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1.
Medicine (Baltimore) ; 99(14): e19605, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243383

RESUMO

Patients suffering from extremely medial clavicle fractures combined with distinct displacement generally need surgical intervention. Double-plate fixation is a widely applied technique in the treatment of distal radius fracture, which has been reported to fix lateral clavicle fracture as well. This study reveals the effect of double-plate fixation as an innovative procedure in the treatment of extremely medial clavicle fractures for the first time.Nine patients complaint of extremely medial clavicle fracture were enrolled in this research from May 2017 to March 2019. Patients were operated with an open reduction and internal fixation using the double-plate technique. Postoperative x-ray was taken regularly to observe the fracture healing at each visit, and the related complications were also recorded. The rating score systems of Constant Murley score of treated shoulder and contralateral shoulder, ROWE score as well as American Shoulder and Elbow Surgeons (ASES) were evaluated to comment on the postoperative shoulder joint function.All patients achieved postoperative fracture healing with no complications. Only 1 patient complained of slight restriction, 2 patients complained of pain during overhead work, and another patient was found with plate breakage. Meanwhile, the Constant Murley scores of treated and contralateral shoulder were 94.1 and 98.5 points, respectively, indicating the similar shoulder function. Furthermore, the ROWE and ASES scores of the involved shoulder were 96.7 and 96.3 points at average, respectively.It is the first time to introduce the surgical technique of vertical double-plate fixation implied in stable fixation of extremely medial clavicle fractures, which could provide the surgeons with an alternative method for this type of fracture.


Assuntos
Placas Ósseas , Clavícula/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Redução Aberta/métodos , Adulto , Idoso , Clavícula/cirurgia , Estudos de Viabilidade , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
2.
Emerg Med Clin North Am ; 38(1): 103-124, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757245

RESUMO

Shoulder pain is a common presentation in the emergency department. The list of differential diagnoses is broad. This article summarizes common diagnoses of shoulder pain, including bony, infectious, and connective tissue pathologies and their proper treatment. It also reviews which shoulder pain conditions are emergency diagnoses and need immediate treatment and which diagnoses need conservative management and outpatient follow-up.


Assuntos
Articulação Acromioclavicular/lesões , Clavícula/lesões , Emergências , Úmero/lesões , Procedimentos Ortopédicos/métodos , Radiografia/métodos , Ferimentos e Lesões/diagnóstico , Articulação Acromioclavicular/diagnóstico por imagem , Clavícula/diagnóstico por imagem , Gerenciamento Clínico , Humanos , Úmero/diagnóstico por imagem , Ferimentos e Lesões/terapia
3.
J Shoulder Elbow Surg ; 29(1): 27-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31563507

RESUMO

BACKGROUND: Conventional treatment of displaced midshaft clavicular fractures is nonoperative. Recent studies have implied that operative treatment might result in a faster return to work, resulting in a decreased productivity loss for society. The cost utility of plate fixation vs. nonoperative treatment of displaced midshaft clavicular fractures has not previously been investigated using a societal perspective. METHODS: Decision analytical modeling of incremental costs and quality-adjusted life-years (QALYs) was performed. Data on utility, hospitalization, and productivity costs were retrieved from a Danish randomized controlled trial. Supplementary data were taken from randomized controlled trials identified in the literature. A 1-year time horizon was applied, and all prices were reported with respect to a 2016 level. RESULTS: Operative treatment was associated with a larger QALY gain in patients and a higher cost compared with nonoperative treatment. The incremental cost-effectiveness ratio (ICER) was estimated in Danish currency (Danish krone [kr]) at kr1,360,000 (€182,306) per QALY from a health-sector perspective and kr1,388,738 (€186,158) per QALY from a societal perspective. Considering a subgroup analysis of patients with a high-load shoulder profession, operative treatment was dominated by nonoperative treatment from a health-sector perspective. Considering a societal perspective, the ICER was estimated at -kr889,091 (-€119,181) per reduction of 1 QALY. One-way and probabilistic sensitivity analyses showed that the results were subject to uncertainty. CONCLUSION: Operative treatment is not cost-effective when considering a threshold of €34,000/QALY. However, for a subgroup of patients with a high-load shoulder profession, operative treatment might be cost-effective compared with nonoperative treatment.


Assuntos
Clavícula/lesões , Tratamento Conservador/economia , Efeitos Psicossociais da Doença , Fraturas Ósseas/economia , Fraturas Ósseas/terapia , Procedimentos Ortopédicos/economia , Placas Ósseas , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Dinamarca , Diáfises/lesões , Eficiência , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Hospitalização/economia , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
4.
Bone Joint J ; 101-B(11): 1385-1391, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674242

RESUMO

AIMS: The primary aim of this study was to determine if delayed clavicular fixation results in a greater risk of operative complications and revision surgery. PATIENTS AND METHODS: A retrospective case series was undertaken of all displaced clavicular fractures that underwent plate fixation over a ten-year period (2007 to 2017). Patient demographics, time to surgery, complications, and mode of failure were collected. Logistic regression was used to identify independent risk factors contributing towards operative complications. Receiver operating characteristic (ROC) curve analysis was used to determine if a potential 'safe window' exists from injury to delayed surgery. Propensity score matching was used to construct a case control study for comparison of risk. RESULTS: A total of 259 patients were included in the analysis. Postoperative infection occurred in 3.9% of all patients (n = 10); the only variable associated was a greater time interval from injury to fixation (p = 0.001). Failed primary surgery requiring revision fixation was required in 7.7% of the cohort (n = 20), with smoking (p < 0.001), presence of a postoperative infection (p < 0.001), increasing age (p = 0.018), and greater time delay from injury to surgery (p = 0.015) identified as significant independent predictors on regression analysis. ROC analysis revealed that surgery beyond 96 days from injury increased the rate of major complications and revision surgery. Using a matched case cohort of cases before (n = 67) and after (n = 77) the 'safe window', the risk of postoperative infection increased (odds ratio (OR) 7.7, 95% confidence interval (CI) 1.9 to 62.9; p = 0.028), fixation failure (OR 3.8, 95% CI 1.2 to 12.1; p = 0.017) and revision surgery (OR 4.8, 95% CI 1.5 to 15.0; p = 0.004). CONCLUSION: A delay to primary fixation of up to three months following injury may be acceptable, beyond which there is an increased risk of major operative complications and revision surgery. Cite this article: Bone Joint J 2019;101-B:1385-1391.


Assuntos
Clavícula/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Redução Aberta/métodos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/cirurgia , Complicações Pós-Operatórias/etiologia , Curva ROC , Reoperação/estatística & dados numéricos , Fatores de Risco , Infecção da Ferida Cirúrgica , Tempo para o Tratamento , Adulto Jovem
5.
Medicine (Baltimore) ; 98(38): e17299, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568015

RESUMO

China's child population ranked second in the world. However, data on the overall patterns and epidemiologic trends of TULFs among children and adolescents in Chongqing, China are scarce. With development of urbanization, motorization, building industry, the incidence patterns of traumatic upper limb fractures in children and adolescents might be about to change. To investigate the incidence patterns of traumatic upper limb fractures in children and adolescents (≤18 years old) according to age (≤3 years old, 3-6 years old, 6-12 years old, and 12-18 years old), gender, time, and etiology groups in Chongqing, China, we retrospectively reviewed 1078 children and adolescents who had traumatic upper limb fractures and who came to our university-affiliated hospitals from 2001 to 2010. The patients were grouped into different age groups, genders, year of admission range groups, and aetiologies. We used Pearson chi-square tests and independent samples t tests to assess differences of the grouped data and continuous variables, respectively. This study enrolled 1078 patients (849 males, 229 females) aged 11.0 ±â€Š4.7 years old. The most common aetiologies and fracture sites of patients were low falls (705, 65.4%) and humerus (492, 45.6%). A total of 146 (13.5%) patients suffered a nerve injury, 94 (8.7%) patients sustained associated injuries, and 106 (9.8%) patients sustained complications. The proportion of injuries due to motor vehicle collisions increased with increasing age and year of admission. Female patients presented with significantly higher proportion of injuries due to motor vehicle collisions and significantly lower proportion of injuries due to hit by others. The proportion decreased from 63.2% to 33.3% in humeral fracture, increased from 8.8% to 35.5% in radius fracture, increased from 7.4% to 28.9% in ulna fracture with increasing age. Female patients presented with significantly higher proportion of humeral fracture, clavicle fracture and significantly lower proportion of radius fracture, ulna fracture, and hand fracture. Low falls and humerus fractures were the most common aetiologies and fracture sites. The pattern of traumatic upper limb fractures has specific age, gender, time, and etiology differences.


Assuntos
Fraturas do Úmero/epidemiologia , Fraturas do Rádio/epidemiologia , Fraturas da Ulna/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Pré-Escolar , China/epidemiologia , Clavícula/lesões , Feminino , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/etiologia , Humanos , Fraturas do Úmero/etiologia , Incidência , Lactente , Recém-Nascido , Masculino , Fraturas do Rádio/etiologia , Fatores de Risco , Escápula/lesões , Fatores Sexuais , Fraturas da Ulna/etiologia
6.
Acta Chir Orthop Traumatol Cech ; 86(4): 299-303, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31524594

RESUMO

Superior Shoulder Suspensory Complex (SSSC) is a bone and soft-tissue ring securing the connection of the upper extremity to the axial skeleton via the clavicle and sternoclavicular joint. An isolated injury to one component of SSSC is usually stable. An injury to 2 of its components is a potential source of shoulder girdle instability and requires surgical stabilisation. An injury affecting 3 and more components is extremely rare and surgical stabilisation should be indicated. Our study presents the case of a 50-year-old man who fell off the bicycle and sustained a direct blow to his left shoulder resulting in an ipsilateral fracture of the coracoid and acromion process combined with the fracture of the distal end of the clavicle. Following a standard clinical examination and a subsequent X-ray and a CT scan with three-dimensional shoulder reconstruction, an open reduction and stabilisation of all the injured SSSC components was performed. Later, early and gradual rehabilitation of the shoulder girdle was commenced. At 48 weeks after the surgery, almost full range of motion of the shoulder joint was achieved and the muscle strength of the operated upper extremity was comparable to that of the healthy one. Key words:Superior Shoulder Suspensory Complex, fracture, acromion, coracoid process, clavicle.


Assuntos
Clavícula/lesões , Fraturas Ósseas/cirurgia , Escápula/lesões , Lesões do Ombro/cirurgia , Acrômio/diagnóstico por imagem , Acrômio/lesões , Clavícula/diagnóstico por imagem , Processo Coracoide/diagnóstico por imagem , Processo Coracoide/lesões , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Escápula/diagnóstico por imagem , Lesões do Ombro/diagnóstico por imagem , Lesões do Ombro/reabilitação
7.
Medicine (Baltimore) ; 98(33): e16836, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415405

RESUMO

RATIONALE: Isolated fracture of clavicle is usually treated with nonoperative conservative treatment. However, surgical treatment, customized for individual patient's need, is increasingly done. With regard to the surgery of the clavicle fracture, pneumothorax is a possible, but rare complication. PATIENT CONCERNS: We report the case of a 32-year-old healthy female patient who underwent minimally invasive plate osteosynthesis (MIPO) due to a clavicle fracture. To avoid direct exposure of fracture site, the pre-contoured plate was inserted through the lateral incisional port to reach the medial incisional port. There was no problem during the surgery, but the patient complained of dyspnea in the post-anesthesia care unit. DIAGNOSES: A chest radiograph was taken immediately, and a definitive finding of pneumothorax was revealed. INTERVENTIONS: A tube was inserted at the right chest. OUTCOMES: The patient's dyspnea was resolved. On the 6th day after the surgery, the chest radiograph revealed that pneumothorax was nearly resolved, enabling to remove the chest tube. On the 9th day after the surgery, the patient was discharged without complication. LESSONS: After clavicle surgery requiring strong dissection like MIPO, the possibility of pneumothorax is suspected and the patient should be carefully observed.


Assuntos
Clavícula/lesões , Fixação Interna de Fraturas/efeitos adversos , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Fraturas do Ombro/cirurgia , Adulto , Placas Ósseas/efeitos adversos , Feminino , Fixação Interna de Fraturas/métodos , Humanos
9.
Medicine (Baltimore) ; 98(34): e16898, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441868

RESUMO

Both spiral plate and Herbert screw fixations have been clinically adopted for treating midshaft displaced clavicle fractures. However, the biomechanical properties of the 2 implant fixations have not yet been thoroughly evaluated. Here we report the results of a finite element analysis of the biomechanical properties of midshaft clavicle fractures treated with Herbert screw and spiral plate fixation. Hebert screw fixation showed stress distribution similar to intact clavicle under all loading conditions, but provided less stability than did spiral plate fixation. Postoperatively, excessive shoulder activities and weight-bearing should be avoided. Spiral plate fixation provides greater stability, but is associated with stress shielding. These results demonstrate that Herbert screw fixation is suitable for the treatment of simple displaced clavicluar fractures, but excessive shoulder activity and weight-bearing should be avoided after the operation. Therefore, spiral plate fixation may be preferred for patients requiring an early return to activity.


Assuntos
Clavícula/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Adulto , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Clavícula/anatomia & histologia , Clavícula/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Modelos Anatômicos , Melhoria de Qualidade , Adulto Jovem
10.
Bone Joint J ; 101-B(8): 995-1001, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362556

RESUMO

AIMS: The primary aim of this study was to establish the cost-effectiveness of the early fixation of displaced midshaft clavicle fractures. PATIENTS AND METHODS: A cost analysis was conducted within a randomized controlled trial comparing conservative management (n = 92) versus early plate fixation (n = 86) of displaced midshaft clavicular fractures. The incremental cost-effectiveness ratio (ICER) was used to express the cost per quality-adjusted life-year (QALY). The Six-Dimension Short-Form Health Survey (SF-6D) score was used as the preference-based health index to calculate the cost per QALY at 12 months after the injury. RESULTS: The mean 12-month SF-6D was 0.9522 (95% confidence interval (CI) 0.9355 to 0.9689) following conservative management and 0.9607 (95% CI 0.9447 to 0.9767) following fixation, giving an advantage for fixation of 0.0085, which was not statistically significant (p = 0.46). The mean cost per patient was £1322.69 for conservative management and £5405.32 for early fixation. This gave an ICER of £480 309.41 per QALY. For a threshold of £20 000 per QALY, the benefit of fixation would need to be present for 24 years to be cost-effective compared with conservative treatment. Linear regression analysis identified nonunion as the only factor to adversely influence the SF-6D at 12 months (p < 0.001). CONCLUSION: Routine plate fixation of displaced midshaft clavicular fractures is not cost-effective. Nonunion following conservative management has an increased morbidity with comparable expense to early fixation. This may suggest that a targeted approach of fixation in patients who are at higher risk of nonunion would be more cost-effective than the routine fixation of all displaced fractures. Cite this article: Bone Joint J 2019;101-B:995-1001.


Assuntos
Clavícula/lesões , Tratamento Conservador/economia , Análise Custo-Benefício/estatística & dados numéricos , Fixação Interna de Fraturas/economia , Fraturas Ósseas/cirurgia , Custos de Cuidados de Saúde/estatística & dados numéricos , Adulto , Placas Ósseas , Clavícula/cirurgia , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/economia , Humanos , Masculino , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento , Reino Unido
11.
J Bone Joint Surg Am ; 101(15): 1335-1341, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393423

RESUMO

BACKGROUND: Fractures of the lateral aspect of the clavicle with complete displacement have a high nonunion rate and are associated with poor functional outcomes following nonoperative treatment. Various techniques are available to treat these fractures, but preliminary studies of open reduction and tunneled suspensory device (ORTSD) fixation have shown good early functional outcomes with a low rate of complications; our goal was to assess the functional outcomes and complications in the medium term in a larger series of patients treated using this technique. METHODS: Sixty-seven patients with displaced lateral-end clavicular fractures were treated with ORTSD fixation. Outcome was assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Oxford shoulder score at 6 weeks and 3, 6, and 12 months postoperatively. Fifty-five of 64 surviving patients were subsequently contacted at a mean of 69 months (range, 27 to 120 months) postoperatively to complete DASH and Oxford shoulder scores, to evaluate their overall level of satisfaction, and to document any further complications. RESULTS: At 1 year postoperatively, the mean Oxford shoulder score was 46.4 points and the mean DASH score was 2.4 points in 59 of the 67 patients assessed at this time interval. At the later follow-up (mean, 69 months), the mean Oxford shoulder score was 46.5 points and the mean DASH score was 2.2 points in the 55 surviving patients who were able to be contacted. There were no significant differences between the 1-year functional scores and those at the latest follow-up. Two patients developed a symptomatic nonunion requiring reoperation, and 2 patients developed an asymptomatic fibrous union not requiring a surgical procedure. The 5-year survival when considering only obligatory revision for implant-related complications was 97.0%. CONCLUSIONS: ORTSD fixation for isolated displaced lateral-end clavicular fractures in medically fit patients is associated with good functional outcomes and a low rate of complications in the medium term. Routine implant removal was not necessary. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Clavícula/cirurgia , Fratura-Luxação/cirurgia , Fraturas Ósseas/cirurgia , Redução Aberta/instrumentação , Amplitude de Movimento Articular/fisiologia , Adolescente , Adulto , Idoso , Clavícula/lesões , Estudos de Coortes , Feminino , Seguimentos , Fratura-Luxação/diagnóstico por imagem , Consolidação da Fratura/fisiologia , Fraturas Ósseas/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Fixadores Internos , Masculino , Pessoa de Meia-Idade , Redução Aberta/efeitos adversos , Redução Aberta/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Articulação do Ombro/fisiologia , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
J Shoulder Elbow Surg ; 28(12): 2364-2370, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31371161

RESUMO

BACKGROUND: Recalcitrant clavicular nonunion is a rare but complicated problem of clavicular fracture fixation. Nonunion is most often treated with clavicular shortening or in extreme cases vascularized bone grafting. Herein we describe our experience using the vascularized medial femoral condyle (MFC) free flap for the reconstruction of segmental defects in cases of recalcitrant clavicular nonunion. METHODS: A retrospective chart review was conducted of patients with symptomatic recalcitrant nonunion of the clavicle who underwent reconstruction with the vascularized MFC free flap from June 2003 to January 2018. Patients' demographics, time to union, and postoperative complications were collected. RESULTS: A total of 7 patients (6 women; 39.8 ± 9.01 years old) underwent clavicular reconstruction after an average of 3.7 ± 1.3 previous surgical procedures. Average preoperative visual analog scale score for pain was 4.1. The graft size ranged from 2 to 5 cm in length with approximately 1 cm in width and depth. The average time of total nonunion was 66 ± 48.2 months before surgery. All flaps survived and all clavicles healed with an average time to radiographic union of 15 ± 6.7 months. Patients regained full shoulder motion, and average postoperative visual analog scale score was 1.6 ± 1.8. All patients returned to their preoperative employment status. Donor site morbidity from the knee was minimal. CONCLUSION: The MFC free flap is a good option for recalcitrant bone nonunion of the clavicle where larger vascularized flaps are not warranted. It is effective and offers minimal donor site morbidity.


Assuntos
Transplante Ósseo/métodos , Clavícula/cirurgia , Fêmur/transplante , Fraturas não Consolidadas/cirurgia , Retalhos de Tecido Biológico/transplante , Adulto , Clavícula/lesões , Epífises/transplante , Feminino , Fixação Interna de Fraturas , Fraturas não Consolidadas/complicações , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Medição da Dor , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Estudos Retrospectivos
13.
Injury ; 50(8): 1423-1428, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31256910

RESUMO

There has been very limited analysis of the relationship between obesity and fractures in the orthopaedic literature. It has been established for some years that underweight individuals are at greater risk of proximal femoral fractures but recently there has been interest in the susceptibility of obese post-menopausal females to fracture. We have undertaken an analysis of 4886 adult patients who presented with a fracture and had their BMI assessed. Analysis has confirmed the relationship between underweight individuals and proximal femoral fractures but there is also a negative association between obesity and clavicle fractures in males and females and with calcaneal fractures in females. There is a positive relationship between obesity and proximal humeral, finger phalangeal and ankle fractures in males and with humeral diaphyseal, carpal and ankle fractures in females. There was no relationship found between open or multiple fractures and obesity.


Assuntos
Densidade Óssea/fisiologia , Fraturas Ósseas/epidemiologia , Obesidade/epidemiologia , Fraturas por Osteoporose/epidemiologia , Magreza/epidemiologia , Adulto , Índice de Massa Corporal , Calcâneo/lesões , Clavícula/lesões , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/fisiopatologia , Inquéritos Epidemiológicos , Humanos , Úmero/lesões , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/fisiopatologia , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/fisiopatologia , Prevalência , Escócia/epidemiologia , Fatores Sexuais , Ossos do Tarso/lesões , Magreza/complicações , Magreza/fisiopatologia
15.
J Orthop Surg Res ; 14(1): 220, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311567

RESUMO

BACKGROUNDS: The aim of our study was to investigate failure rates of reconstruction plate and non-reconstruction plate, and find the best strategy for implant selection for different fracture types for midshaft clavicular fractures. PATIENTS AND METHODS: Two hundred twenty-six consecutive patients with midshaft clavicular fractures who received open reduction and plate fixation during Jan 2012 to July 2017 were reviewed. The correlations between implant failure rates and risk factors including demographic data, fracture classifications, and implant types were analyzed. RESULTS: AO/OTA fracture classification and plate types are the most important factors affecting implant failure for midshaft clavicular fractures. Reconstruction plate had a significantly higher failure rate (53%) than that of non-reconstruction plates (3%) in comminuted midshaft clavicular (AO/OTA 15-2C) fractures (P value < 0.01). However, the difference was not significant in AO/OTA 15-2A and 2B classifications. CONCLUSION: Patients with comminuted midshaft clavicular (AO/OTA 15-2C) fractures treated with reconstruction plates had very high implant failure rates compared to non-reconstruction plates. We suggested that patients with comminuted midshaft clavicular (AO/OTA 15-2C) fractures treated with reconstruction plates need more protection and more frequent follow-up in the postoperative period.


Assuntos
Placas Ósseas/tendências , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Fixação Interna de Fraturas/tendências , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas/classificação , Clavícula/lesões , Feminino , Seguimentos , Fixação Interna de Fraturas/classificação , Fraturas Ósseas/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
BMC Musculoskelet Disord ; 20(1): 333, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319841

RESUMO

BACKGROUND: Intraosseous suture-button devices have been used for acromioclavicular joint reconstruction due to its relative simplicity compared with other procedures. However, the complications of acromioclavicular joint reconstruction using a suture-button are not fully understood. Here, we describe a case of a clavicle fracture at the suture hole following acromioclavicular joint reconstruction using a suture-button and hook plate. CASE PRESENTATION: A 28-year-old man presented at our hospital after a fall from his bicycle. The patient had a history of acromioclavicular joint reconstruction with a suture-button and a hook plate for right acromioclavicular joint dislocation, seven months ago at another hospital. The hook plate had been removed four months ago, while X-ray radiography before removal had shown the widening of a suture hole. In the current fall from the bicycle, X-ray radiography revealed a clavicle fracture through the previous drill hole for suture-button. We removed the suture-button and performed an open reduction and internal fixation for the clavicle fracture. CONCLUSION: The present case indicated that a clavicle fracture at the suture hole, although rare, is one of the complications after an acromioclavicular joint reconstruction using a suture-button. This case suggested that drilling to the necessary minimum when making suture holes and paying attention to the widening of suture holes are important to prevent a postoperative clavicle fracture.


Assuntos
Articulação Acromioclavicular/cirurgia , Clavícula/lesões , Fraturas Ósseas/etiologia , Complicações Pós-Operatórias/etiologia , Técnicas de Sutura/efeitos adversos , Acidentes por Quedas , Articulação Acromioclavicular/lesões , Adulto , Ciclismo , Clavícula/cirurgia , Humanos , Luxações Articulares/cirurgia , Masculino , Técnicas de Sutura/instrumentação
17.
J Pediatr Orthop ; 39(7): 377-381, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31305382

RESUMO

OBJECTIVES: The purpose of this study was to evaluate pediatric scapula fractures occurring in high-energy motorized vehicle accidents and their associated injury patterns in a pediatric patient population. METHODS: One thousand nine hundred sixty-eight pediatric patients who presented after either on-road or off-road motorized vehicle accidents between 1996 and 2015 were retrospectively reviewed. Thirty-eight patients were found to have scapula fractures and the remaining 1930 were identified as controls. RESULTS: A total of 39 scapula fractures occurred in 38 patients. The most common pattern was the AO/OTA 14-A3 (n=32), followed by 14-A2 (n=5), 14-B1 (n=1), and 14-C2 (n=1). Scapula fracture patients experienced higher rate of spine fractures (42% vs. 18%, P=0.001), skull fractures (26% vs. 12%, P=0.02), rib fractures (40% vs. 7.6%, P<0.0001), clavicle fractures (34% vs. 6%, P<0.0001), and upper extremity fractures (58% vs. 21%, P<0.0001) compared with controls. Scapula fracture patients had higher Injury Severity Scores (22.1 vs. 10.8, P<0.0001), thoracic injury (79% vs. 31%, P<0.0001), intracranial hemorrhage (32% vs. 15%, P=0.012), pneumothorax (55% vs. 8%, P<0.0001), and lung contusion (63% vs. 12%, P<0.0001). No difference in mortality was observed for scapula and control patients (5% vs. 2%, P=0.302). CONCLUSIONS: Pediatric scapula fractures were not associated with higher mortality rates in this series but were associated with significant morbidity as demonstrated by high rates of associated intracranial hemorrhage, skull fractures, thoracic injury, upper extremity fractures, and spine fractures compared with control patients. Surgeons who care for pediatric trauma patients should view scapula fractures as an indicator for more significant injuries. LEVEL OF EVIDENCE: Level III.


Assuntos
Fraturas Múltiplas/epidemiologia , Escápula/lesões , Acidentes de Trânsito , Adolescente , Clavícula/lesões , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Minnesota/epidemiologia , Traumatismo Múltiplo , Estudos Retrospectivos , Fraturas da Coluna Vertebral/epidemiologia
18.
Medicine (Baltimore) ; 98(28): e16359, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305431

RESUMO

RATIONALE: Asymmetrical bilateral sternoclavicular joint (SCJ) dislocation consists of posterior SCJ dislocation on one side and anterior SCJ dislocation on the other side. This is an extremely rare injury and only a few cases have been reported in the literature. If not been diagnosed timely and accurately, asymmetrical bilateral SCJ dislocation can be life-threatening. PATIENTS CONCERNS: We experienced a patient who has a life-threatening posterior dislocation of right SCJ and anterior dislocation on the left SCJ combined with bilateral clavicular fracture after a traffic accident. DIAGNOSES: A computed tomography (CT) scan with three-dimensional reconstructions of SCJ showed potentially life-threatening posterior dislocation of right SCJ and anterior dislocation on the left SCJ combined with bilateral clavicular fracture. INTERVENTIONS: Because of failed attempts at closed reduction, electively surgical intervention was made. We repaired the ruptured joint capsule and ligaments and fixed bilateral SCJ by Kirschner wire during the operation. OUTCOMES: Three-dimensional CT scans confirmed bilateral SCJ reduction and alignment after operation 1 week as well as at the 2-month follow-up. LESSONS: SCJ dislocation is an extremely rare and life-threatening injury. The aim of the operation is to repair the ruptured joint capsule and its ligaments and to fix the dislocated joints.


Assuntos
Clavícula/lesões , Fraturas Ósseas/complicações , Luxações Articulares/complicações , Articulação Esternoclavicular/lesões , Acidentes de Trânsito , Adulto , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/cirurgia , Articulação Esternoclavicular/diagnóstico por imagem , Articulação Esternoclavicular/cirurgia
19.
J Shoulder Elbow Surg ; 28(10): 1877-1885, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272891

RESUMO

BACKGROUND: The purpose of this study was to measure the distance of the clavicle in 3 dimensions (3D) and each direction (anterior to posterior, medial to lateral, and superior to inferior) and to analyze the correlation of the angular orientation of the scapula according to each directional distance of the clavicle. METHODS: Sixty-seven patients with Robinson 2B1 and 2B2 clavicle midshaft fracture (46.0 ± 17.4 years, men = 50, women = 17) were selected as final subjects. Patients' computed tomography was reconstructed using an image processing program (3D Slicer 4.3 software). Anteroposterior (AP) distance, medial-to-lateral distance, superior-to-inferior distance, and 3D distance of both clavicles were measured. The plane connecting the 3 points (superior pole, inferior pole, and center of glenoid) of the scapula was used to calculate differences in the angular orientation between both scapulae. RESULTS: Among each directional distance of the clavicle, only the AP distance showed negative correlation with scapular angular orientation with anterior tilting, internal rotation, and upward rotation of the scapula (Pearson's correlation coefficient: -0.68, -0.24, and -0.28; P < .001, P = .048, and P = .021). CONCLUSION: The shortening of the AP distance of the clavicle was related to the angular orientation of the scapula in acute clavicle fracture. AP shortening should be considered when determining the treatment of clavicle fracture.


Assuntos
Clavícula/diagnóstico por imagem , Clavícula/lesões , Fraturas Ósseas/diagnóstico por imagem , Escápula/diagnóstico por imagem , Adulto , Diáfises/lesões , Feminino , Fraturas Ósseas/fisiopatologia , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Rotação , Escápula/fisiopatologia , Tomografia Computadorizada por Raios X
20.
J Shoulder Elbow Surg ; 28(12): 2343-2349, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31351904

RESUMO

BACKGROUND: Nonoperative management has long been the preferred treatment for clavicular fractures; however, good outcomes, particularly with a shortened and malunited clavicle, are not universal. We report on radiographic and patient-based outcomes of a patient cohort with symptomatic clavicular malunions managed with corrective osteotomy, plate fixation, and local bone graft. We hypothesized that local bone graft would be sufficient for achieving union and length of malunion time would not affect the outcome. METHOD: Over a 10-year period, 59 cases underwent operative management of symptomatic clavicular malunion. The surgical technique included osteotomy of the malunion, restoration of length, fixation with a plate, and local bone graft. The average length of time between fracture and surgery was 193.42 weeks (range, 8 weeks to 30 years). All patients were followed up postoperatively until radiographic union was achieved. Disabilities of the Arm, Shoulder and Hand scores were obtained and patients completed questionnaires to assess patient-based outcomes postoperatively. RESULTS: All 59 cases achieved union with an average time of 9.25 weeks (range, 6-38 weeks) and only required local bone graft. All patients improved postoperatively with a mean Disabilities of the Arm, Shoulder and Hand score of 1.81 (range, 0-20.68) at 12 months. In 2 patients, infection developed, requiring revision of fixation, and union was subsequently achieved. Two patients had fractures adjacent to their hardware after union was achieved. CONCLUSIONS: Corrective osteotomy with restoration of length and alignment, soft-tissue preservation, local bone graft, and plate fixation is a reliable treatment option for midshaft clavicular malunion. Union can be achieved, with good clinical outcomes independent of malunion time.


Assuntos
Clavícula/lesões , Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos , Adolescente , Adulto , Placas Ósseas , Transplante Ósseo , Criança , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Diáfises/diagnóstico por imagem , Diáfises/lesões , Diáfises/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Consolidação da Fratura , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , /cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Período Pós-Operatório , Radiografia , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
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