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1.
Mymensingh Med J ; 30(1): 73-78, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33397854

RESUMO

In adults, distal humerus fractures are infrequent and frequently intra-articular. Customarily encompass both medial and lateral columns. Operative management gives constructive outcomes. The aim of this study was to evaluate clinical outcome in intra articular distal humerus fractures in adults treated by different hardware. This prospective study consists of 20 purposively selected patients with intra articular distal humerus fractures treated by surgical intervention with different hardware who were admitted to Mymensingh Medical College and Hospital, Bangladesh in between November 2016 to October 2018. Surgical approaches were standard dorsal with or without olecranon osteotomy. The mean age of the patients was 32.3 years, range between 18-55 years. The maximum patients i.e. 85% were between 18-45 years. Seventy percent (70%) of the cases admitted were due to Road traffic accident (RTA). Most of the patients were males 14(70%) with right upper limb was involved in 13(65%) cases. Mean Mayo Elbow Performance Score was 81.5 post-operatively. According to Mayo Elbow Performance (MEP) score clinical outcome was excellent in 20%, good in 50%, fair in 25% and poor in 10% of patients. Distal humerus fractures are censorious in nature. Proper anatomical articular reconstruction and stable fixation by surgical intervention helps in fruitful results.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Adolescente , Adulto , Bangladesh/epidemiologia , Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/cirurgia , Úmero , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
Zhongguo Gu Shang ; 33(12): 1166-70, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369326

RESUMO

OBJECTIVE: To evaluate the clinical outcome of tibiotalocalcaneal fusion using cannulated screw and humeral proximal locking plate inverted fixation through a lateral transfibular approach. METHODS: From June 2015 to December 2018, 15 patients underwent a tibiotalocalcaneal fusion operation using cannulated screw and inverted proximal humerus locking plate through a transfibular approach. There were 10 males and 5 females with the age ranging from 45 to 72 (58.9±6.1) years, and the course of disease ranged from 2 to 35 (11.9±7.9)years. Preoperative diagnosis included 8 cases of post traumatic arthritis, 2 cases of Charcot arthritis, 2 cases of Charcot-Marie -Tooth (CMT), 1 case of ankle tuberculosis, 1 case of talar necrosis, and 1 case of pigmented villonnodular synovitis. Among them, 8 patients were combined with simple varus deformity, 4 patients with simple valgus deformity, 2 patients with equinovarus deformity, 1 patient with equinovarus deformity, 2 patients with adduction and internal rotation of middle and forefoot. American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and the visual analogue scale (VAS) score were used to evaluate the clinical outcome at the last follow up. RESULTS: One lost follow up and remaining fourteen patients were followed up. The follow up time ranged from 10 to 25(16.6±4.3) months. All the 15 patients had primary healing. Fusion time ranged from 15 to 24 (16.8 ± 2.4) weeks after operation. One patient with diabetes experienced delayed union and was successfully treated with secondary bone grafting combined with Platelet-Rich Plasma (PRP) injection. The AOFAS score increased from 38.7±3.3 to 84.5±2.6 (P<0.05), and the VAS score decreased from 7.5±1.6 to 1.9±0.3(P<0.05). CONCLUSION: Tibiotalocalcaneal fusion used cannulated screw and humeral proximal locking plate inverted fixation through a lateral transfibular approach has the advantages of relatively simple technique, high fusion rate, especially for patients with posterior foot deformity, which has satisfactory short term effects.


Assuntos
Placas Ósseas , Parafusos Ósseos , Articulação do Tornozelo , Artrodese , Feminino , Humanos , Úmero , Masculino , Estudos Retrospectivos , Resultado do Tratamento
3.
Zhongguo Gu Shang ; 33(12): 1171-4, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369327

RESUMO

Proximal humerus fracture is one of the common shoulder fractures. With the increase in incidence, the proportion of surgical intervention is increasing. This paper explores the traditional and new treatment methods for proximal humerus fracture. Locking plate technology is the most commonly used method in the clinic, but its complication rate of intra-articular screw penetration and reoperation is too high.Fibular strut allografts can provide adequate support, but it is a significant trauma surgery and has a high incidence of potential disruption to necessary vascular.Arthroplasty is one of the treatments for complex proximal humerus fractures, but it has a long learning curve and high cost.In recent years, the proximal humerus cage's intervention model has emerged, which has the inherent advantagesof a three dimensional structure, which can provide adequate load bearing support for the humeral head and provide flexible screw placement Angle. The cage offers a new technical option to reduce postoperative complications and improve patients' rehabilitation safety. A comprehensive grasp of the treatments of proximal humerus fracture and rational choice of intervention measures will benefit patients.


Assuntos
Cabeça do Úmero , Fraturas do Ombro , Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas , Humanos , Úmero , Fraturas do Ombro/cirurgia , Resultado do Tratamento
4.
Rev Med Suisse ; 16(719): 2414-2420, 2020 Dec 16.
Artigo em Francês | MEDLINE | ID: mdl-33325658

RESUMO

Proximal humerus fracture (PHF) is the 3rd most common fracture over age 65, and its incidence increases with age. The combination of an aging population and a high incidence in geriatric patients constitute a serious potential public health concern. The treatment of PHF is debated. Recent publications report similar results of conservative versus surgical treatment in several types of fractures. Therapeutic decision based on a multiparametric analysis is recommended, there is yet no consensus on the parameters to be analyzed. A recent study suggests taking into consideration individual parameters in deciding the therapeutic strategy and provides a pragmatic treatment algorithm. We propose here a simplified version of this algorithm, guiding therapeutic decision between conservative treatment, osteosynthesis and arthroplasty.


Assuntos
Fraturas do Úmero/cirurgia , Úmero/cirurgia , Fraturas do Ombro/cirurgia , Artroplastia , Tratamento Conservador , Fixação Interna de Fraturas , Humanos , Resultado do Tratamento
5.
Rev Med Suisse ; 16(719): 2421-2425, 2020 Dec 16.
Artigo em Francês | MEDLINE | ID: mdl-33325659

RESUMO

Humeral shaft fractures are relatively common, representing up to 5% of all fractures. Conservative management is the treatment of choice for most humeral shaft fractures and offers good functional and union outcomes. Age and oblique fractures of the proximal third are two risk factors for non-union. Surgical indication threshold should be lower for patients with these factors. Functional outcomes and union rates after plating and intramedullary nailing are comparable, but the likelihood of shoulder complications is higher with intramedullary nailing. Finally, there is no advantage to early exploration of the radial nerve even in case of secondary radial nerve palsy.


Assuntos
Fraturas do Úmero , Fixação Interna de Fraturas , Fixação Intramedular de Fraturas , Humanos , Fraturas do Úmero/cirurgia , Úmero/cirurgia , Resultado do Tratamento
6.
J Stroke Cerebrovasc Dis ; 29(12): 105350, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33254372

RESUMO

INTRODUCTION: Carbon dioxide (CO2) as a contrast agent has been in use as early as the 1920s for visualization of retroperitoneal structures. Digital subtraction angiography (DSA) using CO2 as a contrast agent for vascular imaging was developed in the 1980s. Currently, CO2  angiography is an alternative agent in patients with chronic kidney disease (CKD) and those who are at risk of developing contrast-induced nephropathy. However, CO2 causes neurotoxicity if the gas inadvertently enters the cerebrovascular circulation leading to fatal brain injury. CASE PRESENTATION: A 71-year-old female with h/o sickle cell trait, hypertension, obesity, metastatic renal cell cancer status post nephrectomy, bone metastasis, chronic kidney disease was admitted for elective embolization of the humerus bone metastasis. Given the high probability of contrast-induced nephropathy, CO2 angiography was chosen for embolization of the metastasis. During the procedure, the patient became unresponsive. Emergent medical management with hyperventilation, 100% fraction oxygen inhalation was performed. Her neuroimaging showed global cerebral edema. An intracranial pressure monitor was placed which confirmed intracranial hypertension. Hyperosmolar therapy was administered with no improvement in clinical examination. She progressed to brain stem herniation. Given poor prognosis, the family opted for comfort measures and the patient expired. DISCUSSION AND CONCLUSIONS: Inadvertent carbon dioxide entry into cerebrovascular circulation during angiography can cause fatal brain injury. Caution must be exercised while performing CO2  angiography in blood vessels above the diaphragm.


Assuntos
Angiografia/efeitos adversos , Neoplasias Ósseas/diagnóstico por imagem , Edema Encefálico/induzido quimicamente , Dióxido de Carbono/efeitos adversos , Meios de Contraste/efeitos adversos , Embolia Aérea/induzido quimicamente , Úmero/diagnóstico por imagem , Neoplasias Renais/patologia , Idoso , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/terapia , Dióxido de Carbono/administração & dosagem , Meios de Contraste/administração & dosagem , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/terapia , Embolização Terapêutica , Evolução Fatal , Feminino , Humanos , Úmero/patologia
7.
PLoS One ; 15(11): e0242005, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33166328

RESUMO

Transhumeral percutaneous osseointegrated prostheses provide upper-extremity amputees with increased range of motion, more natural movement patterns, and enhanced proprioception. However, direct skeletal attachment of the endoprosthesis elevates the risk of bone fracture, which could necessitate revision surgery or result in loss of the residual limb. Bone fracture loads are direction dependent, strain rate dependent, and load rate dependent. Furthermore, in vivo, bone experiences multiaxial loading. Yet, mechanical characterization of the bone-implant interface is still performed with simple uni- or bi-axial loading scenarios that do not replicate the dynamic multiaxial loading environment inherent in human motion. The objective of this investigation was to reproduce the dynamic multiaxial loading conditions that the humerus experiences in vivo by robotically replicating humeral kinematics of advanced activities of daily living typical of an active amputee population. Specifically, 115 jumping jack, 105 jogging, 15 jug lift, and 15 internal rotation trials-previously recorded via skin-marker motion capture-were replicated on an industrial robot and the resulting humeral trajectories were verified using an optical tracking system. To achieve this goal, a computational pipeline that accepts a motion capture trajectory as input and outputs a motion program for an industrial robot was implemented, validated, and made accessible via public code repositories. The industrial manipulator utilized in this study was able to robotically replicate over 95% of the aforementioned trials to within the characteristic error present in skin-marker derived motion capture datasets. This investigation demonstrates the ability to robotically replicate human motion that recapitulates the inertial forces and moments of high-speed, multiaxial activities for biomechanical and orthopaedic investigations. It also establishes a library of robotically replicated motions that can be utilized in future studies to characterize the interaction of prosthetic devices with the skeletal system, and introduces a computational pipeline for expanding this motion library.


Assuntos
Membros Artificiais , Úmero/cirurgia , Robótica/instrumentação , Atividades Cotidianas , Amputados , Fenômenos Biomecânicos , Interface Osso-Implante/fisiologia , Humanos , Úmero/fisiologia , Cinética , Osseointegração , Desenho de Prótese , Amplitude de Movimento Articular
8.
Bone Joint J ; 102-B(12): 1629-1635, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33249912

RESUMO

AIMS: The aim of this study was to explore why some calcar screws are malpositioned when a proximal humeral fracture is treated by internal fixation with a locking plate, and to identify risk factors for this phenomenon. Some suggestions can be made of ways to avoid this error. METHODS: We retrospectively identified all proximal humeral fractures treated in our institution between October 2016 and October 2018 using the hospital information system. The patients' medical and radiological data were collected, and we divided potential risk factors into two groups: preoperative factors and intraoperative factors. Preoperative factors included age, sex, height, weight, body mass index, proximal humeral bone mineral density, type of fracture, the condition of the medial hinge, and medial metaphyseal head extension. Intraoperative factors included the grade of surgeon, neck-shaft angle after reduction, humeral head height, restoration of medial support, and quality of reduction. Adjusted binary logistic regression and multivariate logistic regression models were used to identify pre- and intraoperative risk factors. Area under the curve (AUC) analysis was used to evaluate the discriminative ability of the multivariable model. RESULTS: Data from 203 patients (63 males and 140 females) with a mean age of 62 years (22 to 89) were analyzed. In 49 fractures, the calcar screw was considered to be malpositioned; in 154 it was in the optimal position. The rate of malpositioning was therefore 24% (49/203). No preoperative risk factor was found for malpositioning of the calcar screws. Only the neck-shaft angle was found to be related to the risk of screw malpositioning in a multivariate model (with an AUC of 0.72). For the fractures in which the neck-shaft angle was reduced to between 130° and 150°, 91% (133/46) of calcar screws were in the optimal position. CONCLUSION: The neck-shaft angle is the key factor for the appropriate positioning of calcar screws when treating a proximal humeral fracture with a locking plate. We recommend reducing the angle to between 130° and 150°. Cite this article: Bone Joint J 2020;102-B(12):1629-1635.


Assuntos
Fixação Interna de Fraturas/métodos , Úmero/cirurgia , Fraturas do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fraturas do Ombro/diagnóstico por imagem , Adulto Jovem
9.
Acta Ortop Mex ; 34(2): 81-86, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33244906

RESUMO

INTRODUCTION: The quality of reduction in proximal humerus fractures is valuable with radiographic criteria (Neck-shaft angle [NSA]; medial offset [MO]; distance head tuberosity [DHT] and subacromial space [SS]) that predict functionality. These criteria set for other implants are not described for the intramedullary nail. MATERIAL AND METHODS: Observational cohort study, retrospective, with patients 18 years, with osteosynthesis with intramedullary nail (2014 to 2017), evaluating demographic characteristics, severity of injury (Neer classification), progressive radiographic measurements and complications. RESULTS: 84 cases with an average age of 65 ± 2 years and an average follow-up of 13.9 months were analyzed. By Neer rating 40.4% were grade II, 29.7% grade III and 29.7% grade IV. Consolidation in varus increases to 10.7% at the end of follow-up, with Neer III and IV patients. The 140° deformity is prevalent for Neer II (n = 15/34). 30.9% have a change of neck-shaft angle of 10°. Overall 86.9% has HTD changes 5 mm. Cases Neer III/IV 32% has alteration of SS 5 mm. The most common complication is avascular necrosis (AVN) with 44% of cases. CONCLUSIONS: Radiographic measurements have changes in long-term follow-up. Alterations in NSA ( 10o) and SS ( 5 mm) occur in higher proportion of Neer III/IV patients, according to the severity of the fracture, favoring vicious consolidations in varus or valgus and increased presence of AVN.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Ombro , Idoso , Placas Ósseas , Fixação Interna de Fraturas , Humanos , Úmero , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Resultado do Tratamento , Raios X
10.
Bone Joint J ; 102-B(11): 1475-1483, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135447

RESUMO

AIMS: The aim of this study was to determine the current incidence and epidemiology of humeral diaphyseal fractures. The secondary aim was to explore variation in patient and injury characteristics by fracture location within the humeral diaphysis. METHODS: Over ten years (2008 to 2017), all adult patients (aged ≥ 16 years) sustaining an acute fracture of the humeral diaphysis managed at the study centre were retrospectively identified from a trauma database. Patient age, sex, medical/social background, injury mechanism, fracture classification, and associated injuries were recorded and analyzed. RESULTS: A total of 900 fractures (typical 88.9%, n = 800/900; pathological 8.3%, n = 75/900; periprosthetic 2.8%, n = 25/900) were identified in 898 patients (mean age 57 years (16 to 97), 55.5% (n = 498/898) female). Overall fracture incidence was 12.6/100,000/year. For patients with a typical fracture (n = 798, mean age 56 years (16 to 96), 55.1% (n = 440/798) female), there was a bimodal distribution in men and unimodal distribution in older women (Type G). A fall from standing was the most common injury mechanism (72.6%, n = 581/800). The majority of fractures involved the middle-third of the diaphysis (47.6%, n = 381/800) followed by the proximal- (30.5%, n = 244/800) and distal-thirds (n = 175/800, 21.9%). In all, 18 injuries (2.3%) were open and a radial nerve palsy occurred in 6.7% (n = 53/795). Fractures involving the proximal- and middle-thirds were more likely to occur in older (p < 0.001), female patients (p < 0.001) with comorbidities (p < 0.001) after a fall from standing (p < 0.001). Proximal-third fractures were also more likely to occur in patients with alcohol excess (p = 0.003) and to be classified as AO-Orthopaedic Trauma Association type B or C injuries (p < 0.001). CONCLUSION: This study updates the incidence and epidemiology of humeral diaphyseal fractures. Important differences in patient and injury characteristics were observed based upon fracture location. Injuries involving the proximal- and middle-thirds of the humeral diaphysis should be considered as fragility fractures. Cite this article: Bone Joint J 2020;102-B(11):1475-1483.


Assuntos
Diáfises/lesões , Fraturas do Úmero/epidemiologia , Úmero/lesões , Fraturas por Osteoporose/epidemiologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reino Unido/epidemiologia , Adulto Jovem
11.
J Am Acad Orthop Surg ; 28(22): e1014-e1019, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33156588

RESUMO

INTRODUCTION: Metastatic bone disease of the extremities is a notable cause of morbidity and mortality. Surgical management is not curative; therefore, risks and benefits of surgery must be carefully considered. Previous studies of surgical outcomes are limited by small sample sizes because of the rare incidence of these procedures. In this study, we aim to describe the rates of complications and mortality in the first 30 days after surgical treatment of metastatic bone disease of the femur and humerus. METHODS: A retrospective review of patients in the National Surgical Quality Improvement Program database who underwent surgery between 2005 and 2016 was performed. Demographics, comorbidities, preoperative factors, surgical parameters, and postoperative complications were extracted. The cohort was also partitioned by surgical site and surgical modality. RESULTS: One thousand one hundred fifty-four patients were identified, 13.1 percent of patients experienced one or more complications within 30 days of surgery. The most common complications were urinary tract infection (2.9%), deep vein thrombosis (2.5%), pneumonia (2.4%), pulmonary embolism (2.0%), and surgical site infections (1.9%). In addition, intraoperative or postoperative bleeding requiring transfusion occurred in 32.9% of cases. The rates of unplanned readmission and unplanned revision surgery were 12.7% and 4.1%, respectively. The 30-day mortality rate was 7.1%. Femur and arthroplasty cases were associated with a higher risk of bleeding requiring transfusion. Prophylactic stabilization was associated with a lower risk of unplanned revision surgery (P = 0.015) and a lower overall complication rate (P < 0.0001). CONCLUSION: Our study demonstrates a higher 30-day mortality rate than previously reported. In additon, prophylactic stabilization of impending pathologic fractures may be associated with a lower risk of complications and unplanned revision surgery. The National Surgical Quality Improvement Program or other large database reports can help surgeons counsel patients appropriately regarding the risks and benefits of surgery.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Extremidades , Fêmur/cirurgia , Úmero/cirurgia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Ósseas/mortalidade , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Pneumonia/epidemiologia , Embolia Pulmonar/epidemiologia , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Infecções Urinárias/epidemiologia , Trombose Venosa/epidemiologia
12.
Medicine (Baltimore) ; 99(47): e23237, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33217841

RESUMO

BACKGROUND: To evaluate the effectiveness and safety of warm needle acupuncture (WNA) treatment for Scapulohumeral periarthritis. METHODS: Relevant randomized controlled trials will be searched from the databases of Pubmed, the Cochrane Library, Embase, CNKI, Wanfang Database, CBM and VIP Database from their inception to September 2021. The primary outcomes are effective rate, visual analog scale score. The secondary outcomes are Constant-Murley score, Japanese Orthopaedic Association scores, adverse events. Two reviewers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. The Stata 14.0 will be used for meta-analysis. RESULTS: This study is ongoing and will be submitted to a peer-reviewed journal for publication. CONCLUSION: This study will provide an assessment of the current state of WNA for the scapulohumeral periarthritis, aiming to show the efficacy and safety of WNA treatment. ETHICS AND DISSEMINATION: There is no requirement of ethical approval and informed consent, and it will be in print or published by electronic copies. REGISTRATION: INPLASY2020100049.


Assuntos
Terapia por Acupuntura/métodos , Periartrite/terapia , Articulação do Ombro , Humanos , Úmero , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Escápula , Revisões Sistemáticas como Assunto
14.
J Small Anim Pract ; 61(12): 757-765, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33058190

RESUMO

OBJECTIVES: To report complications, clinical outcomes and CT-imaging outcomes of a surgical system designed for the management of humeral intracondylar fissures and humeral condylar fractures. MATERIALS AND METHODS: Retrospective review of fracture healing from medical records, direct owner contact and an online data-submission service. Follow-up included CT scans and a calculated "bone-opacity continuity index" to quantify bone healing. RESULTS: There was one major surgical complication and one major medical complication out of 34 fissure cases, and two major surgical and one major medical complication out of 14 fractures. Follow-up times ranged from 29 to 1268 days. All cases with CT follow-up had some continuity of bone opacity across the condyle. CLINICAL SIGNIFICANCE: In the cases included in this study, this repair system was associated with low complication rates and favourable healing rates, particularly for humeral intracondylar fissure.


Assuntos
Fixação Interna de Fraturas , Fraturas do Úmero , Animais , Fixação Interna de Fraturas/veterinária , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Fraturas do Úmero/veterinária , Úmero , Estudos Retrospectivos , Resultado do Tratamento
16.
Acta Vet Scand ; 62(1): 58, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081826

RESUMO

BACKGROUND: In this 4-year prospective observational study, all elbows in a dysplasia screening program including 14,073 dogs were studied using radiographs in two projections. Elbows were evaluated for the presence of medial humeral epicondylar lesions or discreet calcified structures and were described as they appeared. The age, breed, and sex of affected dogs were recorded. The prevalence for each lesion was calculated exclusively on breeds where the number of radiographed dogs exceeded 500. RESULTS: Medial humeral epicondylar lesions or medial discreet calcified structures were diagnosed in 183 dogs and 211 elbows. The prevalence of true Flexor enthesopathy (FE) in this Norwegian population of mainly young, large breed dogs was calculated to be approximately 1.4 per 1000 dogs and varied by breed. Also, the prevalence of the other lesions varied considerably by breed. The most common finding was discreet calcified structures, termed medial ossified structures (MOS) (0.7%). In elbows affected with fragmented medial epicondyles (FME) (0.07%) and especially FE (0.14%), the degree of periarticular new bone formation (PNBF) was increased when compared to unaffected elbows. In joints affected with MOSs or medial lucent lesions MLLs (0.25%), there was no difference in the presence or degree of PNBF compared to unaffected joints, even in older dogs. CONCLUSIONS: The prevalence of medial humeral epicondylar lesions and MOSs differs considerably among dog breeds. Elbow joints with FMEs and particularly FE had a highly increased presence and degree of PNBF compared to joints without these lesions. Elbow joints with MOSs or MLLs did not have an increased presence or degree of PNBF compared to joints without these lesions.


Assuntos
Calcinose/veterinária , Doenças do Cão/diagnóstico por imagem , Membro Anterior/patologia , Úmero/patologia , Artropatias/veterinária , Animais , Calcinose/diagnóstico por imagem , Doenças do Cão/patologia , Cães , Feminino , Membro Anterior/diagnóstico por imagem , Úmero/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Artropatias/patologia , Masculino , Estudos Prospectivos , Radiografia/veterinária
17.
Zhongguo Gu Shang ; 33(10): 895-902, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33107249

RESUMO

OBJECTIVE: To compare clinical effect of Kirschner wire radial sector fixation and bilateral ulnar radial cross fixation in treating supracondylar fracture of humerus in children after closed reduction. METHODS: From March 2017 to December 2018, 60 children with supracondylar fracture of humerus treated with closed reduction and Kirschner wire fixation were analyzed retrospectively, and divided into two groups according to different needling methods. Thirty patients in radial three needles fan fixation group (group A), including 19 males and 11 females, aged from 2 to 10 years old with an average of (5.00±2.10) years old, 21 patients were typeⅡ and 9 patients were typeⅢ according to Gartland classification. Thirty patients in cross fixationwith 3 needles on both ulnar and radial side group(group B), including 22 males and 8 females, aged from 1 to 9 years old with an average of(5.13±2.08) years old, 19 patients were typeⅡand 11 patients were typeⅢ. Healing time of fracture, postoperative complications, elbow flexion and extension activity, forearm rotation activity recovery, elbow carrying angle and angle loss after operation between two groups were observed and compared. Mayo Elbow function score at the final following up was used to evaluate clinical efficacy. RESULTS: All patients were followed up, while there were no significant difference in follow-up time and fracture healing time between two groups (P>0.05);there was 1 patient occurred iatrogenic ulnar nerve injury in group A, 9 patients in group B, and there was difference between two groups (P<0.01);2 patients in group A occurred mild displacement and 1 patient in group B, while no significant difference between two groups(P>0.05). No cubitus varus deformity, needle infection, osteofascial compartment syndrome and myositis ossificans occurred. There was no significant difference in elbow flexion, extension activity, and forearm rotation activity between two groups at 3 months after operation(P>0.05); there was no significant difference in elbow carrying angle and its loss angle between two groups at 3 and 6 months after operation (P>0.05);there was also no significant difference in Mayo Elbow function score and efficacy evaluation at the final follow-up (P>0.05). CONCLUSION: Closed reduction and Kirschner wire at the early stage of fracture has advantages of less trauma, easy reduction, stable fixation, and early functional exercise. The risk of iatrogenic ulnar nerve injury caused by fan-shaped fixation of three radial needles is less than that of cross fixation of three radial needles.


Assuntos
Fios Ortopédicos , Fraturas do Úmero , Criança , Pré-Escolar , Feminino , Humanos , Fraturas do Úmero/cirurgia , Úmero/cirurgia , Lactente , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos
18.
Zhongguo Gu Shang ; 33(10): 902-6, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33107250

RESUMO

OBJECTIVE: To explore clinical effects of micro external fixator for the treatment of supracondylar fracture of humerus in children. METHODS: From October 2017 to December 2018, 20 children with supracondylar fracture of humerus (treatment group) were admitted and treated with micro-external fixation after closed reduction, including 14 males and 6 females, aged from 6 to 14 years old with an average of (7.9±2.4) years old, classified to Gartland Ⅲ. Thirty nine children with supracondylar fracture of humerus were admitted as control group from January 2015 to September 2017, and treated with closed reduction Kirschner wire fixation. Among them, including 24 males and 15 females, aged from 6 to 14 years old with an average of (8.1±1.9) years old, classified to GartlandⅢ. Operation time, times of intraoperative fluoroscopy, and complications between two groups were observed and compared, Mayo scoring system at the latest follow up was used to evaluate clinical effect. RESULTS: Twenty children in treatment group were followed up from 6 to 12 months with an average of (8.0±2.5) months, operation time was(30.10±12.50) min, times of intraoperative fluoroscopy was(10.00±2.50). Fifteen patients got excellent results, 3 good, 2 fair according to Mayo elbow joint scoring. No ulnar nerve injury moderate or severe elbow varus occurred in treatment group. Thirty-nine children in control group were followed up from 5 to 13 months with an average of (9.0±3.1) months, operation time was(45.60±18.90) min, times of intraoperative fluoroscopy was(19.00±5.60). Twenty-three patients got excellent results, 12 good, 3 fair and 1 poor according to Mayo elbow joint scoring. One child occurred ulnar nerve injury and recovered at the final follow-up, 1 child occurred severe cubitus varus and 2 children occurred moderate cubitus varus. There was no statistical difference in clinical effect between two groups (P>0.05). Occurrence rate of moderate and server cubitus varus, operation time and times of intraoperative fluoroscopy in treatment group were better than that of control group(P<0.05). CONCLUSION: Treated with closedreduction and mini external fixator fixed on children humerus condyle fracture could receive the same clinical result as closed as reduction gram needle fixation, which has advantages of shorter operation time, less times of intraoperative fluoroscopy, not esay to damage ulnar nerve during operation, less incidence of moderate and severe cubitus varus deformity after operation, and the permeation was simple.


Assuntos
Fixação Interna de Fraturas , Fraturas do Úmero , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Fixadores Externos , Feminino , Humanos , Fraturas do Úmero/cirurgia , Úmero , Masculino
19.
Zhongguo Gu Shang ; 33(10): 907-11, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33107251

RESUMO

OBJECTIVE: To investigate the effect of ultrasound guided reduction and exploration of ulnar nerve position and percutaneous crossed pin fixation for the treatment of displaced supracondylar fracture of the humerus in children. METHODS: The clinical data of 45 patients with displaced supracondylar fracture of humerus from December 2017 to December 2018 were analyzed retrospectively, including 26 boys and 19 girls, ranging in age from 1 year and 3 months to 11 years and 4 months, with an average of 7.6 years old;44 cases of crashing injury, 1 case of falling injury;29 cases on the left side, 16 cases on the right side;12 patients classified to Gartland typeⅡand 33 patients classified to Gartlandtype Ⅲ. The operation was performed from 4 h to 7 d after injury, with an average of 2.5 d. There were no neurological and vascular injuries occurred in the children. Ultrasound was used to guide the fracture reduction of the child, and the cross-needle was fixed. In the medial needle insertion, the ulnar nerve position was detected by ultrasound to avoid damage to the ulnar nerve. The ulnar nerve state was observed during operation. The clinical function evaluation criteria of Flynn was used at the latest follow-up. The evaluation criteria was used to evaluate the functional and aesthetic characteristics of the elbow joints of the children, and to observe the complications such as ulnar nerve injury after operation. RESULTS: Ultrasound was used to detect the fracture from the medial side of the elbow, the lateral aspect of the elbow and the sagittal plane of the elbow. The position of the ulnar nerve could be clearly explored to avoid ulnar nerve injury when the needle was inserted inside. All children were followed up, and the duration ranged from 6 to 12 months, with an average of 9 months. None of the patients had a loss of repositioning and the fractures healed. The healing time ranged from 4 to 6 weeks, with an average of 5 weeks. At the latest follow-up, according to Flynn's evaluation criteria:compared with the healthy side, 41 patients with flexion and extension limitation were 0° to 5°, clinically evaluated as excellent;3 patients with flexion and extension limitation were 6° to 10°, clinically evaluated as good;1 patient with flexion and extension limitation was 11° to 15°, clinically evaluated as acceptable. Compared with the healthy side, 40 patients lost 0° to 5°of the angle, and 5 patients lost 6° to 10°of the angle. There were no complications such as ulnar nerve injury and cubitus varus. CONCLUSION: Although ultrasound-guided treatment of displaced supracondylar fracture of the humerus in children has higher requirements for the operator at present, because of its advantages of clear development, portability, effectiveness and no impact on health, it could clearly explorethe fracture situation during the operation, guide the reduction of the fracture, and accurately show the position of the ulnar nerve, effectively improve the safety of the medial puncture, so as to minimize the complications The occurrence of the disease. Therefore, the treatment of displaced supracondylar fracture of humerus with ultrasound-guided manual reduction and percutaneous cross needle fixation is effective and worthy of further promotion.


Assuntos
Fraturas do Úmero , Criança , Feminino , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Úmero , Masculino , Estudos Retrospectivos , Ultrassonografia , Ultrassonografia de Intervenção
20.
Zhongguo Gu Shang ; 33(10): 948-53, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33107259

RESUMO

OBJECTIVE: To establish a new mechanical model of distal humerus in children with epiphysial cartilage, stimulate supracondylar humerus fracture and perform three dimensional finite elements, and study effect of pins numbers, pin tract, outlet height and pin configurations on stability of fixation. METHODS: Three dimensional computed tomography (CT) data of 6-year-old boy with distal humerus was downloaded from picture archiving and communications systems software (PACS), the data of picture was imported into Simpleware and SolidWorks 2016 software to establish distal humerus fracture in children contained ossific nucleus of the capitellum (ONC) and distal cartilage. Normal extense supracondylar humerus fracture model was established to stimulate configurations of crossed and lateral pinning fixation, 30 N was added on the direction of flexion extension and varus valgus, while 50 N was added on the direction of internal and external turning. Stability was analyzed by displacement degree of distal fracture. RESULTS: Among 2-pin configurations, 2-crossed pins were more stable against rotation forces which could resist rotation stress over 2 585 Nmm/ °, while low position through ONC of 2-divergent lateral pins were more stable, which could resist stress of 45 N /mm and 190 N /mm during the test of resistant strains and varus-valgus stress. The third pins was added into the more stable lateral 2-pins, the stability in all directions were increased obviously, and 3 crossed pins is the most stable, stress of flexion-extension, varus-valgus and internal-external turning were 198 N /mm, 395 N /mm and 6 251 Nmm/ °. CONCLUSION: Two-divergent lateral pins could provide enough stability for supracondylar humerus fracture in children. In two-crossed pins, the upper border of MDJ could provide the best stability. Three-crossed pins could offer the best stability against both translation and rotation forces.


Assuntos
Fios Ortopédicos , Fixação Interna de Fraturas , Fenômenos Biomecânicos , Criança , Análise de Elementos Finitos , Humanos , Úmero , Masculino
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