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1.
Bone Joint J ; 101-B(10): 1263-1271, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564142

RESUMO

AIMS: The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires. PATIENTS AND METHODS: This was a multicentre, parallel group, randomized controlled noninferiority trial conducted at 12 tertiary trauma centres in Germany. A total of 290 patients with acute displaced fractures of the fifth metacarpal neck were randomized to either intramedullary single-wire (n = 146) or dual-wire fixation (n = 144). The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire six months after surgery, with a third of the minimal clinically important difference (MCID) used as the noninferiority threshold. Secondary outcomes were pain, health-related quality of life (EuroQol five-dimensional questionnaire (EQ-5D)), radiological measures, functional deficits, and complications. RESULTS: Overall, 151/290 of patients (52%) completed the six months of follow-up, leaving 83 patients in the single-wire group and 68 patients in the dual-wire group. In the modified intention-to-treat analysis set, mean DASH scores six months after surgery were 3.8 (sd 7.0) and 4.4 (sd 9.4), respectively. With multiple imputation (n = 288), mean DASH scores were estimated at 6.3 (sd 8.7) and 7.0 (sd 10.0). Upper (1 - 2α)) confidence limits consistently remained below the noninferiority margin of 3.0 points in the DASH instrument. While there was a statistically nonsignificant trend towards a higher rate of shortening and rotational malalignment in the single wire group, no statistically significant differences were observed across groups in any secondary outcome measure. CONCLUSION: A single thick K-wire is sufficient for intramedullary fixation of acute displaced subcapital fractures of the fifth metacarpal neck. The less technically demanding single-wire technique produces noninferior clinical and radiological outcomes compared with the dual-wire approach. Cite this article: Bone Joint J 2019;101-B:1263-1271.


Assuntos
Fios Ortopédicos , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Ossos Metacarpais/lesões , Adulto , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Alemanha , Força da Mão/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Ossos Metacarpais/cirurgia , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Amplitude de Movimento Articular/fisiologia , Medição de Risco
2.
Bone Joint J ; 101-B(10): 1307-1312, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564143

RESUMO

AIMS: In order to determine whether and for whom serial radiological evaluation is necessary in one-part proximal humerus fractures, we set out to describe the clinical history and predictors of secondary displacement in patients sustaining these injuries. PATIENTS AND METHODS: Between January 2014 and April 2016, all patients with an isolated, nonoperatively treated one-part proximal humerus fracture were prospectively followed up. Clinical and radiological evaluation took place at less than two, six, 12, and 52 weeks. Fracture configuration, bone quality, and comminution were determined on the initial radiographs. Fracture healing, secondary displacement, and treatment changes were recorded during follow-up. RESULTS: In 100 patients (59 female, 41 male; mean age 57 years), 91 of the fractures (91%) remained stable. In five of nine patients (55%) with secondary displacement, surgery was recommended. Comminution, present in 23 patients (23%), was identified as a predictor of secondary displacement (p < 0.001). Patients' age, sex, fracture configuration, and bone quality were not associated with secondary displacement (p ≥ 0.438). Nonoperative treatment resulted in a mean absolute Constant score (CS) of 80 (49 to 98), relative CS of 101% (63% to 138%), median subjective shoulder value of 95% (interquartile range (IQR) 90% to 100%), and median EuroQol five-dimensional questionnaire score of 0.89 (IQR 0.80 to 1.00) with bone union in all cases at one-year follow-up. CONCLUSION: Radiological re-evaluation was only necessary in patients presenting with comminution and may be redundant for 77% of patients with one-part proximal humerus fractures. Nonoperative treatment of one-part proximal humerus fractures remains the mainstay of treatment with a low rate of secondary surgery, a high union rate, and good clinical results. Cite this article: Bone Joint J 2019;101-B:1307-1312.


Assuntos
Tratamento Conservador/métodos , Consolidação da Fratura/fisiologia , Radiografia/estatística & dados numéricos , Sistema de Registros , Fraturas do Ombro/diagnóstico por imagem , Procedimentos Desnecessários/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Fixação de Fratura/métodos , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Fraturas do Ombro/terapia , Estatísticas não Paramétricas , Fatores de Tempo
3.
Bone Joint J ; 101-B(10): 1292-1299, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564146

RESUMO

AIMS: This study explores data quality in operation type and fracture classification recorded as part of a large research study and a national audit with an independent review. PATIENTS AND METHODS: At 17 centres, an expert surgeon reviewed a randomly selected subset of cases from their centre with regard to fracture classification using the AO system and type of operation performed. Agreement for these variables was then compared with the data collected during conduct of the World Hip Trauma Evaluation (WHiTE) cohort study. Both types of surgery and fracture classification were collapsed to identify the level of detail of reporting that achieved meaningful agreement. In the National Hip Fracture Database (NHFD), the types of operation and fracture classification were explored to identify the proportion of "highly improbable" combinations. RESULTS: The records were reviewed for 903 cases. Agreement for the subtypes of extracapsular fracture was poor; most centres achieved no better than "fair" agreement. When the classification was collapsed to a single option for "extracapsular" fracture, only four centres failed to have at least "moderate" agreement. There was only "moderate" agreement for the subtypes of intracapsular fracture, which improved to "substantial" when collapsed to "intracapsular". Subtrochanteric fracture types were well reported with "substantial" agreement. There was near "perfect" agreement for internal fixation procedures. "Perfect" or "substantial" agreement was achieved when the type of arthroplasty surgery was reported at the level of "hemiarthroplasty" and "total hip replacement". When reviewing data submitted to the NHFD, a minimum of 5.2% of cases contained "highly improbable" procedures for the stated fracture classification. CONCLUSION: The complexity of collecting fracture classification data at a national scale compromises the accuracy with which detailed classification systems can be reported. Data around type of surgery performed show similar tendencies. Data capture, reporting, and interpretation in future studies must take this into account. Cite this article: Bone Joint J 2019;101-B:1292-1299.


Assuntos
Artroplastia de Quadril/métodos , Fixação Interna de Fraturas/métodos , Hemiartroplastia/métodos , Fraturas do Quadril/classificação , Fraturas do Quadril/cirurgia , Reoperação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Estudos de Coortes , Confiabilidade dos Dados , Inglaterra , Feminino , Fixação Interna de Fraturas/efeitos adversos , Consolidação da Fratura/fisiologia , Hemiartroplastia/efeitos adversos , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Amplitude de Movimento Articular/fisiologia , Reoperação/métodos , Resultado do Tratamento , País de Gales
4.
Bone Joint J ; 101-B(10): 1300-1306, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564159

RESUMO

AIMS: The primary aim of this study was to develop a reliable, effective radiological score to assess the healing of humeral shaft fractures, the Radiographic Union Score for HUmeral fractures (RUSHU). The secondary aim was to assess whether the six-week RUSHU was predictive of nonunion at six months after the injury. PATIENTS AND METHODS: Initially, 20 patients with radiographs six weeks following a humeral shaft fracture were selected at random from a trauma database and scored by three observers, based on the Radiographic Union Scale for Tibial fractures system. After refinement of the RUSHU criteria, a second group of 60 patients with radiographs six weeks after injury, 40 with fractures that united and 20 with fractures that developed nonunion, were scored by two blinded observers. RESULTS: After refinement, the interobserver intraclass correlation coefficient (ICC) was 0.79 (95% confidence interval (CI) 0.67 to 0.87), indicating substantial agreement. At six weeks after injury, patients whose fractures united had a significantly higher median score than those who developed nonunion (10 vs 7; p < 0.001). A receiver operating characteristic curve determined that a RUSHU cut-off of < 8 was predictive of nonunion (area under the curve = 0.84, 95% CI 0.74 to 0.94). The sensitivity was 75% and specificity 80% with a positive predictive value (PPV) of 65% and a negative predictive value of 86%. Patients with a RUSHU < 8 (n = 23) were more likely to develop nonunion than those with a RUSHU ≥ 8 (n = 37, odds ratio 12.0, 95% CI 3.4 to 42.9). Based on a PPV of 65%, if all patients with a RUSHU < 8 underwent fixation, the number of procedures needed to avoid one nonunion would be 1.5. CONCLUSION: The RUSHU is reliable and effective in identifying patients at risk of nonunion of a humeral shaft fracture at six weeks after injury. This tool requires external validation but could potentially reduce the morbidity associated with delayed treatment of an established nonunion. Cite this article: Bone Joint J 2019;101-B:1300-1306.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Radiografia/métodos , Adulto , Fatores Etários , Tratamento Conservador/métodos , Bases de Dados Factuais , Feminino , Seguimentos , Fixação de Fratura/métodos , Fraturas não Consolidadas/cirurgia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Curva ROC , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo
5.
Acta Cir Bras ; 34(7): e201900702, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531537

RESUMO

PURPOSE: To investigate the effect of intermittent vibration at different intervals on bone fracture healing and optimize the vibration interval. METHODS: Ninety sheep were randomized to receive no treatment (the control group), incision only (the sham control group), internal fixation with or without metatarsal fracture (the internal fixation group), and continuous vibration in addition to internal fixation of metatarsal fracture, or intermittent vibration at 1, 2, 3, 5, 7 and 17-day interval in addition to internal fixation of metatarsal fracture (the vibration group). Vibration was done at frequency F=35 Hz, acceleration a=0.25g, 15 min each time 2 weeks after bone fracture. Bone healing was evaluated by micro-CT scan, bone microstructure and mechanical compression of finite element simulation. RESULTS: Intermittent vibration at 7-day interval significantly improved bone fracture healing grade. However, no significant changes on microstructure parameters and mechanical properties were observed among sheep receiving vibration at different intervals. CONCLUSIONS: Clinical healing effects should be the top concern. Quantitative analyses of bone microstructure and of finite element mechanics on the process of fracture healing need to be further investigated.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas Ósseas/diagnóstico por imagem , Ossos do Metatarso/lesões , Vibração/uso terapêutico , Animais , Análise de Elementos Finitos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/normas , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Distribuição Aleatória , Ovinos , Microtomografia por Raio-X
7.
Spine (Phila Pa 1976) ; 44(13): 951-958, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205176

RESUMO

STUDY DESIGN: Retrospective multicenter study. OBJECTIVE: Analysis of impact of conservative and surgical treatments on functional outcome of geriatric odontoid fractures. SUMMARY OF BACKGROUND DATA: Treatment of odontoid fractures in aged population is still debatable. METHODS: One hundred fourty-seven consecutive odontoid fractures in elderly patients were classified according to Anderson-D'Alonzo and Roy-Camille classifications. Philadelphia type collar was always positioned and kept as a treatment whenever acceptable. Halo-vest, anterior screw fixation, C1-C2 posterior arthrodesis, and occipito-cervical fixation were the other treatments adopted. Conservative or surgical treatment strategy was more significantly influenced by antero-posterior displacement (< or >5 mm) and by surgeon decision. On admission ASA, modified Rankin scale (mRS-pre) and Charlson Comorbidity Index (CCI) were assessed. Modified Rankin scale (mRS-post), Neck Disability Index (NDI), and Smiley Webster Pain Scale (SWPS) were administered 12 to 15 months after treatment to estimate functional outcome in terms of general disability, neck-related disability, and ability to return to work/former activity. Risk of treatment crossover was calculated considering factors affecting outcome. Fracture healing process in terms of fusion-stability, no fusion-stability, no fusion-no stability was evaluated at 12 months through a cervical computed tomography (CT) scan. Dynamic cervical spine x-rays were obtained whether necessary. No fusion-stability was considered an adequate treatment goal in our geriatric population. Chi square/Fisher exact test and logistic regression were performed for statistical anal. RESULTS: Overall 67 patients were treated conservatively whereas 80 underwent surgery. Collar was adopted in 45 patients, while anterior odontoid fixation and C1-C2 posterior arthrodesis were preferred for 30 patients each. 79.8% of patients showed good outcomes according to NDI. No significant differences were observed between patients of 65 to 79 years and more than or equal to 80 years (P = 0.81). CCI greatly correlated with mRS-post, with higher indexes in 68.8% of cases characterized by good outcomes (P = 0.05). mRS-pre correlated with NDI (P < 0.000001) and mRS-post (P = 0.04). CCI, mRS-pre, and surgery were associated with worse NDI, while both C1-C2 posterior arthrodesis and occipito-cervical stabilization were associated with worse mRS-post, respectively in 40% and 30% of cases. Younger patients had a higher risk of treatment crossover. CONCLUSION: mRS-pre and CCI provided two independent predictive values respectively for functional outcome and post-treatment disability. Compared with conservative immobilizations, surgery revealed no advantages in the elderly in terms of functional outcome. LEVEL OF EVIDENCE: 3.


Assuntos
Consolidação da Fratura , Processo Odontoide/lesões , Processo Odontoide/cirurgia , Recuperação de Função Fisiológica , Fraturas da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Consolidação da Fratura/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Processo Odontoide/diagnóstico por imagem , Medição da Dor/tendências , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
8.
Acta Medica (Hradec Kralove) ; 62(1): 19-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931892

RESUMO

INTRODUCTION: A nightstick fracture is an isolated fracture of the ulnar shaft. Although operative and non-operative treatments have been commonly decided by the degree of displacement of the fracture, still there is a controversy specially in those moderately displaced. Herein we report our experience with nightstick fractures. OBJECTIVE: To evaluate operative and non-operative treatment of nightstick fracture. MATERIALS AND METHODS: We retrospectively reviewed the clinical notes, physiotherapy letters and radiographs of 52 patients with isolated ulnar shaft fractures. Outcome Measurements included radiographic healing, post-operative range of motion and complications. RESULTS: The study included 13 females and 39 males, with a mean age of 26 years [range, 18-93 years]. The mean Follow-up period was 32 months ranged from 12 to 54 months. Ten patients were treated non-operatively; forty-two patients had open reduction and internal fixation including six open fractures. The average wait for surgery was 2.5 days. Mobilisation was commenced immediately after the surgeries non-load bearing. 40 patients had no complications post-operatively with good outcome and average of four visits follow-up. In the non-operative group, five out ten failed and had a mean follow-up of nine visits. CONCLUSION: Satisfactory outcome is to be expected with open reduction and internal fixation. Fractures with less than 50% displacement should be treated on individual bases, considering; age, pre-morbid functional status, co-morbidities, compliance and associated injuries.


Assuntos
Tratamento Conservador/estatística & dados numéricos , Fixação Interna de Fraturas/estatística & dados numéricos , Consolidação da Fratura/fisiologia , Imobilização/estatística & dados numéricos , Fraturas da Ulna/terapia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/patologia , Adulto Jovem
9.
Medicine (Baltimore) ; 98(9): e14701, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817607

RESUMO

RATIONALE: We present 2 cases of lateral incomplete impending fracture of the femoral neck without trauma in elderly patients taking long-term bisphosphonate (BP) treatment, and we defined it as atypical femoral neck fracture (AFNF). To the best of our knowledge, this is the first report on the follow-up results of AFNF. PATIENT CONCERNS: Patients in both cases had been taking BP drugs for a long time with osteoporosis. The duration of BP treatment was 6 years, and there was no history of repeated stresses. DIAGNOSES: All fractures were linear at the lateral aspect of the mid portion of the femoral neck, and the BMD of the femoral neck was -0.9, and -1.8, respectively. INTERVENTIONS: Internal fixation was performed in both cases (73 years, 68 years) using cannulated screws. OUTCOMES: In both patients who underwent screw fixation, the fracture line started to extend distally at 4 weeks and 2 weeks following surgery. In the 3-month follow-up image, the length of the fracture increased by 20.1 mm and 9.9 mm, respectively. There was a problem with active rehabilitation, and the possibility of revision was also found to be a burden in terms of mortality and cost in older patients. LESSONS: In the case of AFNF, guidelines for treatment should be set in consideration of the decreased bone healing, even when the fracture pattern is simple. Arthroplasty based on a wider indication may be worth considering.


Assuntos
Difosfonatos/efeitos adversos , Fraturas do Colo Femoral/induzido quimicamente , Fraturas do Colo Femoral/cirurgia , Consolidação da Fratura/fisiologia , Idoso , Difosfonatos/uso terapêutico , Feminino , Fixação Interna de Fraturas , Humanos , Osteoporose/tratamento farmacológico
10.
Medicine (Baltimore) ; 98(13): e14949, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921194

RESUMO

This study aims to investigate the clinical effect of the combined an additional locking plate with bone graft based on retaining the original intramedullary nail for the treatment of lower limb nonunion.From June 2008 to December 2012, 39 patients were admitted and treated, who developed non-infectious bone nonunion after intramedullary nail fixation for long bone fracture in the lower limb. Additional locking plate and autogenous iliac bone grafting were performed for these patients, in which the original intramedullary nail was retained. Follow-ups were performed once at postoperative months 1, 2, 3, 6, and 12, and every year onwards. During these follow-ups, imaging and clinical function examinations were performed, in order to observe callus growth and the fractured limb functions.All patients have been followed-up, in which the duration of these follow-ups ranged between 8 and 24 months. All patients gained bony union within 6 to 11 months, and the healing rate was 100%. Radiographic healing time ranged between 8 and 15 months. Full weight-bearing time ranged between 2 and 10 months. According to Harris hip scores and Hospital for Special Surgery (HSS) Knee joint scores, 17 cases were excellent, 2 cases were good, and 1 case was acceptable; with an excellent and good rate of 95.00%. According to HHS score for the knee, 15 cases were excellent, 3 cases were good, and 1 case was acceptable; with an excellent and good rate of 94.74%.The combined treatment of the additional blocking plate with bone grafting based on retaining the original intramedullary nail for bone nonunion could effectively eliminate lateral and rotatory instability of the fractured ends. This surgical method had a short operation time, high healing rate and other advantages.


Assuntos
Pinos Ortopédicos/normas , Placas Ósseas/normas , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas não Consolidadas/cirurgia , Extremidade Inferior/cirurgia , Adolescente , Adulto , Assistência ao Convalescente , Transplante Ósseo/métodos , Transplante Ósseo/normas , Terapia Combinada/métodos , Terapia Combinada/estatística & dados numéricos , Feminino , Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/complicações , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Adulto Jovem
11.
J Foot Ankle Surg ; 58(2): 226-230, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30850094

RESUMO

Open reduction internal fixation (ORIF) is an accepted treatment for displaced tarsometatarsal joint (TMTJ) fracture dislocations. In general, hardware is routinely removed after 4 months to allow restoration of joint motion and avoid complications of hardware failure. Because few studies report outcomes of TMTJ fractures with retained hardware, there is little consensus regarding the optimal time for hardware removal or if hardware retention leads to adverse outcomes. We retrospectively reviewed the radiographic outcomes of retained hardware after ORIF of TMTJ fractures/dislocations in 61 patients. The mean age at the time of operation was 37.3 ± 14.9 years. ORIF was performed with 3.5 fully threaded cortical screws. Assessment of clinical and radiographic results was performed at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months after surgical treatment. Out of the 61 patients that were included in this study, only 2 demographic variables demonstrated a trend for an adverse outcome. Older age correlated with lost reduction and elevated body mass index correlated with hardware failure. The presence of diabetes was correlated with an increased risk of postoperative infection but not hardware failure. During our follow-up period there were 49 patients (80.3 %) without failure of fixation. In conclusion, our study suggests that routine removal of hardware following open reduction and internal fixation of Lisfranc injuries in patients may not be necessary.


Assuntos
Remoção de Dispositivo/métodos , Traumatismos do Pé/cirurgia , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Articulações Tarsianas/lesões , Adulto , Idoso , Feminino , Traumatismos do Pé/diagnóstico por imagem , Fratura-Luxação/diagnóstico por imagem , Fixação Interna de Fraturas/efeitos adversos , Humanos , Fixadores Internos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Redução Aberta/efeitos adversos , Redução Aberta/métodos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Articulações Tarsianas/diagnóstico por imagem , Articulações Tarsianas/cirurgia , Centros de Atenção Terciária , Centros de Traumatologia , Resultado do Tratamento
12.
J Foot Ankle Surg ; 58(2): 248-252, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30850096

RESUMO

Reduction of calcaneal fractures via a small incision approach at the sinus tarsi is technically difficult. This study was undertaken to determine if preoperative virtual simulation based on computed tomographic data improves reduction and reduces complications. Fifty-five patients with calcaneal fractures were treated via the sinus tarsi approach with minimally invasive plates between February 2013 and December 2015. DICOM files obtained from computed tomographic imaging preoperatively were imported into Superimage software, and virtual surgery was performed. Preoperative planning time, operative time, and complications were recorded. Clinical function was analyzed with radiology and with the American Orthopaedic Foot and Ankle Society and visual analogue scale scores. As a result, preoperative planning time was 30.7 ± 4.1 minutes, which increased with the severity of the fracture (Sanders III vs Sanders II: 34.2 ± 2.5 minutes vs 27.8 ± 2.7 minutes), which was in line with the real surgery, with a mean operative time of 86.7 ± 4.5 minutes (Sanders III vs Sanders II: 89.5 ± 2.7 minutes vs 84.3 ± 4.4 minutes). Radiologic results indicated that the calcaneal width, length, height, Böhler angle, and Gissane angle were significantly corrected from preoperatively to postoperatively. After a mean follow-up of 21.5 ± 6.1 months, no complications were observed. The mean American Orthopaedic Foot and Ankle Society score was 88.7 ± 4.0, with an excellent/good rate of 94.5% (52 of 55). The mean visual analogue scale score was 0.8 ± 0.9. In conclusion, preoperative virtual simulation may be efficient to promote accomplishment of sinus tarsi surgery, and this step may help improve outcomes for calcaneal fractures.


Assuntos
Calcâneo/lesões , Simulação por Computador , Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Calcâneo/cirurgia , China , Estudos de Coortes , Feminino , Seguimentos , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/cirurgia , Consolidação da Fratura/fisiologia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Imagem Tridimensional , Escala de Gravidade do Ferimento , Fraturas Intra-Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
13.
J Foot Ankle Surg ; 58(2): 328-332, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30850102

RESUMO

This study aims to compare outcomes of open reduction and internal fixation (ORIF) and primary arthrodesis in management of Lisfranc injuries. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, a systematic review was carried out. MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched to identify both randomised controlled trials (RCTs) and nonrandomised studies comparing the outcomes of ORIF and primary arthrodesis for Lisfranc injuries. Random- and fixed-effect statistical models were applied to calculate the pooled outcome data. Two RCTs and 3 observational studies were identified, compiling a total of 187 subjects with acute Lisfranc injuries and a mean follow-up duration of 62.3 months. Our results demonstrate that ORIF is associated with a significantly higher need for revision surgery (odds ratio [OR] 6.37, 95% confidence interval [CI] 2.68 to 15.11, p < .0001) and a significantly higher rate of persistent pain (OR 6.29, 95% CI 1.07 to 36.89, p = .04) compared with primary arthrodesis. However, we found no significant difference between the groups in terms of visual analogue scale pain score, American Orthopaedic Foot & Ankle Society functional score, or rates of infection. Separate analysis of RCTs showed that ORIF was associated with a more frequent need for revision surgery (OR 17.56, 95% CI 5.47 to 56.38, p < .00001), higher visual analogue scale pain score (mean difference 2.90, 95% CI 2.84 to 2.96, p < .00001), and lower American Orthopaedic Foot & Ankle Society score (mean difference -29.80, 95% CI -39.82 to -19.78, p < .00001). The results of the current study suggest that primary arthrodesis may be associated with better pain and functional outcomes and lower need for revision surgery compared with ORIF. The available evidence is limited and is not adequately robust to make explicit conclusions. The current literature requires high-quality and adequately powered RCTs.


Assuntos
Artrodese/métodos , Fixação Interna de Fraturas/métodos , Ossos do Metatarso/cirurgia , Redução Aberta/métodos , Ossos do Tarso/cirurgia , Artrodese/efeitos adversos , Feminino , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/cirurgia , Consolidação da Fratura/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Ossos do Metatarso/lesões , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/métodos , Reoperação/estatística & dados numéricos , Medição de Risco , Ossos do Tarso/lesões
15.
Sensors (Basel) ; 19(4)2019 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-30813465

RESUMO

Vibrational characteristics of bone are directly dependent on its physical properties. In this study, a vibrational method for bone evaluation is introduced. We propose a new type of quantitative vibro-acoustic method based on the acoustic radiation force of ultrasound for bone characterization in persons with fracture. Using this method, we excited the clavicle or ulna by an ultrasound radiation force pulse which induces vibrations in the bone, resulting in an acoustic wave that is measured by a hydrophone placed on the skin. The acoustic signals were used for wave velocity estimation based on a cross-correlation technique. To further separate different vibration characteristics, we adopted a variational mode decomposition technique to decompose the received signal into an ensemble of band-limited intrinsic mode functions, allowing analysis of the acoustic signals by their constitutive components. This prospective study included 15 patients: 12 with clavicle fractures and three with ulna fractures. Contralateral intact bones were used as controls. Statistical analysis demonstrated that fractured bones can be differentiated from intact ones with a detection probability of 80%. Additionally, we introduce a "healing factor" to quantify the bone healing progress which successfully tracked the progress of healing in 80% of the clavicle fractures in the study.


Assuntos
Consolidação da Fratura/fisiologia , Ultrassonografia/métodos , Adolescente , Criança , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Projetos Piloto
16.
Eur J Trauma Emerg Surg ; 45(2): 181-189, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30725152

RESUMO

The number of geriatric patients is increasing. These patients exhibit specific characteristics, which influence the type of fracture care. Many patients have comorbidities, which make them more vulnerable to surgical procedures. The soft tissue envelope around the fracture often is compromised due to pre-existing diseases such as diabetes, chronic venous insufficiency or peripheral vascular disease. Bone mineral density has decreased, which enhances the risk of implant loosening. The goals of treatment differ from those, which are valid for younger adults. Primary goal is preserving independency of the elderly patient in his activities of daily life. Advantages and drawbacks of surgical procedures have to be balanced with those of conservative treatment. Fractures of the lower extremities will more often need surgical treatment than fractures of the upper extremities. Patient´s autonomy is best obtained by creating high stability in the fracture plane, which enables motion and weight-bearing. Second priority is prevention of general and local post-operative complications by the use of less invasive surgical procedures. Restoring anatomy and optimal function are less important goals. The implants, which are used, are inserted through small incisions, placed deep under the skin and use long anatomic or osseous corridors. Intramedullary devices have important advantages. This paradigm shift takes the special challenges and requirements of geriatric patients into account.


Assuntos
Tratamento Conservador/estatística & dados numéricos , Fixação Intramedular de Fraturas/estatística & dados numéricos , Geriatria , Fraturas por Osteoporose/terapia , Complicações Pós-Operatórias/fisiopatologia , Lesões dos Tecidos Moles/terapia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Consolidação da Fratura/fisiologia , Geriatria/tendências , Humanos , Fraturas por Osteoporose/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Lesões dos Tecidos Moles/fisiopatologia , Resultado do Tratamento
17.
Injury ; 50(3): 811-813, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30739761

RESUMO

Fractures of the medial comminuted clavicle are rare injuries but are associated with significant morbidity and mortality. Although rare, such injuries deserve rapid diagnosis and effective treatment to avoid future complications. An optimal, standardized operative treatment has not yet been established. We presented a medial-end comminuted clavicle fracture and demonstrated successful results using a bridging plate technique across the sternum maintaining reduction and achieving union. We aim to provide an alternative technique to fix a displaced periarticular medial clavicle fracture, which we believe is simple, safer and promising.


Assuntos
Clavícula/cirurgia , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Ósseas/cirurgia , Fraturas Cominutivas/cirurgia , Acidentes por Quedas , Placas Ósseas , Clavícula/diagnóstico por imagem , Clavícula/lesões , Clavícula/fisiopatologia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
18.
Injury ; 50(3): 777-783, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30772050

RESUMO

INTRODUCTION: This is a retrospective study that evaluate the outcome of patients with extremity sarcoma between extramedullary plate and intramedullary nailing for the biological reconstruction after tumor resection. METHODS: 58 patients (40 treated with plate fixation and 18 with intramedullary nailing, IM group) with sarcomas of the lower and upper extremity who received biological reconstruction at our bone tumor center from November 2003 to November 2015 were reviewed for the study. There were 29 male and 29 female patients with a mean age of 20.8 years (range, 5-72 years). The mean follow-up duration was 90.8 months (range, 12.2-244.4 months). All data were obtained from the clinical, radiograph records and follow-up information. The analysis of outcome, survival, local recurrence, function and complications of patients in the plate group and IM group was performed. RESULTS: 28 cases in the plate group lived at the last follow-up, of which 26 had no evidence of disease, 2 lived with the pulmonary metastasis, whereas 15 in the IM group lived at the last follow-up, of which all had no evidence of disease and no lived with the pulmonary metastasis. There was no significant difference between the two groups for the prognosis. Meanwhile, there was no significant difference of incidence of nonunion, graft fracture and fixation breakage between the two groups, whereas the time to diaphysis union in the plate group (11.6 ± 2.7 months) was shorter than that in IM group (14.7 ± 4.8 months, P = 0.015). It had the tendency that the time to mechanical complications in the intramedullary nailing group (38.1 ± 39.6 months) was longer than that in the plate group (15.7 ± 13.4 months, P = 0.058,95% CI,-45.6-0.8). Furthermore, the infection occurred in 12 cases and five grafts of them developed the deep infection and the mean time to deep infection was 14.8 ± 20.5 months. Furthermore, the incidence of local recurrence for the patients who had plate fixation was similar to the incidence of patients who had nailing fixation. At the last follow-up, the functional evaluation was performed for 39 patients. There was no significant difference in MSTS and VAS functional score for patients between in the plate group (n = 32) and IM group (n = 7). CONCLUSIONS: The findings of the present study showed that intramedullary nailing does not improve the union rate or decrease the incidence of mechanical complications for patients with extremity sarcoma after biological reconstruction. However, intramedullary nailing may have potential advantages on the service life for the biological reconstruction after extremity sarcoma resection.


Assuntos
Extremidades/cirurgia , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Espontâneas/cirurgia , Sarcoma/cirurgia , Adolescente , Adulto , Idoso , Pinos Ortopédicos , Placas Ósseas , Criança , Extremidades/diagnóstico por imagem , Extremidades/patologia , Feminino , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Radiografia , Estudos Retrospectivos , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Resultado do Tratamento , Adulto Jovem
19.
Injury ; 50(3): 690-696, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30792004

RESUMO

OBJECTIVE: Fracture line of the sacrum always involves the Zone II region because sacral foramina are anatomically and physiologically weak regions of the sacrum. The purpose of this study is to compare the therapeutic effects of a sacroiliac screw and a minimally invasive adjustable plate (MIAP) for Zone II sacral fractures. METHODS: Patients with unilateral Zone II sacral fractures fixed with a unilateral sacroiliac screw or MIAP from August 2009 to January 2016 were recruited into this study and were divided into two groups: group A (sacroiliac screw) and group B (MIAP). Surgical time, blood loss, frequency of intraoperative fluoroscopy, and relative complications were reviewed. Radiographs and CT scans were routinely acquired to evaluate the fracture displacement and reduction quality. Fracture healing was evaluated in the radiographs at each follow-up. Functional outcome was assessed based upon the Majeed scoring system at the final follow-up. RESULTS: Thirty-one patients in group A and thirty-nine patients in group B were included in this study. No significant differences in average surgical time (P = 0.221) or blood loss (P = 0.234) were noted between group A and group B. The mean frequency of intraoperative fluoroscopy was 15.74±2.98 in group A and 6.08±1.94 in group B (P = 0.000). All fractures healed well within four months in all patients, and the healing time exhibited no significant difference between the two groups (P = 0.579). Satisfactory rates of reduction quality and functional outcome were not statistically different between the two groups (P > 0.05). The complication rate was 16.13% (5/31) in group A and 5.13% (2/39) in group B (P = 0.222). CONCLUSION: MIAP has a fixation effect and exhibits reduction potential for Zone II sacral fractures. Favourable radiographic and functional results could be obtained through the MIAP technique, which is easy to conduct without pre-contouring. Compared with the unilateral S1 sacroiliac screw technique, repeated projections and iatrogenic sacral injury can be avoided.


Assuntos
Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/cirurgia , Articulação Sacroilíaca/cirurgia , Adulto , Feminino , Fluoroscopia/estatística & dados numéricos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/lesões , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
20.
Injury ; 50(3): 733-737, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30797542

RESUMO

BACKGROUND AND PURPOSE: To compare the radiological and clinical results of sliding hip screw (SHS) fixation with or without a Trochanteric Support Plate (TSP) on unstable three-or-more-part trochanteric fractures. METHODS: A randomized prospective non blinded study of one hundred patients with trochanteric fractures; Evans-Jensen type 3, 4 and 5, reduced and fixed with SHS. Patients were randomized into two study groups; with or without TSP supplementation ('TSP' and 'NoTSP' groups). Radiologic measurements of the hip in the frontal plane (primary outcome), including fracture movement, nonunion and loss of fixation were measured, as well as pain, ambulation, mobility, institution residence, complications and death, twelve months post operatively (secondary outcomes). RESULTS: At one-year follow-up four patients in the TSP and ten patients in the NoTSP group had either died or been lost in follow-up. Within this period, forty-three fractures healed and three had a loss of fixation in the TSP group; thirty-nine fractures healed and one had a loss of fixation in the NoTSP group. Frontal X-rays showed fracture subsidence on average 1 mm less in the TSP group compared to the NoTSP group. This difference was negligible, as was the difference in all subgroups, in fixation failure/cutout, modified Merle d'Aubigne Postel scores (measuring function and pain), institution residence, complications and death between the groups. INTERPRETATION: This study cannot confirm that TSP has any beneficial effects on unstable three-or-more-part trochanteric fractures. If any effect at all, the difference is most likely slight and clinically irrelevant.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura/fisiologia , Fraturas do Quadril/cirurgia , Instabilidade Articular/cirurgia , Idoso , Parafusos Ósseos , Feminino , Seguimentos , Fixação Interna de Fraturas/mortalidade , Humanos , Instabilidade Articular/diagnóstico por imagem , Masculino , Estudos Prospectivos , Radiografia , Taxa de Sobrevida , Resultado do Tratamento
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