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1.
Arthroscopy ; 36(5): 1261-1263, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370888

RESUMO

Clinical outcomes following shoulder subpectoral biceps tenodesis are generally favorable, with a very low complication rate (2%). One of the most devastating complications following this procedure is the occurrence of a proximal humerus fracture. Although all constructs have their unique advantages and disadvantages, creating a smaller bone hole while achieving good biomechanical outcomes is worth considering. This may be most advantageous in overhead-throwing athletes, tennis players, and/or volleyball athletes, who subject their shoulders to more torsional load due to the requirements of their sport. Thus, in addition to screws and buttons, smaller-diameter suture anchors could also be thoughtfully considered as a biceps tenodesis fixation option.


Assuntos
Tenodese , Fenômenos Biomecânicos , Parafusos Ósseos , Cadáver , Humanos , Úmero/cirurgia , Músculo Esquelético/cirurgia , Tendões/cirurgia
2.
N Engl J Med ; 382(18): 1732-1738, 2020 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-32348644

RESUMO

We report the use of a bone-anchored, self-contained robotic arm with both sensory and motor components over 3 to 7 years in four patients after transhumeral amputation. The implant allowed for bidirectional communication between a prosthetic hand and electrodes implanted in the nerves and muscles of the upper arm and was anchored to the humerus through osseointegration, the process in which bone cells attach to an artificial surface without formation of fibrous tissue. Use of the device did not require formal training and depended on the intuitive intent of the user to activate movement and sensory feedback from the prosthesis. Daily use resulted in increasing sensory acuity and effectiveness in work and other activities of daily life. (Funded by the Promobilia Foundation and others.).


Assuntos
Amputação Traumática/reabilitação , Amputação/reabilitação , Membros Artificiais , Neuroestimuladores Implantáveis , Desenho de Prótese , Robótica , Adulto , Membros Artificiais/efeitos adversos , Humanos , Úmero/lesões , Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Osseointegração
3.
Zhonghua Wai Ke Za Zhi ; 58(3): 213-219, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187925

RESUMO

Objective: To explore the operative effect and treatment strategies for the low distal humerus fracture. Methods: A retrospective analysis was conducted on the clinical data of 16 patients with the low distal humerus fracture between January 2016 and January 2018 at Department of Orthopaedics, Shanghai Tongji Hospital Affiliated to Tongji University.All fractures were coronal fractures of humeral head, partly combined fractures of humeral trochlea or posterior part. Fractures were classified according to Dubberley classification as 9 cases in type Ⅰ, 3 cases in typeⅡ and 4 cases in type Ⅲ.Selection of the kind of operative approach and internal fixation was made according to the fracture type and shape. For simple coronal fractures of humeral head or combining humeral trochlea fractures, which were relatively stable, single or multiple countersunk screws fixation by the lateral approach were chosen.For humeral head coronal fractures, which combining obviously displaced comminuted humeral trochlea factures, posterolateral locking plates and countersunk screws internal fixation by the olecranon osteotomy approach were chosen. The incision and elbow soft tissues were observed within 2 weeks after operation.The radiographic evaluation of fracture reduction, bone healing, internal fixation, arthritis and elbow range of motion were made at 3, 6, 12 months after operation. The Mayo elbow functional scores were documented for analysis of elbow joint function, and compared between different surgery groups by Kruskal-Wallis H test. Results: The follow-up time was (22.1±9.2)months(range: 15 to 39 months). The incisions healed well in 2 weeks after operation without soft tissue infection, necrosis or vascular complications. There was no fracture reduction loss or internal fixation loosening according to radiographic evaluation 3 months after operation. One case of ectopic ossification was observed 6 months after operation and inhibited by the treatment of non steroidal anti-inflammatory drugs.One case of ulnar neuritis occurred after operation and released after removing the long screw and loosing the ulnar.Osteoarthritis images were observed at the end of follow-up.Arc of motion was (120.4±11.2) ° in flexion and (5.5±1.9) ° in extension. The Mayo score was 88.7±9.1, including 11 excellent, 4 good, and 1 fair.The Mayo score was 90.1±3.7 in Dubberley classification type Ⅰcases, 89.7±4.6 in type Ⅱ cases and 84.5±5.8 in type Ⅲ cases. There were no significant differences in Mayo scores between 3 types cases according to Kruskal-Wallis H test. Conclusion: Choosing the appropriate surgical approach and composite internal fixation according to the fracture types and shapes of low distal humerus fracture, anatomic reduction of the articular surface and early functional exercise are the keys to obtain ideal curative effect.


Assuntos
Fixação Interna de Fraturas , Fraturas do Úmero/cirurgia , Placas Ósseas , China , Articulação do Cotovelo/cirurgia , Humanos , Úmero/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
4.
Bone Joint J ; 102-B(1): 64-71, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888359

RESUMO

AIMS: The purpose of this study was to report the long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma. METHODS: A total of 35 consecutive patients treated with extendable endoprosthetic replacement of the humerus in children were included. There were 17 boys and 18 girls in the series with a median age at the time of initial surgery of nine years (interquartile range (IQR) 7 to 11). RESULTS: The median follow-up time was 10.6 years (IQR 3.9 to 20.4). The overall implant survival at ten years was 75%. Complications occurred in 13 patients (37%). Subluxation at the proximal humerus occurred in 19 patients (54%) but only six (17%) were symptomatic. Subluxation was seen more commonly in children under the age of nine years (86%) than in those aged nine years or more (33%) (p = 0.002). Implant failure occurred in nine patients (26%): the most common cause was aseptic loosening (four patients, 11%). Lengthening of the implant was carried out in 23 patients (66%). At final follow up, three patients had a limb that was shortened by 5 cm or more. The mean Musculoskeletal Tumor Society (MSTS) functional score was 79% (73% to 90%). CONCLUSION: Extendable endoprosthetic replacement is a reliable method of reconstructing humerus after excision of a bone sarcoma. Children who are less than nine years old have a high risk of subluxation. Cite this article: Bone Joint J 2020;102-B(1):64-71.


Assuntos
Neoplasias Ósseas/cirurgia , Úmero/cirurgia , Osteossarcoma/cirurgia , Membros Artificiais , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/mortalidade , Criança , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/mortalidade , Condrossarcoma/cirurgia , Feminino , Humanos , Úmero/diagnóstico por imagem , Masculino , Margens de Excisão , Metástase Neoplásica , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/mortalidade , Estudos Prospectivos , Próteses e Implantes , Desenho de Prótese , Falha de Prótese , Implantação de Prótese/métodos , Implantação de Prótese/mortalidade , Amplitude de Movimento Articular/fisiologia , Sarcoma de Ewing/diagnóstico por imagem , Sarcoma de Ewing/mortalidade , Sarcoma de Ewing/cirurgia , Resultado do Tratamento
5.
J Shoulder Elbow Surg ; 29(1): 126-131, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31564575

RESUMO

BACKGROUND: Aseptic loosening is a main concern in elbow arthroplasty. Evaluation of implant migration using radiostereometric analysis (RSA) might increase understanding of implant loosening. Previously, 2-year RSA results of 16 Instrumented Bone Preserving (IBP) elbow prostheses showed migration of the humeral component in the first weeks but most components stabilized within 6 months postoperatively. In follow-up, the present study evaluated long-term survival, the relation between early migration and survival, and the long-term migration and clinical outcomes. METHODS: Sixteen patients who received an IBP prosthesis were prospectively followed with a median follow-up time of 136 months (range 82-165). Migration was measured using RSA. Clinical results were described using the Elbow Function Assessment (EFA), Broberg and Morrey elbow functional rating index, Oxford Elbow Score (OES), and visual analog scale (VAS) for pain and satisfaction. RESULTS: Four patients underwent a revision within 10 years, and 2 more were planned for revision surgery after 14 years. Five patients died with their prosthesis in situ. Early migration was not associated with survival. Long-term migration patterns varied widely. Median EFA score was 58.5, Broberg and Morrey score was 50, and OES score was 32. Median VAS score for pain was 2 and that for satisfaction was 7.5. CONCLUSION: Ten-year survival of the IBP total elbow prosthesis was 75%, decreasing to 63% after 14 years of follow-up. Long-term implant failure could not be predicted by 2-year migration results in this study. Although short-term clinical results were promising, long-term outcomes worsened in all patients.


Assuntos
Artroplastia de Substituição do Cotovelo/métodos , Articulação do Cotovelo/diagnóstico por imagem , Prótese de Cotovelo/efeitos adversos , Falha de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Substituição do Cotovelo/instrumentação , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Feminino , Seguimentos , Humanos , Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Análise Radioestereométrica , Reoperação , Resultado do Tratamento
6.
Orthop Clin North Am ; 51(1): 87-95, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739883

RESUMO

Proximal humeral bone loss in revision shoulder arthroplasty poses a significant obstacle to achieving stable and reliable fixation of the humeral stem. It is important to identify and classify this bone loss preoperatively, which can range from epiphyseal to substantial diaphyseal bone loss. There are several reconstructive options that can address the varying levels of bone loss, including cemented long-stem fixation, a composite construct using proximal humeral allograft or femoral allograft, proximal humeral endoprosthetic replacement, or total humeral replacement. All of these are viable reconstructive options that have demonstrated adequate to good outcomes.


Assuntos
Artroplastia do Ombro/efeitos adversos , Artroplastia de Substituição/efeitos adversos , Úmero/patologia , Aloenxertos/transplante , Artroplastia de Substituição/métodos , Cimentos para Ossos , Reabsorção Óssea/classificação , Reabsorção Óssea/diagnóstico por imagem , Reabsorção Óssea/patologia , Epífises/patologia , Epífises/cirurgia , Humanos , Úmero/diagnóstico por imagem , Úmero/cirurgia , Prótese Articular , Complicações Pós-Operatórias/cirurgia , Período Pré-Operatório , Próteses e Implantes , Radiografia , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
7.
Orthop Clin North Am ; 51(1): 97-108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739884

RESUMO

Osteochondritis dissecans (OCD) of the capitellum is a relatively rare condition, with a higher incidence in adolescents who participate in repetitive overhead sports. The surgical treatment approach for this uncommon problem has varied from microfracture, loose body removal, abrasion chrondroplasty, lesion fixation, osteochondral allograft transplantation surgery, and osteochondral autologous transplantation surgery. The purpose of this study is to present the authors' preferred surgical technique for the treatment of unstable OCD lesions of the capitellum with osteochondral autologous transplantation surgery using autograft from the ipsilateral knee.


Assuntos
Cartilagem Articular/cirurgia , Articulação do Cotovelo/cirurgia , Úmero/cirurgia , Osteocondrite Dissecante/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Criança , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/patologia , Feminino , Fraturas de Estresse , Humanos , Úmero/diagnóstico por imagem , Úmero/patologia , Úmero/transplante , Incidência , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/epidemiologia , Osteocondrite Dissecante/patologia , Radiografia , Esportes , Transplante Autólogo/métodos , Resultado do Tratamento
9.
J Comp Pathol ; 172: 27-30, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31690411

RESUMO

A 7-year-old neutered male domestic shorthair cat was presented with chronic lameness in the right forelimb. A cystic bony lesion was identified in the distal right humerus and amputation was performed. The epiphyseal trabecular bones of the capitulum and trochlea was replaced by a tan to pink, expansile mass that was surrounded by a thin rim of cortical bone. Microscopically, the tumour was composed of a bland, osteoid producing spindle cell population within a well-vascularized fibrous stroma. Radiographical and histological features were consistent with osteoblastoma. Osteoblastoma and the related osteoid osteoma are uncommon, benign osteoblastic tumours that are reported rarely in animals. These tumours should be considered as differential diagnoses for slow growing, cystic bony lesions in cats.


Assuntos
Úmero/patologia , Neoplasias de Tecido Ósseo/veterinária , Osteoblastoma , Animais , Doenças do Gato/patologia , Doenças do Gato/cirurgia , Gatos , Diagnóstico Diferencial , Úmero/cirurgia , Masculino , Neoplasias de Tecido Ósseo/diagnóstico , Neoplasias de Tecido Ósseo/cirurgia , Osteoblastoma/diagnóstico , Osteoblastoma/patologia , Osteoblastoma/cirurgia
10.
PLoS One ; 14(11): e0225648, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31774856

RESUMO

PURPOSE: The purpose of this study was to compare the biomechanical properties of an all-suture anchor to a conventional anchor used commonly in rotator cuff repairs. Furthermore, the biomechanical influence of various implantation angles was evaluated in both anchor types in a human cadaveric model. METHODS: 30 humeri were allocated into three groups with a similar bone density. The two different anchor types were inserted at a predefined angle of 45°, 90° or 110°. Biomechanical testing included an initial preload of 20N followed by a cyclic protocol with a stepwise increasing force of 0,05N for each cycle at a rate of 1Hz until system failure. Number of cycles, maximum load to failure, stiffness, displacement and failure mode were determined. RESULTS: 27 anchors failed by pullout. There was no significant difference between the conventional and the all-suture anchor regarding mean pullout strength. No considerable discrepancy in stiffness or displacement could be perceived. Comparing the three implantation angles no significant difference could be observed for the all-suture or the conventional anchor. CONCLUSION: All-suture anchors show similar biomechanical properties to conventional screw shaped anchors in an unlimited cyclic model. The exact insertion angle is not a significant predictor of failure.


Assuntos
Parafusos Ósseos , Úmero/cirurgia , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Âncoras de Sutura/classificação , Técnicas de Sutura/instrumentação , Adulto , Idoso , Artroscopia , Fenômenos Biomecânicos , Cadáver , Humanos , Teste de Materiais , Pessoa de Meia-Idade , Âncoras de Sutura/estatística & dados numéricos , Resistência à Tração , Adulto Jovem
11.
BMC Musculoskelet Disord ; 20(1): 550, 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31739803

RESUMO

BACKGROUND: This meta-analysis aimed to compare the clinical outcomes and complications of minimally invasive plate osteosynthesis (MIPO) and open reduction-internal fixation (ORIF) in patients with proximal humeral fractures. METHODS: We searched PubMed, EMBASE, Ovid, and the Cochrane Library to identify all relevant studies from inception to April 2019. Cochrane Collaboration's Review Manage 5.3 was used for meta-analysis. RESULTS: Sixteen studies involving 1050 patients (464 patients in the MIPO group and 586 patients in the ORIF group) were finally included. According to the meta-analysis, MIPO was superior to ORIF in operation time, blood loss, postoperative pain, fracture union time, and constant score. However, MIPO was associated with more exposure to radiation and axillary nerve injury. No significant differences were found in length of hospital stays and complication except for axillary nerve injury. CONCLUSION: The present evidence indicates that compared to ORIF, MIPO had advantages in functional outcomes, operation time, blood loss, postoperative pain, and fracture union time for the treatment of PHFs. However, the MIPO technique had a higher rate of axillary nerve injury and longer radiation time compared to ORIF.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Consolidação da Fratura , Úmero/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Redução Aberta , Osseointegração , Fraturas do Ombro/cirurgia , Idoso , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Úmero/diagnóstico por imagem , Úmero/lesões , Úmero/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Redução Aberta/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Fatores de Risco , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
12.
Arch Pediatr ; 26(7): 411-414, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31630906

RESUMO

Xanthomas are rare bone tumors that occur more often in patients with hyperlipidemia or metabolic disorders. We report the case of a 9-year-old child presenting with right shoulder pain after a trauma. A benign osteolytic lesion was found in the proximal humeral metaphysis. Curettage of the lesion was performed. Histologic findings confirmed intraosseous xanthoma. Although there was no evidence of dyslipidemia or metabolic disease, the patient suffered local recurrence at the 8-month follow-up, requiring a second surgery with bone grafting. This difficult and rare diagnosis must be kept in mind with osteolytic lesions.


Assuntos
Doenças Ósseas/diagnóstico , Úmero , Xantomatose/diagnóstico , Doenças Ósseas/patologia , Doenças Ósseas/cirurgia , Criança , Humanos , Úmero/patologia , Úmero/cirurgia , Hiperlipidemias , Masculino , Recidiva , Xantomatose/patologia , Xantomatose/cirurgia
13.
BMC Musculoskelet Disord ; 20(1): 419, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31506075

RESUMO

BACKGROUND: Proximal humeral fractures can be treated non-operatively or operatively with open reduction and internal fixation (ORIF) and arthroplasty. Our objective was to assess practice patterns for operative and non-operative treatment of proximal humeral fractures. We also report on complications, readmissions, in-hospital mortality, and need for surgery after initial treatment of proximal humeral fractures in California, Florida, and New York. METHODS: The State Inpatient Databases and State Emergency Department Databases from the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality, were used for the states of California (2005-2011), Florida (2005-2014), and New York (2008-2014). Data on patients with proximal humeral fractures was extracted. Patients underwent non-operative or operative (ORIF or arthroplasty) treatment at baseline and were followed for at least 4 years from the index presentation. If the patient needed subsequent surgery, time to event was calculated in days, and Kaplan-Meier survival curves were plotted. RESULTS: At the index visit, 90.3% of patients with proximal humeral fractures had non-operative treatment, 6.7% had ORIF, and 3.0% had arthroplasty. 7.6% of patients initially treated non-operatively, 6.6% initially treated with ORIF, and 7.2% initially treated with arthroplasty needed surgery during follow-up. Device complications were the primary reason for readmission in 5.3% of ORIF patients and 6.7% of arthroplasty patients (p < 0.0001). All-cause in-hospital mortality was 9.8% for patients managed non-operatively, 8.8% for ORIF, and 10.0% for arthroplasty (p = 0.003). CONCLUSIONS: A majority of patients with proximal humeral fractures underwent non-operative treatment. There was a relatively high all-cause in-hospital mortality irrespective of treatment. Given the recent debate on operative versus non-operative treatment for proximal humeral fractures, our study provides valuable information on the need for revision surgery after initial treatment. The differences in rates of revision surgery between patients treated non-operatively, with ORIF, and with arthroplasty were small in magnitude. At nine years of follow-up, ORIF had the lowest probability of needing follow-up surgery, and arthroplasty had the highest.


Assuntos
Artroplastia/efeitos adversos , Fixação de Fratura/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fraturas do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia/métodos , Artroplastia/estatística & dados numéricos , California/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Florida/epidemiologia , Seguimentos , Fixação de Fratura/métodos , Fixação de Fratura/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Úmero/lesões , Úmero/cirurgia , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Fraturas do Ombro/mortalidade , Resultado do Tratamento
14.
J Plast Reconstr Aesthet Surg ; 72(12): 1887-1899, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31563475

RESUMO

BACKGROUND: Limb salvage is important in pediatric patients with bone sarcomas. The vascularized fibula flap is a versatile option, combined or not with a bone allograft. The authors evaluated the functional long-term outcomes, complications, and survival of using this technique in pediatric patients. METHODS: A retrospective review of 27 pediatric patients reconstructed between 2011 and 2018 with the fibula flap after bone sarcoma resection was conducted. Long-term functional outcomes, complications, and survival were assessed. Variables analyzed were age, sex, Capanna technique, follow-up, complications, additional surgeries, time to weight bearing, length discrepancy, and sport practice. RESULTS: Twenty-seven patients with a mean age of 9.3 years were included. The mean follow-up was 44.33 months. The Capanna technique was performed in 15 patients. All extremities but one were salvaged. The overall complication rate was 74.07%. Fibula fracture and nonunion rates were 34.04% and 11.11%, respectively. Partial weight bearing was resumed at a mean of 9.07 months. About 79.17% of patients with a 12-month follow-up achieved full weight bearing. An age below 8 years was significantly associated with a lower major complication rate and a shorter time to weight bearing and full weight bearing. Major complications and additional surgeries were significantly associated with longer periods until weight bearing and full weight bearing. CONCLUSIONS: The fibula flap allows the majority of extremities to be reconstructed. However, a high rate of complications and additional surgeries should be anticipated. Full weight bearing is usually achieved within the first year, with modest functional increase afterward. Less complications and a faster functional recovery are expected in patients below the age of 8 years.


Assuntos
Neoplasias Ósseas/cirurgia , Transplante Ósseo/métodos , Fíbula/transplante , Osteossarcoma/cirurgia , Sarcoma de Ewing/cirurgia , Retalhos Cirúrgicos , Adolescente , Aloenxertos/irrigação sanguínea , Calcâneo/cirurgia , Criança , Pré-Escolar , Feminino , Neoplasias Femorais/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Espontâneas/cirurgia , Humanos , Úmero/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Rádio (Anatomia)/cirurgia , Estudos Retrospectivos , Terapia de Salvação/métodos , Transplante Homólogo/métodos , Resultado do Tratamento
15.
J Shoulder Elbow Surg ; 28(12): 2259-2271, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31500986

RESUMO

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


Assuntos
Artroplastia do Ombro , Tratamento Conservador , Fraturas do Ombro/terapia , Articulação do Ombro/fisiopatologia , Dor de Ombro/etiologia , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Epífises/cirurgia , Feminino , Humanos , Úmero/cirurgia , Masculino , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Fraturas do Ombro/complicações , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/fisiopatologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
16.
J Craniofac Surg ; 30(7): 2085-2087, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31490442

RESUMO

INTRODUCTION: Currently, vascularized autologous bone transplantation is considered the gold standard for large mandibular continuity defect reconstruction. Donor site morbidity is a major concern. Therefore, bone tissue engineering (BTE) seems to be the ideal solution. Fresh-frozen bone allograft is the closest material to autologous bone. The purpose of this clinical report is to show a new technique of large mandibular continuity defect reconstruction using a fresh-frozen humeral allograft seeded with autologous iliac bone marrow aspirate and vascularized with a radial forearm flap. METHODS: A 33-year-old man presented with severe cranio-facial trauma resulting in several fractures of the facial skeleton including a comminuted mandibular fracture from left parasymphysis to left angle, which caused a large continuity defect. RESULTS: Result at 6 months was aesthetically and functionally satisfactory with osseointegration of the bone graft. DISCUSSION: The authors chose to use iliac bone marrow aspirate to seed the allograft scaffold since hematopoietic stem cells and mesenchymal stem cell are able to differentiate into osteoblasts, ease of harvest of the iliac crest and its low rate of morbidity. Contemporary biomaterials used for BTE are bioceramic but bone is still the better scaffold to engineer bone and only allografting avoids donor site morbidity. Vascularization is one of the main challenges of BTE; insertion of autologous vascular bundles from pedicle or free flaps is 1 solution. The authors chose the radial forearm flap since the pedicle is long and the authors did not need a great amount of soft tissue.


Assuntos
Medula Óssea , Úmero/cirurgia , Adulto , Transplante Ósseo/métodos , Antebraço/cirurgia , Retalhos de Tecido Biológico , Humanos , Ílio/transplante , Masculino , Mandíbula/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Engenharia Tecidual , Transplante Homólogo
17.
Chin J Traumatol ; 22(5): 249-254, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31492575

RESUMO

PURPOSE: Supracondylar fractures of the humerus cause significant morbidity in children. Nerve damage and loss of fracture reduction are common recognised complications in patients with this injury. Uncertainty surrounds the optimal Kirschner wire configuration and diameter for closed reduction and pinning of these fractures. This study describes current practice and examined the association between wire configuration or diameter and outcomes (clinical and radiological) in the operative management of paediatric supracondylar fractures. METHODS: Children presenting with Gartland II or III supracondylar fractures at five hospitals in south-west England were eligible for inclusion. Collaborators scrutinised paper and electronic case notes. Outcome measures were maintenance of reduction and iatrogenic nerve injury. RESULTS: Altogether 209 patients were eligible for inclusion: 15.7% had a documented neurological deficit at presentation; 3.9% who were neurologically intact at presentation sustained a new deficit caused by treatment and 13.4% experienced a clinically significant loss of reduction following fixation. Maintenance of reduction was significantly better in patients treated specifically with crossed ×3 Kirschner wire configuration compared to all other configurations. The incidence of iatrogenic nerve injury was not significantly different between groups treated with different wire configurations. CONCLUSION: We present a large multicentre cohort study showing that crossed ×3 Kirschner wires are associated with better maintenance of reduction than crossed ×2 or lateral entry wires. Greater numbers would be required to properly investigate nerve injury relating to operative management of supracondylar fractures. We found significant variations in practice and compliance with the British Orthopaedic Association Standard for Trauma (BOAST) 11 guidelines.


Assuntos
Fios Ortopédicos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Úmero/cirurgia , Criança , Estudos de Coortes , Inglaterra , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Doença Iatrogênica , Masculino , Traumatismos dos Nervos Periféricos/etiologia , Estudos Retrospectivos
18.
Bone Joint J ; 101-B(9): 1144-1150, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474137

RESUMO

AIMS: The aim of this study was to report the results of custom-made endoprostheses with extracortical plates plus or minus a short, intramedullary stem aimed at preserving the physis after resection of bone sarcomas in children. PATIENTS AND METHODS: Between 2007 and 2017, 18 children aged less than 16 years old who underwent resection of bone sarcomas, leaving ≤ 5 cm of bone from the physis, and reconstruction with a custom-made endoprosthesis were reviewed. Median follow-up was 67 months (interquartile range 45 to 91). The tumours were located in the femur in 11 patients, proximal humerus in six, and proximal tibia in one. RESULTS: The five-year overall survival rate was 78%. No patient developed local recurrence. The five-year implant survival rate was 79%. In all, 11 patients (61%) developed a complication. Seven patients (39%) required further surgery to treat the complications. Implant failures occurred in three patients (17%) including one patient with aseptic loosening and two patients with implant or periprosthetic fracture. The preserved physis continued to grow at mean 3.3 cm (0 to 14). The mean Musculoskeletal Society score was 88% (67% to 97%). CONCLUSION: Custom-made endoprostheses that aim to preserve the physis are a safe and effective option for preserving physeal growth, limb length, and joint function with an acceptable rate of complications. Cite this article: Bone Joint J 2019;101-B:1144-1150.


Assuntos
Neoplasias Ósseas/cirurgia , Lâmina de Crescimento/cirurgia , Osteossarcoma/cirurgia , Próteses e Implantes , Adolescente , Criança , Feminino , Fêmur/cirurgia , Fixação Intramedular de Fraturas , Humanos , Úmero/cirurgia , Salvamento de Membro/métodos , Masculino , Desenho de Prótese , Falha de Prótese , Implantação de Prótese/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Recuperação de Função Fisiológica , Reoperação , Tíbia/cirurgia
19.
Bone Joint J ; 101-B(9): 1107-1114, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474140

RESUMO

AIMS: The aim of this study was to evaluate the differences in revision and complication rates, functional outcomes, and radiological outcomes between cemented and press-fit humeral stems in primary anatomical total shoulder arthroplasty (TSA). MATERIALS AND METHODS: A comprehensive systematic review and meta-analysis was conducted searching for studies that included patients who underwent primary anatomical TSA for primary osteoarthritis or rheumatoid arthritis. RESULTS: There was a total of 36 studies with 927 cemented humeral stems and 1555 press-fit stems. The revision rate was 5.4% (95% confidence interval (CI) 3.9 to 7.4) at a mean of 89 months for cemented stems, and 2.4% (95% CI 1.1 to 4.7) at a mean of 40 months for press-fit stems. A priori subgroup analysis to control for follow-up periods demonstrated similar revision rates: 2.3% (95% CI 1.1 to 4.7) for cemented stems versus 1.8% (95% CI 1.4 to 2.9) for press-fit stems. Exploratory meta-regression found that longer follow-up was a moderating variable for revision (p = 0.003). CONCLUSION: Cement fixation had similar revision rates when compared to press-fit stems at short- to midterm follow-up. Rotator cuff pathology was a prevalent complication in both groups but is likely not related to fixation type. Overall, with comparable revision rates, possible easier revision, and decreased operative time, humeral press-fit fixation may be an optimal choice for primary anatomical TSA in patients with sufficient bone stock. Cite this article: Bone Joint J 2019;101-B:1107-1114.


Assuntos
Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/métodos , Úmero/cirurgia , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Prótese de Ombro/efeitos adversos , Cimentos para Ossos , Cimentação , Humanos , Complicações Pós-Operatórias , Falha de Prótese , Recuperação de Função Fisiológica , Reoperação , Resultado do Tratamento
20.
Biomed Res Int ; 2019: 9107898, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31428650

RESUMO

Purpose: This study aims to compare the functional outcomes of nonunion humeral diaphyseal fractures following conservative treatment when managed surgically with either a plate or intramedullary (IM) nail fixation. Methods: This was a retrospective study of 56 patients with nonunion humeral fractures following conservative treatment who underwent plate or IM nail fixation between 2007 and 2014. Comparison was made for short term profile (intraoperative blood loss, duration of surgery, and length of hospitalization) and long term clinical outcome with functional score (Constant-Murley score (CMS)) and Disabilities of the Arm, Shoulder and Hand (DASH) score). The union and complication rate were also compared. Results: There were 36 and 20 patients included in plate and IM nail fixation group with the average of 36.14 ± 7.54-month follow-up time. The intraoperative blood loss, duration of surgery, and length of hospitalization were superior in IM nail group compared to plate group (p < 0.001, p < 0.001, and p < 0.001, respectively). The mean CMS and DASH score were superior in the plate group compared to the IM nail group (82.40 ± 16.84 versus 77.58 ± 12.96; 17.46 ± 11.05 versus 20.86 ± 11.63, respectively; with p = 0.246, p = 0.299, respectively). Plate fixation group showed higher union rate and complication rate compared to IM nail group (100% versus 90%, 13.8% versus 10%, respectively). Conclusions: IM nail and plate fixation demonstrated comparable clinical outcome. IM nail fixation showed superior short term result with lower complication rate which benefits the elderly group patients with significant comorbidities.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Fixação Intramedular de Fraturas , Fraturas do Úmero/cirurgia , Úmero/cirurgia , Auditoria Médica , Adulto , Idoso , Idoso de 80 Anos ou mais , Diáfises/lesões , Diáfises/cirurgia , Feminino , Seguimentos , Humanos , Úmero/lesões , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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