas do Fêmur/etiologia , Humanos , Masculino , Estudos Retrospectivos
9.
World J Surg Oncol ; 18(1): 247, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943050

RESUMO

BACKGROUND: Closure of large skin-soft tissue defects following soft tissue sarcoma (STS) resection has been a great challenge. The objective of this study was to evaluate the effectiveness of a novel, simple, and cheap skin-stretching device (bidirectional regulation-hook skin closure system, BHS) for closing large skin-soft tissue defects resulting from the removal of STS and the complications associated with the use of the BHS. METHODS: From January 2017 to September 2018, 25 patients with STS underwent BHS therapy after tumor resection. BHS was used for two main clinical applications: securing wound closure after high-tension suture closure and delayed wound closure. We described a detailed reconstruction procedure regarding this therapy. Wound closure and complications associated with BHS therapy were recorded. We also analyzed tumor recurrence and metastases. RESULTS: All patients were observed for 16-36 months with an average follow-up of 25.6 months. During the follow-up period, no significant functional restriction was observed and the final scar was aesthetically acceptable. Superficial wound infection occurred in six patients, wound edge ischemia in two patients, and small skin tears in two patients. Two patients developed pulmonary metastasis, two patients had a local recurrence, and one patient died of pulmonary metastasis. CONCLUSIONS: BHS therapy can effectively close large skin-soft tissue defects following STS resection and obtain acceptable functional results, without severe complications. However, larger studies are required to further evaluate the effectiveness, indications, and complications of BHS therapy.

11.
J Orthop Surg Res ; 15(1): 246, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631395

RESUMO

BACKGROUND: Postoperative pain in children has always been inadequately evaluated. This study aims to evaluate the postoperative pain response using an additional dose of brachial plexus block (BPB) for younger children receiving elbow surgeries under general anesthesia (GA). METHODS: This retrospective case-control study included pediatric patients (3-10 years) who underwent surgeries for elbow injuries between January 2015 and January 2019. Patients with previous history of surgeries around the elbow, neurological impairment of injured limb, polytrauma, undergoing pain management for different causes, and open or old fractures were excluded. Patients were dichotomized into the GA group and the GA + BPB group as per the presence or absence of BPB. RESULTS: In all, 150 patients (102/48, male/female) in the GA and 150 patients (104/46, male/female) in the GA + BPB group were included. There existed no significant differences between the two groups in age, sex, fracture side, and types of elbow procedures. As for the pain response after lateral condyle fracture of the humerus (LCFH), the FLACC pain scale was significantly higher for those in the GA group (6.2 ± 0.8) when compared to the GA + BPB group (1.6 ± 0.5) (P < 0.001). As for the pain response after medial epicondyle fracture of the humerus (MCFH), the FLACC pain scale was significantly higher for those in the GA group (6.0 ± 0.8) when compared to the GA + BPB group (1.5 ± 0.5) (P < 0.001). As for the pain response after supracondylar fracture of the humerus (SCFH), the FLACC pain scale was significantly higher for those in the GA group (6.0 ± 0.8) when compared to the GA + BPB group (1.6 ± 0.5) (P < 0.001). As for the pain response after cubitus varus correction, the FLACC pain scale was significantly higher for those in the GA group (6.7 ± 0.7) when compared to the GA + BPB group (2.1 ± 0.7) (P < 0.001). CONCLUSION: An additional shot of BPB for patients undergoing surgeries for elbow surgeries resulted in better postoperative pain response in younger children without significant BPB-related complications.

12.
BMC Musculoskelet Disord ; 21(1): 503, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727439

RESUMO

BACKGROUND: Most patients suffering from distal femoral unicameral bone cysts (UBCs) are adolescents that require an early return to normal activities, including school attendance and sports exercises. However, the optimal choice of implants for such patients remains controversial. This study evaluated the application of pediatric physeal slide-traction plate (PPSP) in the treatment of pathological distal femoral fracture caused by UBCs. METHODS: Between Jan 2014 and Jan 2016, 11 (male = 6, female = 5) patients were reviewed retrospectively. Age, sex, operative time, limb-length discrepancy (LLD), and valgus angulation were all recorded for every patient. RESULTS: The average age of 11 patients was 12.2 ± 1.1 years. The operating time was 94.8 ± 7.8 min. The postoperative hospital stay was 5 to 7 days. The epiphyseal morphology in the operative leg was nearly normal. The plate was removed in an average of 19.5 ± 3.1 months. The knee range of motion (ROM) was normal in 9 patients, whereas 2 female patients reported a loss of less than 10 degrees of ROM as compared to the contralateral knee joint. Breakage of plates or refracture did not occur in our cases. All patients had a follow-up of at least 24 months. At the latest follow-up visit, all patients walked without a limp. None of the patients manifested obvious LLD and valgus deformity. CONCLUSION: PPSP combined with curettage and bone grafting allows early mobilization and produces satisfactory outcomes for pathological fracture of distal femur secondary to UBCs in adolescents.

13.
Medicine (Baltimore) ; 99(27): e21053, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629731

RESUMO

Internal fixation such as elastic stable intramedullary(ESIN) nail and submuscular plate (SMP) is gaining popularity for femoral shaft fractures in school-aged children. However, external fixation (ExFix) might be a valuable option for the distal third femoral shaft fractures, where the fracture heals rapidly, but it is crucial to avoid angular malunion. This study aims to compare the clinical outcomes, postoperative complications of distal third femoral shaft fractures in school-aged children treated by ESIN versus ExFix.Patients aged 5 to 11 years with distal third femoral shaft fractures treated at our institute from January 2014 to January 2016 were included and categorized into ESIN (n = 33) and ExFix (n = 38) group. The preoperative data, including baseline information of the patients, radiographic parameters, and type of surgical procedure, were collected from the hospital database, and postoperative data, including complications, were collected during the follow-up visit.In all, 33 patients (average, 8.0 ±â€Š2.1 years, male 20, female 13) in the ESIN group and 38 patients (average, 8.3 ±â€Š2.3 years, male 23, female 15) in the ExFix group were included in this study. There was significantly less operative time for the ExFix group (45.4 ±â€Š7.8 min) as compared to the ESIN group (57.8 ±â€Š11.3 min) (P < .01), reduced estimated blood loss (EBL) in the ExFix group (9.9 ±â€Š3.5) as compared to the ESIN group (16.4 ±â€Š6.5) (P < .01). As for the frequency of fluoroscopy, there was a significant difference between the ExFix group (13.9 ±â€Š2.4) and the ESIN group (15.5 ±â€Š3.2) (P = .02). The rate of major complications was not significantly different between the 2 groups (P = .19). The rate of implant irritation was significantly higher in the ExFix group (28/38, 73.7%) than the ESIN group (12/33, 36.4%) (P < .01). The rate of surgical site infection (SSI) is significantly higher in the ExFix group (18/38, 47.4%)) than the ESIN group (1/33, 3%) (P < .01). The rate of scar concern was significantly higher in the ExFix (9/38, 23.7%) than the ESIN (2/33, 6.1%), (P = .04). According to the Flynn scoring system, 30(90.9%) patients in the ESIN group and 24(89.5%) patients in the ExFix group were rated as excellent. None of the patients had poor outcomes.Both ESIN and ExFix produced satisfactory outcomes in distal third femoral shaft fractures. ExFix remains a viable choice for selected cases, especially in resource-challenged and austere settings.


Assuntos
Pinos Ortopédicos/efeitos adversos , Placas Ósseas/efeitos adversos , Fixadores Externos/efeitos adversos , Fraturas do Fêmur/cirurgia , Assistência ao Convalescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pinos Ortopédicos/normas , Placas Ósseas/normas , Criança , Pré-Escolar , China/epidemiologia , Diáfises/diagnóstico por imagem , Diáfises/patologia , Fixadores Externos/normas , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fluoroscopia/estatística & dados numéricos , Fixação de Fratura/métodos , Fixação de Fratura/tendências , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
14.
BMC Musculoskelet Disord ; 21(1): 365, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517675

RESUMO

BACKGROUND: Conservative treatment remains the preferred choice for distal radius fracture in children. However, loss of reduction is problematic, especially in an older child. Crossed Kirschner-wires is widely used to treat distal radius fracture in adolescents. This study aimed to compare the application of crossed Kirschner-wiring (KW) and non-bridging external fixator (EF) for the treatment of delayed distal radial fracture involving metaphyseal diaphyseal junction (MDJ) in adolescents. METHODS: Between January 2012 to January 2017, 146 (male = 101, female = 45) patients in EF group and 117 (male = 76, female = 41) in KW group, were reviewed retrospectively. Preoperative data were collected from the hospital database, and postoperative clinical outcomes data were collected during the follow-up visits. We used SPSS for data analysis. RESULTS: There existed no significant difference between EF and KW regarding sex, body weight, fracture side, duration from injury to surgery. The duration of surgery was significantly shorter in EF (30.5 ± 6.1 min) than the KW group (44.6 ± 9.4 min), P < 0.001. The number of intraoperative X-ray images was significantly lower in EF (6.5 ± 1.1) than KW (11.8 ± 2.3), P < 0.001. The incidence of tendon irritation is significantly higher in the KW (19.7%) than the EF group (0%), P < 0.001. The residual angulation on the AP view was higher in KW (3.8 ± 2.3, degrees) than the EF group (2.5 ± 1.6, degrees), P < 0.001. The volar tilting is better in EF (6.6 ± 1.1, degrees) than the KW group (1.0 ± 1.5, degrees), P < 0.001. However, the functional outcomes of the wrist showed no significant difference between EF and KW group, P = 0.086. CONCLUSION: The EF was superior to KW in the treatment of radial MDJ fractures in adolescents. The EF displayed shorter duration of surgery, less tendon irritation, and better radiographic outcomes than the KW. However, the cost-effect analysis remains to be investigated, because the EF is more expensive than KW.

15.
Medicine (Baltimore) ; 99(23): e20563, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502025

RESUMO

Unicameral bone cyst (UBC) is a benign fluid-filled lesion, mainly located in the metaphyses of long bones in children and adolescents. Elastic stable intramedullary nail (ESIN) is adopted in our institute for UBCs since 2010, and bone grafting was performed simultaneously. This study aims to evaluate the efficacy of ESIN decompression combined with different bone graft materials.All patients with the diagnoses of UBCs of the humerus, treated with ESINs and bone grafting between January 2010 and June 2018, were analyzed retrospectively. The bone grafting included injectable calcium sulfate, a mixture of the autologous iliac bone and allogeneic bone. All patients were categorized into 2 groups: ICS (injectable calcium sulfate) group and MIX (a mixture of the autologous iliac bone and allogeneic bone, ratio: 1:3) group. All the information was collected from the Hospital Database.In all, 17 patients (8.8 ±â€Š2.3-year-old, male 8, female 9) in the ICS group and 19 patients (8.9 ±â€Š1.9-year-old, male 10, female 9) in the MIX group were included in this study. Patients in both groups were followed up for more than 2 years (average, 3.4 ±â€Š1.3 years). No recurrence was observed in either group. There was no significant difference between the two groups concerning the patient's demographic parameters, including sex, age, and affected side. All patients in both groups displayed excellent and good shoulder function, and there was no significant difference between the 2 groups (P = .29). As for the Capanna classification, there was no significant difference between these 2 groups (P = .78).Intramedullary nailing has the advantage of a minimally invasive procedure, immediate stability, and continuous decompression. ICS showed similar results as a mixture of the autologous iliac bone and allogeneic bone.


Assuntos
Cistos Ósseos/cirurgia , Transplante Ósseo/métodos , Fixação Intramedular de Fraturas/instrumentação , Transplante Homólogo/métodos , Cistos Ósseos/complicações , Pinos Ortopédicos , Sulfato de Cálcio/administração & dosagem , Criança , Descompressão Cirúrgica/métodos , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Úmero/lesões , Úmero/patologia , Úmero/cirurgia , Ílio/transplante , Masculino , Estudos Retrospectivos , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(25): e20796, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569225

RESUMO

The utilization of elastic stable intramedullary nail (ESIN) in length unstable femoral shaft fractures in children remains controversial, and the results in different studies vary a lot. This study aims to investigate the clinical outcomes of ESINs versus submuscular plate (SMP) in length unstable femoral shaft fractures.Patients aged 5 to 11 years old with length unstable femoral shaft fractures treated at our institute from January 2008 to January 2018 were included and categorized into ESIN and SMP group. The preoperative data and operative variables were collected from the hospital database, and postoperative data including complications were collected at follow-up visits.In all, 77 patients (8.1 ±â€Š1.9 years old, male 45, female 32) in ESIN group and 45 patients (8.0 ±â€Š2.2 years old, male 26, female 19) in SMP group were included in this study. Comparing operative variables, there was significantly less operative time, reduced estimated blood loss (EBL) and shortened hospital stay for ESINs as compared with SMP (P < .001). However, the fluoroscopy frequency was not significantly different between these 2 fixation methods (P = .42). As for elective removal surgery, there was significantly reduced operative time, EBL and shortened hospital stay for ESINs as compared with SMP (P < .001).Both ESIN and SMP are safe and effective choices for length unstable femoral shaft fractures in children aged 5 to 11 years. In ESIN, extra care is required to provide additional immobilization using spica cast or brace. Compared with SMP, ESIN is able to deliver comparable clinical outcomes with less EBL, operative time and shorter hospital stay.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Criança , Pré-Escolar , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Masculino , Estudos Retrospectivos
17.
BMC Musculoskelet Disord ; 21(1): 234, 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32284063

RESUMO

BACKGROUND: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopaedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group. METHODS: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups. RESULTS: The mean duration of hospital stay was significantly reduced from 10.0 ± 3.1 in the traditional care group to 6.0 ± 0.8 days in the ERAS(P < 0.001). The average VAS score in the first 3 days was significantly lower in the ERAS group (2.9 ± 0.8) than the traditional non-ERAS group (4.0 ± 0.8) (P < 0.001). However, there was no significant difference in the frequency of break-out pain (VAS > 4) between two groups (29.5 ± 6.3 times vs.30.6 ± 6.5 times, P = 0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery. CONCLUSION: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

18.
Medicine (Baltimore) ; 99(10): e19449, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150100

RESUMO

Radial external fixator has been proposed to treat delayed irreducible Gartland type III supracondylar humeral fracture, and this study aims to compare its effects with crossed pinning in a retrospective fashion. Delayed supracondylar humeral fracture is defined as more than 72 hours after injury, 2 or more than 2 times failed attempts of closed reduction can be deemed as irreducible fracture.Between January 2010 and January 2017, patients of Gartland type III supracondylar fractures of the humerus receiving surgery were all selected and reviewed. Overall, 39 patients fitting the inclusion criteria were chosen for the External Fixator Group and patients for control group of crossed pinning with matched age, sex, and clinical parameters (fracture location, injured side, and fracture type) were selected from the database. Surgery duration, number of intraoperative X-ray images, incidence of ulnar nerve injury, postoperative redisplacement, and function of the elbow joint were recorded and analyzed.In this study, 39 patients treated with radial external fixator had significantly shorter surgery duration, fewer intraoperative X-ray images, and lower incidence of ulnar nerve injury, and postoperative redisplacement than those receiving crossed pinning. Patients in 2 groups displayed similar range of motion for elbow joint at follow-up.Radial external fixator is an effective and safe method to treat Gartland type III supracondylar fractures that were diagnosed late.


Assuntos
Pinos Ortopédicos , Fixadores Externos , Fixação de Fratura/instrumentação , Fraturas do Úmero/cirurgia , Criança , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
19.
Medicine (Baltimore) ; 99(3): e18425, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011435

RESUMO

RATIONALE: Hypophosphatemic rickets (HR) is a rare hereditary disease characterized by hypophosphatemia, defects in bone mineralization, and rickets, and surgical intervention is warranted for the patient of severe skeletal deformity. PATIENT CONCERNS: Here we report a case of an 11-year-old boy who presented with severe varus deformities of the bilateral lower extremities and was associated with uncoordinated gait with multiple unintentional falls onto ground resulting in fractures of lower extremities. DIAGNOSES: He was diagnosed as HR caused by genetic mutations in the phosphate-regulating endopeptidase homologue. Based on his family history and laboratory tests, including high serum alkaline phosphatase, high urinary phosphorus, hypophosphatemia, and normal serum calcium level, the patient was diagnosed with this disorder. INTERVENTIONS: Rotational and translational osteotomy was performed to redress the severe varus deformity and readjust the malalignment of the lower extremity. OUTCOMES: Right after the surgery, the alignment in the left lower extremity was readjusted, and his appearance seemed normal. Combined with rehabilitation and pharmacological intervention, including oral intake of phosphate and alphacalcidol, the bone healed uneventfully. After the second surgery of a similar procedure on the right femur, the patient was able to walk almost like a normal teenager. LESSONS: This case proposed a novel technique to treat severe varus or valgus deformity of the lower extremity. HR is a rare disease, and it is important to stress its recognition to avoid delay of diagnosis and surgical intervention if necessary.


Assuntos
Raquitismo Hipofosfatêmico Familiar/diagnóstico , Raquitismo Hipofosfatêmico Familiar/terapia , Criança , Fêmur/cirurgia , Humanos , Hidroxicolecalciferóis/administração & dosagem , Masculino , Osteotomia/métodos , Fosfatos/administração & dosagem
20.
J Surg Oncol ; 121(3): 570-577, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31902136

RESUMO

BACKGROUND: Joint-preserving intercalary tumor resection can result in better proprioception and a more normal joint function after reconstruction. However, most reported reconstruction techniques are usually associated with frequent complications. Therefore, the approach of reconstruction following joint-preserving tumor resection warrants further study. METHODS: Between September 2016 and October 2018, 12 patients with metaphyseal malignant bone tumors around the knee joint were treated by joint-preserving intercalary resections with the aid of three-dimensional (3D)-printed osteotomy guide plates and reconstructions using 3D-printed intercalary prostheses. We assessed the accuracy of the resection by comparing the cross sections at the resection plane with 3D-printed matching surface of the prostheses. The functional outcomes, complications and oncological status were also evaluated. RESULTS: All patients were observed for 7 to 32 months with an average follow-up of 22.5 months. The achieved resection was accurate, with accurate matching between the residual bone and prosthesis. The mean MSTS score was 28 (range, 26-30). Superficial infection occurred in two patients. Local recurrence was observed in one patient, while pulmonary metastasis was identified in one patient. CONCLUSIONS: The personalized osteotomy guide plate and prosthesis based on 3D printing technique facilitate joint-preserving tumor resection and functional reconstruction. However, longer follow-up and larger sample size are required to clarify its long-term outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Doenças Ósseas/cirurgia , Neoplasias Ósseas/cirurgia , Articulação do Joelho/cirurgia , Tratamentos com Preservação do Órgão/métodos , Impressão Tridimensional/instrumentação , Implantação de Prótese , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Neoplasias Ósseas/patologia , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Prognóstico , Desenho de Prótese , Estudos Retrospectivos
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