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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1243-1247, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063487

RESUMO

Objective: To investigate the effectiveness of non-absorbable suture cerclage combined with patella claw fixation for the treatment of inferior patella fractures. Methods: Between September 2016 and January 2019, 22 patients with inferior patella fractures were treated. There were 12 males and 10 females, with a mean age of 49.1 years (range, 32-67 years). The causes of injury were traffic accident in 8 cases, falling in 12 cases, and other causes in 2 cases. The interval from injury to operation was 3-7 days (mean, 4.4 days). For the operation, 3 or 4 longitudinal tunnels were drilled backward from the surface of the proximal fracture fragment with Kirschner wires; under the guidance of lumbar puncture needles and steel wires, non-absorbable suture passed through the tunnels and encircled the inferior fracture fragment, then tighten to achieve a satisfactory reduction of the fracture; finally, the patella claw was used to strengthen the fixation. During the follow-up, complications were observed, maximum motion range of the knee joint was measured, X-ray examination was performed and fracture healing time was recorded. The knee function was evaluated according to Böstman scores. Results: All the 22 patients were followed up 12-36 months (mean, 19.4 months). No infection, joint stiffness, bone nonunion, loss of reduction, or displacement of internal fixation occurred. All fractures were clinically healed, and the bone healing time was 2-3 months (mean, 2.6 months). At last follow-up, the maxium motion range of knee joint was 130°-135°, with an average of 132.6°. The Böstman score of the affected knee was 28-30 (mean, 29.2). All cases were graded as excellent results. Conclusion: Non-absorbable suture cerclage combined with patella claw fixation for inferior patella fractures has the advantages of simple operation, reliable fixation, and few complications, and the clinical results are satisfactory.


Assuntos
Fraturas Ósseas , Patela , Adulto , Idoso , Fios Ortopédicos , Feminino , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Patela/cirurgia , Suturas , Resultado do Tratamento
2.
Handchir Mikrochir Plast Chir ; 52(5): 413-418, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32992392

RESUMO

Scaphoid nonunion has traditionally been treated by open surgery where the pseudarthrosis has been cleaned while either a structural wedged bone graft, or chips of cancellous bone has been used to fill the defect. K-wires or a screw has been used to stabilize the bone. Using the arthroscopic technique for treatment of nonunion of the scaphoid gives us small exposure to the joint, however with an excellent view of the bones, the articular surfaces and the intraarticular ligaments. The results from arthroscopic treatment for scaphoid nonunion with bone grafting using chips of cancellous bone are as good as from the open technique. The arthroscopic treatment, though, helps us to diagnose and treat concomitant lesions. There is less damage of blood supply, nerves and capsule, which might lead to a faster recovery and rehabilitation. The technique will be described and discussed.


Assuntos
Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/cirurgia , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Parafusos Ósseos , Fios Ortopédicos , Fixação Interna de Fraturas , Humanos
3.
Medicine (Baltimore) ; 99(39): e22294, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991433

RESUMO

RATIONALE: Kirner's deformity is an uncommon deformity of finger, characterized by palmo-radial curvature of distal phalanx of the fifth finger. The specific mechanism remains unknown yet. This study aims to present a case report to add the knowledge on this type of deformity. PATIENT CONCERNS: A 9-year-old girl presenting with deformity of her fifth finger since she was born was admitted to our hand surgery clinic. MRI findings showed widened epiphyseal plate, L-shaped physis, but normal flexor digitorum profundus tendon insertion, without any significantly enhanced soft issues. DIAGNOSIS: Kirner's deformity of the fifth finger. INTERVENTIONS: We presented 2 surgical choices for the patient: one was wedge osteotomy of the distal phalanx to correct the mechanical line of the distal phalanx and fixation with Kirschner wire and the other one was cut-off of deep flexor tendon insertion with brace immobilization, but her guardians refused either of them. OUTCOMES: Consecutive follow-up was performed for 19 months after the first visit, showing no any change in finger shape and function. LESSONS: The L-shaped epiphyses may be the cause of Kirner's deformity and further attention should be paid on in the clinic. This case report provided a basis for the etiological diagnosis and future treatment of Kirner's deformity.


Assuntos
Falanges dos Dedos da Mão/anormalidades , Deformidades Congênitas da Mão/diagnóstico por imagem , Osteotomia/instrumentação , Assistência ao Convalescente , Fios Ortopédicos/normas , Braquetes/normas , Criança , Feminino , Falanges dos Dedos da Mão/cirurgia , Lâmina de Crescimento/anormalidades , Lâmina de Crescimento/diagnóstico por imagem , Deformidades Congênitas da Mão/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Osteotomia/métodos , Tendões/diagnóstico por imagem , Tendões/cirurgia , Recusa do Paciente ao Tratamento
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1195-1199, 2020 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-32929916

RESUMO

Objective: To review the research progress of interphalangeal arthrodesis in the treatment of interphalangeal joint deformity. Methods: The literature about interphalangeal arthrodesis at home and abroad was extensively consulted, and the indications, fusion methods, fixation methods, complications, and so on were summarized and analysed. Results: The indications of interphalangeal arthrodesis are hammer toe, claw toe, and mallet toe. From the different forms of fusion surface, fusion methods include end-to-end, peg-in-hole, conical reamer type, and V-shape arthrodesis. There are three kinds of fixation methods: Kirschner wire fixation, stainless-steel wire suture fixation, and intramedullary fixation, and there are many kinds of intramedullary fixation. The complications of interphalangeal arthrodesis include vascular injury, fixation related complications, and postoperative complications. Conclusion: Interphalangeal arthrodesis is a good way to correct some deformities of toes, but the incidence of various complications can not be ignored, and there is still a lack of clinical research on interphalangeal arthrodesis.


Assuntos
Síndrome do Dedo do Pé em Martelo , Articulação do Dedo do Pé , Artrodese , Fios Ortopédicos , Humanos , Dedos do Pé
5.
Zhonghua Wai Ke Za Zhi ; 58(9): 713-717, 2020 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-32878419

RESUMO

Objective: To investigate the clinical effect of static staple in the treatment of metatarsal neck fracture. Methods: The clinical data of 34 patients with the 2(nd) to 5(th) metatarsal neck fracture admitted to the Department of Orthopaedic Surgery, Tianjin Fifth Central Hospital from January 2017 to December 2018 were retrospectively analyzed.Seventeen patients were treated with static staple and 17 with retrograde Kirschner wire.In solustaple group, there were 11 males, 6 females, aged 34.6 years (range: 21 to 50 years), 10 cases on the right side, 7 cases on the left side.In retrograde Kirschner wire group, there were 12 males and 5 females, aged 36.2 years (range: 23 to 53 years), 9 on the right and 8 on the left.The fracture healing time was recorded and the postoperative complications were counted.The American Orthopedic Foot and Ankle Society Score (AOFAS) forefoot score, visual analogue scale (VAS), and the active flexion and extension range of metatarsophalangeal joints were measured to compare the clinical efficacy of the two groups.The data were compaired by t test, non-parametric or χ(2) test. Results: All patients were followed up for 14.2 months (range: 12 to 17 months).All the fractures were healed and there was no statistically significant difference between solustaple group and retrograde Kirschner wire group in fracture healing time ((11.2±2.1) week vs.(11.5±3.1) week, t=0.030, P=0.743).There was no statistically significant difference between VAS (1.00 (1.00) vs.1.00 (1.50) M(Q(R)), Z=-0.443, P=0.658) and AOFAS scores(90.9±5.3 vs. 88.6±6.1, t=1.174, P=0.249) at the last follow-up. The difference in active dorsiflexion((35.1±4.3)° vs.(31.2±6.4)°, t=2.055, P=0.048) and flexion range of motion ((34.7±4.5)° vs. (30.2±5.3)°, t=2.681, P=0.011) between the two groups was statistically significant. One case of open fracture in the Solustaple group had local skin necrosis, and three patients had metatarsal pain after weight-bearing walking. Four patients in the retrograde Kirschner wire group developed metatarsalgia after weight-bearing walking, and two patients developed mild dorsal extension contracture and joint pain. Conclusions: The treatment of the 2(nd) to 5(th) metatarsal neck fracture by static staple is minimally invasive and firmly fixed. It can effectively reduce the complications of tendon and joint adhesion, and is beneficial to the fracture healing and joint function recovery.


Assuntos
Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/métodos , Ossos do Metatarso/cirurgia , Adulto , Fios Ortopédicos , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Ossos do Metatarso/lesões , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
Medicine (Baltimore) ; 99(33): e21696, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872043

RESUMO

INTRODUCTION: Lateral condylar fracture (LCF) of the humerus in children is one of the commonest elbow injuries in children. Early recognition of the problem and appropriate management usually yields satisfactory outcomes. Closed or open reduction with Kirschner-wire (KW) is a cost-effective choice of fixation method for displaced fracture. However, various other methods, including partially threaded cannulated cancellous screw and biodegradable pin (BP), have also been used. This study aimed to investigate the efficacy of BP and compare its clinical outcomes with KW. MATERIAL AND METHODS: Patients with LCF admitted from January 2008 to January 2016 at our institute were reviewed retrospectively. Baseline information and clinical data were collected from Hospital Database. Patients were divided into the KW group and BP group. RESULTS: In all, 85 patients (male 50, female 35) in the KW group and 76 patients (male 47, female 29) in the BP group were included in this study. The average age of patients in the KW group was 5.2 years, and that of BP was 5.9 years. No nonunion or malunion was observed in either group. At the last follow-up visit, there was no statistically significant difference between the 2 groups with regard to elbow function and appearance. The incidence of long-term complications, including avascular necrosis, fishtail deformity, and lateral prominence, showed no significant difference between both the groups. The incidence of hardware prominence was higher in the KW (13/85, 15.6%) than BP (2/76, 2.6%) group (P < .001). CONCLUSIONS: Both KW and BP are safe and effective choices for LCF of the humerus in children. Both the implant designs produce satisfactory and comparable clinical outcomes. However, BP has the advantage of less hardware prominence, no need for hardware removal, and fewer long-term complications.


Assuntos
Implantes Absorvíveis , Fios Ortopédicos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Criança , Pré-Escolar , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Fraturas do Úmero/diagnóstico por imagem , Masculino , Estudos Retrospectivos
7.
Bone Joint J ; 102-B(8): 1082-1087, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731834

RESUMO

AIMS: Osteopetrosis (OP) is a rare hereditary disease that causes reduced bone resorption and increased bone density as a result of osteoclastic function defect. Our aim is to review the difficulties, mid-term follow-up results, and literature encountered during the treatment of OP. METHODS: This is a retrospective and observational study containing data from nine patients with a mean age of 14.1 years (9 to 25; three female, six male) with OP who were treated in our hospital between April 2008 and October 2018 with 20 surgical procedures due to 17 different fractures. Patient data included age, sex, operating time, length of stay, genetic type of the disease, previous surgery, fractures, complications, and comorbidity. RESULTS: The mean follow-up period was 92.5 months (25 to 140). Bony union was observed in all of our patients. Osteomyelitis developed in two patients with femoral shaft fractures, and two patients had peri-implant stress fractures. CONCLUSION: Treatment of fractures in OP patients is difficult, healing is protracted, and the risk of postoperative infection is high. In children and young adults with OP who have open medullary canal and the epiphyses are not closed, fractures can be treated with surgical techniques such as intramedullary titanium elastic nail (TENS) technique or fixation with Kirschner (K)-wire. Cite this article: Bone Joint J 2020;102-B(8):1082-1087.


Assuntos
Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Ósseas/cirurgia , Osteopetrose/complicações , Adolescente , Pinos Ortopédicos , Fios Ortopédicos , Criança , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Osteopetrose/diagnóstico por imagem , Osteopetrose/cirurgia , Estudos Retrospectivos , Medição de Risco , Amostragem , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
J Am Acad Orthop Surg ; 28(15): e651-e661, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732656

RESUMO

Fractures of the carpus can be debilitating injuries and often lead to chronic pain and dysfunction when not properly treated. Although scaphoid fractures are more common, fractures of the other carpal bones account for nearly half of all injuries of the carpus. Often missed on initial presentation, a focused physical examination with imaging tailored to the suspected injury is needed to identify these fractures. In addition to plain radiographs, advanced imaging such as CT and MRI are helpful in diagnosis and management. Treatment of carpal fractures is based on the degree of displacement, stability of the fracture, and associated injuries. Those that require surgical fixation often affect the congruency of the articular surfaces, are unstable, are at risk for symptomatic nonunion, are associated with notable ligamentous injury, or are causing nerve or tendon entrapment. Surgical strategies involve percutaneous Kirschner wires, external fixation, screws and/or plates, excision, or fusion for salvage. Owing to the intimate articulations in the hand, small size of the carpal bones, and complex vascular supply, carpal fracture complications include symptomatic nonunion, osteonecrosis, and posttraumatic arthritis.


Assuntos
Ossos do Carpo/lesões , Ossos do Carpo/cirurgia , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Artrite/etiologia , Placas Ósseas , Parafusos Ósseos , Fios Ortopédicos , Ossos do Carpo/irrigação sanguínea , Fraturas Ósseas/complicações , Humanos , Osteonecrose , Terapia de Salvação
9.
Medicine (Baltimore) ; 99(21): e20015, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481269

RESUMO

The purpose of this study is to define the rate of implant failure and risk factors for failure in patients treated operatively for displaced medial epicondyle fractures.Patients <18 years of age with medial epicondyle humerus fractures that were treated with screw or k-wire fixation between 2005 and 2015 were eligible. Inclusion criteria included follow-up until radiographic union and no known medical conditions that could impair healing.Thirty four patients with 35 fractures were identified with an average age of 12 years old. 11.4% (n = 4/35) of fractures were treated using K-wires, 25.7% (n = 9/35) were treated using a screw and washer construction, and 62.9% (n = 22/35) were treated using screw alone. There were 16 reported complications (46%) including implant prominence requiring reoperation (6), implant failure (1), and fracture displacement (1). Other complications included non-union/delayed union (4), new ulnar nerve palsy (2), and decreased range of motion (2). Rates of complications were not different between the types of fixation (P = 1.0). Those who developed complications were younger than those who did not (P = 0.05). 91.4% of patients returned to full activity including weight bearing and throwing sports.Although 25% of patients experienced implant complications and the overall complication rate approached 50%, nearly all reported return to full activity.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas do Úmero/cirurgia , Complicações Pós-Operatórias/etiologia , Adolescente , Parafusos Ósseos/efeitos adversos , Fios Ortopédicos/efeitos adversos , Criança , Falha de Equipamento , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 99(26): e20862, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590787

RESUMO

RATIONALE: Talar fracture accompanied with malleolar fracture is rare, and its management is complex. Ankle soft tissue is much thinner than other parts of the human body, and the shape of the ankle makes wounds difficult to close immediately after surgery, which may result in poor skin condition if the wound tension is too high. However, joint congruity and osteonecrosis are the main concerns of talar fracture. PATIENT CONCERNS: A 57-year-old man presented at the emergency department following a motorcycle accident. DIAGNOSES: Physical examination revealed swelling and tenderness of the left ankle and midfoot. The patient had comminuted talar fracture and was indicated for dual-screw fixation or even plate with screw fixation. INTERVENTIONS: We performed single screw fixation after assessing the soft tissue condition and employed a technique of using continuous longitudinal force to bring together fracture fragments (ankle ligamentotaxis) during surgery. Open reduction with a mini-hook plate and tension band wire was used for bimalleolar fracture repair using the combined anteromedial and anterolateral approach with extension of the incision. Kirschner wire for temporary fixation was performed using ligamentotaxis, and a 2.4 headless screw was inserted from the posteromedial to the anterolateral direction. OUTCOMES: The patient was discharged with a standard short leg splint and was instructed not to bear weight on the affected ankle for 2 months. The patient walked well without discomfort, and the Hawkins sign was clearly visible. Single screw fixation preserves the integrity of the talus bone as minimal space is used for this operative technique. Single screw fixation preserves more bony stock when most of the internal fixator is located within the bone. Additionally, surgery time is shorter than multiple implantations even when performing the same procedure; as a result, there was less ankle soft tissue swelling. LESSONS: This case provides evidence of using the single screw fixation technique for addressing both malleolar and talar fractures, and that talar fracture management can be less aggressive with limited weight bearing and initial limited range of motion given the presence of malleolar fracture. The alignment and stability of bony fragments also benefit from ankle ligamentotaxis.


Assuntos
Fraturas do Tornozelo/diagnóstico , Acidentes de Trânsito , Fraturas do Tornozelo/cirurgia , Placas Ósseas , Fios Ortopédicos , Serviço Hospitalar de Emergência/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Motocicletas , Redução Aberta/métodos , Tálus/cirurgia , Tomografia Computadorizada por Raios X/métodos
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(6): 671-675, 2020 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-32538554

RESUMO

Objective: To evaluate the effectiveness of nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid perilunate dislocation. Methods: Between September 2011 and October 2018, 17 patients with trans-scaphoid perilunate dislocation were treated with nitinol memory alloy two foot fixator and Kirschner wire. There were 12 males and 5 females, with an average age of 32.6 years (range, 23-52 years). The disease duration was 8 hours to 9 days, with an average of 6.5 days. The causes of injury included 6 cases of falling injury, 4 cases of traffic accident injury, 3 cases of stress injury of wrist caused by sports, 2 cases of violent injury of wrist caused by machine impact, 1 case of military training injury, and 1 case of other injury. One case was complicated with nerve injury. According to Herbert's classification, all the fractures were type B4. At 1 week before operation, 3 months, 6 months after operation and last follow-up, the wrist function was evaluated according to the Krimmer scale score. Results: All the 17 patients were followed up 10.5-48 months, with an average of 18.6 months. There was no loosening or infection of the internal fixator, no necrosis of the scaphoid and lunate. The periosteal dislocations of the patients were well reduced and the scaphoid fractures all healed. The healing time was 4-18 months, with an average of 11.3 months. The Krimmer wrist scores were 37.5±4.4, 61.3±7.2, 83.3±9.3, 87.3±8.2 at 1 week before operation, 3 months, 6 months after operation and last follow-up, respectively. The Krimmer wrist score at each time point after operation was significantly improved when compared with that before operation ( P<0.05), and at 6 months after operation and last follow-up than at 3 months after operation ( P<0.05). There was no significant difference between at 6 months and last follow-up ( P>0.05). At last follow-up, the Krimmer wrist function was excellent in 13 cases, good in 2 cases, fair in 1 case, poor in 1 case, and the excellent and good rate was 88.23%. Conclusion: Nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid periosteal dislocation has definite effectiveness, simple operation, and good recovery of wrist function after operation.


Assuntos
Ligas , Fios Ortopédicos , Fixação Interna de Fraturas , Fraturas Ósseas , Luxações Articulares , Osso Escafoide , Adulto , Ligas/uso terapêutico , Fios Ortopédicos/normas , Feminino , Fixação Interna de Fraturas/normas , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Osso Escafoide/cirurgia , Resultado do Tratamento , Adulto Jovem
14.
Zhongguo Gu Shang ; 33(4): 379-82, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32351096

RESUMO

OBJECTIVE: To explore the operative method and clinical effect of lateral mini plate and Kirschner wire in the treatment of distal humeral metaphysis junction fracture in children. METHODS: From January 2015 to December 2018, 21 cases of distal humeral diaphyseal metaphyseal junction fracture were analyzed retrospectively, including 12 males and 9 females, aged 2 to 10 years with an average age of 4.5 years, and the time from injury to operation was 6 hours to 7 days. The imaging data showed that the fracture line was located at the junction of the distal humerus and metaphysis. There were 10 oblique fractures, 8 transverse fractures and 3 comminuted fractures. The operation methods were open reduction, lateral mini plate and Kirschner wire assisted internal fixation, and the improved Flynn elbow joint scoring standard was used to evaluate the clinical effect. RESULTS: All the 21 children were followed up for 8 to 24 months, with an average of 13 months. The healing time was 6 to 8 weeks, with an average of 7.2 weeks. There were no complications such as fracture displacement, cubitus varus and ulnar nerve injury. According to the improved Flynn elbow joint scoring standard, 19 cases were excellent and 2 cases were good. CONCLUSION: The treatment of distal humeral metaphyseal junction fracture in children is different from that of supracondylar fracture of humerus.


Assuntos
Fios Ortopédicos , Fraturas do Úmero , Placas Ósseas , Criança , Pré-Escolar , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/cirurgia , Úmero , Masculino , Estudos Retrospectivos , Resultado do Tratamento
15.
Indian J Dent Res ; 31(2): 331-333, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32436919

RESUMO

In the treatment of mid-facial fractures circum-zygomatic suspension wiring is one of the treatment modality. Earlier zygomatic awls were used to pass wire, which used to cause conspicuous trauma. In the present case we have used 16 gauge lumbar puncture needle for the suspension wiring for Lefort 1 fracture, which is inconspicuous as compared to an awl. The needle was passed in close proximity to bone to prevent soft tissue impaction between the wire and bone as it might lead to the necrosis of soft tissue, and the wire was twisted around the maxillary arch bar. The fragments were stable and occlusion was maintained. Six weeks post-operatively the bone healing was satisfactory, and the wires and arch bar were removed.


Assuntos
Fraturas Maxilares , Fraturas Zigomáticas , Fios Ortopédicos , Fixação Interna de Fraturas , Humanos , Maxila , Punção Espinal
16.
BMC Surg ; 20(1): 71, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293417

RESUMO

BACKGROUND: Simultaneous dislocation of the radial head and distal radio-ulnar joint without fracture (Criss-Cross Injury) in an adult patient is rarely reported in previous studies. The pathological changes and injury patterns have not been clearly demonstrated. CASE PRESENTATION: A 26-year-old woman presented with acute pain of the right wrist and elbow after a fall from cycling. Physical examination revealed an unstable elbow and wrist joint. Plain radiographs showed volar dislocation of the radial head and dorsal dislocation of the distal radius without associated fracture, forming a criss-cross appearance of the ulna and radius on the lateral radiograph. MRI images confirmed partial rupture of the proximal interosseous membrane from its dorsal attachment on the radius, as well as partial rupture of the medial collateral ligament. Conservative treatment failed because the radiocapitellar joint and distal radio-ulnar joint could not be simultaneously reduced. Surgical exploration revealed a highly unstable radial head, but the annular ligament was found to be intact. Manual force was applied to reduce the radial head and a percutaneous K-wire was used to stabilize the proximal radioulnar joint with the forearm in full supination. After surgery, the elbow was immobilized in 90° flexion by a long arm cast for 4 weeks. The K-wire was removed at 6 weeks postoperatively. At 18 months postoperatively, the patient had regained a full range of flexion and extension, with normal supination and a slight limitation in pronation. CONCLUSIONS: The proximal IOM, especially the dorsal band, was injured in Criss-Cross injuries, while the central part of the IOM remained intact. This injury pattern distinguished itself from Essex-Lopresti injury, which mainly involves rupture of the central band of the IOM.


Assuntos
Articulação do Cotovelo/patologia , Luxações Articulares/cirurgia , Articulação do Punho/patologia , Adulto , Fios Ortopédicos , Feminino , Humanos , Radiografia , Rádio (Anatomia)/patologia , Amplitude de Movimento Articular , Ruptura , Ulna/patologia
17.
J Hand Surg Asian Pac Vol ; 25(2): 177-183, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32312196

RESUMO

Background: The purpose of this study was to identify the optimal pin insertion point to minimize finger motion restriction for proximal phalangeal fixation in cadaver models. Methods: We used 16 fingers from three fresh-frozen cadavers (age, 82-86 years). Each finger was dissected at the level of the carpometacarpal joint and fixated to a custom-built range of motion (ROM)-measuring apparatus after skin removal. The pin was inserted into the bone through four gliding soft tissues: the interosseous hood, dorsal capsule, lateral band, and sagittal band. Then, each tendon was pulled by a prescribed weight in three finger positions (flexion, extension, and intrinsic plus position). Changes in the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) angles were measured before and after pinning. We compared the differences between the insertion points using the Tukey-Kramer post hoc test. Results: Placement of pins into the sagittal band significantly restricted MCP joint flexion, while placement into the dorsal capsule and lateral band significantly restricted PIP joint flexion. Only placement into the interosseous hood showed no significant difference in joint angles between the three finger positions compared to pre-pin insertion. There were no significant effects on MCP, PIP, and DIP joint extension. Conclusions: The ROM of the MCP joint was obstructed due to pinning in most areas of insertion. However, pin insertion to the interosseous hood did not obstruct the finger flexion ROM compared to that of other gliding soft tissues; therefore, we believe that the interosseous hood may be a suitable pin insertion point for proximal phalangeal fixation.


Assuntos
Fios Ortopédicos , Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/cirurgia , Fixação Intramedular de Fraturas , Articulação Metacarpofalângica/fisiopatologia , Idoso de 80 Anos ou mais , Cadáver , Articulações Carpometacarpais/fisiopatologia , Feminino , Articulações dos Dedos/fisiopatologia , Humanos , Masculino , Amplitude de Movimento Articular , Tendões/cirurgia
18.
J Hand Surg Asian Pac Vol ; 25(2): 226-231, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32312197

RESUMO

Background: Pediatric supracondylar humerus fracture (PSHF) is one of the most common fractures of the elbow seen among boys aged between 5 and 7 years. The timing of surgical treatment for this type of fracture is still controversial. Thus, we aimed to investigate whether the timing of surgery for PSHFs affects the incidence of early postoperative complications and reduction of PSHFs. Methods: We retrospectively reviewed the medical records of PSHF patients who underwent surgery at our hospital between January 2007 and March 2019. We classified patients who underwent surgery within 12 h and more than 12 h after the fracture as the early and delayed groups, respectively. The outcome measures compared between the two groups were the incidence of postoperative early complications such as neurological deficits, including iatrogenic ulnar nerve injury, vascular compromise, compartment syndrome, K-wire migration, and unplanned returns to the operating room. We also examined surgical time, reduction procedure, and perioperative radiographic parameters. Results: There was no significant difference in the incidence of early complications between the early and delayed groups for either modified Gartland type II or type III fractures. There was also no significant difference in surgical time, reduction procedure, or perioperative radiographic parameters between the two groups. Conclusions: Delayed surgery was not associated with an increased rate of postoperative early complications in either type II or type III fractures. The timing of surgery does not affect the difficulty or quality of reduction.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas do Úmero/cirurgia , Complicações Pós-Operatórias/epidemiologia , Tempo para o Tratamento , Fatores Etários , Fios Ortopédicos , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Tempo
19.
J Hand Surg Asian Pac Vol ; 25(2): 172-176, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32312200

RESUMO

Background: The vast majority of acute closed tendinous mallet injuries are treated with a splint. Very few studies have directly compared splinting versus pinning the distal interphalangeal joint for this injury. The aim of this cohort study is to determine the outcomes of both methods. Methods: A total of 59 patients with acute tendinous mallet injury were retrospectively enrolled (29 patients in conservative treatment and 30 patients in surgical treatment). Conservative treatment was performed using custom-made thermoplastic splint and surgical treatment was conducted with oblique K-wire fixation of the distal interphalangeal (DIP) joint. The DIP joint was immobilized for eight weeks in both treatments. Active ranges of motion of the affected finger and Miller's classification were evaluated postoperatively. Results: The mean extension lag of the DIP joint in the surgical treatment group was significantly better than it was with conservative treatment (2.1° vs 13.8°). Three patients who were noncompliant with the splint showed poor results, while no patients in the surgical treatment group had a poor result. Conclusions: Surgical treatment with K-wire fixation leads to satisfactory results for acute tendinous mallet injury.


Assuntos
Fios Ortopédicos , Traumatismos dos Dedos/terapia , Articulações dos Dedos/cirurgia , Contenções , Traumatismos dos Tendões/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Arch Orthop Trauma Surg ; 140(5): 623-638, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32193675

RESUMO

Wrist arthroscopy is mainly used to assist fracture reduction and fixation and to diagnose and treat concomitant injuries mainly to the scapholunate (SL), lunotriquetral (LT) ligament and the triangular fibrocartilage complex (TFCC). Arthroscopy is beneficial in improving anatomical reduction of fracture steps and gaps in intra-articular distal radius fractures (DRFs). Yet, the literature that the functional outcome correlates with the use of arthroscopy, is limited. Non-surgical treatment and immobilization is recommended for Geissler grade I-III Sl-ligament injuries, while open reduction, ligament suture and/or K-wire pinning is mandatory for complete ligament tears according to Geissler grade IV. This manuscript describes the current literature and gives insight into the authors' opinions and practice.


Assuntos
Artroscopia/métodos , Fios Ortopédicos , Fixação Intramedular de Fraturas/métodos , Redução Aberta/métodos , Fraturas do Rádio/cirurgia , Traumatismos do Punho/cirurgia , Articulação do Punho/cirurgia , Humanos , Ligamentos Articulares/cirurgia , Fraturas do Rádio/complicações , Fraturas do Rádio/diagnóstico , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico , Articulação do Punho/diagnóstico por imagem
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