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1.
Mayo Clin Proc ; 96(5): 1379-1380, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33958073

RESUMO

Stamp Vignettes focus on biographical details and accomplishments related to science and medicine, and not individual views and prejudices except when they had a major impact on the subject's life. The authors of Stamp Vignettes do not intend to imply any endorsement of such views when discussing a Stamp Vignette on Medical Science.


Assuntos
Acetábulo/lesões , Fixação de Fratura/história , Fraturas Ósseas/história , Filatelia , Acetábulo/cirurgia , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , França , História do Século XX , Humanos , Ortopedia/história
2.
Ann R Coll Surg Engl ; 103(6): 420-425, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33851891

RESUMO

INTRODUCTION: Fractures of the pelvis and acetabulum (PAFs) are challenging injuries, requiring specialist surgical input. Since implementation of the major trauma network in England in 2012, little has been published regarding the available services, workforce organisation and burden of PAF workload. The aim of this study was to assess the recent trends in volume of PAF workload, evaluate the provision of specialist care, and identify variation in available resources, staffing and training opportunity. METHODS: Data on PAF volume, operative caseload, route of admission and time to surgery were requested from the Trauma Audit and Research Network. In order to evaluate current workforce provision and services, an online survey was distributed to individuals known to provide PAF care at each of the 22 major trauma centres (MTCs). RESULTS: From 2013 to 2019, 23,823 patients with PAF were admitted to MTCs in England, of whom 12,480 (52%) underwent operative intervention. On average, there are 3,971 MTC PAF admissions and 2,080 operative fixations each year. There has been an increase in admissions and cases treated operatively since 2013. Three-quarters (78%) of patients present directly to the MTC while 22% are referred from regional trauma units. Annually, there are on average 37 operatively managed PAF injuries per million population. Notwithstanding regional differences in case volume, the average number of annual PAF operative cases per surgeon in England is 30. There is significant variation in frequency of surgeon availability. There is also variation in rota organisation regarding consistent specialist surgeon availability. CONCLUSIONS: This article describes the provision of PAF services since the reorganisation of trauma services in England. Future service development should take into account the current distribution of activity, future trends for increased volume and casemix, and the need for a PAF registry.


Assuntos
Fraturas Ósseas/cirurgia , Ossos Pélvicos/lesões , Cirurgiões/provisão & distribuição , Centros de Traumatologia/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Acetábulo/lesões , Inglaterra , Fixação de Fratura/estatística & dados numéricos , Recursos em Saúde/provisão & distribuição , Mão de Obra em Saúde/organização & administração , Humanos , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Encaminhamento e Consulta/estatística & dados numéricos , Sistema de Registros , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários , Tempo para o Tratamento/estatística & dados numéricos , Centros de Traumatologia/organização & administração
3.
JAMA Netw Open ; 4(2): e2037519, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33599774

RESUMO

Importance: In acetabular fracture surgery, achieving an optimal reconstruction of the articular surface decreases the risk of osteoarthritis and the subsequent need for total hip arthroplasty. However, no one-size-fits-all osteosynthesis plate is available owing to differences in fracture patterns and variations in pelvic anatomy. Currently, osteosynthesis plates need to be manually contoured intraoperatively, often resulting in inadequate reduction and fixation of the fractured segments. Objective: To determine the feasibility and accuracy of a novel concept of fast-track 3-dimensional (3-D) virtual surgical planning and patient-specific osteosynthesis for complex acetabular fracture surgery. Design, Setting, and Participants: This case series study examines the use of patient-specific osteosynthesis plates for patients needing operative treatment for displaced associated-type acetabular fractures at a tertiary university-affiliated referral center and level 1 trauma center between January 1, 2017, and December 31, 2018. Models were created in 3-D based on computed tomography (CT) data, fractures were virtually reduced, and implant positions were discussed in a multidisciplinary team of clinicians and engineers. Patient-specific osteosynthesis plates with drilling guides were designed, produced, sterilized and clinically applied within 4 days. Data were analyzed at the 1-year follow-up. Exposures: Development and clinical implementation of personalized fracture surgery. Main Outcomes and Measures: The primary outcome was the quality of the reduction as determined by the postoperative CT scan. The secondary outcomes were accuracy of the screw placement and clinical outcome using patient-reported outcome measures. Results: Ten patients with a median (range) age of 63 (46-79) years with an acetabular fracture were included. The median (interquartile range [IQR]) preoperative gap was 20 (15-22) mm, and the median (IQR) step-off was 5 (3-11) mm. Postoperatively, the median (IQR) gap was reduced to 3 (2-5) mm (P = .005), and the median (IQR) step-off was reduced to 0 (0-2) mm (P = .01), indicating good fracture reduction, indicating good fracture reduction. The mean difference between the preoperative and postoperative gap was 14.6 (95% CI, 10-19) mm, and the mean difference in step-off was 5.7 (95% CI, 2-9) mm. The median (IQR) difference in screw direction between the planning and actual surgery was only 7.1° (7°-8°). All patients retained their native hip and reported good physical functioning at follow-up. Conclusions and Relevance: These findings suggest that 3-D virtual surgical planning, manufacturing, and clinical application of patient-specific osteosynthesis plates and drilling guides was feasible and yielded good clinical outcomes. Fast-track personalized surgical treatment could open a new era for the treatment of complex injuries.


Assuntos
Acetábulo/lesões , Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Acetábulo/diagnóstico por imagem , Idoso , Estudos de Viabilidade , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Masculino , Indústria Manufatureira , Pessoa de Meia-Idade , Modelos Anatômicos , Medidas de Resultados Relatados pelo Paciente , Impressão Tridimensional , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
BMC Musculoskelet Disord ; 22(1): 203, 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33602187

RESUMO

BACKGROUND: The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the anatomical plates. METHODS: A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with a limited approach and the anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. RESULTS: All of the patients were operated using the limited pararectus approach and the anatomical plates successfully. The mean operative time and blood loss were 90.9 min and 334.1 ml, respectively. The average postoperative residual gap and step displacement on CT were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively. CONCLUSIONS: The limited pararectus approach with the advantages of less trauma, direct exposure to the anterior column and quadrilateral plate. The anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction. The combination approach can be a good choice for limited surgery of displaced anterior acetabular fractures especially involving the quadrilateral plate.


Assuntos
Fraturas Ósseas , Fraturas do Quadril , Fraturas da Coluna Vertebral , Acetábulo/diagnóstico por imagem , Acetábulo/lesões , Acetábulo/cirurgia , Placas Ósseas , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Resultado do Tratamento
5.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462049

RESUMO

Hip dislocations are common orthopaedic emergencies which need early intervention to have a better outcome. They usually occur as a result of high energy trauma with motor vehicle accidents being the most common cause followed by fall from height. Posterior hip dislocation is more common than anterior. However, bilateral hip dislocations are rare compared with unilateral. Here we report our case with bilateral posterior hip dislocation with one side having head of femur fracture and contralateral side acetabulum fracture. Both hips were reduced under general anaesthesia on the same day of the trauma. Staged definitive treatment was carried out. The patient had an early recovery with no complications. This case represents an unusual, type of injury resulting from a high speed motor vehicle accident. Early diagnosis, immediate resuscitation and reduction of the hip joints followed by a careful and planned definitive treatment is necessary to have a better outcome.


Assuntos
Acetábulo/lesões , Cabeça do Fêmur/lesões , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/etiologia , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/etiologia , Acidentes de Trânsito , Adulto , Luxação do Quadril/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Masculino
6.
Sports Med Arthrosc Rev ; 29(1): e1-e8, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395227

RESUMO

Advances in hip preservation surgery have to lead to increased utilization of hip arthroscopy. With this, there has also been a growth in the understanding of various hip conditions, therefore, leading to an increase in hip conditions amenable to arthroscopic intervention. The acetabular hip labrum has been at the forefront of arthroscopic advances in the hip. The labrum is important for hip stability, provision of the suction seal, and joint proprioception. Given the labrum's central role in hip biomechanics, there is increasing emphasis on labral preservation in the form of debridement and repair. In revision settings, advanced techniques such as labral augmentation and reconstruction may play a role in the management of labral pathology. Appropriate management of the hip labrum at the time of surgery can be an important mediator of the outcome. As such, an understanding of the evolving evidence base and surgical indications and techniques are integral to the treatment and management of labral pathology.


Assuntos
Acetábulo/lesões , Acetábulo/cirurgia , Artroscopia/métodos , Desbridamento , Acetábulo/diagnóstico por imagem , Cartilagem Articular/cirurgia , Tratamento Conservador , Humanos , Exame Físico , Radiografia
8.
Acta Chir Orthop Traumatol Cech ; 87(5): 329-332, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-33146600

RESUMO

PURPOSE OF THE STUDY Continuous epidemiologic data on changes in the spectrum of acetabular fractures is rare. The purpose of this study is to evaluate changes in the types of acetabular fractures over the last two decades. MATERIAL AND METHODS In the period between 2007 and 2016, a total of 522 patients were treated at the authors department (Traumacentre Level I) for acetabular fractures. 15 patients sustained bilateral fractures. The group consisted of 361 men and 161 women, with the mean age of 49 years (the range of 10-96 years). Standard procedure was applied to diagnose the fractures (X-ray and CT scan). Non-operative treatment was opted for in fractures without displacement, fractures with minimum displacement of acetabular weight bearing area less than 2 mm, confirmed by the CT scan (e.g. low fractures of anterior column, low transverse fractures), fractures with secondary congruence in patients over the age of 70, and fractures in patients contraindicated for surgery due to their serious overall medical condition or severe osteoporosis. A surgery was indicated in case of instability or incongruent acetabular joint space due to the displacement of weight bearing area fragments, or a bone fragment or soft tissue interposition. A surgery was indicated also in a non-displaced acetabular injury with concurrent femoral head injury. AO/ASIF classification was used to classify the fractures. The following data was monitored in the referred to group of patients: gender, age, mechanism of injury, associated injuries, type of fracture, and treatment method. RESULTS Type A fracture was reported in 293 patients (56%), type B fracture in 150 patients (29%) and type C fracture in 79 patients (15%). A high-energy trauma occurred in 334 patients (64%), namely 254 men and 50 women, with the mean age of 41 years. A low-energy trauma was sustained by 188 patients (36%), namely 77 men and 111 women, with the mean age of 69 years (56-91). This difference in the share of men and women with respect to the seriousness of the mechanism of injury was statistically significant (p < 0.0001). Non-operative treatment was used in 248 patients (48%), of whom 167 were men and 81 were women. The mean age in this sub-group was 60 years, namely 58 years in men and 62 years in women. Operative treatment was opted for in 272 patients (52%), of whom 206 were men and 50 were women, with the mean age of 45 years in women as well as in men. The statistical processing of differences between the non-operative and operative treatment in dependence on the type of fractures revealed a significantly higher percentage of operative treatment in type C fractures compared to type A and B fractures (p < 0.0001, or p = 0.0009). In the group of patients treated by the authors in the 1996-2002 period, type A fractures constituted 45% of all fractures, where A1 fractures prevailed with 29%, A2 fractures represented 9% and A3 fractures only 6 %. In the recent group of patients, type A fractures constituted 56%, but A3 fracture were seen in 29% of patients, which was a significant increase (p < 0.0001). A3 fractures (anterior wall or anterior column fractures) were associated with a low-energy mechanism of injury and occurred in 48% of patients (73, mostly elderly women). DISCUSSION When compared to the published groups of other authors, the monitored group showed no difference in the mean age and gender ratio. There was an obvious increase in the number of patients with a low-energy mechanism of injury. The authors believe that this is the result of population ageing. It is also related to the growing share of patients treated non-operatively. The number of patients with a high-energy mechanism injury increased to a lesser degree. The spectrum of fractures significantly changed over the last 20 years. It was caused by an increase in low-energy injuries and partly also by improved diagnostics. CONCLUSIONS In the last 20 years, the authors noticed a rise in some types of acetabular fractures. It was caused by a statistically significantly higher number of fractures with a low-energy mechanism of injury, especially in elderly patients, the so-called "fragility fractures". Therefore, the share of non-operatively treated acetabular fractures increased as well. The number of acetabular fractures in young patients as a result of a high-energy injury grew more slowly, and it was only the share of posterior-wall acetabular fractures that was significantly higher. Key words: epidemiology of acetabular fractures, mechanism of injury, types of acetabular fractures.


Assuntos
Fraturas Ósseas , Fraturas do Quadril , Fraturas da Coluna Vertebral , Acetábulo/diagnóstico por imagem , Acetábulo/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
Medicine (Baltimore) ; 99(38): e22210, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957355

RESUMO

BACKGROUND: Total hip arthroplasty (THA) is a safe and mature surgical method for the treatment of post-traumatic arthritis and end-stage degenerative osteoarthritis. The cohort study regarding the outcomes of THA following acetabulum fracture is sparse. Therefore, we carried out this present retrospective paired cohort study to study the long-term outcomes of patients receiving THA after the acetabular fracture versus patients receiving THA for the primary osteoarthritis. METHODS: Patients with posttraumatic arthritis who received the initial THA after open reduction and internal fixation of acetabular fractures or patients with end-stage degenerative osteoarthritis were included in our study. A retrospective review of patients who receiving the primary total hip arthroplasty in the same institution from 2008 to 2015 was conducted. This present retrospective cohort research was authorized via our hospital institutional review committee. The patients in cohort group were matched 2:1 with the patients in study group according to following criteria: body mass index (±3 points), and age at THA time (±3 years), sex, as well as the score of American Society of Anesthesiologists (±1 point). The measure of primary outcome was the improved Harris Hip Score. Secondary outcomes included surgery time, hip range of motion, revision, complications (infection, loosening, polyethylene wear, dislocation, wound complications, deep vein thrombosis, or pulmonary embolism). RESULTS: It was assumed that there is a remarkable difference in postoperative outcomes between the 2 groups. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5921).


Assuntos
Acetábulo/lesões , Artroplastia de Quadril , Fraturas Ósseas , Osteoartrite do Quadril/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
11.
Am J Sports Med ; 48(8): 1961-1966, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32520591

RESUMO

BACKGROUND: BST-CarGel (CarGel) is an injectable chitosan scaffold that is mixed with fresh, autologous blood and injected into the site of microfracture (MF) to physically stabilize clots and enhance cartilage repair. PURPOSE: To evaluate short-term clinicoradiological outcomes of patients treated arthroscopically for acetabular chondral defects with CarGel in conjunction with MF compared with those treated with MF alone. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: All patients who underwent hip arthroscopy and received MF with or without CarGel for acetabular chondral defects between 2014 and 2018 with a minimum 2-year clinicoradiological follow-up were included. Intraoperative details, postoperative complications, and clinical outcome scores, including the international Hip Outcome Tool-33 (iHOT-33), Hip Outcome Score (HOS)-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sports Profile, were analyzed. Serial plain radiographs were assessed independently by 2 blinded observers. A survival analysis was performed to identify the number of cases converted to total hip arthroplasty (THA) in both groups, which was correlated with the cartilage defect size at the time of surgery. RESULTS: Eighty patients (54 CarGel and 26 MF) were evaluated, including 56 men (70%) and 48 right hips (60%). Three patients were lost to follow-up. There were no major adverse events in either group. The average defect size was 3.63 and 4.97 cm2 in MF and CarGel, respectively (P = .002). There was a statistically significant improvement in iHOT-33 (from 43.24 to 60.17 in MF and from 41.13 to 58.39 in CarGel) and HOS-ADL (from 62.25 to 76.75 in MF and from 44.69 to 79.16 in CarGel) scores. There was no difference between the 2 groups in the outcome scores after adjusting for covariates. Survival analysis showed 34.6% of MF cases and 5.9% of CarGel cases were converted to THA (P = .001). The mean defect size of the failure group was higher in CarGel than in MF (8.83 and 3.72 cm2, respectively). Mean joint space reduction was 1.41 mm in MF and 0.19 mm in CarGel (P < .001). CONCLUSION: Two-year clinicoradiological results were promising in these lesions that are difficult to treat. Arthroscopic treatment of chondral acetabular defects with CarGel demonstrated a significant decrease in progressive loss of joint space and conversion to THA compared with MF as an isolated procedure.


Assuntos
Acetábulo/lesões , Cartilagem/lesões , Quitosana/uso terapêutico , Fraturas de Estresse/terapia , Articulação do Quadril/cirurgia , Tecidos Suporte , Atividades Cotidianas , Adulto , Artroscopia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Rev. Soc. Andal. Traumatol. Ortop. (Ed. impr.) ; 37(2): 58-68, abr.-jun. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-198467

RESUMO

OBJETIVO DEL TRABAJO: El objetivo principal del estudio es la revisión de la casuística de modelos impresos en 3D para planificación quirúrgica en el Servicio de Cirugía Ortopédica y Traumatología del Hospital Universitario Virgen del Rocío (Sevilla).MATERIALES Y MÉTODOS: Se realizó un estudio epidemiológico, retrospectivo, descriptivo y analítico a partir de una base de datos encriptada sobre pacientes diagnosticados y tratados quirúrgicamente de lesión traumática junto con el uso de un biomodelo 3D. RESULTADOS: Se analizaron 173 biomodelos 3D y se clasificaron según tipo de lesión, localización anatómica de la misma y unidad solicitante. El tipo de lesión implicada con mayor frecuencia fue la fractura compleja o secuelas de ésta. La meseta tibial y la pelvis son las localizaciones en las que se utilizó con mayor frecuencia los biomodelos 3D. CONCLUSIONES: La impresión 3D en el campo de la Cirugía Ortopédica y Traumatología es una tecnología actual, en rápida evolución y permite a los cirujanos ortopédicos y traumatólogos comprender mejor los casos complejos, ayudando a la planificación quirúrgica de los mismos. Por tanto, podemos considerarla como un complemento para mejorar la atención al paciente por los beneficios que conlleva su uso


PURPOSE: The main aim of this study is the collection and review of information about the application of 3D printed models for surgical planning of complex injuries in the Orthopedic Surgery and Traumatology service of "Virgen del Rocío" University Hospital (Sevilla). MATERIALS AND METHODS: An epidemiological, retrospective, descriptive and analytical study is carried out from an encrypted database of patients diagnosed and treated surgically with complex traumatic injury together with the use of a 3D anatomical biomodel. RESULTS: The results of 173 patients classified by type of injury, anatomical location of the injury and requesting unit are obtained. The results suggest that the type of injury most frequently involved is complex fracture or its sequelae. The tibial plateau and the pelvis are the locations where 3D printing is most widely used due to its complexity. CONCLUSIONS: 3D printing is a rapidly evolving field which allows surgeons to better understand complex cases, aiding in their surgical planning. Therefore, we should consider it as a complement to improve patient care due to the benefits of its use


Assuntos
Humanos , Masculino , Adolescente , Adulto , Idoso , Modelos Anatômicos , Impressão Tridimensional , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Período Pré-Operatório , Traumatismos do Joelho/cirurgia , Fraturas da Tíbia/cirurgia , Acetábulo/lesões , Fêmur/lesões , Osteotomia , Resultado do Tratamento
13.
Ulus Travma Acil Cerrahi Derg ; 26(3): 445-452, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436967

RESUMO

BACKGROUND: This study aims to evaluate the effects of the anesthesia technique on the intraoperative blood loss in acetabular fracture patients undergoing the Modified Stoppa approach. METHODS: We retrospectively identified 63 patients who underwent a Modified Stoppa approach for acetabular fracture from January 2014 to July 2018. A total of 20 patients were excluded from this study for the following reasons: bilateral acetabular fractures (n=6), undergoing antiaggregant treatment (n=3), incomplete anesthesia records (n=3), emergency pelvic surgery due to hemodynamic instability (n=5), splenic rupture (n=2), and liver laceration (n=1). The patients were divided into two groups as follows: patients undergoing general anesthesia (GA) (n=22) and patients undergoing combined epidural-general anesthesia (CEGA) (n=21). The main outcome measurements studied were the intraoperative blood loss and the need for intraoperative and/or postoperative blood transfusions. RESULTS: No statistically significant differences were found between the groups concerning the age, gender, type of fracture, mechanism of injury, time from injury to surgery, Injury Severity Score, associated injuries, and comorbidities (p>0.05). The mean intraoperative blood losses were 717.27 ml (300-1.600 ml) in the GA group and 473.81 ml (150-1.020 ml) in the CEGA group (p<0.001). In the cases with only an isolated acetabular fracture, the intraoperative blood transfusion means were 2.43 units (1-5 units) in 14 patients in the GA group and 1.27 units (1-4 units) in 15 patients in the CEGA group (p<0.001). CONCLUSION: Less intraoperative bleeding was seen in those patients undergoing CEGA when compared to those undergoing GA. This is a significant advantage for acetabular surgery, which has a long learning curve and a high risk of bleeding.


Assuntos
Acetábulo , Anestesia Epidural/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Acetábulo/lesões , Acetábulo/cirurgia , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Humanos , Estudos Retrospectivos
14.
J Am Acad Orthop Surg ; 28(18): 750-755, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32235242

RESUMO

INTRODUCTION: The goal of this study was to identify the current practices and rationale of orthopaedic surgeons regarding venous thromboembolism (VTE) prophylaxis for pelvic and acetabular (P&A) fractures. METHODS: A 25-item web-based questionnaire was made available to all Orthopaedic Trauma Association (OTA) members on the OTA website. Analysis of data was performed after the three-month study period. RESULTS: One hundred three active OTA members completed the survey. Most respondents practiced at an academic level I trauma centers. The most important factor in selecting a VTE regimen was its effectiveness, whereas cost was the least important. Low-molecular-weight heparin (LMWH) remains the preferred agent for VTE prophylaxis after P&A trauma. Factors such as surgical intervention and weight-bearing had a variable effect on surgeons' opinions regarding the type and duration of VTE prophylaxis. CONCLUSION: Most surgeons treating P&A fractures use LMWH for VTE prophylaxis, but the decision on which agent to use and duration of treatment is multifactorial. Published VTE prophylaxis literature and guidelines provide some guidance, but there is no consensus. Overall, LMWH appears to be the VTE prophylaxis agent of choice for most orthopaedic trauma surgeons, irrespective of nonsurgical or surgical management of these fractures.


Assuntos
Acetábulo/lesões , Fraturas Ósseas/cirurgia , Heparina de Baixo Peso Molecular/administração & dosagem , Cirurgiões Ortopédicos , Ossos Pélvicos/lesões , Complicações Pós-Operatórias/prevenção & controle , Padrões de Prática Médica , Trombose Venosa/prevenção & controle , Fixação de Fratura/métodos , Humanos , Inquéritos e Questionários
15.
Adv Clin Exp Med ; 29(4): 459-468, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32348038

RESUMO

BACKGROUND: Three-dimensional (3D) printing of an acetabular wing-plate is a new minimally invasive surgical technique for complex acetabular fractures. OBJECTIVES: To investigate the biomechanical stability of 3D printing acetabular wing-plates. The results were compared with 2 conventional fixation systems. MATERIAL AND METHODS: Eighteen fresh frozen cadaveric pelvises with both column fractures were randomly divided to 3 groups: A - iliosciatic plates fixation system; B - 3D printing plates; C - 2 parallel reconstruction plates fixation system. These constructions were loaded onto a biomechanical testing machine. Longitudinal displacement and stiffness values of the constructs were measured to estimate their stability. RESULTS: When the load force reached 700 N, Group A was superior to Group B in the longitudinal displacement of point 1 (p > 0.05). The longitudinal displacement of point 2 showed no significant differences among Groups A, B and C, and the displacement of the fracture line over point 3 showed no significant differences between Groups A and B (p > 0.05). The axial stiffness of Groups A, B and C were 122.4800 ±8.8480 N/mm, 168.4830 ±14.8091 N/mm and 83.1300 ±3.8091 N/mm, respectively. Group B was significantly stiffer than A and C (p < 0.05). Loads at failure of internal fixation were 1378.83 ±34.383 N, 1516.83 ±30.896 N and 1351.00 ±26.046 N for Groups A, B and C, respectively. Group B was significantly superior to Groups A and C (p > 0.05). CONCLUSIONS: Customized 3D printing acetabular-wing plates provide stability for acetabular fractures compared to intraspecific buttressing fixation.


Assuntos
Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Impressão Tridimensional , Acetábulo/lesões , Fenômenos Biomecânicos , Fêmur/fisiopatologia , Fêmur/cirurgia , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Resultado do Tratamento , Suporte de Carga
16.
Arch Orthop Trauma Surg ; 140(7): 973-979, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32296966

RESUMO

INTRODUCTION: We evaluated the clinical and radiological outcomes of patients following total hip arthroplasty (THA) for acetabular fracture. MATERIALS AND METHODS: This was a retrospective cohort study in a single center. The medical records of patients who underwent THA from March 2002 to March 2017 were reviewed. Inclusion criteria were THA and a history of open reduction and internal fixation of acetabular fractures. Thirty-seven patients with a mean age of 56.2 years were enrolled. The Harris hip score (HHS), acetabular fracture classification, time interval between acetabular fracture and THA, cause of THA, surgical approach, implant type, complications, radiographic results, and Kaplan-Meier survival curves were analyzed. RESULTS: All patients were followed up for an average of 6.6 years. The mean preoperative HHS of 42.5 had improved to 83.5 at the final follow-up (p < 0.05). There were 29 cases of post-traumatic arthritis, 6 cases of avascular necrosis, and 4 cases of non-union. The average interval from injury to THA was 58 months (range 4-336 months). The re-admission rate was 18.9%. Patients who underwent conversion to THA due to post-traumatic arthritis combined with non-union acetabular fracture developed clinical failure more frequently than patients with post-traumatic arthritis (p = 0.037). At 12 years, 83.4% of patients were free from revision of femoral and acetabular components. CONCLUSION: THA secondary to an operatively treated acetabular fracture provides good symptomatic relief, but shows relatively inferior survival rates, and clinical failure was related to post-traumatic arthritis with acetabular non-union.


Assuntos
Acetábulo , Artroplastia de Quadril , Fixação de Fratura , Fraturas do Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/lesões , Acetábulo/cirurgia , Artrite , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Osteonecrose , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
17.
Jt Dis Relat Surg ; 31(1): 109-14, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160503

RESUMO

OBJECTIVES: This study aims to determine if there is an axial plane coverage insufficiency in patients with symptomatic labral tears compared to the contralateral asymptomatic side and healthy control subjects. PATIENTS AND METHODS: This retrospective study was conducted between December 2017 and January 2019. Thirty patients (21 males, 9 females; mean age 28 years; range, 20 to 36 years) operated due to unilateral symptomatic acetabular labral tears secondary to femoroacetabular impingement were evaluated. Twenty asymptomatic patients (13 males, 7 females; mean age 27±9 years; range, 19 to 36 years) were included in the control group. The relationship between acetabular morphology and labral tear was investigated with the comparison of unilateral symptomatic hips with contralateral asymptomatic hips and the control group by using radiological parameters on plain radiographs and computed tomography. RESULTS: When the patient group symptomatic side was compared to the control group, acetabular anteversion angle (A A A) and alpha (α) angle were higher, while posterior acetabular sector angle and horizontal acetabular sector angle were lower. When the asymptomatic side was compared to the control group, AAA was higher in the patient group. There was no difference between the symptomatic and asymptomatic sides in the patient group; the symptomatic side yielded a higher α; angle. CONCLUSION: Posterior axial plane coverage deficiency in combination with cam deformity (increased α angle) seems to play a role in the pathogenesis of symptomatic acetabular labral tears, even creating a side-to-side difference in some individuals.


Assuntos
Acetábulo/lesões , Impacto Femoroacetabular/cirurgia , Acetábulo/cirurgia , Adulto , Estudos de Casos e Controles , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
18.
Orthop Surg ; 12(2): 488-497, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32162455

RESUMO

OBJECTIVES: To evaluate the efficacy and safety of a novel fixation technique referred to as the dynamic anterior plate-screw system for quadrilateral plate (DAPSQ) for complex acetabular fractures with quadrilateral plate involvement through the single ilioinguinal approach. METHODS: A total of 32 patients with acetabular fractures, selected between January 2009 and March 2016, were managed by DAPSQ with "quadrilateral screws" through single ilioinguinal approach. The primary outcomes measure was the reduction quality evaluated according to the Matta radiological criteria, and the functional outcomes were evaluated by the modified Merle d'Aubigné score at the last follow-up. Secondary outcomes were postoperative complications and intraoperative conditions included, for instance, operation time and blood loss. RESULTS: Of these 32 consecutive patients, 19, 9, and 4 were classified as both columns, anterior column posterior hemi-transverse, and T-shaped fractures, respectively, and with an average of 47 months' follow-up. Anatomic reduction was obtained in 19 cases (59%), imperfect reduction in 9 cases (28%), and poor reduction in 4 cases (13%). The modified Merle d'Aubigné scores were excellent in 15 cases (47%), good in 13 cases (41%), fair in 2 cases (6%), and poor in 2 cases (6%). Three cases sustained temporary lateral femoral cutaneous nerve injuries. One patient had a superficial wound infection that resolved after debridement. Five patients had posttraumatic arthritis; one of them underwent total hip arthroplasty at 46 months. No cases had quadrilateral screws entering the hip joint. CONCLUSION: The use of DAPSQ with quadrilateral screws is an effective and safe choice for complex acetabular fractures with quadrilateral plate involvement through the single ilioinguinal approach.


Assuntos
Acetábulo/lesões , Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Adulto , Idoso , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade
19.
Ulus Travma Acil Cerrahi Derg ; 26(2): 265-273, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32185778

RESUMO

BACKGROUND: This study aims to evaluate the surgical approaches, complications, clinical and radiological findings in acetabular fractures treated with surgical methods and to determine the parameters affecting prognosis. METHODS: Out of 144 patients undergone surgical treatment with the diagnosis of displaced acetabular fractures between 1994 and 2014, a total of 103 patients with 75 male and 28 female with a mean age of 36.3 years (range 19-67 years) whom clinical and radiologic follow-ups (mean: 34 months, range 2-8 years) were performed at least for two years were included in this study. RESULTS: Clinically excellent to good outcomes were obtained in 64% of the patients and moderate to poor outcomes were recorded in 36% of the patients, while radiologically excellent to good outcomes were achieved in 57.3%of the patients and moderate to poor outcomes were recorded in 42.7% of the patients. Presence of one of the complications, creating mechanical block (chi-square p<0.001), complex fractures (chi-square p=0.023), increased duration between trauma and operation (p=0.039), operational time taking longer than six hours (chi-square p<0.001), more than 3 mm intra-articular step (Fisher's p=0.033), avascular necrosis (p<0.001), arthritis (p=0.006) and heterotopic ossification (p=0.007) worsened the clinical outcomes (chi-square p<0.001). The age of the patient was not effective on the clinical outcome (p=0.461). CONCLUSION: It was found that three major parameters affecting the prognosis of acetabular fractures are as follows: type of fracture, operational time and reduction quality. The duration between trauma and operation indirectly affects the outcomes. Avascular necrosis, heterotopic ossification and arthritis may cause negative effects only on long term outcomes.


Assuntos
Acetábulo , Fraturas Ósseas , Acetábulo/diagnóstico por imagem , Acetábulo/lesões , Acetábulo/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico
20.
Am J Sports Med ; 48(5): 1168-1174, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32150441

RESUMO

BACKGROUND: Recently, a hypertrophic labrum has been reported in the absence of hip dysplasia, which can possibly contribute to an acetabular labral tear. PURPOSE: To compare the clinical outcomes and complications, including the incidence of iatrogenic acetabular labrum and cartilage injury, in patients with tears of hypertrophic versus morphologically normal acetabular labra over a minimum follow-up period of 2 years and to assess the morphologic changes at follow-up computed tomography arthrography in the 2 groups. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between January 2010 and December 2016, 20 patients (22 hips) with a hypertrophic labrum underwent arthroscopic hip surgery. A total of 22 patients (22 hips) without a hypertrophic labrum were assigned to the control group based on matching criteria, including age, sex, body mass index, labral tear, and labral repair. Clinical outcomes were assessed with the visual analog scale score, UCLA activity scale score (University of California, Los Angeles), and modified Harris Hip Score. Radiologic outcomes were assessed through serial radiography. Patients were followed for at least 2 years. RESULTS: The mean age at surgery was 42 years. The most common cause of arthroscopic surgery in the study group was an isolated acetabular labral tear without any bony structural abnormalities (68.2%, 15 of 22 hips). All improvements in both groups were statistically significant at the last postoperative follow-up (P < .001). Although the radiologic and clinical outcomes were not significantly different between the groups, the complication rates, including iatrogenic labral perforations and cartilage injury, were significantly higher in patients with hypertrophic acetabular labral tears (9 vs 3, P = .042). The patient-reported satisfaction scores at the last postoperative follow-up were 8.4 and 7.9 in the study and control groups, respectively (P = .351). CONCLUSION: The high rates of patient-reported satisfaction and the clinical outcomes after arthroscopic repair in both groups are encouraging. Arthroscopic treatment in patients with hypertrophic acetabular labral tears should be carefully performed to prevent iatrogenic injury during the surgery, and isolated hypertrophic labral tears can have good results after repair.


Assuntos
Acetábulo/cirurgia , Tecido Conjuntivo/lesões , Tecido Conjuntivo/patologia , Lesões do Quadril/cirurgia , Acetábulo/diagnóstico por imagem , Acetábulo/lesões , Adulto , Artroscopia , Tecido Conjuntivo/cirurgia , Articulação do Quadril , Humanos , Los Angeles , Estudos Retrospectivos , Resultado do Tratamento
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