Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.757
Filtrar
2.
Medicine (Baltimore) ; 99(35): e22001, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871954

RESUMO

In adolescent patients, cannulated lag screw (CLS) is a widely accepted choice for fixation of the medial epicondylar fracture of the humerus (MEFH). Absorbable implants, including rod, screw, and mini-plate, have been reported in children. However, to the best of our understanding, this study is the first head-to-head comparative study of CLS versus bioabsorbable screw (BS) in the treatment of MEFH.Patients of MEFH operated at our institute, from January 2010 to January 2016, were reviewed retrospectively. The patients were divided into 2 groups, the CLS group and the BS group, as per the type of implant the patient received. The CLS group consisted of 35 patients, whereas the BS group consisted of 30 patients. Demographic data, including sex, age at the time of surgery, operated side, and implant material, were collected from the hospital database. Elbow range of motion (ROM), radiographic manifestation was recorded during the out-patient visit. The elbow joint function was evaluated according to the Broberg and Morrey elbow scale and Mayo elbow performance index score.Thirty patients, including 18 males and 12 females, were included in the CLS group, whereas 35 patients, including 21 males and 14 females, were included in the BS group. At 6-month follow-up, elbow range of motion, Broberg and Morrey elbow scale and Mayo elbow performance index scale showed no significant difference between the 2 groups. The carrying angle was within the normal range in both groups. There was no nonunion or malunion in either group. The rate of hypoplasia or hyperplasia was low in both groups, 3.3% in CLS and 2.9% in BS. The rate of implant prominence was significantly higher in the CLS group (33.3%) than BS (0%).Both CLS and BS are safe and effective choices for displaced MEFH in adolescents. The BS can produce a satisfactory clinical outcome and is comparable to the CLS. Besides, the BS has the advantage of not needing second surgery for implant removal.


Assuntos
Implantes Absorvíveis , Parafusos Ósseos , Articulação do Cotovelo/lesões , Fixação de Fratura/instrumentação , Fraturas do Úmero/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 99(30): e21126, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791687

RESUMO

RATIONALE: Bilateral brachial plexus block (BPB) generally requires a relatively large dose of local anesthetic for a successful block, resulting in a high risk of local anesthetic systemic toxicity. It can also result in inadvertent bilateral phrenic nerve palsy, leading to respiratory failure. Hence, it has not been widely used. However, it can be performed in selected patients. In this report, we present a case of ultrasound-guided BPB for bilateral upper extremity surgery in a patient with cervical spinal cord injury (SCI). PATIENT CONCERNS: A 25-year-old woman with SCI secondary to traumatic fifth cervical spine fracture scheduled for surgical treatment of bilateral elbow fracture received bilateral BPB. DIAGNOSES: Due to the complications of SCI, the patient had incomplete sensory loss, loss of motor function, and complete diaphragmatic paralysis on the right side. INTERVENTIONS: Right infraclavicular and left axillary BPB was performed as the sole anesthetic procedure for bilateral upper extremity surgery. OUTCOMES: Bilateral BPB was successful for bilateral upper extremity surgery. The surgery was uneventful and without further complications. LESSONS: Patients with cervical SCI have a high risk of respiratory complications. Bilateral BPB can be a suitable option for bilateral upper extremity surgery in selected patients. It is imperative to select an appropriate anesthetic technique that preserves respiratory function to minimize the potential risk of respiratory complications.


Assuntos
Bloqueio do Plexo Braquial , Articulação do Cotovelo/cirurgia , Fraturas Ósseas/cirurgia , Traumatismos da Medula Espinal/complicações , Adulto , Bloqueio do Plexo Braquial/métodos , Vértebras Cervicais , Articulação do Cotovelo/lesões , Feminino , Humanos , Cuidados Intraoperatórios , Ultrassonografia de Intervenção , Extremidade Superior/lesões , Extremidade Superior/cirurgia
5.
Bone Joint J ; 102-B(8): 1041-1047, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731824

RESUMO

AIMS: The Wrightington classification system of fracture-dislocations of the elbow divides these injuries into six subtypes depending on the involvement of the coronoid and the radial head. The aim of this study was to assess the reliability and reproducibility of this classification system. METHODS: This was a blinded study using radiographs and CT scans of 48 consecutive patients managed according to the Wrightington classification system between 2010 and 2018. Four trauma and orthopaedic consultants, two post CCT fellows, and one speciality registrar based in the UK classified the injuries. The seven observers reviewed preoperative radiographs and CT scans twice, with a minimum four-week interval. Radiographs and CT scans were reviewed separately. Inter- and intraobserver reliability were calculated using Fleiss and Cohen kappa coefficients. The Landis and Koch criteria were used to interpret the strength of the kappa values. Validity was assessed by calculating the percentage agreement against intraoperative findings. RESULTS: Of the 48 patients, three (6%) had type A injury, 11 (23%) type B, 16 (33%) type B+, 16 (33%) Type C, two (4%) type D+, and none had a type D injury. All 48 patients had anteroposterior (AP) and lateral radiographs, 44 had 2D CT scans, and 39 had 3D reconstructions. The interobserver reliability kappa value was 0.52 for radiographs, 0.71 for 2D CT scans, and 0.73 for a combination of 2D and 3D reconstruction CT scans. The median intraobserver reliability was 0.75 (interquartile range (IQR) 0.62 to 0.79) for radiographs, 0.77 (IQR 0.73 to 0.94) for 2D CT scans, and 0.89 (IQR 0.77 to 0.93) for the combination of 2D and 3D reconstruction. Validity analysis showed that accuracy significantly improved when using CT scans (p = 0.018 and p = 0.028 respectively). CONCLUSION: The Wrightington classification system is a reliable and valid method of classifying fracture-dislocations of the elbow. CT scans are significantly more accurate than radiographs when identifying the pattern of injury, with good intra- and interobserver reproducibility. Cite this article: Bone Joint J 2020;102-B(8):1041-1047.


Assuntos
Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Fratura-Luxação/classificação , Imageamento Tridimensional , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Estudos de Coortes , Feminino , Fratura-Luxação/diagnóstico por imagem , Fraturas Ósseas/classificação , Fraturas Ósseas/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
6.
Rev Med Suisse ; 16(701): 1421-1427, 2020 Aug 05.
Artigo em Francês | MEDLINE | ID: mdl-32833357

RESUMO

The elbow joint is highly congruent and subject to less stress than other joints. This contributes to a rather low incidence of pathologies in the general population. However, in athletes who perform repeated movements with supraphysiological forces, diverse pathologies may appear. The objective of this article is to develop an anatomopathological approach to elbow pain in order to identify its origin. A rapid and precise diagnosis allows initiating an adequate treatment and minimizing time of sporting activity arrest.


Assuntos
Atletas , Traumatismos em Atletas/diagnóstico , Articulação do Cotovelo/lesões , Cotovelo/lesões , Traumatismos em Atletas/complicações , Humanos , Dor/diagnóstico , Dor/etiologia , Dor/prevenção & controle
7.
J Shoulder Elbow Surg ; 29(9): 1737-1742, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32713663

RESUMO

BACKGROUND: Because of the rapid spread of COVID-19, on March 8, 2020 Italy became a "protected area": people were told not to leave their homes unless it was essential. The aim of this study was to evaluate the activity of our trauma center, relative to shoulder and elbow, in the 30 days starting from March 8, 2020, the first day of restrictions in Italy, and to compare it with the same days of 2019 to weigh the impact of COVID-19 on shoulder and elbow trauma. MATERIALS AND METHODS: Patients managed in our trauma center between March 8, 2020, and April 8, 2020 (COVID period), for shoulder and elbow trauma were retrospectively included and compared to patients admitted in the same period of 2019 (no-COVID period). Clinical records of all participants were examined to obtain information regarding age, sex, mechanism of injury, and diagnosis. RESULTS: During the no-COVID period, 133 patients were admitted for a shoulder or elbow trauma; in the COVID period, there were 47 patients (65% less first aid). In the no-COVID and COVID period, patients with shoulder contusion totaled 60 (14.78% of all; male [M]: 34; female [F]: 26; mean age 51.8 years, range 18-88) and 11 (12.09% of all contusions; M: 7, F: 4; mean age 43 years, range 24-60), respectively. In the no-COVID period, 27 fractures (9.34% of all fractures) involved the shoulder, whereas 18 fractures (8.69%) were registered in the COVID period. In the no-COVID period, 14 elbow fractures were treated (4.8% of all fractures), compared with 4 in the COVID period. In the no-COVID and COVID periods, 6 patients (M: 5, F: 1; mean age 42 years, range 21-64) and 2 patients (M: 1, F: 1; mean age 29.5 years, range 24-35) reported having a feeling of momentary post-traumatic shoulder instability, and 0 and 1 patients (M: 1, F: 0; age 56 years), respectively, reported similar symptoms at the elbow. Finally, first or recurrent dislocations in the no-COVID period were 10, and in the COVID period, 7; elbow dislocations in the no-COVID period were 2, and in the COVID period, there were 3. CONCLUSIONS: During the COVID period, we provided a reduced number of health services, especially for patients with low-energy trauma and for those who underwent sports and traffic accidents. However, during the COVID period, elderly subjects remain exposed to shoulder and elbow trauma due to low-energy (domestic) falls. The subsequent hospitalization of these patients has contributed to making it more difficult to manage the hospital wards that are partly occupied by COVID-19 patients.


Assuntos
Traumatismos do Braço/complicações , Betacoronavirus , Infecções por Coronavirus/complicações , Articulação do Cotovelo/lesões , Pneumonia Viral/complicações , Vigilância da População , Luxação do Ombro/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Braço/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Luxação do Ombro/epidemiologia , Adulto Jovem
8.
J Shoulder Elbow Surg ; 29(7): 1380-1386, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32553438

RESUMO

HYPOTHESIS: Heterotopic ossification (HO) is a common complication of surgically treated elbow fractures that can inhibit range of motion and impair quality of life. Although there are many treatment methods for HO, there is a lack of consensus as to the best option. We hypothesized that contracture release combined with Botox injection would lead to improved functional outcome scores when compared with current treatment methods. METHODS: A retrospective review was conducted of patients who presented to a single surgeon with HO secondary to elbow fracture between 2005 and 2018. A total of 59 patients were identified who met inclusion criteria. Data were classified into 3 groups: contracture release (control - CR), Botox injection with CR (Botox + CR), and radiation therapy with CR (CR + RT). Range of motion measurements were obtained, including flexion, extension, pronation, and supination. RESULTS: A total of 30 patients (30 of 59, 50.8%) received CR, 6 (6 of 59, 9.2%) were treated with CR + RT, and 23 (23 of 59, 40.0%) had CR + Botox. There was a significant difference between pre- and postoperative arc of motion for both CR + RT (P < .01) and CR + Botox (P < .01). In addition, there was a significant difference in pre- and postoperative extension for patients who received intraoperative Botox injections (P < .05). There was no significant difference between pre- and postoperative motion nor extension in the CR group. CONCLUSION: Intraoperative Botox injection with CR is an effective method in the treatment of post-traumatic elbow stiffness caused by HO.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Articulação do Cotovelo/cirurgia , Fraturas Ósseas/cirurgia , Liberação da Cápsula Articular , Fármacos Neuromusculares/uso terapêutico , Ossificação Heterotópica/terapia , Adulto , Terapia Combinada , Contratura/etiologia , Contratura/terapia , Cotovelo/lesões , Cotovelo/cirurgia , Articulação do Cotovelo/lesões , Articulação do Cotovelo/fisiopatologia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/etiologia , Radioterapia , Amplitude de Movimento Articular , Estudos Retrospectivos
9.
J Shoulder Elbow Surg ; 29(7): 1387-1393, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32553439

RESUMO

BACKGROUND: Hyperuricemia is considered a risk factor for increased postoperative complications and adverse functional outcomes in a variety of orthopedic surgeries. The purpose of this retrospective study was to investigate the clinical efficacy of patients with different uric acid levels after elbow arthrolysis. METHODS: The study included 131 patients with post-traumatic elbow stiffness who underwent arthrolysis between March 2014 and March 2016. All patients were divided into 4 groups based on the preoperative serum level of uric acid (UA). The quartile method was used for grouping patients, including 33 in Q1 (UA <293 µmol/L), 34 in Q2 (293-348 µmol/L), 32 in Q3 (348-441 µmol/L), and 32 in Q4 (441-710 µmol/L). At baseline and each time point of follow-up, functional performance, Mayo Elbow Performance Score, visual analog scale for pain, and complications were evaluated. RESULTS: Preoperative data were not significantly different among the 4 groups (Q1, Q2, Q3, and Q4). At the final follow-up, the following data showed significant differences among the 4 groups: extension (P = .031), flexion (P = .008), range of motion (P = .003), Mayo Elbow Performance Score (P = .011), and visual analog scale (P = .032). Interestingly, patients in the Q4 group had the poorest clinical outcomes. However, no significant differences were found among the 4 groups in new onset or exacerbation of nerve symptoms (P = .919), reduced muscle strength (P = .536), instability (P = .567), or infection (P = .374) at the last follow-up. CONCLUSION: This study confirms that in patients with post-traumatic elbow stiffness, abnormal serum uric acid metabolism was a risk factor for poor performance and postoperative pain after arthrolysis. Therefore, detecting the preoperative serum uric acid levels of the patients would be helpful for evaluating the postoperative outcomes.


Assuntos
Articulação do Cotovelo/fisiopatologia , Hiperuricemia/fisiopatologia , Artropatias/cirurgia , Ácido Úrico/sangue , Adulto , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Fixadores Externos , Feminino , Humanos , Hiperuricemia/sangue , Artropatias/etiologia , Artropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/sangue , Dor Pós-Operatória/etiologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
10.
J Pediatr Orthop ; 40(6): 267-270, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501905

RESUMO

BACKGROUND: Medial epicondyle fractures represent up to 20% of elbow fractures in children and adolescents. There is a growing body of literature to support surgical fixation for displaced fractures. However, controversy regarding imaging modality for displacement measurement and surgical indications remain controversial. The purpose of this survey was to gauge Latin American surgeons' practices and preferences for the evaluation and treatment of medial epicondyle fractures. METHODS: A web-based survey containing 19 questions was distributed to active members of SLAOTI (Sociedad Latinoamericana de Ortopedia y Traumatología Infantil) in November 2018. The survey elicited information regarding surgeon demographics, evaluation methods, the factors involved in the decision to perform surgery, and their experience in cases of symptomatic nonunion. Categorical variables were summarized using frequencies and proportions. Analysis of associations between surgeon demographics and treatment preferences were carried out. RESULTS: A total of 193 out of 354 completed questionnaires were returned (54% response rate). In total, 74% of the participants (142/193) favored radiographs for the evaluation of the fracture displacement, and 25.4% (49/193) added a computed tomography scan for a more detailed evaluation. The majority of respondents (48.2%) would consider a 5 mm displacement as the cutoff for surgical treatment, 21.8% 2 mm, 20.7% 10 mm, and 9.3% 15 mm. There were no differences between the experience of the participants, academic versus private setting, or training regarding surgical/nonsurgical management. CONCLUSIONS: There are significant differences in opinions between SLAOTI members as to the optimal management of medial epicondyle fractures. Implications of disagreement in evaluation and treatment support the need for multicenter prospective studies to develop evidence-based guidelines for the management of this fracture. LEVEL OF EVIDENCE: Level V-expert opinion. Cross-sectional electronic survey.


Assuntos
Articulação do Cotovelo , Fratura-Luxação , Fixação de Fratura , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Criança , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Fratura-Luxação/diagnóstico , Fratura-Luxação/cirurgia , Fixação de Fratura/métodos , Fixação de Fratura/estatística & dados numéricos , Humanos , América Latina , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e Questionários
11.
Metas enferm ; 23(5): 7-14, jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-194587

RESUMO

OBJETIVO: describir las características epidemiológicas y clínicas, el abordaje terapéutico y la evolución de las fracturas supracondíleas de húmero distal (FxH) en la población pediátrica de un hospital terciario. MÉTODO: estudio descriptivo transversal (serie de casos). Se incluyó a todos los pacientes pediátricos atendidos en urgencias de un hospital terciario por FxH entre 2015 y 2019. Se recopilaron datos epidemiológicos (sexo, edad, época del año), clínicos y radiográficos (tipo de fractura según clasificación de Gartland, lateralidad, antecedentes), tipo de tratamiento, complicaciones y resultados funcionales a partir de la revisión de las historias clínicas. Se realizaron índices de estadística descriptiva. RESULTADOS: se obtuvieron 121 casos (53,7% chicos, edad media de 5,2 años). La lesión se produjo con más frecuencia en parques de juego (59,5%) en épocas cálidas. El 53,7% se localizó en el codo izquierdo. Un 41,3% fue FxH tipo 1 (no desplazadas), el 23,1% tipo 2 y el 35,3% tipo 3. El tratamiento fue conservador en el 100% de las FxH tipo 1 y quirúrgico en el 54,5% del total de casos. Se encontraron complicaciones en el 2,5% de los pacientes. El 87,6% recuperó la movilidad completa, solo se encontró limitación para la flexión en pacientes con Fx tipo 3 (34,9%). CONCLUSIÓN: las FxH fueron más habituales en varones de unos 5 años tras caídas en parques de juego y con mayor frecuencia tipo 1. El tratamiento más común fue quirúrgico. Las complicaciones y recuperaciones parciales se dieron tras fracturas desplazadas. Es importante que las/os enfermeras/os estén familiarizadas con esta patología para prevenir complicaciones potenciales


OBJECTIVE: to describe the epidemiological and clinical characteristics, the treatment approach and evolution of supracondylar fractures of the distal humerus (SFDH) in the pediatric population of a tertiary hospital. METHOD: a descriptive cross-sectional study (case series), including all pediatric patients seen at the Emergency Unit of a tertiary hospital due to SFDH between 2015 and 2019. Epidemiological details were collected (gender, age, time of the year), as well as clinical and radiographic (type of fracture according to the Gartland classification, laterality, background), type of treatment, complications, and functional outcomes based on a review of clinical records. Descriptive statistical indexes were conducted. RESULTS: in total, 121 cases were retrieved (53.7% boys, 5.2 years as mean age). The injury occurred more frequently in playgrounds (59.5%) in warm weather; 53.7% were located in the left elbow; and 41.3% were Type 1 SFDH (non-displaced), 23.1% were Type 2 and 35.3% were Type 3. Treatment was conservative in 100% of Type 1 SFDHs, and surgical in 54.5% of cases. Complications were found in 2.5% of patients: 87.6% of them recovered complete mobility, and limited flexion was only found in patients with Type 3 (SFDH) (34.9%). CONCLUSION: SFDHs were more frequent in 5-year-old males after falls in playgrounds, and Type 1 cases were more frequent. The most common treatment was surgical. Complications and partial recoveries occurred after displaced fractures. It is important for nurses to be familiar with this condition in order to prevent any potential complications


Assuntos
Humanos , Masculino , Feminino , Criança , Fraturas do Úmero/terapia , Fraturas do Úmero/epidemiologia , Papel do Profissional de Enfermagem , Estudos Transversais , Articulação do Cotovelo/lesões , Acidentes por Quedas/prevenção & controle
12.
Am J Sports Med ; 48(8): 1884-1892, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32453667

RESUMO

BACKGROUND: Biomechanical studies have compared augmented primary repair with internal bracing versus reconstruction techniques of the anterior ulnar collateral ligament (aUCL) in the elbow. However, aUCL repair alone has not been compared with augmented repair or reconstruction techniques. HYPOTHESIS: Internal bracing of aUCL repair provides improved time-zero stabilization in terms of gap formation, torsional stiffness, and residual torque compared with both repair alone and the modified docking technique, with enhanced valgus stability restoration to that of the native ligament. STUDY DESIGN: Controlled laboratory study. METHODS: We randomized 8 matched pairs of cadaveric elbows to undergo either augmented aUCL repair or a modified docking technique through use of the palmaris longus tendon. Valgus laxity testing was consecutively performed at 90° of flexion on the intact, torn, and repaired conditions as well as the previously assigned techniques. First, intact elbows were loaded up to 10 N·m valgus torque to evaluate time-zero ligament rotations at valgus moments of 2.5, 5.0, 7.5, and 10 N·m. Rotation controlled cycling was performed (total 1000 cycles) for each surgical condition. Gap formation, stiffness, and residual torque were analyzed. Finally, these elbows and 8 additional intact elbows underwent torque to failure testing (30 deg/min). RESULTS: Repair alone revealed low torsional resistance and gapping, similar to the torn state. The augmented repair technique showed significantly higher torsional stiffness (P < .001) and residual torque (P < .001) compared with all other conditions and restored native function. Although reconstruction revealed similar initial stiffness and residual torque compared with an intact ligament, a steady decrease of torsional resistance led to a completely loose state at higher valgus rotations. Analysis of covariance between all groups showed significantly less gap formation for augmented repair (P < .001). The native failure load and stiffness were significantly higher and were similar to those of augmented repair (P = .766). CONCLUSION: Internal bracing of aUCL repair restored valgus stability to the native state with statistically improved torsional resistance, loading capability, and gap formation compared with reconstruction, especially at the upper load range of native aUCL function in the elbow. CLINICAL RELEVANCE: We found that aUCL repair with an internal brace effectively improves time-zero mechanical characteristics and may provide stabilized healing with accelerated and reliable recovery without the need for a tendon graft.


Assuntos
Ligamento Colateral Ulnar , Articulação do Cotovelo , Instabilidade Articular , Procedimentos Ortopédicos/métodos , Fenômenos Biomecânicos , Cadáver , Ligamento Colateral Ulnar/lesões , Ligamento Colateral Ulnar/cirurgia , Cotovelo , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Humanos , Instabilidade Articular/cirurgia , Distribuição Aleatória , Amplitude de Movimento Articular
13.
Clin Sports Med ; 39(3): 623-636, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446579

RESUMO

The elbow joint consists of the humeroulnar, humeroradial, and proximal radioulnar joints. Elbow stability is maintained by a combination of static and dynamic constraints. Elbow fractures are challenging to treat because the articular surfaces must be restored perfectly and associated soft tissue injuries must be recognized and appropriately managed. Most elbow fractures are best treated operatively with restoration of normal bony anatomy and rigid internal fixation and repair and/or reconstruction of the collateral ligaments. Advanced imaging, improved understanding of the complex anatomy of the elbow joint, and improved fixation techniques have contributed to improved elbow fracture outcomes.


Assuntos
Articulação do Cotovelo/lesões , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Redução Aberta , Placas Ósseas , Ligamentos Colaterais/lesões , Ligamentos Colaterais/cirurgia , Articulação do Cotovelo/anatomia & histologia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Olécrano/lesões , Olécrano/cirurgia , Redução Aberta/instrumentação , Redução Aberta/métodos , Osteotomia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/cirurgia
14.
Radiologe ; 60(7): 581-590, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32382829

RESUMO

The complex anatomy of the elbow joint enables a wide range of movement and complex functions in everyday and professional life. Typical injuries of this joint include a variety of different pathologies. Due to overlaying structures in plain radiographs, diagnosis of injuries to the elbow joint places high demands on the treating physicians and often needs further diagnostic imaging. The following article will give an overview of the most common of these injuries and their diagnosis.


Assuntos
Traumatismos do Braço , Articulação do Cotovelo , Fraturas do Rádio , Braço , Traumatismos do Braço/diagnóstico , Cotovelo/lesões , Articulação do Cotovelo/lesões , Humanos , Fraturas do Rádio/diagnóstico , Resultado do Tratamento
15.
J Shoulder Elbow Surg ; 29(6): 1282-1288, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32284308

RESUMO

BACKGROUND: Radial head arthroplasty (RHA) has become a successful procedure for addressing acute unreconstructible radial head fractures that compromise elbow stability in complex elbow trauma. The purpose of this study was to investigate the incidence of and risk factors for the development of neurologic complications after surgical treatment of complex elbow fractures that require an RHA. METHODS: Sixty-two patients with an unreconstructible radial head fracture and complex elbow instability treated with RHA were included. There were 33 men and 29 women, with a mean age of 54 years (range, 22-87 years). The average follow-up period was 5.2 years (range, 3-16 years). All patients were neurologically intact before surgery. The arthroplasty was implanted through a Kocher approach in 55 cases, whereas a Kaplan approach was used in 7. An uncemented smooth stem arthroplasty (Evolve) was used in 27 patients, and an anatomic ingrowth system (Anatomic Radial Head), in 35. At the time of surgery, 23 patients underwent fixation of a coronoid fracture and 15 underwent plating of the proximal ulna. All patients were clinically examined immediately after surgery and during follow-up to detect any degree of neurologic deficit. Radial and ulnar nerve injuries were classified according to the Hirachi and McGowan classifications, respectively. Functional outcomes were evaluated with the Mayo Elbow Performance Score. RESULTS: A complete posterior interosseous nerve palsy occurred postoperatively in 2 patients. Hand function had completely recovered in both at 2 months after surgery without sequelae. Nine patients complained of ulnar nerve symptoms (immediately after surgery in 6 and as delayed ulnar neuropathy in 3). Most patients with ulnar nerve deficits had undergone additional surgical procedures to address ulnar fractures. Among patients with ulnar neuropathies, only 3 complained of mild sensory symptoms at the latest follow-up. No significant differences in range of motion and Mayo Elbow Performance Score were found between patients with and without neurologic complications. Associated olecranon or coronoid fixation and a prolonged tourniquet time were identified as risk factors for neurologic complications. CONCLUSION: This study shows that the incidence of neurologic complications associated with the surgical treatment of complex elbow fractures requiring implantation of a radial head prosthesis may be underestimated in the literature. Inappropriate retraction in the anterior aspect of the radial neck, a prolonged ischemia time, and concomitant coronoid or olecranon fracture fixation represent the main risk factors for the development of this complication. Although the great majority of patients have full recovery of their nerve function, they should be advised on the risk of this stressful complication.


Assuntos
Artroplastia de Substituição do Cotovelo/efeitos adversos , Articulação do Cotovelo/lesões , Fixação Interna de Fraturas/efeitos adversos , Doenças do Sistema Nervoso/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fraturas do Rádio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Substituição do Cotovelo/instrumentação , Estudos de Coortes , Articulação do Cotovelo/cirurgia , Prótese de Cotovelo , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/complicações , Amplitude de Movimento Articular , Resultado do Tratamento , Fraturas da Ulna/complicações , Fraturas da Ulna/cirurgia , Adulto Jovem
16.
J Shoulder Elbow Surg ; 29(5): 996-1001, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32305108

RESUMO

BACKGROUND: Heterotopic ossification (HO) is a common complication after surgery for elbow trauma. Uric acid is the end product of purine metabolism and has several physiological and pathogenic roles. However, the relationship between HO and uric acid has not been explored. This retrospective study aimed to assess the relationship between HO and serum uric acid (SUA). MATERIAL AND METHODS: We retrospectively reviewed data from 155 patients undergoing elbow trauma surgery in our hospital between January 2013 and December 2018. One hundred patients were included according to the inclusion criteria. They were divided into 2 groups according to the presence or absence of HO, and the SUA level was compared between groups using the independent samples t test. The optimal prognostic cutoff value was obtained using the maximum value of the Youden index. RESULTS: The SUA level was significantly higher in the HO group than in the non-HO group (362.0 ± 87.4 µmol/L vs. 318.3 ± 87.0 µmol/L; P < .05). Using the maximum value of Youden index, 317.5 µmol/L was determined to be the optimal SUA cutoff value for the prediction of HO, with a sensitivity of 68.75% (95% confidence interval [CI], 54.67%-80.05%) and specificity of 55.77% (95% CI, 42.34%-68.40%). CONCLUSIONS: Our study was the first to find that the high SUA level is a risk factor for HO of the elbow joint after trauma. Moreover, 317.5 µmol/L is the SUA threshold predicting the occurrence and development of HO of the elbow, with high sensitivity and specificity.


Assuntos
Articulação do Cotovelo/cirurgia , Cotovelo/cirurgia , Ossificação Heterotópica/sangue , Ossificação Heterotópica/etiologia , Ácido Úrico/sangue , Adulto , Idoso , Cotovelo/lesões , Articulação do Cotovelo/lesões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Prognóstico , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Fatores de Tempo , Adulto Jovem
17.
J Shoulder Elbow Surg ; 29(5): 982-988, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32305107

RESUMO

BACKGROUND: Stress radiography measures medial joint space opening of the elbow, but its value in the management of throwing athletes is unclear. The purpose of this study was to analyze the relationship between medial joint opening (gapping and excess opening) and ulnar collateral ligament (UCL) injury severity on magnetic resonance imaging, as well as to explore factors related to the unexpected finding of a greater opening of the uninjured elbow compared with the injured elbow (negative excess opening) with valgus stress radiography. METHODS: Medial joint space measurements were independently performed by 2 raters in a clinical series of 74 patients evaluated with standardized valgus stress radiography as part of their clinical workup for throwing-related medial elbow pain. Demographic data were collected by chart review, and UCL injury severity was classified based on available imaging into intact UCLs, partial-thickness tears of the anterior bundle, or full-thickness tears of the anterior bundle. RESULTS: Joint gapping was related to UCL injury severity (P = .003), and group-level comparison showed a difference among tear severity groups (P = .050). Excess opening was not significantly related to UCL injury severity (P = .109). A negative excess opening was observed in 22% of patients, but no factors corroborating guarding or a mechanical explanation were significant for a decreased medial joint opening of the injured elbow compared with the uninjured elbow. CONCLUSIONS: Medial joint gapping was correlated to UCL injury severity in throwing athletes with medial elbow pain and a clinical suggestion of UCL injury, but no association between injury severity and excess opening was observed in this clinical series, which may limit the usefulness of stress radiography in the clinical workup of throwing athletes.


Assuntos
Ligamento Colateral Ulnar/lesões , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Estresse Mecânico , Adolescente , Adulto , Atletas , Beisebol , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Radiografia , Estudos Retrospectivos , Adulto Jovem
18.
J Shoulder Elbow Surg ; 29(7): 1394-1400, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32279987

RESUMO

HYPOTHESIS AND BACKGROUND: An elbow contracture in a young person can be a devastating problem. Significant contractures will lead to functional loss of the extremity. Appropriately performed contracture release can have profound implications on the overall well-being of the patient. The purpose of this study was to report improvements in sagittal-plane range of motion and the complication rate following an anterior elbow release for flexion contractures in patients 21 years or younger. METHODS: We performed a retrospective review of 27 patients with a median age of 16.8 years who were treated surgically for elbow flexion contracture with an anterior approach. Follow-up was possible in 18 of these patients at an average of 31 months. An anterior approach was performed in all 18 patients, with 4 patients undergoing an additional posterior incision to address posterior structures limiting extension. RESULTS: Elbow extension improved by an average of 35°, from -54° to -19°. The mean total arc of elbow motion improved by 37°, from 65° to 102°. Two complications occurred: traction-related neurapraxia of the lateral antebrachial cutaneous nerve and transient neurapraxia of the posterior interosseous nerve. DISCUSSION AND CONCLUSION: Elbow contracture release through an anterior approach is an acceptable surgical option. Significant improvement is obtained with a low risk of complications.


Assuntos
Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Cotovelo/cirurgia , Liberação da Cápsula Articular/métodos , Adolescente , Criança , Contratura/etiologia , Contratura/fisiopatologia , Contratura/cirurgia , Cotovelo/lesões , Cotovelo/patologia , Articulação do Cotovelo/lesões , Feminino , Seguimentos , Humanos , Liberação da Cápsula Articular/efeitos adversos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Adulto Jovem
19.
Orthopedics ; 43(3): 141-146, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32191948

RESUMO

The aim of this study was to evaluate risk factors for symptomatic hardware and removal of hardware (ROH) after olecranon open reduction and internal fixation (ORIF) and to assess differences between olecranon locking plate and screws (P&S) or tension band (TB) wire cohorts. The medical records of 331 patients with olecranon fractures treated at two academic level I trauma centers with ORIF from 2012 to 2016 were reviewed. A total of 189 patients were included in the study. Complications, ROH, and subsequent surgery were assessed and compared between cohorts. There were 124 cases in the P&S cohort and 65 in the TB cohort. The overall reoperation rate was 31.2% (59 of 189). The overall incidence of ROH for all cases was 29.1% (55 of 189). Patients who required ROH or developed symptomatic hardware were significantly younger than those who did not (P&S, P<.003; TB, P<.004). Age and body mass index (BMI) were associated with ROH plus symptomatic hardware after P&S. Age (but not BMI) was associated with ROH/symptomatic hardware after TB. Measured hardware prominence was not associated with ROH or ROH plus symptomatic hardware for either the P&S or the TB cohort. Risk factors including patient age and BMI were found to be significantly associated with hardware-related complications. [Orthopedics. 2020;43(3):141-146.].


Assuntos
Placas Ósseas/efeitos adversos , Parafusos Ósseos/efeitos adversos , Remoção de Dispositivo , Fixação Interna de Fraturas/efeitos adversos , Olécrano/cirurgia , Complicações Pós-Operatórias/epidemiologia , Fraturas da Ulna/cirurgia , Adulto , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Olécrano/lesões , Redução Aberta/efeitos adversos , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco
20.
Phys Ther Sport ; 43: 108-119, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32143085

RESUMO

OBJECTIVE: The purpose of this study was to perform a systematic review and meta-analysis of the current literature surrounding risk factors associated with shoulder and elbow injuries among adolescent baseball pitchers. METHODS: Relevant studies were assessed for inclusion and retained from PubMed, EMBASE, SportDiscus, and CINAHL databases. Data was extracted from the retained studies and underwent methodological quality assessment and meta-analysis. RESULTS: The search resulted in 1238 studies identified with 10 ultimately retained for systematic review. Five studies including one case-control, two prospective cohort, and two cross-sectional studies met inclusion criteria for meta-analysis. This meta-analysis revealed that playing with arm fatigue was a significant risk factor (pooled odds ratio = 13.32, 95% confidence interval: 3.22-55.09). The other three risk factors (long competitive season, pitching for more than one team or league, and playing catcher as a secondary position) were not statistically significant. CONCLUSION: Pitching with arm fatigue is a significant risk factor for shoulder and elbow injuries among adolescent baseball pitchers. Future efforts in assessment and mitigation of pitching with arm fatigue among this population may help to reduce the risk of arm injuries. Furthermore, investigations of additional risk factors in a more homogeneous population of adolescent pitchers may be warranted.


Assuntos
Beisebol/lesões , Articulação do Cotovelo/lesões , Medição de Risco/métodos , Lesões do Ombro/etiologia , Articulação do Ombro/lesões , Adolescente , Estudos Transversais , Humanos , Estudos Prospectivos , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA