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1.
JAMA ; 323(6): 519-526, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-32044942

RESUMO

Importance: Following surgery to treat major trauma-related fractures, deep wound infection rates are high. It is not known if negative pressure wound therapy can reduce infection rates in this setting. Objective: To assess outcomes in patients who have incisions resulting from surgery for lower limb fractures related to major trauma and were treated with either incisional negative pressure wound therapy or standard wound dressing. Design, Setting, and Participants: A randomized clinical trial conducted at 24 trauma hospitals representing the UK Major Trauma Network that included 1548 patients aged 16 years or older who underwent surgery for a lower limb fracture caused by major trauma from July 7, 2016, through April 17, 2018, with follow-up to December 11, 2018. Interventions: Incisional negative pressure wound therapy (n = 785), which involved a specialized dressing used to create negative pressure over the wound, vs standard wound dressing not involving negative pressure (n = 763). Main Outcomes and Measures: The primary outcome measure was deep surgical site infection at 30 days diagnosed according to the criteria from the US Centers for Disease Control and Prevention. A preplanned secondary analysis of the primary outcome was performed at 90 days. The secondary outcomes were patient-reported disability (Disability Rating Index), health-related quality of life (EuroQol 5-level EQ-5D), surgical scar assessment (Patient and Observer Scar Assessment Scale), and chronic pain (Douleur Neuropathique Questionnaire) at 3 and 6 months, as well as other local wound healing complications at 30 days. Results: Among 1548 participants who were randomized (mean [SD] age, 49.8 [20.3] years; 561 [36%] were aged ≤40 years; 583 [38%] women; and 881 [57%] had multiple injuries), 1519 (98%) had data available for the primary outcome. At 30 days, deep surgical site infection occurred in 5.84% (45 of 770 patients) of the incisional negative pressure wound therapy group and in 6.68% (50 of 749 patients) of the standard wound dressing group (odds ratio, 0.87 [95% CI, 0.57 to 1.33]; absolute risk difference, -0.77% [95% CI, -3.19% to 1.66%]; P = .52). There was no significant difference in the deep surgical site infection rate at 90 days (11.4% [72 of 629 patients] in the incisional negative pressure wound therapy group vs 13.2% [78 of 590 patients] in the standard wound dressing group; odds ratio, 0.84 [95% CI, 0.59 to 1.19]; absolute risk difference, -1.76% [95% CI, -5.41% to 1.90%]; P = .32). For the 5 prespecified secondary outcomes reported, there were no significant differences at any time point. Conclusions and Relevance: Among patients who underwent surgery for major trauma-related lower limb fractures, use of incisional negative pressure wound therapy, compared with standard wound dressing, resulted in no significant difference in the rate of deep surgical site infection. The findings do not support the use of incisional negative pressure wound therapy in this setting, although the event rate at 30 days was lower than expected. Trial Registration: isrctn.org Identifier: ISRCTN12702354.


Assuntos
Bandagens , Fixação Interna de Fraturas , Fraturas Expostas/cirurgia , Extremidade Inferior/lesões , Tratamento de Ferimentos com Pressão Negativa , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica/epidemiologia
2.
Medicine (Baltimore) ; 99(8): e19195, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080105

RESUMO

RATIONALE: Less-Invasive Stabilization System (LISS) plate is an internal fixation commonly used for the periprosthetic distal femur fractures. Failure associated with LISS plate has been rarely reported, and the reasons for LISS plate failure are multitudinous. Various advantages have been reported, but failures continue. PATIENT CONCERNS: We present 3 cases illustrating the failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures. The shaft screws of the LISS plate broke in 2 cases, and the plate placement was incorrect in 1 case. Early weight bearing, obesity, osteoporosis, and lateral collateral ligament injury due to incorrect plate placement constituted the etiologies of LISS plate failure. DIAGNOSIS: Failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures after Total knee arthroplasty. INTERVENTIONS: Three patients underwent Less-Invasive Stabilization System plates removal with replacement of the total knee arthroplasty revision surgery with rotating hinged knee prosthesis. OUTCOMES: After completing the total knee arthroplasty revision surgery, all patients underwent regular follow-up examinations. Case 2 could walk unaided, without pain, final union was confirmed for both case 1 and case 3. CONCLUSION: Less-Invasive Stabilization System (LISS) plate provides satisfactory results in periprosthetic fractures after Total knee arthroplasty (TKA). The LISS plate has many advantages, but failures continue to occur. The causes for failure were early weight bearing, obesity, osteoporosis, and lateral collateral ligament (LCL) injury due to incorrect plate placement in our series. We recommend that protection or properly delay of weight-bearing, active anti-osteoporosis treatment, and intraoperative fluoroscopy are the effective methods to avoid failure.


Assuntos
Placas Ósseas/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Periprotéticas/cirurgia , Idoso , Artroplastia do Joelho/métodos , Falha de Equipamento , Feminino , Fraturas do Fêmur/epidemiologia , Humanos , Obesidade/epidemiologia , Osteoporose/epidemiologia , Fraturas Periprotéticas/epidemiologia , Suporte de Carga/fisiologia
3.
J Surg Res ; 246: 476-481, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31668607

RESUMO

INTRODUCTION: Rib fractures are a major problem in trauma patients, and the associated pain is not well understood. Measuring total pain experience, duration, and intensity could facilitate comparisons of treatments. This study was intended to evaluate the feasibility of quantifying pain over the course of an admission and identify factors associated with increased pain experience in adults with rib fractures. METHODS: Patients admitted to a level I trauma center with rib fractures between 2015 and 2017 were included. Maximum pain score (verbal or nonverbal) was captured for each hospital day. Total pain was defined as the sum of the area under the curve (AUC) of the max pain scores plotted against time. A general linear model was used to determine demographic, injury, and clinical predictors of the pain AUC. RESULTS: We identified 3713 patients. Increased pain experienced (greater AUC) was associated with age group 40-59 y compared with 18-39 y (B = 6.1, P = 0.002); Injury Severity Score 9-14 (B = 11.5, P < 0.001) and ≥16 (B = 36.9, P < 0.0001); patients with flail chest versus multiple rib fractures (B = 17.1, P < 0.001); and patients who underwent rib fixation (B = 20.7, P = 0.004). Decreased pain experience was observed for male gender (B = -3.7, P = 0.032) and blunt mechanism of injury (B = -13.7, P < 0.0001). CONCLUSIONS: This study demonstrates the feasibility of measuring patients' total pain experience over the duration of their admission. Pain is a subjective but relevant measure of patients' experience. Our study identifies a number of predictive factors, some expected and some unexpected. Increased overall experience pain following fixation may be the result of severe pain before intervention.


Assuntos
Tórax Fundido/diagnóstico , Fixação Interna de Fraturas/efeitos adversos , Dor Musculoesquelética/diagnóstico , Medição da Dor/métodos , Fraturas das Costelas/complicações , Adolescente , Adulto , Fatores Etários , Estudos de Viabilidade , Feminino , Tórax Fundido/etiologia , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico , Fraturas das Costelas/cirurgia , Índice de Gravidade de Doença , Fatores Sexuais , Fatores de Tempo , Centros de Traumatologia/estatística & dados numéricos , Adulto Jovem
4.
Medicine (Baltimore) ; 98(44): e17850, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689876

RESUMO

BACKGROUND: Lateral humeral condyle fractures are the second most common elbow fracture in children. Displaced and rotated fractures require stabilization and reduction. Kirschner wires (K-wires) are most commonly used in the fixation of these fractures. Here, we introduce a new fixation method that uses an absorbable screw. We aim to determine if it is feasible to treat lateral humeral condyle fractures with an absorbable screw by comparing functional outcomes following absorbable screw fixation vs. K-wire fixation. METHODS: Between May 2007 and September 2010, 86 patients were treated with absorbable screws (43 patients) or K-wire (43 patients). All patients had been diagnosed with lateral condyle fractures that were classified as either Jacob type II (unstable) or III. One absorbable screw (3.5 mm-diameter) was used for fixation in 1 group, while two 1.6 to 1.8 mm K-wires were used in the other group. Patients were followed 6 months about the elbow function according to Broberg and Morrey standard. On 5-7 years, the patients were followed about the carrying angle (valgus deformities and varus deformities), range of motion (flexion loss and extension loss), prominent lateral condyle, symptomatic implants, and fishtail deformity. RESULTS: Anatomic reduction was achieved in all patients. Each group had one radial nerve injury that were present preoperatively. Nerve function recovered spontaneously within 3 to 4 weeks of surgery in both patients. No patient developed necrosis of the capitulum in both groups. Nine patients in K-wires group and 2 in absorbable screw group developed symptomatic implants (P = .048). On the sixth month, there was no significant difference on elbow function according to Broberg and Morrey standard. On 5 to 7 years (average, 6.7 ±â€Š1.3 years), valgus deformities was 6.8 ±â€Š1.2 vs 5.7 ±â€Š0.8, varus deformities was 7.2 ±â€Š1.5 vs 5.1 ±â€Š1.9, flexion loss was 12.4 ±â€Š2.2 vs 9.5 ±â€Š3.1, extension loss was 11.1 ±â€Š3.1 vs 10.2 ±â€Š2.7, prominent lateral condyle was 27.9% vs 37.2%, fishtail deformity was 7.3% vs 4.9%, no significant difference between these groups. CONCLUSIONS: Open reduction with absorbable screw fixation is feasible and safe for the treatment of lateral condyle fractures of the humerus in children. LEVEL OF EVIDENCE: Therapeutic III.


Assuntos
Implantes Absorvíveis , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Redução Aberta , Suturas , Adolescente , Fios Ortopédicos , Criança , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Fraturas do Úmero/classificação , Fraturas do Úmero/fisiopatologia , Masculino , Complicações Pós-Operatórias , Amplitude de Movimento Articular , Estudos Retrospectivos
5.
J Hand Surg Asian Pac Vol ; 24(4): 392-399, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690191

RESUMO

Background: The aim of this study was to identify the risk factors for median nerve dysfunctions after volar locking plate (VLP) fixation for distal radius fracture (DRF). Methods: We prospectively assessed the incidence of median nerve symptoms (MNS) such as numbness, pain, paresthesia, or hypesthesia in the area innervated by the median nerve and evaluated post-operative nerve conduction (NC) in 91 hands of 121 patients after VLP fixation for DRF. Multivariate logistic regression analysis was conducted to identify factors independently associated with MNS and abnormal NC in the injured wrist. Results: There were 18 cases (20%) of MNS on the injured side, 9 hands (10%) of both MNS and abnormal NC, 11 hands (12%) with only abnormal NC, and 9 hands with only MNS. Sensitivity, specificity, and diagnostic accuracy of abnormal NC for diagnosing MNS were 50%, 86%, and 78%, respectively. Four cases did not respond to conservative treatment and received carpal tunnel release concomitantly with plate removal. Logistic regression examination revealed that volar placement of the plate and short stature were significant independent predictors of MNS, while patient age was the sole independent predictor of abnormal NC. Conclusions: Our study demonstrated that plate prominence, short stature, and age were significant independent risk factors for median nerve dysfunctions after VLP fixation for DRF.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Nervo Mediano/fisiopatologia , Traumatismos dos Nervos Periféricos/diagnóstico , Fraturas do Rádio/complicações , Idoso , Eletromiografia , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Nervo Mediano/lesões , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/epidemiologia , Traumatismos dos Nervos Periféricos/etiologia , Complicações Pós-Operatórias , Estudos Prospectivos , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/cirurgia
6.
Medicine (Baltimore) ; 98(46): e17952, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725653

RESUMO

BACKGROUND: There is no consensus regarding the surgical treatment of humeral shaft fracture. The present meta-analysis was performed to compare the efficacy and safety between antegrade intramedullary nailing (IMN) and plating for humeral shaft fracture. METHODS: PubMed, MEDLINE, Cochrane Library, EMBASE, Clinical Trails, Ovid, ISI Web of Science, and Chinese databases including WanFang Data, China National Knowledge Infrastructure were searched through March 10, 2019. The Review Manager software was adapted to perform statistical analysis and relative risk (RR) were used for the binary variables, and weighted mean difference and standardized mean difference (SMD) were used to measure the continuous variables. Each variable included its 95% confidence interval (CI). RESULTS: A total of 15 trials with 839 patients were included in the analysis. There was significant difference between IMN group and plate group in blood loss (SMD = 3.49, 95% CI: 1.19, 5.79, P = .003) and postoperative infections (RR = 3.04, 95% CI: 1.49, 6.24, P = .002). Additionally, significant difference was observed between minimally invasive plate osteosynthesis (MIPO) group and IMN group in nonunion rate (RR = 3.20, 95% CI: 0.12, 0.84, P = .02). Statistical significance was also observed between the open reduction plate fixation group and IMN group in restriction of shoulder and elbow joints results (RR = 0.49, 95% CI: 0.26, 0.96, P < .05). No significant difference was observed for the operation time, American Shoulder and Elbow Surgeons score, nerve injury, delayed union, reoperation in either group. CONCLUSION: IMN may be superior to plate in reducing blood loss and postoperative infections for the treatment of humeral shaft fracture. However, MIPO was superior to IMN group in nonunion and equal to IMN in other parameters. Further research is required and future studies should include analysis of assessments at different stages and follow-up after removal of the implants.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Complicações Pós-Operatórias/epidemiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Placas Ósseas , Fixação Interna de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Humanos , Duração da Cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia
7.
Medicine (Baltimore) ; 98(42): e17611, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626138

RESUMO

There is no consensus regarding the references to determine the exact location of the skin incision to minimize iatrogenic sural nerve injury in the sinus tarsi approach for calcaneal fracture.The purpose of this cadaveric study was to describe the anatomical course of the sural nerve in relation to easily identifiable landmarks during the sinus tarsi approach and to provide a more practical reference for surgeons to avoid sural nerve injury.Twenty-four foot and ankle specimens were dissected. The bony landmarks used in the following reference points were the tip of the lateral malleolus (point A), lateral border of the Achilles tendon on the collinear line with point A (point B), posteroinferior apex of the calcaneus (point C), inferior margin of the calcaneus on the plumb line through point A (point D), and tip of the fifth metatarsal base (point E). After careful dissection, the distances of the sural nerve to points A and B in the horizontal direction (lines D1 and D2), points A and C in the diagonal direction (lines D3 and D4), points A and D in the vertical direction (lines D5 and D6), and points A and E in the diagonal direction (lines D7 and D8) were measured.The median ratio of D1 to D1+D2, D3 to D3+D4, D5 to D5+D6, and D7 to D7+D8 were 0.37 (range, 0.26-0.50), 0.23 (range, 016-0.33), 0.35 (range, 0.25-0.45), and 0.32 (range, 0.20-0.45), respectively.The distance ratios from this study can be helpful to avoid sural nerve injury during the sinus tarsi approach for calcaneal fractures. Established standard incision may have to be modified to minimize sural nerve injury.


Assuntos
Traumatismos do Tornozelo/cirurgia , Calcâneo/lesões , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Complicações Intraoperatórias/prevenção & controle , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervo Sural/lesões , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Tornozelo/diagnóstico , Cadáver , Calcâneo/cirurgia , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Ossos do Tarso/cirurgia
8.
Bone Joint J ; 101-B(10): 1292-1299, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564146

RESUMO

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


Assuntos
Artroplastia de Quadril/métodos , Fixação Interna de Fraturas/métodos , Hemiartroplastia/métodos , Fraturas do Quadril/classificação , Fraturas do Quadril/cirurgia , Reoperação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Estudos de Coortes , Confiabilidade dos Dados , Inglaterra , Feminino , Fixação Interna de Fraturas/efeitos adversos , Consolidação da Fratura/fisiologia , Hemiartroplastia/efeitos adversos , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Amplitude de Movimento Articular/fisiologia , Reoperação/métodos , Resultado do Tratamento , País de Gales
9.
BMC Musculoskelet Disord ; 20(1): 397, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31472691

RESUMO

BACKGROUND: Thoracolumbar fractures are most frequent along the spine, and surgical treatment is indicated for unstable fractures. Percutaneous minimally invasive surgery was introduced to reduce the pain associated with the open posterior approach and reduce the morbidity of the procedure by avoiding damage and dissection of the paravertebral muscles. The goal of this study is to compare the surgical treatment of fractures of the thoracolumbar spine treated by the conventional open approach and the percutaneous minimally invasive approach using similar types of pedicle spine fixation systems. METHODS/DESIGNS: This study is designed as a multi-center, randomized controlled trial of patients aged 18-65 years who are scheduled to undergo surgical posterior fixation. Treatment by the conventional open approach or percutaneous minimally invasive approach will be randomly assigned. The primary outcome measure is postoperative pain, which will be measured using the visual analogue scale (VAS). The secondary outcome parameters are intraoperative bleeding, postoperative drainage, surgery time, length of hospital stay, SF-36, EQ-5D-5 l, HADS, pain medication, deambulation after surgery, intraoperative fluoroscopy time, vertebral segment kyphosis, fracture vertebral body height, compression of the vertebral canal, accuracy of the pedicle screws, and breakage or release of the implants. Patient will be followed up for 1, 2, 3, 6, 12 and 24 months postoperatively and evaluated according to the outcomes using clinical and radiological examinations, plain radiographs and computed tomografy (CT). DISCUSSION: Surgical treatment of thoracolumbar fractures by the open or percutaneous minimally invasive approach will be compared in a multicenter randomized study using similar types of fixation systems, and the results will be evaluated according to clinical and radiological parameters at 1, 2, 3, 6, 12 and 24 months of follow-up. TRIAL REGISTRATION: ClinicalTrial.gov approval number: 1.933.631, code: NCT03316703 in may 2017.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Redução Aberta/efeitos adversos , Dor Pós-Operatória/diagnóstico , Fraturas da Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Tempo de Internação/estatística & dados numéricos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Multicêntricos como Assunto , Redução Aberta/instrumentação , Redução Aberta/métodos , Duração da Cirurgia , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Parafusos Pediculares , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
10.
Chin J Traumatol ; 22(5): 249-254, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31492575

RESUMO

PURPOSE: Supracondylar fractures of the humerus cause significant morbidity in children. Nerve damage and loss of fracture reduction are common recognised complications in patients with this injury. Uncertainty surrounds the optimal Kirschner wire configuration and diameter for closed reduction and pinning of these fractures. This study describes current practice and examined the association between wire configuration or diameter and outcomes (clinical and radiological) in the operative management of paediatric supracondylar fractures. METHODS: Children presenting with Gartland II or III supracondylar fractures at five hospitals in south-west England were eligible for inclusion. Collaborators scrutinised paper and electronic case notes. Outcome measures were maintenance of reduction and iatrogenic nerve injury. RESULTS: Altogether 209 patients were eligible for inclusion: 15.7% had a documented neurological deficit at presentation; 3.9% who were neurologically intact at presentation sustained a new deficit caused by treatment and 13.4% experienced a clinically significant loss of reduction following fixation. Maintenance of reduction was significantly better in patients treated specifically with crossed ×3 Kirschner wire configuration compared to all other configurations. The incidence of iatrogenic nerve injury was not significantly different between groups treated with different wire configurations. CONCLUSION: We present a large multicentre cohort study showing that crossed ×3 Kirschner wires are associated with better maintenance of reduction than crossed ×2 or lateral entry wires. Greater numbers would be required to properly investigate nerve injury relating to operative management of supracondylar fractures. We found significant variations in practice and compliance with the British Orthopaedic Association Standard for Trauma (BOAST) 11 guidelines.


Assuntos
Fios Ortopédicos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Úmero/cirurgia , Criança , Estudos de Coortes , Inglaterra , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Doença Iatrogênica , Masculino , Traumatismos dos Nervos Periféricos/etiologia , Estudos Retrospectivos
11.
J Orthop Surg Res ; 14(1): 295, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484547

RESUMO

OBJECTIVE: To investigate the incidence of postoperative overall complications or secondary procedures following distal radius fractures treated by volar locking plate (VLP) METHODS: Electronic medical records (EMR) of 1152 patients with 1175 distal radius fractures treated by volar locking plate between January 2013 and September 2018 were retrospectively reviewed and the data were extracted. The picture archiving and communication system (PACS) was inquired to assess the fracture severity and to determine the fracture type. Univariate and multivariate logistic regression analyses were used to identify the associated risk factors. RESULTS: During the median follow-up period of 6 months, a total of 138 complications in 131 patients were determined, indicating the accumulated rate of 11.7%; there were 68 cases of secondary procedures, with the rate of 5.8%. The independent associated factors for postoperative overall complications were AO type C fracture (OR, 2.6; 95%CI, 1.2 to 4.0), open fracture (OR, 4.2; 95%CI, 1.9 to 6.5), and significant collapse of the lunate fossa (OR, 2.9; 95%CI, 13 to 4.3), and for secondary procedures were significant collapse of the lunate fossa (OR, 3.7; 95%CI, 1.7 to 6.4) and the low-volume of surgeons (OR, 95%CI, 1.2 to 3.6) CONCLUSIONS: Identification of these factors is of importance for the risk assessment of postoperative complications and the additional need of surgery. For patients with the above factors, especially those with combined risk factors, optimized operation scheme and high-volume surgeon should be considered to prevent or reduce the complications.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/cirurgia , Reoperação/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
Bull Hosp Jt Dis (2013) ; 77(3): 217-220, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487489

RESUMO

Olecranon fractures are common trauma presentations, and generally good or excellent functional outcomes are expected after surgical treatment. The development of heterotopic ossification (HO) is a well-known complication, leading to restricted motion, subsequent joint contractures, and marked functional limitation of the upper extremity. Whereas most olecranon fractures complicated by HO have less extensive ossification and limited clinical implications, we report a rare case of HO that required revision surgery for elbow contracture after tension band wiring for an isolated olecranon fracture. Our findings indicate that even patients with isolated olecranon fractures should be notified about the potential risk of HO development, which could result in restricted motion and subsequent joint contractures. The risk factors associated with the development of HO after elbow trauma should be recognized during surgical treatment for olecranon fracture. Fractures of the olecranon are common trauma presentations. 1 Most olecranon fractures are treated surgically, and good or excellent functional outcomes are expected after surgical treatment.1 The development of heterotopic ossification (HO) is a well-known complication after elbow trauma that causes restricted motion, subsequent joint contractures, and marked functional limitation of the affected upper extremity.2 The severity of HO is related to the nature of the injury. Most olecranon fractures complicated by HO have less extensive ossification, and the clinical implications of this type of injury are limited.3 We report a rare case of HO in which revision surgery for the treatment of elbow contracture was required after an isolated olecranon fracture.


Assuntos
Contratura/cirurgia , Fixação Interna de Fraturas , Olécrano , Ossificação Heterotópica , Reoperação/métodos , Fraturas da Ulna , Idoso , Contratura/diagnóstico , Contratura/etiologia , Contratura/fisiopatologia , Articulação do Cotovelo/lesões , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Humanos , Olécrano/lesões , Olécrano/cirurgia , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/fisiopatologia , Ossificação Heterotópica/cirurgia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fraturas da Ulna/diagnóstico , Fraturas da Ulna/cirurgia
13.
BMC Musculoskelet Disord ; 20(1): 357, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31387574

RESUMO

BACKGROUND: Scaphoid fractures are the most common carpal fractures. They often need to be treated by surgery, where the use of a compression screw is the globally accepted gold standard. Surgeons may choose between different implant materials including titanium alloys, which remain in the body or are removed after healing. An alternative are biodegradable magnesium-based implants. Properties of magnesium alloys include high stability, osteoconductivity, potential reduction of infections and few artifacts in magnetic resonance imaging (MRI). The aim of this trial is to demonstrate non-inferiority of magnesium-based compression screws compared with titanium Herbert screws for scaphoid fractures. METHODS: The trial is designed as a multicenter, blinded observer, randomized controlled parallel two-group post market trial. Approximately 190 patients will be randomized (1:1) with stratification by center either to titanium or magnesium-based compression screws. Follow-up is 1 year per patient. Surgical procedures and aftercare will be performed according to the German treatment guideline for scaphoid fractures. The first primary endpoint is the patient-rated wrist evaluation (PRWE) score after 6 months. The second primary endpoint is a composite safety endpoint including bone union until 6 months, no adverse device effect (ADE) during surgery or wound healing and no serious ADE or reoperation within 1 year. The third primary endpoint is the difference in change MRI artifacts over time. Non-inferiority will be investigated for primary endpoints 1 (t-test confidence interval) and 2 (Wilson's score interval) using both the full analysis set (FAS) and the per protocol population at the one-sided 2.5% test-level. Superiority of magnesium over titanium screws will be established using the FAS at the two-sided 5% test-level (Welch test) only if non-inferiority has been established for both primary endpoints. Secondary endpoints include quality of life. DISCUSSION: This study will inform care providers whether biodegradable magnesium-based implants are non-inferior to standard titanium Herbert screws for the treatment of scaphoid fractures in terms of wrist function and safety. Furthermore, superiority of magnesium-based implants may be demonstrated using MRI, which is used as surrogate endpoint for screw degradation. TRIAL REGISTRATION: DRKS, DRKS00013368 . Registered Dec 04, 2017.


Assuntos
Implantes Absorvíveis/efeitos adversos , Parafusos Ósseos/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Osso Escafoide/lesões , Traumatismos do Punho/cirurgia , Adolescente , Adulto , Ensaios Clínicos Fase IV como Assunto , Estudos de Equivalência como Asunto , Fixação Interna de Fraturas/efeitos adversos , Humanos , Magnésio/efeitos adversos , Imagem por Ressonância Magnética , Masculino , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Titânio/efeitos adversos , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/fisiopatologia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto Jovem
14.
Iowa Orthop J ; 39(1): 167-172, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413690

RESUMO

Yablon originally described that late posttraumatic degenerative ankle arthritis was due to ongoing tibio-talar joint incongruity, and more importantly that anatomic reduction of the lateral malleolus was key to anatomic reduction of the ankle joint, as the talus "faithfully followed that of the lateral malleolus." Ankle fractures involving the lateral malleolus, left unreduced, can lead to malunion and posttraumatic degenerative arthritis. Treatment of this often includes a fibular osteotomy to restore length and rotation. We revisit Yablon's original principles and present a review of the literature pertaining to techniques and outcomes of lateral malleolus malunions treated with distal fibular osteotomies as well as a case report highlighting the challenges and considerations when facing this problem.


Assuntos
Fraturas do Tornozelo/cirurgia , Artroscopia/métodos , Fíbula/lesões , Fixação Interna de Fraturas/efeitos adversos , Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos , Fraturas do Tornozelo/diagnóstico por imagem , Feminino , Fíbula/cirurgia , Fluoroscopia/métodos , Seguimentos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Pessoa de Meia-Idade , Reoperação/métodos , Resultado do Tratamento
15.
Int Orthop ; 43(11): 2539-2547, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31440891

RESUMO

BACKGROUND: Tibiofibular syndesmosis injury leads to ankle pain and dysfunction when ankle injuries are not treated properly. Despite several studies having been performed, many questions about diagnosis and treatment remain unanswered, especially in ankle syndesmosis injury with interosseous membrane injury. Therefore, the purpose of this study was to help guide best practice recommendations. METHODS: This review explores the mechanism of injury, clinical features, diagnosis methods, and the treatment strategy for ankle syndesmosis injury with interosseous membrane injury to highlight the current evidence in terms of the controversies surrounding the management of these injuries. RESULTS: Radiological and CT examination are an important basis for diagnosing ankle syndesmosis injury. Physical examination combined with MRI to determine the damage to the interosseous membrane is significant in guiding the treatment of ankle syndesmosis injury with interosseous membrane injury. In the past, inserting syndesmosis screws was the gold standard for treating ankle syndesmosis injury. However, there were increasingly more controversies regarding loss of reduction and broken nails, so elastic fixation has become more popular in recent years. CONCLUSIONS: Anatomical reduction and effective fixation are the main aspects to be considered in the treatment of ankle syndesmosis injury with interosseous membrane injury and are the key to reducing postsurgery complications.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Fixação Interna de Fraturas/efeitos adversos , /cirurgia , Adulto , Fraturas do Tornozelo/complicações , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/complicações , Fíbula/diagnóstico por imagem , Fíbula/lesões , Fíbula/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Guias de Prática Clínica como Assunto , Lesões dos Tecidos Moles/complicações , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/lesões , Tíbia/cirurgia
16.
Arch Orthop Trauma Surg ; 139(10): 1461-1470, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31432205

RESUMO

BACKGROUND: The simultaneous occurrence of periprosthetic fracture (PPF) and periprosthetic joint infection (PJI) is among the most devastating complications in arthroplasty and carries the risk of limb loss. For the first time, this study will describe the characteristics, treatment concepts, and outcomes of this complication. METHODS: Patients were consecutively included who were treated at our specialized interdisciplinary department between 2015 and 2016 with a PJI and an additional PPF of the hip. The treatment algorithm followed a three-step procedure: the complete removal of any foreign material (step 1), fracture stabilization by plate, intramedullary rod osteosynthesis or cerclages using an additional spacer (step 2), and reimplantation of a new prosthesis (step 3). RESULTS: Overall, eight cases [four male, four female, mean age 77 years (55-91)] were included. The mean follow-up was 34 ± 8 months. The fractures included one PPF Vancouver B1, three B2/3, and four type C. Most frequent microbes were CNS (Coagulase-negative staphylococci) (n = 4), Cutibacterium (n = 2) and Staphylococcus aureus (n = 2). Mixed infections (≥ 2 microorganisms) occurred in five cases. The time between explanation and reimplantation was 42 ± 34 (range 7-123) days. A re-infection took place in one, a re-revision in four cases, and in five cases fracture healing was noticed. In all eight cases, freedom from the infection and limb preservation could be achieved. CONCLUSION: PPF in the case of a PJI is a devastating situation and a huge challenge. Extremity preservation should be the primary goal. The described procedure offers a possible solution.


Assuntos
Artrite Infecciosa/terapia , Artroplastia de Quadril/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Periprotéticas/terapia , Complicações Pós-Operatórias/terapia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Artrite Infecciosa/microbiologia , Placas Ósseas/efeitos adversos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/cirurgia , Complicações Pós-Operatórias/microbiologia , Estudos Prospectivos
17.
J Orthop Traumatol ; 20(1): 29, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31432281

RESUMO

BACKGROUND: Plate protrusion is a risk factor for flexor pollicis longus (FPL) rupture following volar locking plate (VLP) surgery. However, plate prominence on follow-up radiographs is common. We hypothesised that a VLP that does not touch the FPL tendon can appear as a plate prominence projected over the volar ridge on lateral radiographs. MATERIALS AND METHODS: We studied six current designs of widely used plates in formalin-fixed cadavers. Each plate was placed in six cadavers. We analysed 36 different plate-cadaver combinations. The main aim of plate fixation was to position the plate in the most distal position without FPL tendon contact. Radiographs were obtained using fluoroscopy. We evaluated plate prominence from the volar ridge according to the Soong grading system. RESULTS: Soong grades 0 (plate did not extend beyond volar ridge), 1 (plate protruded beyond volar ridge) and 2 (plate directly on or located beyond the volar ridge) were observed in 23 (63.9%), 9 (25.0%) and 4 (11.1%) cadavers, respectively. VariAx, DVR and VALCP showed grade 1 prominence, whereas Acu-Loc2, HYBRIX and MODE showed grade 2 prominence. CONCLUSIONS: Implant protrusion was observed in 36% of plate-cadaver combinations, even if the plate did not touch the FPL. Estimating the risk of FPL rupture using lateral radiographs alone is likely insufficient. Our findings can be applied to accurately identify the presence of implant prominence following VLP surgery.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Placa Palmar/cirurgia , Fraturas do Rádio/cirurgia , Traumatismos dos Tendões/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Radiografia , Fatores de Risco , Traumatismos dos Tendões/etiologia
18.
BMC Musculoskelet Disord ; 20(1): 381, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421675

RESUMO

BACKGROUND: Our hypothesis was that minimally invasive plate osteosynthesis (MIPO) using long philos plate (LPP) would show better clinical and radiological outcomes and less complications than narrow locking compression plate (NLCP) for spiral humerus shaft fractures with or without metaphyseal fracture extension. METHODS: From January 2009 to May 2016, we retrospectively studied 35 patients who underwent MIPO for spiral humerus shaft fractures with or without metaphyseal fracture extension (AO classification 12 A, B, C except A3). Eighteen patients underwent MIPO with a 4.5 mm NLCP (group I) in the early period of this study, while 17 patients underwent MIPO with LPP (group II) in the later period. Range of motion (ROM), pre- and post-operative anteroposterior (AP) and lateral angulation of the fracture, operation time, amount of bleeding, and functional outcomes including American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, and Simple Shoulder Test score were analyzed at the final follow up. RESULTS: All patients had complete bony union and achieved satisfactory functional outcomes except 2 patients. In LPP group, better outcomes in postoperative fracture angulation on X-ray and operation time (p < 0.05) were shown. But, two revision surgery with NLCP and bone graft was performed owing to 2 metal failures. CONCLUSIONS: In spiral humeral shaft fractures, LPP group showed better fracture reduction on X-ray and shorter operation time except metal failure owing to weak fixation. Even though MIPO technique using LPP is easier and more accurate reduction method, rigid fixation should be considered.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fraturas do Úmero/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Falha de Prótese , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/fisiopatologia , Úmero/diagnóstico por imagem , Úmero/lesões , Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Período Pós-Operatório , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
19.
Plast Reconstr Surg ; 144(3): 659-664, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461022

RESUMO

BACKGROUND: Kirschner wires are commonly used during hand surgical procedures. These pins are often left exposed (protruding from the skin) for ease of removal. Complications such as loosening, migration, or infection are not uncommon (ranging from 7 to 18 percent in current retrospective studies) and can compromise surgical outcome. This study evaluated the frequency of Kirschner wire-related complications. METHODS: All patients who had Kirschner wires placed as part of their surgical procedure in the hand or wrist by one of 12 attending hand surgeons over a 6-month period were enrolled prospectively. Complications were recorded by the attending surgeon at follow-up visits. Demographics and patient comorbidities including diabetes mellitus and smoking history were recorded. RESULTS: There were 141 patients enrolled and 230 pins used, including 65 women and 76 men. The mean age was 40.7 years. Thirteen patients were smokers, and eight had a history of diabetes. There were 35 soft-tissue procedures and 106 fractures. There were 35 complications (25 percent). There was a 12 percent rate of infection (n = 17), including two cases of osteomyelitis. There were 18 other complications, nine of which were major complications (6.4 percent). Smoking, age, and location (hand/fingers versus wrist) were significantly associated with infection. CONCLUSIONS: In this study, one in four patients treated with Kirschner wires developed a minor or major complication, a rate that is substantially higher than reported in existing retrospective studies. Although Kirschner wires are often needed during hand surgery, surgeons should be aware that adverse events are frequent. Patients and surgeons should be vigilant in the perioperative period. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Fios Ortopédicos/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Traumatismos da Mão/cirurgia , Complicações Pós-Operatórias/etiologia , Traumatismos do Punho/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecção da Ferida Cirúrgica/etiologia , Adulto Jovem
20.
Medicine (Baltimore) ; 98(33): e16836, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415405

RESUMO

RATIONALE: Isolated fracture of clavicle is usually treated with nonoperative conservative treatment. However, surgical treatment, customized for individual patient's need, is increasingly done. With regard to the surgery of the clavicle fracture, pneumothorax is a possible, but rare complication. PATIENT CONCERNS: We report the case of a 32-year-old healthy female patient who underwent minimally invasive plate osteosynthesis (MIPO) due to a clavicle fracture. To avoid direct exposure of fracture site, the pre-contoured plate was inserted through the lateral incisional port to reach the medial incisional port. There was no problem during the surgery, but the patient complained of dyspnea in the post-anesthesia care unit. DIAGNOSES: A chest radiograph was taken immediately, and a definitive finding of pneumothorax was revealed. INTERVENTIONS: A tube was inserted at the right chest. OUTCOMES: The patient's dyspnea was resolved. On the 6th day after the surgery, the chest radiograph revealed that pneumothorax was nearly resolved, enabling to remove the chest tube. On the 9th day after the surgery, the patient was discharged without complication. LESSONS: After clavicle surgery requiring strong dissection like MIPO, the possibility of pneumothorax is suspected and the patient should be carefully observed.


Assuntos
Clavícula/lesões , Fixação Interna de Fraturas/efeitos adversos , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Fraturas do Ombro/cirurgia , Adulto , Placas Ósseas/efeitos adversos , Feminino , Fixação Interna de Fraturas/métodos , Humanos
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