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1.
Medicine (Baltimore) ; 98(43): e17498, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651853

RESUMO

This study aimed to compare the efficacy and safety among Kirschner wire, anatomical plate fixation and cannulated screw treatments in patients with open calcaneal fractures, and to explore the predictive factors for treatment response and complication occurrence.The 142 open calcaneal fracture patients were enrolled in this study, who received fixation procedures of Kirschner wire, anatomical plate fixation or cannulated screw on demand. Treatment efficacy was assessed by AOFAS score and occurrence of complications was recorded.No difference of AOFAS score was observed among Kirschner wire, anatomical plate fixation and cannulated screw groups (P = .792), and the numbers of patients with excellent, good, medium, and poor AOFAS score in Kirschner wire group were 16 (16.2%), 42 (42.4%), 32 (32.3%), and 9 (9.1%), which in anatomical plate fixation group were 4 (16.7%), 11 (45.8%), 7 (29.2%), and (8.3%), and in cannulated screw group were 1 (5.3%), 10 (52.6%), 6 (31.6%), and 2 (10.5%), respectively. No difference of total complication occurrence (P = .709) or specific complications including skin graft (P = .419), flap graft (P = .229), deep infection (P = .644) or amputation (P = .428) was discovered among 3 groups. Logistic regression analysis revealed that fixation options did not affect treatment response and complication occurrence (all P > .05), while higher Gustilo type correlates with decreased treatment response (P < .001) and elevated complication occurrence (P < .001) independently.Kirschner wire, anatomical plate fixation, and cannulated screw are equally efficient and tolerated in treating patients with open calcaneal fractures, and higher Gustilo type correlates with decreased treatment response and increased complication occurrence independently.


Assuntos
Calcâneo/lesões , Fixação Interna de Fraturas/instrumentação , Fraturas Expostas/cirurgia , Fixadores Internos , Adulto , Placas Ósseas , Parafusos Ósseos , Fios Ortopédicos , Calcâneo/cirurgia , Cateterismo , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
2.
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
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(10): 1239-1244, 2019 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-31544432

RESUMO

Objective: To explore the feasibility and effectiveness of maintaining the reduction of unstable intertrochanteric fractures by Kirschner wire-fixation-cortical bone technique. Methods: Forty patients with intertrochanteric fracture [AO/Orthopaedic Trauma Association (AO/OTA) type 31-A2.2] admitted between May 2015 and January 2017 and requiring closed reduction and proximal femoral nail antirotation (PFNA) were randomly divided into trial group (intraoperative Kirschner wire-fixation-cortical bone technique group, 20 cases) and control group (conventional treatment group, 20 cases). There was no significant difference in general data of gender, age, side, body mass index, cause of injury, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, and intraoperative fluoroscopy times of the two groups were recorded; the reduction quality of fracture was observed according to the corresponding relationship between medial and anterior cortex (positive, neutral, and negative support) of intraoperative fluoroscopy proposed by ZHANG Shimin, and the stability of internal fixation and fracture healing were observed; Harris score was used to evaluate the recovery of hip function at 12 months after operation. Results: In the trial group, 6 cases (30%) had 2 Kirschner wires implanted less than 4 times, 7 cases (35%) had 5-8 times, and 7 cases (35%) had 9 times or more. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05), but the blood transfusion volume and intraoperative fluoroscopy times in the trial group were significantly less than those in the control group ( P<0.05). Both groups were followed up 13-21 months, with an average of 17 months. There was no complications such as wound infection, deep venous thrombosis of lower extremities, refracture, and internal fixation-related complications. The quality of intraoperative reduction in the trial group was significantly better than that in the control group ( Z=-2.794, P=0.024). The Harris score of the trial group was significantly better than that of the control group at 12 months after operation ( t=2.98, P=0.01). Conclusion: The use of Kirschner wire-fixation-cortical bone technique during intertrochanteric fracture closed reduction and PFNA internal fixation surgery can effectively maintain the reduction effect, reduce the number of fluoroscopy, improve the reduction quality, reduce allogeneic blood input, obtain better hip function, and do not increase the operation time and intraoperative blood loss.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Pinos Ortopédicos , Fios Ortopédicos , Osso Cortical , Estudos de Viabilidade , Humanos , Resultado do Tratamento
5.
Braz J Cardiovasc Surg ; 34(4): 406-411, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454194

RESUMO

OBJECTIVE: To describe a new technique of sternal closure, modified from the conventional figure-of-eight approach, which can provide a secure closure and prevent sternal complications. METHODS: The modified technique is based on the intercalation of the caudal portion of each steel wire passed along the sternum. This is a retrospective analysis of patients operated with this modified technique at our institution between January 2014 and December 2016. RESULTS: One hundred and forty-three patients underwent sternal closure with the modified technique. In-hospital mortality rate was 1.4% (n=2). No sternal instability was observed at 30 days postoperatively. Two patients developed mediastinitis that required extraction of the wires. CONCLUSION: Short-term results have shown that the modified sternal closure technique can be used safely and effectively, with complications rates being consistent with worldwide experience.


Assuntos
Esterno/cirurgia , Deiscência da Ferida Operatória/prevenção & controle , Técnicas de Sutura/instrumentação , Técnicas de Fechamento de Ferimentos/instrumentação , Adolescente , Adulto , Idoso , Fios Ortopédicos/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Mediastinite/complicações , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Deiscência da Ferida Operatória/etiologia , Técnicas de Sutura/efeitos adversos , Técnicas de Fechamento de Ferimentos/mortalidade , Adulto Jovem
6.
Medicine (Baltimore) ; 98(34): e16862, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441860

RESUMO

This study aimed to investigate the effect of auxiliary Kirschner wire (K-wire) technique in the closed reduction of children with Gartland type III supracondylar humerus fractures by comparing with manual reduction alone.Retrospective analysis was performed on the clinical data of 68 cases of supracondylar humerus fractures. Thirty-six patients received closed reduction and percutaneous fixation with auxiliary K-wire technique (group A). Thirty-two patients received conventional manual reduction and percutaneous pin fixation (Group B).In group A, the average operation time was 20.5 ±â€Š8.5 minutes, the average frequency of intraoperative radiographic observations was 4.3 ±â€Š1.1, the average fracture healing time was 6.2 ±â€Š1.8 weeks, and the complication rate was 3/36, 8.3%. The mean operation time was 36.1 ±â€Š10.2 minutes, the average frequency of intraoperative radiography was 8.9 + 1.7 times, the average fracture healing time was (6.1 ±â€Š1.6) weeks, and the complication rate was 2/32, 6.3%. The operation time in group A was significantly shorter than that in group B. The difference between the 2 groups was statistically significant (P = .012). The frequency of radiography in group A was significantly less than that in group B (P = .001).Compared with manual reduction, auxiliary K-wire technology can significantly shorten the operation time, reduce the radiant quantity of the surgeon, improve the efficiency of closed reduction of children with Gartland type III supracondylar humerus fractures, and reduce the risk of developing postoperative complications. And meanwhile, there is no significant effect on the imaging and functional outcomes of affected extremities, which is worthy of respect.


Assuntos
Fios Ortopédicos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Fraturas do Úmero/classificação , Fraturas do Úmero/diagnóstico por imagem , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
7.
Bone Joint J ; 101-B(8): 978-983, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362548

RESUMO

AIMS: The aim of this study was to compare the clinical effectiveness of Kirschner wire (K-wire) fixation with locking-plate fixation for patients with a dorsally displaced fracture of the distal radius in the five years after injury. PATIENTS AND METHODS: We report the five-year follow-up of a multicentre, two-arm, parallel-group randomized controlled trial. A total of 461 adults with a dorsally displaced fracture of the distal radius within 3 cm of the radiocarpal joint that required surgical fixation were recruited from 18 trauma centres in the United Kingdom. Patients were excluded if the surface of the wrist joint was so badly displaced it required open reduction. In all, 448 patients were randomized to receive either K-wire fixation or locking-plate fixation. In the K-wire group, there were 179 female and 38 male patients with a mean age of 59.1 years (19 to 89). In the locking-plate group, there were 194 female and 37 male patients with a mean age of 58.3 years (20 to 89). The primary outcome measure was the patient-rated wrist evaluation (PRWE). Secondary outcomes were health-related quality of life using the EuroQol five-dimension three-level (EQ-5D-3L) assessment, and further surgery related to the index fracture. RESULTS: At 12 months, 402/448 participants (90%) recruited into the main study provided PRWE scores. At year two, 294 participants (66%) provided scores; at year five, 198 participants (44%) provided scores. There was no clinically relevant difference in the PRWE at any point during the five-year follow-up; at five years, the PRWE score was 8.3 (12.5) in the wire group and 11.3 (15.6) in the plate group (95% confidence interval -6.99 to 0.99; p = 0.139). Nor was there a clinically relevant difference in health-related quality of life. Only three participants had further surgery in the five years after their injury (one in the wire group and two in the plate group). CONCLUSION: This follow-up study continues to show no evidence of a difference in wrist pain, wrist function, or quality of life for patients treated with wires versus locking plates in the five years following a dorsally displaced fracture of the distal radius. Cite this article: Bone Joint J 2019;101-B:978-983.


Assuntos
Placas Ósseas , Fios Ortopédicos , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/instrumentação , Fraturas do Rádio/cirurgia , Traumatismos do Punho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Articulação do Punho/cirurgia
8.
Oper Orthop Traumatol ; 31(5): 384-392, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31346631

RESUMO

OBJECTIVE: Reconstruction of intra-articular impression fractures of the middle phalanx by percutaneous reduction over a small dorsal cortical window. Stabilization by lattice-like arranged K­wires. INDICATIONS: Impression fractures of the base of the middle phalanx with or without dislocation in the proximal interphalangeal joint. CONTRAINDICATIONS: Fractures extending to the shaft of the middle phalanx. SURGICAL TECHNIQUE: By a cortical window at the dorsum of the middle phalanx (through the tendon free triangle) the impression fracture is reduced from the medullary cavity. Reduction is secured and the articular surface is supported by lattice-like arranged K­wires. POSTOPERATIVE MANAGEMENT: Thermoplastic splint for the finger for 6 weeks, subsequently K­wire removal, active range of motion exercises and hand occupational therapy. RESULTS: In two case series already published, good clinical and radiological results were reported. No complications were detected in either series.


Assuntos
Traumatismos dos Dedos , Falanges dos Dedos da Mão/cirurgia , Fraturas Ósseas , Luxações Articulares , Fios Ortopédicos , Traumatismos dos Dedos/cirurgia , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/cirurgia , Amplitude de Movimento Articular , Resultado do Tratamento
9.
Unfallchirurg ; 122(10): 814-819, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31286153

RESUMO

Serial fractures of metatarsal bones are rare and usually caused by direct or indirect high-energy trauma; however, in cases of pre-existing diseases, such as diabetes mellitus, they also can occur spontaneously or as insidious fractures. Due to the substantial soft tissue swelling mostly associated with such injuries, minimally invasive osteosynthesis with intramedullary Kirschner-wires (K­wires) is recommended. The antegrade technique for placement of the K­wires is preferred as the technically simpler retrograde procedure has several significant disadvantages. The preferred operative approach is described in detail exemplified by two clinical cases.


Assuntos
Fixação Intramedular de Fraturas , Fraturas Ósseas , Ossos do Metatarso , Fios Ortopédicos , Fixação Interna de Fraturas , Humanos
10.
Medicine (Baltimore) ; 98(28): e14847, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305388

RESUMO

RATIONALE: Atlantoaxial transarticular screw fixation has been an effective and appealing method for inducing fusion of the C1-C2 complex. This technique is usually performed with Gallie fusion. In performing Gallie fusion using sublaminar wiring, a major concern is the risk of dural tear associated with passing sublaminar wires through the epidural space. We present the first report on symptomatic symptomatic subdural hygroma (SDH) due to transarticular screw fixation with posterior wiring. PATIENTS CONCERNS: A 50-year-old man had sustained dens fracture 20 years ago and presented with severe neck pain following a recent traffic accident. The images showed atlantoaxial instability due to nonunion of the dens fracture and the patient underwent transarticular screw fixation with posterior sublaminar wiring using Gallie technique. When the U-shaped wire was passed under the arch of C1 from inferior to superior, a dural tear and cerebrospinal fluid (CSF) leak occurred. The site of dural tear was repaired by direct application of sutures. The patient was discharged in good condition. Fifteen day after surgery, the patient was readmitted with a history of a progressive headache associated with vomiting and vertigo. DIAGNONSIS: Brain CT and MRI showed bilateral posterior fossa and a right-sided supratentorial SDH. INTERVENTIONS: The patient underwent right occipital burr hole and evacuation of posterior fossa SDH due to deteriorating neurological status. OUTCOMES: The patient's condition gradually improved after the operation and became asymptomatic at 3-year follow-up. LESSONS: Posterior fossa and supratentorial SDH could occur resulting from any intraoperative dural tear and CSF leakage during posterior cervical spinal surgery. Symptomatic SDH after posterior cervical spinal surgery should be cautiously assessed and treated. LEVEL OF EVIDENCE: 5.


Assuntos
Articulação Atlantoaxial/cirurgia , Instabilidade Articular/cirurgia , Complicações Pós-Operatórias , Fusão Vertebral , Derrame Subdural/etiologia , Articulação Atlantoaxial/diagnóstico por imagem , Parafusos Ósseos , Fios Ortopédicos , Diagnóstico Diferencial , Humanos , Instabilidade Articular/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Derrame Subdural/diagnóstico por imagem , Derrame Subdural/cirurgia
11.
Medicine (Baltimore) ; 98(29): e16499, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335717

RESUMO

RATIONALE: Anorexia nervosa is a chronic psychiatric disease defined by severe weight loss, due to fear of obesity, and self-imposed semi-starvation. Of the many complications following anorexia nervosa, low bone mineral density (BMD) is a significant risk factor for fractures. Anorexia nervosa is associated with higher risk of incident fracture in females across all age groups, and in males >40 years old. Sites at highest risk of fracture include the hip/femur and pelvis in females, and vertebrae in males with anorexia nervosa. PATIENT CONCERNS: A 29-year-old woman known to have suffered from anorexia nervosa 15 years ago visited the emergency department due to right hip pain after falling while getting out of a taxi. During the period of anorexia nervosa, she had a body mass index (BMI) of 14.06 kg/m (weight, 36 kg; height, 1.60 m) and suffered from amenorrhea. At the time of presentation, she had a BMI of 19.53 kg/m (weight, 50 kg; height, 1.60 m) and had regular menstrual periods, indicating clinical recovery from anorexia nervosa. DIAGNOSES: Plain radiography, computed tomography, and bone scintigraphy revealed AO 31-A2.2 type right hip proximal femur intertrochanteric fracture. The BMD showed a T score of -3.9 in the hip and -3.6 at the lumbar level, indicating severe osteoporosis. INTERVENTIONS: Osteosynthesis was performed with proximal femoral nail antirotation (PFNA) and wiring. OUTCOMES: There were no specific symptoms, such as trauma or infection, during postoperative rehabilitation and postoperative management, and she was discharged after 2 weeks. After 1 year of follow-up at our outpatient clinic, she had no complications. LESSONS: Here, we describe an unusual case of unilateral femoral intertrochanteric fracture that occurred after clinical recovery from anorexia nervosa. This case indicated that the risk of fracture remains even after recovery of BMI. We propose that women who have clinically recovered from anorexia nervosa should be advised to undergo annual osteodensitometric analyses after consulting with specialists in other areas (psychiatry, endocrinology, eating disorders).


Assuntos
Acidentes por Quedas , Anorexia Nervosa/complicações , Fraturas do Quadril/etiologia , Osteoporose/complicações , Adulto , Índice de Massa Corporal , Pinos Ortopédicos , Fios Ortopédicos , Feminino , Fixação Interna de Fraturas/métodos , Fraturas do Quadril/cirurgia , Humanos , Osteoporose/etiologia , Fatores de Tempo
15.
Chin J Traumatol ; 22(3): 182-185, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31060897

RESUMO

Acromioclavicular joint (ACJ) injury is a common shoulder injury. There are various techniques of ACJ reconstruction. Superficial infection after ACJ reconstruction is not an uncommon complication. However, osteomyelitis post ACJ reconstruction has never been highlighted as a possible complication. Our patient is a 31-year-old male who sustained a Rockwood 5 ACJ dislocation and had anatomical ACJ reconstruction with autogenous gracilis and semitendinosus graft. Our technique involved the anatomical reconstruction of the ACJ and the coracoclavicular ligament with the usage of two bioscrews and the temporary stabilisation of the ACJ with two k-wires. As in any orthopaedic surgery, infection is often disastrous especially when the surgery involves implants. It can be disastrous with high morbidity to the patient as well as a costly complication to treat. Therefore, we wish to highlight this case as despite its rarity, osteomyelitis can be devastating to the patient and should be prevented if possible.


Assuntos
Articulação Acromioclavicular/lesões , Articulação Acromioclavicular/cirurgia , Luxações Articulares/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Osteomielite/etiologia , Osteomielite/terapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Antibacterianos/administração & dosagem , Parafusos Ósseos/efeitos adversos , Fios Ortopédicos/efeitos adversos , Músculo Grácil/transplante , Músculos Isquiotibiais/transplante , Humanos , Masculino , Osteomielite/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Prognóstico
16.
Orthopade ; 48(8): 659-667, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31119306

RESUMO

The purpose of this review is to present the pros and cons as well as the surgical techniques of conventional implants used for fixation of slipped capital femoral epiphysis (SCFE). Worth mentioning are K­wires, Hansson pins, transfixing screws, and gliding screws. We searched PubMed for "ECF" and "SCFE" in combination with "in situ fixation," "pin," "wire," "screw," and "nail." We considered Johansson nail, Knowles pin, and Nyström nail to be obsolete and of historical interest only. We noticed a trend from absolute stability towards some form of dynamic fixation over time, likely related to considerations of growth disturbance of the proximal femur and also the inherent potential for remodeling with time.


Assuntos
Escorregamento das Epífises Proximais do Fêmur , Pinos Ortopédicos , Parafusos Ósseos , Fios Ortopédicos , Humanos , Radiografia
17.
Unfallchirurg ; 122(8): 587-595, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31123800

RESUMO

PURPOSE: The purpose of this study was to evaluate the primary stability of commonly used fixation techniques for metacarpal neck fractures and to compare it with that of an innovative osteosynthesis device: IlluminOss™, the photodynamic bone stabilization system™. MATERIAL AND METHODS: Metacarpal neck fractures were created on the second to fifth metacarpal bones of 24 freshly frozen human cadavers using a band saw. Specimens were randomly assigned to one of six groups and treated with (1) K-wire fixation, (2) dorsal plating, (3) external fixation, (4) cross-threaded K­wire fixation, (5) IlluminOss™ and (6) locked IlluminOss™. In each group 16 specimens each underwent either monocyclic or polycyclic loading protocols. RESULTS: During monocyclic loading none of the specimens failed prior to a maximum deformation of 3 mm. With intramedullary K­wire fixation the mean loads were significantly lower than those of the other techniques. Mean loads causing 2 mm deformation with external fixation were significantly lower than those with dorsal plate osteosynthesis. The mean linear stiffness of the K­wire osteosynthesis was significantly lower than for the other fixation techniques and all methods of external fixation were significantly lower than dorsal plates. There were no significant differences with respect to the linear stiffness between the groups with dorsal plates, fragment fixation system (FFS), IlluminOss™ and locked IlluminOss™. During polycyclic testing the loss of resistance in dorsal plate osteosynthesis was significantly lower than with K­wire and IlluminOss™ fixation. No significant differences in loss of resistance could be shown between dorsal plate osteosynthesis, external fixation, FFS and locked IlluminOss™. CONCLUSION: In summary, IlluminOss™ can be used as an intramedullary stabilization system for treatment of metacarpal neck fractures. In combination with locking screws the biomechanical characteristics of IlluminOss™ are comparable to the other fixation techniques.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/cirurgia , Ossos Metacarpais/fisiopatologia , Ossos Metacarpais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Fios Ortopédicos , Cadáver , Fixadores Externos , Fixação Interna de Fraturas/instrumentação , Humanos , Ossos Metacarpais/lesões , Pessoa de Meia-Idade , Distribuição Aleatória
18.
Med Sci Monit ; 25: 3463-3468, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31074462

RESUMO

BACKGROUND There are many surgical treatment approaches for talar fractures. However, due to the unique anatomical and blood supply characteristics of the talus, the traditional approaches tend to lead to blood supply damage. In order to best preserve the blood supply of the talus, we proposed a surgical approach of internal fixation of the talar fracture with lateral malleolar osteotomy and analyzed its efficacy. MATERIAL AND METHODS Twenty-six patients with talar fractures underwent open reduction surgery between January 2010 and December 2016. Following the lateral malleolar osteotomy, the talus was fully exposed. After anatomical reduction, the talus was fixed with 2 screws, and the lateral malleolus was fixed with distending wires. The treatment effects were assessed in the follow-up. RESULTS All patients were followed for 7 to 22 months, for an average of 14.34 months. According to the Maryland Foot Score, 19 cases were excellent (90-100 points), 4 cases were good (85-90 points), and 3 cases were moderate (50-74 points). CONCLUSIONS Internal fixation of talar fractures with lateral malleolar osteotomy is a viable surgical approach to reduce injury to blood supply and maximize surgical exposure.


Assuntos
Fraturas do Tornozelo/cirurgia , Fixação Interna de Fraturas/métodos , Tálus/cirurgia , Adulto , Articulação do Tornozelo , Parafusos Ósseos , Fios Ortopédicos , Feminino , Fraturas Ósseas/cirurgia , Humanos , Fixadores Internos , Masculino , Pessoa de Meia-Idade , Redução Aberta/métodos , Osteotomia/métodos , Resultado do Tratamento
19.
Acta Chir Orthop Traumatol Cech ; 86(2): 141-146, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31070574

RESUMO

PURPOSE OF THE STUDY The purpose of the study was to assess two therapeutic procedures of temporary fixation of displaced ankle fractures, namely the plaster fixation or Kirschner wire (KW) transfixation via the sole of the foot. MATERIAL AND METHODS Group of patients The randomised prospective study conducted in the period 02/2016-02/2017 compared two methods of temporary fixation of displaced ankle fractures. In total, 38 patients were included in the study (18 patients treated with plaster fixation, 20 patients treated with KW). Methods During the randomisation (by envelopes, drawing of lots by the patient), in one group of patients, temporary stabilisation by plaster fixation was performed, whereas the other group was treated by percutaneously inserted KWs. The attention was focused on the quality of achieved reduction, its retention until the final treatment, and soft tissue status. After one year, the final examination was performed, in which we focused on the assessment of the clinical condition of the ankle joint with the use of the Olerud-Molander Ankle Score (OMAS), the AOFAS (American Orthopedic Foot and Ankle Society) score, and the Visual Analogue Scale (VAS) measuring the overall satisfaction. Moreover, in both the methods potential incidence of arthritic changes was monitored on radiographs. RESULTS Both the methods achieved 100% successful reduction rate. The group with plaster fixation reported a loss of reduction in six patients (33.3%) as against the KW group where no loss of reduction occurred. This difference was significant (p = 0.007). In plaster fixation method, after its removal local complications occurred on skin in 56%, of which skin necrosis in 16.7%, and it always occurred in association with the loss of reduction, which was statistically significant (p = 0.245). In KW method, local complications on skin were present in 25% only. In the group of patients with KW, there was not a single case of surface or deep infection reported. No KW migration was observed. DISCUSSION Potential complications of conservative treatment of displaced fractures with plaster fixation include the migration of fragments and widening of the ankle fork during the further course which may threaten the vitality of soft tissues. A total of six patients (33.3%) treated with plaster fixation showed a failure of reduction, which is by approximately 10% more than described in literature. In seven cases after the plaster fixation removal bullae were observed (38.9%) and in three cases skin necrosis was present (16.7%), which occurred in re-displaced fractures only. The bullae were present whether the reduction was successfully maintained or not. In literature, local complications after plaster fixation removal are reported in roughly 14%. Temporary percutaneous ankle KW transfixation is applied to maintain the reduced fracture in a favourable position and to facilitate monitoring and treating the soft tissues. Prior to the final surgical solution, bullae were observedin four cases (20%), of which skin necrosis in one case (5%). Bullae formation and necrosis are most likely related to the initial damage to soft tissues due to the injury and were not caused by the KW insertion. The literature describes local complications in 7% with respect to the KW technique, however, the type of complications is not specified. In our group, at a one-year follow-up arthritic changes grade I and II according to Kellgren and Lawrence scale were reported in 70% of cases with KW technique. Whether the osteoarthritis was caused by fixation or the fracture itself and what would be the percentage of individual types of osteoarthritis after several years of follow-up is a question. CONCLUSIONS Plaster fixation or Kirschner wires for temporal fixation of displaced ankle fractures shall be applied on a case by case basis. Based on our findings, the application of plaster fixation to displaced ankle fractures does not provide adequate stability of the reduced fracture and in case of re-displacement the status of soft tissues deteriorates. The impossibility to control the status of soft tissues in plaster fixation and the lower complication rate in fixation with K wires constitute additional reasons why this fixation technique via the sole of the foot appears to reap more benefits. Key words:displaced ankle fractures, temporal fixation, plaster fixation, Kirschner wire transfixation, complications.


Assuntos
Fraturas do Tornozelo , Fios Ortopédicos , Fixação Interna de Fraturas , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo , Humanos , Estudos Prospectivos , Resultado do Tratamento
20.
Medicine (Baltimore) ; 98(20): e15481, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096445

RESUMO

RATIONALE: Mallet finger fracture is a common sports-related injury that may lead to the tearing of extensor tendon and protrusion of a bony fragment located at the base of the distal phalanx. We affirmed that the elastic fixation of with two K-wires technique is a good method to deal with Mallet Finger fractures that fractures could gain effective fixation than the conventional treatment method and avoid surgical incision complication PATIENT CONCERNS:: We reported a 33-year-old female patient came to our hospital complaining of mild pain, swelling and her right little finger was deformed because of sport's injury. DIAGNOSIS: Acute mallet finger fracture type IV B according to Doyle classification of mallet injuries. INTERVENTIONS: We performed an emergency operation for the elastic fixation of the mallet finger fractures with two K-wires. OUTCOMES: After the surgery, the patient showed functional recovery. No evidence of recurrence was noted 6 months after the operation, and the patient showed no symptoms of sports-related injuries. LESSONS: We discuss the clinical diagnosis, treatment, and follow-up of the patient and suggest that elastic fixation with two K-wires is a good method to treat mallet finger fractures.


Assuntos
Fios Ortopédicos/normas , Traumatismos dos Dedos/cirurgia , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/cirurgia , Adulto , Assistência ao Convalescente , Fios Ortopédicos/efeitos adversos , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia , Fixação Interna de Fraturas/métodos , Humanos , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Traumatismos dos Tendões/cirurgia , Resultado do Tratamento
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