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1.
Zhongguo Gu Shang ; 33(1): 87-92, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115932

RESUMO

OBJECTIVE: To systematically evaluate the clinical effects of autologous bone grafting versus bone morphogenetic protein treatment for nonunion of long bone fractures in adults and provide reference for this fracture. METHODS: According to the methods of systematic review of Cochrane, the randomized controlled trials which compared autologous bone grafting with bone morphogenetic protein treatment for nonunion of long bone fractures in adults were searched in PuMed, Embase, Cochrane library, CNKI , Wangfang data and CBM from the databases were established to March 2019. Information was screened and extracted according to the inclusion and exclusion criteria by two researchers respectively, and the qualities of the included studies were assessed by the modified Jadad quality scale. The rate of infection, successful union, second operation, hospital stays and intraoperative blood loss were compared by RevMan 5.3 software from Cochrane Collaboration for Meta-analysis. RESULTS: Seven randomized controlled trials with a total of 652 patients were included, 410 in the autologous bone grafting group and 242 in the bone morphogenetic protein group. Meta analysis showed there were no statistically significant differences regarding infectionï¼»RR=1.32, 95%CI (0.90, 1.93) , P=0.16ï¼½, successful unionï¼»RR=0.95, 95%CI (0.84, 1.08) , P=0.43ï¼½, second operationï¼»RR=1.16, 95%CI (0.43, 3.12) , P=0.76ï¼½, hospital staysï¼»MD=0.69, 95%CI (-0.38, 1.75) , P=0.21ï¼½between the two groups. But compared with the bone morphogenetic protein treatment, autologous bone grafting significantly increased the intraoperative blood lossï¼»MD=223.00, 95%CI (32.72, 413.28) , P=0.02ï¼½. CONCLUSION: Since bone morphogenetic proteins can attain as the same fracture healing rate as autologous bone grafting and can significantly reduce the intraoperative blood loss, bone morphogenetic proteins may be a better choice for nonunion of long bone fractures in adults.


Assuntos
Fraturas Ósseas , Adulto , Proteínas Morfogenéticas Ósseas , Transplante Ósseo , Consolidação da Fratura , Humanos , Transplante Autólogo , Resultado do Tratamento
2.
Zhongguo Gu Shang ; 33(1): 93-6, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115933

RESUMO

Acupuncture has a significant effect on promoting fracture healing. It can dredge meridians and collaterals, regulate qi and blood, eliminate swelling and remove stasis. However, its mechanism is still not fully elucidated. With the development of research, it has been found in recent years that the mechanism of acupuncture and moxibustion promoting fracture healing involves regulating the expression level of cell growth factor, activating Wnt/ß-Catenin and other signal pathways, improving local blood circulation, affecting the content of mineral elements in bone, regulating the endocrine system, promoting the differentiation and proliferation of bone cells, promoting the proliferation and activation of osteoblasts and influencing the apoptosis of bone cells And so on. The mechanism of acupuncture and moxibustion promoting fracture healing is very complex, which is still at the level of animal experiments and cells.


Assuntos
Terapia por Acupuntura , Meridianos , Moxibustão , Pontos de Acupuntura , Animais , Proliferação de Células , Consolidação da Fratura
3.
Orthop Clin North Am ; 51(2): 235-239, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138861

RESUMO

To determine if orthopedic surgeons are more efficient than nonsurgical providers at care of operative injuries in walk-in clinics, patients in a walk-in clinic for evaluation of acute injury who subsequently had surgical treatment of isolated distal radial fracture were compared based on whether the initial visit was with a surgical or nonsurgical provider. Initial evaluation in a walk-in orthopedic clinic setting versus a conventional hand surgeon's clinic was associated with longer delay between initial evaluation and surgical treatment, but this difference may not be significant. Evaluation by a nonsurgical provider was not associated with increased duration to definitive treatment.


Assuntos
Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Instituições de Assistência Ambulatorial , Feminino , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/terapia , Tempo para o Tratamento , Adulto Jovem
4.
Instr Course Lect ; 69: 317-330, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017735

RESUMO

Scaphoid fractures are common and notorious for their troublesome healing. The aim of this review is to reevaluate the current best evidence for the diagnosis, classification, and treatment of scaphoid fractures and nonunions. MRI and CT are used to establish a "definitive diagnosis" with comparable diagnostic accuracy although neither is 100% specific. Current classifications cannot reliably predict union or outcomes; hence, a descriptive analysis of fracture location, type, and extent of displacement remains most useful. Treatment of a nondisplaced scaphoid waist fracture remains an individualized decision based on shared decision-making. Open reduction and internal fixation may be preferred when fracture displacement exceeds 1 mm, and the fracture is irreducible by closed or percutaneous means. For unstable nonunions with carpal instability, either non-vascularized cancellous graft with stable internal fixation or corticocancellous wedge grafts will provide a high rate of union and restoration of carpal alignment. For nonunions characterized with osteonecrosis of the proximal pole, vascularized bone grafting can achieve a higher rate of union.


Assuntos
Fraturas não Consolidadas , Osso Escafoide , Traumatismos do Punho , Transplante Ósseo , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos
5.
Mymensingh Med J ; 29(1): 32-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915332

RESUMO

Bone marrow is a source of osteoprogenitor cells which are the most important factor of bone formation and healing of fracture. The aim of the study is to evaluate the outcome of bone marrow injection in the management of delayed union and non-union. This prospective study was performed in the department of Orthopaedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2017 to June 2019. In this study 21 patients with delayed union and non-union were treated by bone marrow injection. Bone marrow were aspirated from the anterior or posterior iliac crests then injected percutaneously into the fracture site. Full union was achieved in 15 cases, while failed in the others. No major complications were seen during or after the procedure. It is a safe, easy and a minimally invasive procedure compared to usual open bone graft especially for cases with high risk of anesthesia or risk of infection.


Assuntos
Transplante de Medula Óssea/métodos , Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/terapia , Fraturas da Tíbia/terapia , Bangladesh , Fraturas Ósseas , Fraturas não Consolidadas/fisiopatologia , Humanos , Injeções , Masculino , Estudos Prospectivos , Fraturas da Tíbia/fisiopatologia , Resultado do Tratamento
6.
Z Gerontol Geriatr ; 53(2): 163-170, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31950363

RESUMO

Osteoporotic bones heal more slowly and ineffectively than normal bones. A combination of antibodies against sclerosing protein (Scl-Ab), and parathyroid hormone 1-34 (PTH 1-34) may improve healing. A standard osteoporotic rat model was established 12 weeks after bilateral ovarian resection (OVX). Bone defects were created in the right femora of 80 rats, which were randomly divided into 4 groups: control, Scl-Ab (25 mg/kg twice weekly), PTH (60 µg/kg of PTH 1-34 three times a week) and PTH plus Scl-Ab. After 12 weeks of treatment the rats were sacrificed and blood and the distal femora were harvested for biochemical evaluation, histology, microcomputed tomography and biomechanical testing. Compared to the control group, monotherapy and combination therapy with PTH and/or Scl-Ab promoted the formation of new bone, enhanced maximum femoral loading and increased the levels of procollagen type I N­terminal propeptide (PINP) and osteocalcin. The administration of PTH + Scl-Ab maximally enhanced bone defect healing. Combination treatment was better than either treatment alone, indicating a synergistic effect.


Assuntos
Anticorpos/administração & dosagem , Proteínas Morfogenéticas Ósseas/imunologia , Remodelação Óssea/fisiologia , Consolidação da Fratura/efeitos dos fármacos , Hormônio Paratireóideo/uso terapêutico , Animais , Densidade Óssea/efeitos dos fármacos , Calo Ósseo/efeitos dos fármacos , Modelos Animais de Doenças , Quimioterapia Combinada , Feminino , Humanos , Ovariectomia , Hormônio Paratireóideo/farmacologia , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Microtomografia por Raio-X/métodos
7.
J Orthop Res ; 38(2): 277-287, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31535727

RESUMO

Sarcopenia is highly prevalent in fragility fracture patients and is associated with delayed healing. In this study, we investigated the effect of low-magnitude high-frequency vibration (LMHFV) on osteoporotic fracture with sarcopenia and the potential role of myostatin. Osteoporotic fractures created in sarcopenic SAMP8, non-sarcopenic SAMR1 were randomized to control or LMHFV (SAMP8, SAMR1, SAMP8-V, or SAMR1-V) groups. Healing and myostatin expression were evaluated at 2, 4, and 6 weeks post-fracture. In vitro, conditioned-media were collected from myofibers isolated from aged and young SAMP8 or C2C12 myoblasts with or without LMHFV. Osteoblastic MC3T3-E1 under osteogenic differentiation were treated with plain or conditioned-medium (±myostatin propeptide). LMHFV significantly enhanced callus formation was in non-sarcopenic SAMR1 mice; but the enhancement effect was not significant in SAMP8 mice at week 2. Myostatin expressions in callus and biceps femoris of SAMP8 group were significantly higher all groups with significant negative correlation with callus size (R2 = 0.7256; p = 0.0004). Mechanical properties (week 4) and callus remodeling (week 6) were inferior in SAMP8 versus SAMR1 and were significantly enhanced by LMHFV. Alkaline Phosphatase (ALP) and Runx2 expression of MC3T3-E1 was lower in aged myofiber compared with young, but upregulated by LMHFV or myostatin inhibition; also confirmed with C2C12. LMHFV enhanced early callus formation, microarchitecture, callus remodeling and mechanical properties of fracture healing in both SAMP8 and SAMR1; however, more effective in non-sarcopenic SAMR1 mice. Impaired fracture healing in sarcopenic SAMP8 mice is attributed by elevated myostatin expression in callus and muscle, which correlated negatively with callus formation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:277-287, 2020.


Assuntos
Consolidação da Fratura , Miostatina/metabolismo , Fraturas por Osteoporose/terapia , Sarcopenia/terapia , Vibração/uso terapêutico , Células 3T3 , Animais , Fenômenos Biomecânicos , Calo Ósseo/metabolismo , Camundongos , Fraturas por Osteoporose/metabolismo , Distribuição Aleatória , Sarcopenia/metabolismo
8.
Biosci Biotechnol Biochem ; 84(3): 491-499, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31782345

RESUMO

To elucidate the role of POU2F2 (POU class 2 homeobox 2) in fracture healing, 30 rats with femoral fracture were randomly grouped into three groups: FF group, LV-POU2F2 group and LV-scramble group. Rats were injected with PBS, lentivirus expressing POU2F2 or scramble lentivirus once a week for 4 weeks. Results showed that overexpressing of POU2F2 promoted fracture healing and callus growth. Besides, overexpressing of POU2F2 promoted protein and mRNA expression of Col10a1, Runx2, Osterix, and Osteocalcin. High Mobility Group AT-hook 1 (HMGA1) is a non-histone protein participating in chromatin remodeling of cells. Western blotting manifested HMGA1/Wnt/ß-catenin pathway was activated in POU2F2 group. Moreover, in-vitro study of hMSCs cells supported the above data. In conclusion, POU2F2 promotes fracture healing via activating the HMGA1/Wnt/ß-catenin signaling pathway.


Assuntos
Consolidação da Fratura , Proteína HMGA1a/metabolismo , Fator 2 de Transcrição de Octâmero/metabolismo , Transdução de Sinais , Via de Sinalização Wnt , beta Catenina/metabolismo , Animais , Biomarcadores/metabolismo , Humanos , Ratos
9.
Ultraschall Med ; 41(1): 44-51, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30081395

RESUMO

PURPOSE: To assess the value of CEUS in the evaluation of tibial fracture perfusion and its ability to differentiate between physiologic and abnormal fracture healing. MATERIALS AND METHODS: From 2014 to 2017, 107 patients with tibial fractures or tibial non-unions underwent CEUS examination. CEUS was performed at the regular follow-up examination 26 weeks after osteosynthesis or before non-union surgery. Time-intensity curves (TICs) of the contrast enhancement in the fracture gap were generated, and volume parameters such as wash-in rate (WiR), peak enhancement (PE) and wash-in perfusion index (WiPI) were quantified. RESULTS: A total of 34 patients met the inclusion criteria of this study, including 14 consolidated fractures, 12 aseptic non-unions and 8 infected non-unions. WiR, PE and WiPI showed significantly lower values in aseptic non-unions compared to unions (p = 0.009, 0.009, 0.012, resp.). In contrast, infected non-unions showed higher values of WiR, PE and WiPI when compared to unions (p = 0.034, 0.056, 0.029, resp.). CONCLUSION: CEUS represents a feasible method in the assessment of tibial fracture perfusion. Perfusion differences between aseptic and infected tibial non-unions as well as healing tibial fractures could be detected. The deviation of physiologic fracture perfusion seems to be associated with disturbed osseous regeneration leading to non-union.


Assuntos
Meios de Contraste , Fraturas Mal-Unidas , Fraturas da Tíbia , Consolidação da Fratura , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , Perfusão , Fraturas da Tíbia/diagnóstico por imagem , Ultrassonografia/métodos
10.
Orthop Clin North Am ; 51(1): 65-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739880

RESUMO

Surgical strategies for scaphoid nonunions become more complex based on time from injury to treatment. The decision-making process, however, can follow a logical sequence. Scaphoid nonunions less than 1 year after trauma and no carpal malalignment can be treated with percutaneous screw fixation under fluoroscopic and/or arthroscopic guidance. Reinterventions or patients with avascular proximal poles that do not need substantial grafts are reliably treated with pedicle vascularized bone grafts. Resection of the distal pole of the scaphoid is a good option in old nonunions or after a failed scaphoid procedures. When there are radioscaphoid degenerative changes, salvage procedures such as proximal row carpectomy (PRC) should be considered.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Osteonecrose/cirurgia , Osso Escafoide/lesões , Artroscopia/métodos , Transplante Ósseo/métodos , Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/classificação , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Osteonecrose/epidemiologia , Osteonecrose/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Estudos Retrospectivos , Osso Escafoide/irrigação sanguínea , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/patologia , Resultado do Tratamento , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem
11.
Vet Clin North Am Small Anim Pract ; 50(1): 1-15, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31635916

RESUMO

This article reviews the biomechanical parameters of fracture repair that influence construct stiffness and strength. The stiffness influences the relative motion between fracture fragments, known as gap strain, and, thus, callus development. Construct strength determines the magnitude and number of load events that the repair can resist before failure. Surgeons must optimize these parameters in order to achieve satisfactory outcomes for the patients.


Assuntos
Fixação de Fratura/veterinária , Fraturas Ósseas/veterinária , Animais , Fenômenos Biomecânicos , Osso e Ossos/fisiologia , Consolidação da Fratura/fisiologia
12.
J Pediatr Orthop ; 40(1): 48-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31815862

RESUMO

BACKGROUND: Evaluation of the union of osteotomies and fractures in patients with osteogenesis imperfecta (OI) is a critical component of patient care. Studies of the OI patient population have so far used varied criteria to evaluate bony union. The radiographic union score for tibial fractures (RUST), which was subsequently revised to the modified RUST, is an objective standardized method of evaluating fracture healing. We sought to evaluate the reliability of the modified RUST in the setting of the tibias of patients with OI. METHODS: Tibial radiographs of 30 patients with OI fractures, or osteotomies were scored by 3 observers on 2 separate occasions. Each of the 4 cortices was given a score (1=no callus, 2=callus present, 3=bridging callus, and 4=remodeled, fracture not visible) and the modified RUST is the sum of these scores (range, 4 to 16). The interobserver and intraobserver reliabilities were evaluated using intraclass coefficients (ICC) with 95% confidence intervals. RESULTS: The ICC representing the interobserver reliability for the first iteration of scores was 0.926 (0.864 to 0.962) and for the second series was 0.915 (0.845 to 0.957). The ICCs representing the intraobserver reliability for each of the 3 reviewers for the measurements in series 1 and 2 were 0.860 (0.707 to 0.934), 0.994 (0.986 to 0.997), and 0.974 (0.946 to 0.988). CONCLUSIONS: The modified RUST has excellent interobserver and intraobserver reliability in the setting of OI despite challenges related to the poor quality of the bone and its dysplastic nature. The application and routine use of the modified RUST in the OI population will help standardize our evaluation of osteotomy and fracture healing. LEVEL OF EVIDENCE: Level III-retrospective study of nonconsecutive patients.


Assuntos
Consolidação da Fratura , Osteogênese Imperfeita/fisiopatologia , Fraturas da Tíbia/diagnóstico por imagem , Adolescente , Pré-Escolar , Feminino , Humanos , Variações Dependentes do Observador , Osteogênese Imperfeita/complicações , Osteogênese Imperfeita/cirurgia , Osteotomia , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Adulto Jovem
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1467-1473, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823542

RESUMO

Objective: To review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation. Methods: The results of the clinical studies about the AP in treatment of femoral shaft nonunion after intramedullary nail fixation in recent years were widely reviewed and analyzed. Results: The AP has been successfully applied to femoral shaft nonunion after intramedullary nail fixation since 1997. According to breakage of the previous nailing, AP is divided into two categories: AP with retaining the previous intramedullary nail and AP with exchanging intramedullary nail. AP is not only suitable for simple nonunion, but also for complex nonunion with severe deformity. Compared with exchanging intramedullary nail, lateral plate, and dual plate, AP has less surgical trauma, shorter healing time, higher healing rate, and faster returning to society. However, there are still some problems with the revision method, including difficulty in bicortical screw fixation, lack of anatomic plate suitable for femoral shaft nonunion, and lack of postoperative function and quality of life assessment. Conclusion: Compared with other revision methods, AP could achieve higher fracture healing rate and better clinical prognosis for patients with femoral shaft nonunion. However, whether patients benefit from AP in terms of function and quality of life remain uncertain. Furthermore, high-quality randomized controlled clinical studies are needed to further confirm that AP are superior to the other revision fixations.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas não Consolidadas , Pinos Ortopédicos , Placas Ósseas , Consolidação da Fratura , Humanos , Qualidade de Vida , Resultado do Tratamento
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1510-1515, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823549

RESUMO

Objective: To compare the postoperative tibial malrotation between traditional minimally invasive plate osteosynthesis (MIPO) and three-dimensional printing-assisted MIPO (3D-MIPO) for different types of tibial fractures, and explore the change of these differences. Methods: A prospective randomized controlled trial was conducted. The 120 patients with unilateral tibial fracture who met the selection criteria between January 2016 and October 2018 (40 patients in each of AO types A, B, and C) into the trial group (20 patients, 3D-MIPO) and the control group (20 patients, traditional MIPO) at ratio of 1∶1. There was no significant difference between the two groups (P>0.05) in gender, age, fracture site, and other general information. The bilateral tibial rotation angles were measured on the CT images within 1 week after operation, and the difference of tibial rotation angle between affected and unaffected sides was calculated. The tibial malrotation was defined when the difference exceeded 10°. The degree of tibial rotation and the incidence of malrotation between the two groups in different types of tibial fractures were compared. Results: Postoperative infection occurred in 1 case, and improved after the dressing change and anti-inflammatory treatment. No complications such as loosening and displacement of internal fixation occurred. There was no significant difference in the difference of bilateral tibial rotation angles between the two groups in type A fractures after operation (t=0.559, P=0.580); while in types B and C fractures, the differences of bilateral tibial rotation angles in control group were significantly higher than those in trial group (P<0.05). There was no significant difference in distribution of internal or external rotation between the two groups in types A, B, and C fractures (P>0.05). No malrotation occurred in type A fractures, and there was no significant difference in the incidence of malrotation between the two groups in type B fractures (P=1.000). The incidence of malrotation in control group was significantly higher than that in trial group in type C fractures (P=0.044). Conclusion: 3D-MIPO has the same anti-malrotation effect as traditional MIPO for type A tibial fracture, but for types B and C tibial fractures, the anti-malrotation effect of 3D-MIPO is significantly better than that of traditional MIPO. The more complex the fracture type is, the more significant this advantage is.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Fraturas da Tíbia , Consolidação da Fratura , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Impressão Tridimensional , Estudos Prospectivos , Resultado do Tratamento
15.
Zhongguo Gu Shang ; 32(11): 997-1002, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870046

RESUMO

OBJECTIVE: To compare application of minimally invasive plate osteosynthesis (MIPO) through two approaches for patients with humeral midshaft fracture, and analyzes the effect on bone metabolic activity and radial nerve injury. METHODS: From April 2014 to May 2017, 76 patients with humeral midshaft fracture treated by MIPO were selected and randomly divided into group A (anterior approache group) and group B (lateral approach group) according to random number stable. In group A, there were 38 patients including 22 males and 16 females, aged from 18 to 74 years old with an average age of(48.21±5.79) years old; 24 patients were caused by traffic accidents, 6 patients were caused by heavy object crushing, 8 patients were caused by falling down; 20 patient were on the right side, 18 patients were on the left side; 15 patients were type A, 17 patients were type B, 6 patients were type C according to AO classification; the patients were treated by MIPO through anterior approach. In group B, there were 38 patients including 23 males and 15 females, aged from 20 to 73 years old with an average age of(48.40±5.81) years old; 26 patients were caused by traffic accidents, 5 patients were caused by heavy object crushing, 7 patients were caused by falling down; 17 patients were on the right side, 21 patients were on the left side; 15 patients were type A, 18 cases were type B, 5 cases were type C according to AO classification; the patients were treated by MIPO through lateral approach. Intraoperative blood loss, operative time, hospital stays, fracture healing time between two groups were compared. Bone gla protein (BGP), collagen C-terminal peptide (CTX) and osteoprotegerin (OPG) were tested before and after operation. The incidence of radial nerve injury after operation was observed. RESULTS: All patients were followed-up from 12 to 18 months with an average of (15.4±2.1) months. There were no statistical differences in operative time, intraoperative blood loss between two groups. Hospital stays, fracture healing time in group A were(6.52±1.81) d, (13.27±3.01) weeks respectively, while in group B were(9.61±1.99) d, (14.83±3.08) weeks; and had differences between two groups. There were no differences in BGP, OPG and CTX, BGP between two groups and OPG in group A at 1 month after operation were(7.10±0.58) ng/ml, (173.67±9.12) pg/ml and higher than that of group B(6.63±0.62) ng/ml, (152.80±9.23) pg/ml; while CTX in group A (224.52±12.67) µg/ml was lower than that of group B(259.13±13.54) µg/ml(P<0.05). No patient occurred radial nerve injury in group A, 4 patients occurred radial nerve injury in group B, and had statistical differences between two groups(χ²=4.220, P<0.05). CONCLUSIONS: Compared with lateral approach, anterior approach has much more effective in minimally invasive MIPO for humeral shaft fractures, which could improve bone metabolism and reduce risk of radial nerve injury.


Assuntos
Fraturas do Úmero , Nervo Radial , Adolescente , Adulto , Idoso , Placas Ósseas , Feminino , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Úmero , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Resultado do Tratamento , Adulto Jovem
16.
Zhongguo Gu Shang ; 32(11): 1014-1020, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870049

RESUMO

OBJECTIVE: To compare clinical effect of modified anterolateral approach combined with modified posteromedial approach and conventional posterolateral approach combined with medial-aided in treating trimalleolar fractures. METHODS: From January 2015 to August 2017, 108 patients with trimalleolar fractures were enrolled and randomly divided into modified approaches (experimental group) and conventional approaches(control group). There were 53 patients in experimental group including 31 males and 22 females aged from 18 to 67 years old with an average of(40.2±16.4) years old; 19 patients on the left side and 34 patients on the right side; 39 patients were supination external rotation and 14 patients were pronation-external rotation; preoperative waiting time ranged from 6 to 14 d with an average of(9.6±3.1) d; performed operation through modified anterolateral approach combined with modified posteromedial approach. There were 55 patients in control group, including 34 males and 21 females aged from 19 to 69 years old with an average of (42.1±15.3) years old; 18 patients on the left side and 37 patients on the right side; 42 patients were supination external rotation and 13 patients were pronation-external rotation; preoperative waiting time ranged from 7 to 16 d with an average of (10.3±3.4) d; performed operation through conventional posterolateral approach combined with medial-aided. Operation time, intraoperative blood loss, postoperative drainage volume, cases of incision complications and excellent-good reduction, fracture healing time, cases of nerve injury and muscular flexor contracture, cases of incision complications between two groups were compared; AOFAS score were used to evaluate clinical efficacy at 1 year after operation. RESULTS: All patients were followed up from 12 to 24 months with an average of (16.4 ±7.5) months. Operation time, intraoperative blood loss, postoperative drainage volume and incision complication in experimental group were (95.3±22.6) min, (114.7±68.7) ml, (127.5±87.8) ml and 1 case, respectively; while in control group were (112.5±53.8) min, (155.2±79.6) ml, (178.4±73.8) ml and 3 cases respectively; the data in experimental group were better than that of control group. In experimental group, 36 cases got excellent results, 14 good and 3 poor on the quality of reduction, while 30 patients got excellent results, 15 good and 10 poor in control group; the experimental group was better than control group. Fracture healing time in experimental group were(5.5±1.6) months, 2 patients occurred incision complications, while(6.7±2.1) months, 12 patients in control group; the experiment group were better than control group. Postoperative AOFAS score at 12 months in experimental group was 92.9±18.4, and better than control group 80.3±38.3; 32 patients got excellent results, 17 good, 3 moderate and 1 poor in experimental group; 25 patients got excellent results, 18 good, 8 moderate and 4 poor in control group; there was statistical difference between two groups. CONCLUSIONS: Both of modified anterolateral approach combined with modified posteromedial approach and conventional posterolateral approach combined with medial-aided in treating trimalleolar fractures could receive good clinical effect. While compared with conventional posterolateral approach combined with medial-aided, modified anterolateral approach combined with modified posteromedial approach is more fit for blood supply of local soft tissue, and has advantages of less trauma, safety operation and clearly exposure.


Assuntos
Fraturas do Tornozelo , Adolescente , Adulto , Idoso , Fraturas do Tornozelo/terapia , Estudos de Casos e Controles , Feminino , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Supinação , Resultado do Tratamento , Adulto Jovem
17.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 4049-4054, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31612264

RESUMO

PURPOSE: To determine the management of torsional humeral shaft fractures in a group of expert shoulder and elbow surgeons and analyse the rate of return to sport of these throwing athletes. METHODS: A survey was sent to all physician members of two prominent sports medicine professional associations: the American Shoulder and Elbow Surgeons and the Herodicus Society. Due to the rare nature of this injury, a historical survey of management and return to play was performed to allow analysis of trends in treatment and return to play after both non-operative and operative management. RESULTS: The survey was emailed to 858 physician members. Out of the 95 respondents, 35 surgeons indicated they had treated ≥ 1 torsional humeral shaft fractures in throwing athletes (average 1.7 per surgeon). A total of 72 fractures were recorded with an average age of 20.4 years and the majority being male (68/72). Eighty-one percent (58/72) of the fractures were classified as simple spiral. Sixty-one percent (44/72) of the fractures were treated non-operatively, while 35% (25/72) of the fractures were treated by open reduction and internal fixation (ORIF). Patient age, return to sport rate and level, type of fracture, and fracture healing time did not significantly differ based on treatment type. Average time to return to sport was significantly shorter for patients who underwent ORIF compared to non-operative treatment (p = 0.001). Overall, 48 (92.3%) of the 52 athletes returned to sport, with 84% (36/43) returning to the same level of play. CONCLUSION: Torsional humeral shaft fractures in throwers are most commonly seen in young men and can be treated both operatively and non-operatively with overall similar results for healing time, rate of non-union, and return to sport. The only significant difference in the groups was an earlier return to sports in those fixed surgically, however, operative intervention also yielded a higher complication rate. Regardless of the treatment method, the overall rate of return to play was moderate. These finding are clinically relevant and can assist physicians with decision making for treatment and can help when advising throwers of appropriate expectations for recovery after this injury. LEVEL OF EVIDENCE: IV.


Assuntos
Fraturas do Úmero/terapia , Padrões de Prática Médica/estatística & dados numéricos , Volta ao Esporte , Adolescente , Adulto , Braquetes/estatística & dados numéricos , Criança , Feminino , Fixação Interna de Fraturas/estatística & dados numéricos , Consolidação da Fratura , Fraturas Fechadas/terapia , Humanos , Imobilização/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Redução Aberta/estatística & dados numéricos , Modalidades de Fisioterapia , Cuidados Pós-Operatórios , Inquéritos e Questionários , Adulto Jovem
18.
Orthopedics ; 42(6): e532-e538, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31587078

RESUMO

The objective of this study was to review the efficacy of a treatment approach for patients with positive intraoperative cultures during fracture nonunion surgery. The authors performed a retrospective case series at a level I trauma center. In this series, 60 patients without preoperative concern for infection were surgically treated for fracture nonunion. The treatment course of patients after fracture nonunion surgery, including culture results, antibiotic administration, and the presence of clinical infection and radiographic union, was studied. Sixty patients underwent fracture nonunion surgery. Twenty-four patients had a positive intraoperative culture. Fourteen patients had only a positive broth culture, 6 had only a positive routine culture, and 4 had positive mixed (routine and broth) cultures. The most common bacteria was coagulase-negative staphylococci, isolated in 19 of 24 patients, and the only isolated organism in 13 of 24 patients. Patients with a positive broth culture were not treated with antibiotics. Four of 10 patients with either a positive routine or mixed culture grown within 3 days of surgery were treated with antibiotics. All patients achieved clinical healing without signs of infection, and all but 2 patients achieved radiographic union at a mean follow-up of approximately 5 years. In the setting of fracture nonunion surgery, patients with only a positive broth culture and those with only a positive routine or mixed cultures that grew in a delayed fashion (>3 days postoperatively) did not require antibiotic treatment to achieve healing. [Orthopedics. 2019; 42(6):e532-e538.].


Assuntos
Antibacterianos/uso terapêutico , Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/cirurgia , Staphylococcus/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
19.
J Bone Joint Surg Am ; 101(19): 1761-1767, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577681

RESUMO

BACKGROUND: Isolated femoral and tibial fractures are 2 of the top 5 causes of pediatric orthopaedic hospital admission, yet their simultaneous ipsilateral presentation, the "floating knee" injury, remains rare. Historically, treatment consisted of traction and cast immobilization, which resulted in prolonged periods of immobilization, lengthy hospitalizations, and high rates of malunion. As such, previous authors have recommended fixation of at least 1 bone in the setting of a floating knee injury. This strategy, however, has never been evaluated and the outcomes of modern treatment are unknown. METHODS: We performed a multicenter retrospective review of the records of pediatric patients with ipsilateral femoral and tibial fractures that had been treated at 11 tertiary care level-I pediatric trauma centers from 2004 to 2014. Outcomes and treatment strategies were assessed with standardized means. RESULTS: Over the study period, 130 floating knees in 129 patients met the inclusion criteria for evaluation. The average patient age was 10.2 years, and 63.1% were male. One-third of the patients presented with open injuries, and 83.8% of injuries were related to vehicular trauma. Simple diaphyseal fractures (OTA/AO 32-A and B femoral fractures and OTA/AO 42-A and B tibial fractures) were most common. Intramedullary fixation (rigid or flexible) was the most common treatment strategy for femoral fractures (69.2%). Tibial fractures were treated most commonly with casting (27.7%), followed by flexible intramedullary nailing (24.6%). The mean duration of hospitalization was 9.7 days. Outcomes were excellent in 66.6% of cases and good in 26.4% of cases. CONCLUSIONS: Previous literature on pediatric floating knee injuries consisted of small case series that were published prior to the introduction of flexible intramedullary nailing to North America. This multicenter study of a large cohort demonstrates a change in practice pattern from a largely nonoperative treatment strategy to operative fixation of at least the femoral fracture. In the present study, this approach led to good or excellent results in 93.1% of cases and was associated with a short duration of hospitalization. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Moldes Cirúrgicos , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Traumatismos do Joelho/cirurgia , Fraturas da Tíbia/cirurgia , Acidentes de Trânsito , Criança , Feminino , Fraturas do Fêmur/fisiopatologia , Consolidação da Fratura/fisiologia , Humanos , Traumatismos do Joelho/fisiopatologia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fraturas da Tíbia/fisiopatologia , Resultado do Tratamento
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(11): 1394-1398, 2019 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-31650755

RESUMO

Objective: To investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults. Methods: Between March 2016 and January 2018, 20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing. There were 13 cases and 7 cases, with an average age of 43 years (range, 18-56 years). The causes of injury included the traffic accident in 6 cases, falling in 12 cases, and falling from height in 2 cases. The interval between injury and admission ranged from 1 hour to 2 days (mean, 3.2 hours). The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases. The length of incision, the operation time, the visual analogue scale (VAS) score on the 2nd day after operation, the fracture healing time, the postoperative shoulder function and the Disability of Arm Shoulder and Hand (DASH) score, the complications, and the time of second surgical removal of internal fixator and incision length were recorded. Results: The length of incision was 2-6 cm (mean, 4.7cm). The operation time was 45-120 minutes (mean, 77.2 minutes). The VAS score was 1-5 (mean, 3.2) on the 2nd day after operation. All incisions healed by first intention and no infection or nerve injury occurred. All patients were followed up 12-32 months (mean, 18.6 months). All fractures healed with the healing time of 10-15 weeks (mean, 12.1 weeks). The Constant score was 92-98 (mean, 96.3) and DASH score was 0-6.4 (mean, 3.1). The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation. The internal fixators were removed at 12-26 months (mean, 14.6 months) after operation. And the length of incision was 1-2 cm (mean, 1.3 cm) and the operation time was 5-15 minutes (mean, 9.0 minutes). Conclusion: For the midshaft clavicular fracture in adults, the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision, light pain, rapid fracture healing, small secondary operation injury, and avoiding the risk of clavicular epithelial nerve injury, and can obtain good effectiveness.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas , Fraturas Ósseas , Adolescente , Adulto , Clavícula , Consolidação da Fratura , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
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