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1.
Mymensingh Med J ; 27(1): 108-115, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29459600

RESUMO

Graft selection for primary anterior cruciate ligament reconstruction is very important part of knee stability. The purpose of this Qasi experimental study was to compare the clinical outcomes after ACL reconstruction using either a BPTB graft or a four-strand hamstrings graft and conducted from January 2012 to December 2013. Patients presented with a symptomatic unilateral ACL rupture who were underwent ACL reconstruction by using either BPTB or Hamstrings graft, IPD of Department of Orthopedics at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka as well as in a private hospital in Dhaka, Bangladesh were selected as study population. Patients were divided into Group A who were treated with the patellar tendon bone graft and Group B patients who were received hamstrings tendon graft. All surgery was performed by the same surgeon and the both procedures were arthroscopically assisted. Operation was performed at least three (03) weeks after initial trauma. All patients were assessed by independent examiner before surgery, at 6 months, 12 months and then annually by clinically. A total number of 70 patients were recruited for this study. The mean age with SD of Group A and Group B were 27.31±10.91 and 26.97±10.10 years respectively (p=0.892). Tegner scores were measured preoperatively and post-operatively. The score were 2.2±1.1 and 2.1±1.0 in preoperatively (p=0.817). In post-operatively the mean score were 6.0±1.7 and 5.8±1.5 in Group A and Group B respectively (p=0.508). Regarding outcome of the operation excellent was 18(51%) cases in both Group A and Group B, good was 15 (43%) and 16(46%) cases in Group A and Group B respectively (p=0.793). In conclusion there was no significant difference between the two groups of the ACL reconstructions cases.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Patelar , Adolescente , Adulto , Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia , Bangladesh , Humanos , Ligamento Patelar/transplante , Adulto Jovem
2.
Injury ; 48(2): 399-405, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27839795

RESUMO

AIMS: This purpose of this meta analysis was to investigate and quantify the relative risk of hip fracture in patients who have sustained a wrist fracture. METHOD: Studies were identified by searching Medline, Embase, Cochrane CENTRAL database and CINAHL from their inception to August 2015. Studies reporting confirmed hip fracture following wrist fracture were included. Data extraction was carried out using a modified Cochrane data collection form by two reviewers independently. Quality assessment was carried out using a modified Coleman score and the Newcastle Ottawa scale for cohort studies. An assessment of bias was performed for each study using a modified Cochrane Risk of Bias tool. A pooled relative risk(RR) was estimated with 95% CI from the RR/HRs and CIs reported in the studies. RESULTS: 12 studies were included in the final meta-analysis (4 male, 8 female only). Relative risk of hip fracture following wrist fracture for women was 1.43 (CI 1.27 to 1.60). In men it was not significantly increased (RR 2.11, 95% CI: 0.93-4.85). Heterogeneity was low (I squared 0%) for both groups so a fixed effects model was used. CONCLUSION: Risk of a subsequent hip fracture is increased for women who suffer a wrist fracture (RR 1.43). Resources and preventative measures should be targeted towards these high risk patients to prevent the catastrophic event of a hip fracture. This meta analysis confirms and quantifies the increased relative risk of hip fracture after wrist fracture in women.


Assuntos
Fraturas do Quadril/epidemiologia , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Fraturas do Rádio/epidemiologia , Fraturas da Ulna/epidemiologia , Traumatismos do Punho/epidemiologia , Densidade Óssea , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Fraturas do Quadril/prevenção & controle , Humanos , Osteoporose/tratamento farmacológico , Medição de Risco , Distribuição por Sexo , Reino Unido/epidemiologia
3.
J Hand Surg Eur Vol ; 42(2): 144-150, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27697898

RESUMO

This study investigated the accuracy and maintenance of reduction of intra-articular steps achieved with closed reduction and percutaneous K wires and open reduction and a volar locking plate for the treatment of intra-articular distal radius fractures. We performed a retrospective review of 359 patients with an intra-articular fracture of their distal radius. Multivariate linear regression was undertaken to investigate the influence of multiple variables such as age, gender, initial displacement and treatment method on reduction despite differences between groups. A total of 36% of patients treated with K wires and 29% with volar locking plate had a step greater than or equal to 1 mm present on the first post-operative radiograph. A total of 23% treated with K wires and 28% with volar locking plate had a residual step of 1 mm or more on the last available radiograph. There was no difference identified between the two techniques for quality of initial reduction or persisting step on the last available radiographs. Step behaviour and further reduction of step post-operatively was similar for both treatment methods. Initial displacement and increased age influenced initial reduction. Initial fracture displacement shown radiologically was the only variable identified that influenced the persistence of a step on post-operative radiographs. LEVEL OF EVIDENCE: IV.


Assuntos
Placas Ósseas , Fios Ortopédicos , Fixação Interna de Fraturas , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/cirurgia , Adolescente , Adulto , Feminino , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Injury ; 45(3): 528-33, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24176679

RESUMO

Volar locking plates are an increasingly popular treatment for distal radius fractures. We reviewed complications observed after volar locking plate fixation in a busy teaching hospital. The purpose of the study was to assess whether complication rates after volar locking plate use in general, routine trauma practice were higher than published literature from expert users. A retrospective review was carried out of patients treated with a volar locking plate between January 2009 and December 2010. The series included 206 procedures in 204 patients (77 males and 127 females) with mean age of 55 years (range 16-94). Surgery was performed by 18 different consultant surgeons and 11 registrars. A total of 22 complications were observed in 20 patients with an overall complication rate of 9.7%. Seven (3.4%) patients developed tendon problems including four (1.9%) tendon ruptures. Four (1.9%) patients required re-operation for metalwork problems; four patients developed complex regional pain syndrome (CRPS). Three fracture reduction problems were noted. A total of 16 further operations were carried out for complications. The overall complication rate was low even when surgery was done by many surgeons, suggesting that this is a safe and reproducible technique. This study provides information which can be used to counsel patients about risks, including those of tendon and metalwork problems. This allows patients to make an informed decision. Surgeons must have specific strategies to avoid these complications and remain vigilant so that these can be identified and managed early.


Assuntos
Placas Ósseas , Síndromes da Dor Regional Complexa/fisiopatologia , Fixação Interna de Fraturas , Placa Palmar/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Fraturas do Rádio/cirurgia , Traumatismos dos Tendões/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas/efeitos adversos , Síndromes da Dor Regional Complexa/etiologia , Síndromes da Dor Regional Complexa/cirurgia , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Fraturas do Rádio/complicações , Fraturas do Rádio/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia , Resultado do Tratamento
5.
J Hand Surg Eur Vol ; 34(4): 465-70, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19474183

RESUMO

The volumes enclosed by each of 108 hands in 54 rheumatoid arthritis patients were calculated using individual joint measurements. The difference between the flexion and extension volumes is the 'working space' of the hand. Correlations between the working space and parameters of stiffness, pain, deformity, movement, grip and functional disability were performed. The average working space volume was 4921 cc in rheumatoid patients with no visible hand deformity and 1154 cc in the presence of combined finger deformities (P < 0.005). The loss in volume was due mainly to loss of extension. The Patient Evaluation Measure and the Functional Disability Score were significantly related to changes in the working space (P < 0.05). The concept of the working space of the hand may aid the assessment of the rheumatoid hand and help surgical decision-making.


Assuntos
Artrite Reumatoide/fisiopatologia , Avaliação da Deficiência , Articulações dos Dedos/fisiopatologia , Deformidades Adquiridas da Mão/fisiopatologia , Mãos/fisiopatologia , Articulação Metacarpofalângica/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Adulto , Idoso , Artrite Reumatoide/diagnóstico , Feminino , Deformidades Adquiridas da Mão/diagnóstico , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/fisiologia , Medição da Dor , Inquéritos e Questionários , Polegar/fisiopatologia
6.
J Bone Joint Surg Br ; 91(3): 374-8, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19258615

RESUMO

We randomised 79 patients (84 hands, 90 fingers) with Dupuytren's contracture of the proximal interphalangeal joint to have either a 'firebreak' skin graft (39 patients, 41 hands, 44 fingers) or a fasciectomy (40 patients, 43 hands, 46 fingers) if, after full correction, the skin over the proximal phalanx could be easily closed by a Z-plasty. Patients were reviewed after three, six, 12, 24 and 36 months to note any complications, the range of movement and recurrence. Both groups were similar in regard to age, gender and factors considered to influence the outcome such as bilateral disease, family history, the presence of diabetes, smoking and alcohol intake. The degree of contracture of the metacarpophalangeal and interphalangeal joints of the operated fingers was similar in the two groups and both were comparable in terms of grip strength, range of movement and disability at each follow-up. The recurrence rate was 12.2%. We did not identify any improvement in correction or recurrence of contracture after firebreak dermofasciectomy up to three years after surgery.


Assuntos
Contratura de Dupuytren/cirurgia , Transplante de Pele/métodos , Idoso , Contratura de Dupuytren/prevenção & controle , Fasciotomia , Feminino , Articulações dos Dedos/fisiopatologia , Articulações dos Dedos/cirurgia , Força da Mão , Humanos , Masculino , Articulação Metacarpofalângica/fisiopatologia , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Prevenção Secundária , Resultado do Tratamento
7.
J Hand Surg Eur Vol ; 33(1): 65-70, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18332023

RESUMO

Twenty digits in 15 patients with dorsal combined tissue loss were treated by radical debridement, primary non-vascularised iliac crest bone graft and immediate lower abdominal flap cover between 1996 and 2006. The average length of the bone grafts was 3.3 (range 2.5-5) cm. No extensor tendon reconstruction was carried out. The flaps were divided at 3 weeks without delay. Permissible thinning of the flap was done at the time of division of flaps. No secondary procedure was done. All patients were retrospectively reviewed and X-rays obtained. Radiological union was achieved in 18 of 20 digits. One bone graft was removed because of infection. One bridging bone graft united with the distal phalanx but had a painless non-union with the proximal phalanx. There were no flap complications. Bone graft length resorptions of 20% and 15% occurred in two terminal bone grafts. We recommend this protocol as a solution to this challenging problem.


Assuntos
Transplante Ósseo , Traumatismos dos Dedos/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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