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1.
J Coll Physicians Surg Pak ; 31(9): 1069-1074, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34500523

RESUMO

OBJECTIVE: To determine the efficacy of a sternal wire system in secondary sternal dehiscence after repeat closure of the sternum, following surgical revision after open heart surgery. STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Department of Cardiovascular Surgery, Zonguldak Bülent Ecevit University, Zonguldak, Turkey; and Turkey Yuksek Ihtisas Training and Research Hospital, Turkey, from January 2015 to May 2019. METHODOLOGY: Patients, who underwent open heart surgery with median sternotomy, were included in this retrospective study. The patients were divided into two groups, according to the sternal closure material. The time of the sternal reconstruction surgery, because of sternal dehiscence, fracture, broken sternal wire(s) or cable(s) after the first revision surgery, was noted for each patient. RESULTS: A total of 389 patients were identified. Group 1 included 72 (50%) patients whose sternums were closed with a sternal cable system; and Group 2 included 72 (50%) patients whose sternums were closed with conventional steel wires after propensity matching. The duration of cardiopulmonary bypass, number of intra-aortic balloon pumps used, and number of extracorporeal membrane oxygenators used were significantly higher in Group 1 (p = 0.007, p = 0.034, and p = 0.028, respectively). The number of emergency operations was significantly higher in Group 2 (p = 0.021). There was no significant difference in terms of secondary sternal dehiscence between the groups (p = 0.366). CONCLUSION: Application of the sternal wire system in revisional open heart surgery is not more effective than conventional steel wire at preventing secondary sternal dehiscence. Key Words: Sternal dehiscence, Sternal cable, Sternal wire, Open heart surgery, Postoperative revision.


Assuntos
Esterno , Deiscência da Ferida Operatória , Fios Ortopédicos , Estudos de Casos e Controles , Humanos , Reoperação , Estudos Retrospectivos , Esternotomia/efeitos adversos , Esterno/cirurgia , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/prevenção & controle , Deiscência da Ferida Operatória/cirurgia
2.
BMC Musculoskelet Disord ; 22(1): 775, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511084

RESUMO

BACKGROUND: Management of severely angulated Rockwood and Wilkins' type C (RW-C) thumb metacarpal base fractures in children is challenging. We report experiences of percutaneous leverage reduction and dual antegrade crossing Kirschner (DACK) wire fixation in these fractures, aiming to assess the results using our reduction technique. METHODS: From October 2011 to September 2015, A total of 17 patients with severely angulated RW-C thumb metacarpal base fractures were treated at our hospital. The injured arm, including the entire first ray, was immobilized with a thumb-spica cast for 4-6 weeks and evaluated radiologically and clinically. Percutaneous leverage reduction and DACK wire fixation were successfully performed for 17 patients. No patients were treated with open reduction. 16 patients were followed up for a mean of 32 months (range 24-41 months). The results were assessed using the modified Mayo score. The level of significance was set to be p < 0.05. RESULTS: The patients included 9 girls (56.2%) and 7 boys (43.8%), with an average age of 10.8 years (range 7.5 to 14.0 years). Percutaneous leverage reduction and DACK wire fixation were successfully performed within an average total surgery time of 20 min (range 12-32 min). Bone union was achieved in all patients within a mean time of 4.2 weeks (range 4-6 weeks). The average angulation (preoperation: 50.5° (range 40.8°-67.0°) vs postoperation: 5.0° (range 0.0°-7.0°)) significantly changed from pre to post-surgery (P < 0.05). The clinical outcomes were evaluated by the modified Mayo score: 15 patients had an excellent outcome, and one patient had a good outcome. Cosmetic results were described as good and satisfactory by all patients. There were no refractures and no incidences of nonunion, growth arrest in the proximal epiphysis. Only one patient suffered from a superficial infection, which was resolved after the removal of the k-wires and the administration of oral antibiotics. CONCLUSION: Our percutaneous leverage technique with DACK wire fixation can be successfully used to treat these fractures. This technique is simple to learn and minimally invasive, and the results are satisfactory. It may be an appropriate choice for the treatment of irreducible RW-C fractures.


Assuntos
Fraturas Ósseas , Ossos Metacarpais , Adolescente , Fios Ortopédicos , Criança , Epífises , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Ossos Metacarpais/diagnóstico por imagem , Ossos Metacarpais/cirurgia , Polegar/diagnóstico por imagem , Polegar/cirurgia , Resultado do Tratamento
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(8): 994-999, 2021 Aug 15.
Artigo em Chinês | MEDLINE | ID: mdl-34387428

RESUMO

Objective: To compare the effectiveness of improved and traditional Kirschner wire tension band fixation in treatment of type C patellar fractures. Methods: Between January 2017 and January 2019, 26 patients with type C patellar fractures were treated with improved Kirschner wire tension band fixation (group A), and 24 patients were treated with traditional Kirschner wire tension band fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, and side and type of fracture between 2 groups ( P>0.05). The operation time, intraoperative blood loss, the visual analogue scale (VAS) scores at 1 and 3 days after operation, the fracture healing time, and the occurrence of complications (skin irritation of Kirschner wires, failure of internal fixation, fracture reduction loss) were recorded, and the knee function was evaluated by Lysholm scoring standard in 2 groups. Results: The operation time in group A was significantly less than that in group B ( t=-4.742, P=0.000). There was no significant difference in the intraoperative blood loss and VAS scores at 1 and 3 days after operation between 2 groups ( P>0.05). All incisions healed by first intention. All patients were followed up 8-15 months, with an average of 11 months. The fracture healing time was (3.3±0.6) months in group A and (3.2±0.6) months in group B, showing no significant difference ( t=0.589, P=0.559). At last follow-up, the knee joint function was evaluated according to Lysholm scoring standard. And there were 15 cases of excellent, 8 cases of good, and 3 cases of fair, with an excellent and good rate of 88.5% in group A; there were 8 cases of excellent, 7 cases of good, 7 cases of fair, and 2 cases of poor, with an excellent and good rate was 62.5%. The difference between 2 groups was significant ( Z=2.828, P=0.005). The internal fixators were removed after the fracture healed in 2 groups. At last follow-up, no skin irritation of Kirschner wires occurred in group A, but 3 cases in group B. X-ray films reexamination showed that 5 cases of internal fixation failure and no fracture reduction loss were found in group A, while 9 cases of internal fixation failure and 1 case of fracture reduction loss in group B. The incidence of complications in group A was 19.2% (5/26), which was significantly lower than that in group B (54.2%, 13/24) ( χ 2=6.611, P=0.010). Conclusion: Compared with the traditional Kirschner wire tension band fixation, the improved Kirschner wire tension band fixation in treatment of type C patellar fracture can shorten the operation time, reduce the incidence of complications, and benefit the functional recovery of knee joint.


Assuntos
Fraturas Ósseas , Traumatismos do Joelho , Fios Ortopédicos , Fixação Interna de Fraturas , Consolidação da Fratura , Fraturas Ósseas/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(8): 1057-1062, 2021 Aug 15.
Artigo em Chinês | MEDLINE | ID: mdl-34387438

RESUMO

Objective: To review research progress of surgical treatment of patellar fractures. Methods: The domestic and foreign literature about patellar fracture treatment in recent years was extensively consulted, and the advantages, disadvantages, and indications of various surgical treatments were summarized. Results: The patella plays an important role in knee flexion and extension activities, and the fracture significantly affects the patient's quality of life. At present, the surgical methods include open reduction and internal fixation and patella resection. The internal fixation methods include ring/binding patella fixation, tension band wiring and improved technology, tension band wiring combined with other methods, screw fixation (including absorbable screws), steel plate fixation, and patella fixator fixation. Each surgical method has different indications, advantages, and disadvantages. Choosing an appropriate treatment plan plays a crucial role in clinical prognosis. Conclusion: There are many surgical treatments for patellar fractures. In order to improve the effectiveness and reduce postoperative complications, it is necessary to choose the most appropriate treatment strategy for the type of fracture.


Assuntos
Fraturas Ósseas , Qualidade de Vida , Parafusos Ósseos , Fios Ortopédicos , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Humanos , Patela/cirurgia
5.
BMC Musculoskelet Disord ; 22(1): 692, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389015

RESUMO

BACKGROUND: Traditional tension band wiring and plate fixation represent the commonest methods for treating olecranon fractures. However, there is no agreement on which method provides the best outcome. The aim of this retrospective study is to compare the outcomes of tension band wiring (TBW) and plate fixation (PF) for treating displaced olecranon fractures. This is the first study to use propensity score matching analysis to compare treatment methods for olecranon fracture. METHOD: A total of 107 patients aged between 18 and 85 had acute isolated and displaced olecranon fractures. The patients were divided into either TBW (n = 49) or PF (n = 58) groups. To conduct propensity score matching for the treatment method (TBW versus PF), 58 patients were analyzed by logistic regression (29 patients in each group). Various demographic and treatment-related variables were examined and analyzed to determine their correlation. RESULTS: Functional effects between two groups are similar (in terms of Mayo Elbow Performance Score (MEPS), the patients' range of elbow motion (ROM) and forearm rotation (RFR), the time return to work (RTW)). The total adverse events rate and metalwork removal events rate are higher in TBW than that in PF. After propensity score matching analysis, similar primary treatment efficacy (indicated by MEPS> 90) in 2 groups and more primary adverse events (indicated by metalwork removal) were perceived in TBW than that in PF. Logistic regression analysis revealed that fracture type was an independent factor that affected the efficacy of a treatment (regression coefficient = - 1.24 < 0, P = 0.03), indicating that fracture severity was inversely proportional to the efficacy of a treatment for olecranon fracture. Furthermore, logistic regression analysis demonstrated that the treatment method was an independent factor that affected metalwork removal of olecranon fracture (regression coefficient 2.38 > 0, OR = 10.77, P < 0.01), indicating that the risk of metalwork removal in the TBW Group was 10.77 times that in the PF Group. CONCLUSION: When initially discussing the surgical approach with patients, physicians should fully weigh the possibility that TBW may lead to a second surgery due to the higher risk of internal fixation removal and that TBW won't yield better functional outcomes than PF .


Assuntos
Articulação do Cotovelo , Olécrano , Fraturas da Ulna , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fios Ortopédicos , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Humanos , Pessoa de Meia-Idade , Olécrano/diagnóstico por imagem , Olécrano/cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/cirurgia , Adulto Jovem
6.
Medicine (Baltimore) ; 100(22): e26173, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087880

RESUMO

ABSTRACT: Closed reduction with percutaneous pin fixation is commonly used to treat pediatric supracondylar humerus fractures. Various pin configurations of varying biomechanical strength have been described. However, to our knowledge, no biomechanical study has focused on pin alignment in the sagittal plane. Our goal was to compare the stability of fixation using 3 different pin constructs: 3 lateral pins diverging in the coronal plane but parallel in the sagittal plane (3LDP), 3 lateral pins diverging in the coronal and sagittal planes (3LDD), and 2 crossed pins (1 medial and 1 lateral).Transverse fractures were made through the olecranon fossa of 48 synthetic humeri, which were then reduced and pinned in the 3LDP, 3LDD, and crossed-pin configurations (16 specimens per group) using 1.6-mm Kirschner wires. The sagittal plane pin spread was significantly greater in the 3LDD group than in the 3LDP group, whereas we found no difference in the coronal plane. Sagittal extension testing was performed from 0° to 20° at 1°/s for 10 cycles using a mechanical torque stand. The torque required to extend the distal fragment 20° from neutral was compared between groups using one-way analysis of variance with multiple comparison post-hoc analysis. P values ≤.05 were considered significant.The 3LDD configuration was more stable than the 3LDP and crossed-pin configurations. The mean torque required to displace the pinned fractures was 5.7 Nm in the 3LDD group versus 4.1 Nm in the 3LDP group and 3.7 Nm in the crossed-pin group (both, P < .01). We found no difference in stability between the 3LDP and crossed-pin groups (P = .45).In a synthetic biomechanical model of supracondylar humerus fracture, sagittal alignment influenced pin construct stability, and greater pin spread in the sagittal plane increased construct stability when using 3 lateral pins. The lateral pin configurations were superior in stability to the crossed-pin configuration.Level of Evidence: Level V.


Assuntos
Pinos Ortopédicos/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Nervo Ulnar/lesões , Adulto , Fenômenos Biomecânicos/fisiologia , Pinos Ortopédicos/estatística & dados numéricos , Fios Ortopédicos , Criança , Redução Fechada/métodos , Fixação Interna de Fraturas/efeitos adversos , Humanos , Doença Iatrogênica , Modelos Anatômicos , Torque
7.
J Card Surg ; 36(9): 3085-3091, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34133049

RESUMO

BACKGROUND: Sternal complications are common following transverse thoracosternotomy in patients undergoing bilateral lung transplantation. We present a single-institution experience using a next generation rigid fixation system for primary sternal closure following transverse sternotomy for bilateral lung transplantation. METHODS: Retrospective review was performed on all patients who had bilateral sequential lung transplants utilizing a transverse thoracosternotomy from 2016 to 2020. Demographics, baseline characteristics, peri-operative data, and outcomes were collected, reviewed and summarized. Two groups of patients were identified: wire cerclage (Group A), combination plate-and-band rigid fixation (Group B). The primary outcome was sternal complications, which were divided into mechanical and non-mechanical. RESULTS: Twenty-two patients met inclusion criteria. Three patients (13.6%) were in Group A, nineteen patients (86.4%) in Group B. Two patients in each Group A (66.6%) and Group B (10.5%) experienced a sternal complication. Sternal complications included sternal dehiscence (2), sternal malunion (1), and surgical site infection (1). One patient with plate-and-band fixation (5.2%) had a mechanical sternal complication. Three patients required reoperation secondary to sternal complication. CONCLUSIONS: The utilization of a combination plate-and-band rigid fixation system for primary closure is safe and may be an effective method to reduce sternal complications following transverse thoracosternotomy for lung transplantation.


Assuntos
Transplante de Pulmão , Deiscência da Ferida Operatória , Placas Ósseas , Fios Ortopédicos , Humanos , Estudos Retrospectivos , Esternotomia , Esterno/cirurgia , Deiscência da Ferida Operatória/cirurgia
8.
Jt Dis Relat Surg ; 32(2): 397-405, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145817

RESUMO

OBJECTIVES: In this study, we aimed to compare clinical and radiographic outcomes of retrograde intramedullary Kirschner-wire (K-wire) fixation with those of plate-screw (PS) fixation. PATIENTS AND METHODS: A total of 98 metacarpal shaft fractures in 75 patients (65 males, 10 females; mean age: 31.2±10.9 years; range, 16 to 65 years) were included between January 2011 and December 2017. The total joint active range of motion (AROM) and grip strength of the healthy and broken hands were evaluated. The Visual Analog Scale (VAS) and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were recorded. We compared surgery duration, number of fluoroscopy images, and cost-effectiveness for each technique. RESULTS: The overall mean follow-up was 21.9 (range, 12 to 56) months. At the last follow-up, total joint AROM (p=0.072), VAS score (p=0.298), QuickDASH score (p=0.132), and hand grip strength (p=0.947) were similar between the groups. Radiological union occurred in the PS and K-wire groups in a mean of 5.84 (range, 3 to 8) and 4.46 (range, 3 to 20) weeks, respectively (p=0.173). A significant difference was found in surgery duration (p=0.021) and number of fluoroscopy images (p<0.05) between the PS and K-wire groups. Two wound complications were observed in the PS group and one with K-wires. CONCLUSION: Retrograde intramedullary K-wire fixation has certain advantages such as being less invasive and more accessible with shorter operation time, compared to PS fixation. Similar radiological and clinical scores can be obtained in patients undergoing retrograde intramedullary K-wire fixation or PS fixation.


Assuntos
Fixação Intramedular de Fraturas/métodos , Fraturas Ósseas/cirurgia , Ossos Metacarpais/cirurgia , Adolescente , Adulto , Idoso , Placas Ósseas , Parafusos Ósseos , Fios Ortopédicos , Feminino , Fluoroscopia , Seguimentos , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Força da Mão , Humanos , Masculino , Ossos Metacarpais/lesões , Pessoa de Meia-Idade , Duração da Cirurgia , Amplitude de Movimento Articular , Adulto Jovem
9.
Jt Dis Relat Surg ; 32(2): 468-477, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145826

RESUMO

OBJECTIVES: In this study, we describe a novel hemiepiphysiodesis technique to prevent implant-related perichondrial ring injury in a rabbit model. MATERIALS AND METHODS: Proximal tibial epiphyseal plates of a total of 16 white New Zealand rabbits were used for this animal model. The subjects were divided into three equal groups as follows: Group 1 (Kirschner wire [K-wire]/cerclage), Group 2 (8-plate) right-hind legs, Group 3 (Control) left hind legs. Using anteroposterior radiography, the medial slope angle (MSA), articular line-diaphyseal angle (ALDA), and the angle between screws of 8-plate in lateral X-ray tibial slope angle (TSA) were measured. The radiographs were taken early postoperative (Day 1) and on sacrification day (Week 8). The histological evaluation of the perichondrial ring was made on a 7-mm axial section that stained with Safranin O/fast green at X10 magnification. RESULTS: In both K-wire and 8-plate groups, the early postoperative ALDA and TSA were greater than the sacrification ALDA and TSA (p=0.028 and p<0.001, respectively). The early postoperative MSA was lower than the sacrification MSA in groups, (p<0.001). The MSA in the control group was lower than the K-wire and 8-plate groups (p<0.001 and p=0.009; respectively). The perichondrial ring thickness of the K-wire group was greater than the 8-plate group in histological evaluation (p<0.001). CONCLUSION: Both of the K-wire and 8-plate groups showed similar angulation effects in the proximal tibia, although histologically less damage to the perichondrial ring was observed in the K-wire group, compared to the 8-plate group.


Assuntos
Placas Ósseas/estatística & dados numéricos , Fios Ortopédicos/estatística & dados numéricos , Lâmina de Crescimento/cirurgia , Tíbia/cirurgia , Animais , Cartilagem/diagnóstico por imagem , Epífises , Coelhos , Radiografia , Fraturas Salter-Harris/cirurgia
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(6): 710-715, 2021 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-34142497

RESUMO

Objective: To assess the outcomes in indirect reduction technique via Nice knot for transverse patellar fractures. Methods: The clinical data of 25 patients with transverse patellar fractures meeting the inclusion criteria between January 2017 and December 2018 were retrospectively analyzed. The patients were divided into trial group ( n=13) and control group ( n=12) according to different intraoperative reduction methods. No significant difference was found in gender, age, affected side, cause of fracture, classification, or the time from injury to operation between the two groups ( P>0.05). In the trial group, No.2 suture was used to cross the quadriceps tendon and patellar tendon to construct the Nice knot, then the suture was tightened to make the distal and proximal fracture segments contact in an indirect reduction pattern. Depend on Nice knot's sliding compression and self-stabilizing function, the suture mesh created an anterior tension band as a temporary fixation. In the control group, Weber's clamp was used to hold the fracture segments directly and fixed temporarily. After reduction, terminal fixation was conducted using a titanium Kirschner wire with titanium cable in both groups. The operation time, intraoperative blood loss, follow-up time, fracture healing time, and complications were recorded and compared in the two groups. At last follow-up, the knee function was evaluated according to the Böstman scoring criteria for efficacy in patellar fractures. Results: The operation time in the trial group was significantly shorter than that in the control group ( t=-2.165, P=0.041). There was no significant difference of intraoperative blood loss between the two groups ( t=0.514, P=0.612). The incisions of the two groups healed by first intention. All the patients were followed up 12-16 months, with an average of 14.4 months, no significant difference was found in the follow-up time between the two groups ( t=-0.309, P=0.760). One patient in the control group developed soft tissue irritation symptoms at 1 day after operation, and no special treatment was given, the symptoms disappeared at 2 months after operation. The fractures of the two groups healed at the 12-week follow-up. During the follow-up, there was no complication such as loosening and fracture of titanium cables and tendon tissue calcification. At last follow-up, the Böstman score presented no significant difference between the two groups ( t=-0.086, P=0.932). In the trial group, an 80-year-old female patient was evaluated as good (score, 27) due to atrophy of the quadriceps femoris, leg weakness, and affected stair climbing, and the rest 24 patients were all evaluated as excellent. Conclusion: The indirect reduction with Nice knot can shorten the operation time in the treatment of transverse patellar fractures, and obtain good effectiveness.


Assuntos
Fraturas Ósseas , Patela , Fios Ortopédicos , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Humanos , Patela/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
11.
Medicine (Baltimore) ; 100(26): e26395, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190155

RESUMO

INTRODUCTION: With the aggravation of population aging, the incidence of intertrochanteric fracture also increases dramatically. Patients are often elderly accompany with severe osteoporosis and various complications. Therefore, we should select an individualized treatment based on the each patient's state. Arthroplasty is recommended for unstable fractures with obvious osteoporosis, ipsilateral femoral head necrosis or arthritis. Rigid fixation of the greater trochanter with arthroplasty is challenging because of the powerful pulling forces created by multiple muscles being transmitted to the greater trochanter. Currently, there are few contemporary literatures on the evaluation of unstable intertrochanteric fracture with efficient fixation of the greater trochanter. Moreover, there is no consensus to choose which implant to immobilize the greater trochanter. The purpose of this study was to review previous literatures and provide a valuable guidance. CONCLUSIONS: The locking plate, which not only provides rigid fixation but also results in lower rate of postoperative complications. However, further prospective randomized and cohort studies are needed.


Assuntos
Artroplastia de Quadril/métodos , Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas do Quadril/cirurgia , Artroplastia de Quadril/instrumentação , Placas Ósseas , Fios Ortopédicos , Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/complicações , Fixação Interna de Fraturas/instrumentação , Fraturas do Quadril/complicações , Fraturas do Quadril/diagnóstico por imagem , Humanos , Osteoartrite do Quadril/complicações , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Radiografia
12.
Medicine (Baltimore) ; 100(26): e26566, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190198

RESUMO

ABSTRACT: The aim of this study was to investigate the clinical effect of AO miniplate screw internal fixation and Kirschner wire (KW) in the treatment of metacarpal fractures.We retrospectively analyzed the clinical data of 590 metacarpal fracture patients admitted to our hospital from March 2016 to March 2019. Among them, 290 patients were treated with KWs; 300 were treated with AO microplate internal fixation. The clinical, radiological results, time of surgery, and complications were observed and compared between the 2 groups.The imaging characteristics and preoperative fracture types of the 2 groups were similar and comparable (P > .05). The operation time, length of hospital stay, and fracture healing time of AO group were shorter than those of KW group, and the differences were statistically significant (41.22 ±â€Š7.23 vs 25.64 ±â€Š6.29; 7.13 ±â€Š2.38 vs 5.26 ±â€Š1.71; 67.43 ±â€Š22.01 vs 52.57 ±â€Š17.46, P < .05). In addition, the incidence of postoperative complications in AO group was lower than that in KW group (8.3% vs 15.2%, P < .05). In terms of surgical knuckle extension, flexion, and total mobility (compared with the uninjured hand), patients in the AO plate group were significantly improved compared with patients in the KW group, and the difference was statistically significant (4 vs 10 degree; 19 vs 10 degree; 14 vs 29 degree, P < .05); The average degree of finger rotation deformity in AO plate group was significantly lower than that in KW group (1 vs 6 degree, P < .05). In terms of grip strength (compared with the healthy hand), the average grip strength of AO plate group was significantly higher than that of KW group (93% vs 83%, P < .05). Patients in the OA plate group had a lower Disabilities of the Arm, Shoulder and Hand score (P < .05).Compared with KW fixation, AO mini-plate and screw fixation for the metacarpal fracture has a better effect, which can effectively shorten the operation time and reduce the trauma to patients. It can provide patients with better stability and realize the early movement of the palm, promote fracture healing and joint function recovery; it can reduce the incidence of postoperative complications, which has certain safety. In addition, it can effectively reduce the risk of poor finger rotation.


Assuntos
Placas Ósseas , Fios Ortopédicos , Falanges dos Dedos da Mão , Fixação Intramedular de Fraturas , Deformidades da Mão , Ossos Metacarpais/lesões , Complicações Pós-Operatórias , Adulto , China/epidemiologia , Avaliação da Deficiência , Feminino , Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/cirurgia , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura , Fraturas Ósseas/cirurgia , Deformidades da Mão/etiologia , Deformidades da Mão/prevenção & controle , Traumatismos da Mão/cirurgia , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica
13.
J Mech Behav Biomed Mater ; 121: 104611, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34082182

RESUMO

It is known that weight-bearing exercises under Ilizarov circular fixators (ICF) could enhance bone fracture healing by mechano-regulation. However, interfragmentary movements at the fracture site induced by weight-bearing may inhibit angiogenesis and ultimately delay the healing process. To tackle this challenge, a computational model is presented in this study which considers the spatial and temporal changes in mechanical properties of fracture callus to predict optimal levels of weight-bearing during fracture healing under ICF. The study takes sheep fractures as example and shows that the developed model has the capability of predicting patient specific, time-dependent optimal levels of weight-bearing which enhances mechano-regulation mediated healing without hindering the angiogenesis process. The results demonstrate that allowable level of weight-bearing and timings depend on fracture gap size. For normal body weights (BW) and moderate fracture gap sizes (e.g. 3 mm), weight-bearing with 30% BW could start by week 4 post-operation and gradually increase to 100% BW by week 11. In contrast, for relatively large fracture gap sizes (i.e. 6 mm), weight-bearing is recommended to commence in later stages of healing (e.g. week 11 post-operation). Furthermore, increasing ICF stiffness (e.g. using half pins instead of pretension wires) can increase the level of weight-bearing significantly in the early stages up to a certain time point (e.g. week 8 post-operation) beyond which no noticeable benefits could be achieved. The findings of this study have potential applications in designing post-operative weight bearing exercises.


Assuntos
Consolidação da Fratura , Fraturas da Tíbia , Animais , Fios Ortopédicos , Calo Ósseo , Fixadores Externos , Humanos , Ovinos , Suporte de Carga
14.
Kyobu Geka ; 74(6): 481-483, 2021 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-34059598

RESUMO

A 40-year-old man who had been surgically treated for the fracture of the right humerus with two Kirschner wires (K-wires) complained of chest pain and difficulty in breathing at fourth day after surgery and visited our hospital. Chest radiography revealed dislocation of the K-wire and right pneumothorax. Video-assisted thoracic surgery( VATS) was performed immediately, and the K-wire was removed safely.


Assuntos
Migração de Corpo Estranho , Fraturas Ósseas , Pneumotórax , Adulto , Fios Ortopédicos , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida
15.
BMC Musculoskelet Disord ; 22(1): 546, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130660

RESUMO

BACKGROUND: Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes. METHODS: In this retrospective study, 21 children (aged 11-16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS: All patients were followed up for 12-24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2-4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P < 0.001). The average ROM in the MCP joint and apex dorsal angulation of the injured side were not significantly different from those of the uninjured side. The average DASH score was 1.76 ± 1.48 (range, 0-4), the mean VAS was 0.19 ± 0.60 (range, 0-2), and the mean grip strength was 91.55 %±4.52 % (range, 85-101 %). No secondary displacement, dysfunction, nonunion, infection, or osteonecrosis was observed during the follow-up. Although premature epiphyseal closure was found in one patient, no long-term clinical finding of angulation or shortening was identified. CONCLUSIONS: Antegrade intramedullary fixation with single K-wire was an effective and reliable technique that successfully resulted in good functional and cosmetic outcomes for treating adolescents with FMNF. The impact on the growth plate was low in this population given that most patients were at or approaching skeletal maturity. LEVEL OF EVIDENCE: Level IV.


Assuntos
Fixação Intramedular de Fraturas , Fraturas Ósseas , Ossos Metacarpais , Adolescente , Adulto , Fios Ortopédicos , Criança , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Ossos Metacarpais/diagnóstico por imagem , Ossos Metacarpais/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
16.
BMC Surg ; 21(1): 294, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34134678

RESUMO

BACKGROUND: Migration of wires and pins within the heart is an uncommon complication. Intracardic migration of Kirschner wire can cause several complications. CASE PRESENTATION: A 55-year-old male patient was admitted to the emergency service with dyspnea, stabbing chest pain. The patient's medical history showed that he had undergone a fixation operation using Kirschner wire and plate for treatment of the right sternoclavicular joint dislocation about 5 months prior. Chest computerized tomography revealed a metallic foreign body locating in the pericardium between the aorta and the right ventricle. There were not any serious complications occurred before operation due to the timely detection of potential risks. Removal of the wire was performed via median sternotomy under general anesthesia without cardiopulmonary bypass. The symptoms of dyspnea and chest pain were relieved after surgery, and the patient recovered without any complications. CONCLUSION: The Kirschner wire should be used judiciously in amphiarthrosis in orthopedic surgery for the risk of breakage and migration. The possibility of intracardiac migration of wire should be considered when chest symptoms presenting after surgery with the Kirschner wire. Migrated wires must be removed immediately to prevent serious complications. Regular follow-up and early removal of fixation wires are recommended to prevent migration of wires.


Assuntos
Migração de Corpo Estranho , Articulação Esternoclavicular , Aorta , Fios Ortopédicos/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
17.
J Hand Surg Eur Vol ; 46(5): 471-475, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34027732

RESUMO

We retrospectively reviewed 20 children with Salter-Harris II fractures of the distal radius treated with intrafocal pinning according to Kapandji. Unlike conventional crossed K-wire pinning, this method avoids crossing the physis with the pins and thus minimizes the risk of physeal damage. None of the children had fracture re-displacement, angulation or growth deformities. The age, sex, side of injury, fracture displacement or angulation, treatment delay or immobilization period had any significant impact on the functional outcome. At a mean follow-up of 49 months (range 47-60), plain radiographs and MRI showed no growth arrests or physeal bars or bridges. Grip strength, wrist motion and patient-reported outcomes were almost normal with no or minimal pain at the injury site. We conclude that intrafocal K-wire pinning is simple, safe and affordable. We cannot provide data on what is acceptable fracture displacement for different age groups to allow for acceptable final remodelling of any malalignment.Level of evidence: IV.


Assuntos
Fraturas do Rádio , Rádio (Anatomia) , Pinos Ortopédicos , Fios Ortopédicos , Criança , Humanos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Estudos Retrospectivos
18.
J Foot Ankle Surg ; 60(5): 990-993, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33985874

RESUMO

Hammertoe deformity correction surgery is one of the most common procedures performed by foot and ankle surgeons. Recent foot and ankle medical literature presents conflicting opinions regarding the optimal intramedullary fixation device and techniques for use in digital deformity correction. There are a number of varying fixation constructs of intramedullary Kirschner wire fixation reported for proximal interphalangeal joint arthrodesis; however, there are no reports of relative loading strength of the fixations. In this study, 90 sawbone models were divided equally into 3 groups of different intramedullary Kirschner wire fixation techniques: Group A- single straight, Group B- single bent, Group C- double bent. Each fixation construct underwent controlled axial loading and failure points were observed. Results showed no significant difference in load failure from all 3 groups with mean maximum force of Group A = 20N, Group B = 19.1N, and Group C =17.5N. We conclude that all Kirschner wire fixation options for digital deformity correction, will provide similar resistance to sagittal plane axial loads.


Assuntos
Síndrome do Dedo do Pé em Martelo , Deformidades Congênitas da Mão , Artrodese , Fios Ortopédicos , Síndrome do Dedo do Pé em Martelo/diagnóstico por imagem , Síndrome do Dedo do Pé em Martelo/cirurgia , Humanos , Próteses e Implantes
19.
Zhongguo Gu Shang ; 34(5): 437-41, 2021 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-34032045

RESUMO

OBJECTIVE: To explore clinical effectiveness and safety of ultrasound-guided closed reduction and K-wires internal fixation in treating of Kilfoyle Ⅱand Ⅲ medial condylar fracture of humerus in children. METHODS: Clinical data of 32 children with medial condylar fracture of humerus treated with closed reduction and internal fixation with K-wires under the guidance of ultrasound were retrospectively analyzed from January 2014 to August 2019, including 23 males and 9 females, age ranged from 3.2 to 12.8 years old with an average of (8.3±2.1) years old;According to classification of Kilfoyle, 12 patients classified to typeⅡ and 20 patients were type Ⅲ;5 patients combined with elbow dislocation;the time from injury to operation ranged from 1 to 5 days with an average of (3.1±1.3) days. Radiological evaluation of treatment results and complications were observed. At the final follow up, Mayo elbow performance score(MEPS) was used to evaluate elbow function. And humerus-ulna angle on the affect side and healthy side were measured and compared. RESULTS: All patients were followed up from 8 to 26 months with an average of(19.3±5.5) months. All fractures were healed well, the healing time ranged from 4 to 6 weeks with an average of (4.5±0.5) weeks. No infection, vascular and nerve injury, bone nonunion, trochlear necrosis, cubitus varus or valgus deformity were occurred. According to Mayo scoring, all patients were assessed as excellent. There was no significant difference in angle of humerus-ulna between affectedside (9.5±3.6)° and healthy side (9.1±3.5)°, and no difference in MEPS scores between affected side(95.3±2.5) and healthy side(96.3±2.2)(P>0.05). CONCLUSION: For Kilfoyle typeⅡand Ⅲ medial condylar fracture of humerus in children, closed reduction and internal fixation with K-wire under ultrasound guidance is a safe and effective method, and could promote in further.


Assuntos
Fios Ortopédicos , Fraturas do Úmero , Criança , Pré-Escolar , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Úmero , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção
20.
BMJ Case Rep ; 14(5)2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33962924

RESUMO

We present an unusual case of phalangeal fracture resulting from direct penetration by the barb of a conducted electrical weapon (Taser). When a Taser is triggered, compressed gas propels two barbs with trailing insulated wires which deliver a pulsed electrical discharge on contact. A 51-year-old man presented with a single barb of the Taser embedded in the diaphysis of the proximal phalanx and an associated open fracture. The barb was removed under local anaesthesia. The fracture was stable and was mobilised in a flexible splint. Oral antibiotics were commenced in recognition of the risk of flexor sheath and bone inoculation. While the most severe complications associated with Taser are related to the electrical component, the most common injuries are associated with falls and barb penetrations. Clinicians must be mindful of the risk of fracture, infection and soft tissue injury when such a foreign body penetrates a phalanx.


Assuntos
Falanges dos Dedos da Mão , Fraturas Ósseas , Acidentes por Quedas , Fios Ortopédicos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
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