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1.
Medicine (Baltimore) ; 100(17): e25636, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907120

RESUMO

ABSTRACT: The cartilage endplate plays an important role in the stress distribution and nutrition metabolism of the intervertebral disc. The healing morphology of the endplate after spinal fracture and its effect on the intervertebral disc degeneration are still unclear.This was a retrospective study. Patients with traumatic single-level thoracolumbar fractures treated in our orthopedic trauma service center from June 2011 to May 2019 were included and the relevant data were collected from the medical records. Based on combined computed tomography and MRI images, the endplate injury status was determined (no endplate injury, unilateral and bilateral endplate injury). According to the location of the injury, endplate injury was further divided into endplate central injury and endplate peripheral injury. The degree of posttraumatic disc lesions and disc degeneration during follow-up were classified based on the Sander classification and the Pfirrmann classification, respectively. According to the T1 image of MRI at the final follow-up, the healing morphology of endplates was determined and classified. Univariate analyses and correlation analyses were performed to evaluate the within- and between-group differences.There were in total 51 patients included in this study. Cartilage endplate fracture was significantly closely related to the degree of degeneration of the intervertebral disc (P = .003). Injuries in different parts of the endplate have no significant effect on the intervertebral disc degeneration (P = .204). The healing morphology after endplate fracture significantly affected the degree of intervertebral disc degeneration (P = .001). The comparisons of groups showed that the effects of irregular healing and traumatic Schmorl nodes on disc degeneration were not statistically significant, but were significantly significant with increased curvature.These results suggest that the irregular healing and the traumatic Schmorl nodes are closely related to intervertebral disc degeneration. The presence and severity of the endplate injury can provide valuable information for individualized clinical decision-making processes.


Assuntos
Consolidação da Fratura , Degeneração do Disco Intervertebral/patologia , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/patologia , Fraturas da Coluna Vertebral/patologia , Adulto , Cartilagem Articular/patologia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/etiologia , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Ann R Coll Surg Engl ; 103(5): 345-353, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33852340

RESUMO

AIMS: Persistent wound leakage following joint arthroplasty is a known risk for periprosthetic joint infection. Little is known of the predictors of wound leakage, particularly in patients with a fractured neck of femur. We aimed to determine patient and surgical risk factors for wound leakage in this cohort. MATERIALS AND METHODS: All patients undergoing surgery for a fractured neck of femur at Leicester Royal Infirmary between May and August 2017 were included. Patients were identified from a prospective database and placed into two groups: those with wound leakage later than three days postoperatively and those without leakage. All previously reported potential risk factors for wound leakage were compared between groups using a chi-square test and logistic regression. A Kattan-style nomogram was also created to allow probabilities output for the regression predictive models in a visual representation. RESULTS: Two hundred patients underwent surgery for a fractured neck of femur. Overall, 17% of patients (33/200) developed a persistent leaky wound. A multivariable model highlighted increased age (p = 0.01), raised body mass index (BMI; > 25 kg/m2; p = 0.047), diabetes (p = 0.03) and intramedullary hip screw fixation (p = 0.03) as significant risk factors for wound leakage. Patients with persistent wound leakage had significantly longer hospital admission than those without (p = 0.001). DISCUSSION: Our analysis identified four perioperative risk factors for wound leakage following fractured neck of femur surgery. We also developed a novel tool to identify those patients at highest risk of leakage. Once identified, the aggressive management of certain medical comorbidities in these patients may help to reduce their incidence of wound issues and the prolonged admissions that result.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Ferida Cirúrgica/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/estatística & dados numéricos , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/estatística & dados numéricos , Hemiartroplastia/efeitos adversos , Hemiartroplastia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Fatores de Risco , Ferida Cirúrgica/epidemiologia
3.
Clin Sports Med ; 40(2): 375-384, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33673893

RESUMO

Pelvic avulsion fractures are common in youth athletes; many of these injuries can be treated conservatively. This article reviews the etiology, presentation, and management of the more common pelvic avulsion fractures, including anterior superior iliac spine, anterior inferior iliac spine, ischial tuberosity, and iliac crest avulsions. Adolescent pelvic avulsion fractures rely on the amount of fracture displacement to guide treatment. Conservative management includes rest and avoiding use of the muscle(s) that attach to the avulsed fragment. Operative treatment is reserved for widely displaced fractures or symptomatic nonunions. With appropriate treatment, young athletes frequently return to their same level of sport.


Assuntos
Traumatismos em Atletas/diagnóstico , Fratura Avulsão/diagnóstico , Pelve/lesões , Adolescente , Atletas , Traumatismos em Atletas/terapia , Tratamento Conservador/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/terapia , Humanos , Ílio/lesões , Ílio/cirurgia , Ísquio/lesões , Ísquio/cirurgia
4.
Zhongguo Gu Shang ; 34(3): 203-8, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787161

RESUMO

OBJECTIVE: To investigate the related factors of aseptic necrosis of femoral head after closed reduction and internal fixation of femoral neck fracture. METHODS: From January 2009 to January 2016, 236 patients with femoral neck fracture were treated with closed reduction and internal fixation with 3 hollow lag screws, including 111 males and 125 females, aged from 19 to 89 (50.17±12.88) years. According to the follow-up results, the correlation of aseptic necrosis of femoral head was analyzed. Univariate analysis of age, gender, injured side, body weight, injury mechanism, preoperative waiting time, Garden classification and whether there was comminution of femoral neck cortex was conducted to obtain the independent variables with significant difference. Then binary logistic regression analysis was conducted to explore the independent risk factors of avascular necrosis of femoral head. RESULTS: The average follow-up period of 236 cases was 4.58 years. There were significant differences in the range of injury (24.69% vs. 5.16%, χ2=19.405, P=0.000), operation waiting time>48 hours (20.00% vs. 6.38%, χ2=10.065, P=0.002), Garden type Ⅲ/Ⅳ (18.52% vs. 2.97%, χ2=13.357, P=0.000), femoral neck cortex comminution (66.67% vs. 4.88%, χ2=39.968, P=0.000). Multivariate logistic regression analysis showed that:injury mechanism [high energy injury, Exp (B)=4.397, 95%CI=(1.672-11.562), P=0.003], preoperative waiting time >48 h [Exp (B)= 3.060, 95%CI=(1.176-7.966), P=0.022], comminution of femoral neck cortex [comminution of femoral neck pressure side cortex, Exp (B)=3.944, 95%CI=(1.245-12.494), P=0.020;comminution of femoral neck pressure side and tension side cortex, Exp(B)= 23.761, 95%CI=(3.805-148.374), P=0.001) were independent risk factors for avascular necrosis after internal fixation of femoral neck fracture. Garden type Ⅲ/Ⅳ was not an independent risk factor in this study [Exp (B) = 1.985, 95%CI=(0.436-9.032), P=0.375]. CONCLUSION: High energy injury, preoperative waiting time (>48 h) and comminution of femoral neck cortex were independent risk factors for aseptic necrosis of femoral head. In addition, cortical comminution on the pressure side and tension side of the femoral neck is a strong prognostic risk factor for aseptic necrosis of the femoral head, because it indicates a more serious and complex injury mechanism.


Assuntos
Fraturas do Colo Femoral , Necrose da Cabeça do Fêmur , Fraturas Cominutivas , Idoso , Feminino , Fraturas do Colo Femoral/cirurgia , Necrose da Cabeça do Fêmur/cirurgia , Colo do Fêmur , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Fatores de Risco
5.
Zhongguo Gu Shang ; 34(3): 215-9, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787163

RESUMO

OBJECTIVE: To study the relationship between osteonecrosis of femoral head after internal fixation of femoral neck fracture and serum bone metabolism, vascular active factors, and analyze the risk factors. METHODS: Total 150 patients with femoral neck fracture who underwent reduction and internal fixation from April 2016 to April 2019 were selected, including 83 males and 67 females. According to whether there was necrosis of femoral head after operation, they were divided into necrosis group(32 cases) and non necrosis group (118 cases). Before operation and 1, 3, 5 days after operation, the serum levels of beta-C terminal cross-linked telopeptides of typeⅠ collagen(ß-CTX), N-telopeptide of typeⅠ procollagen(PINP), nitric oxide (NO), Endothelin-1 (ET-1) were measured. The clinical characteristics of the two groups were compared. The risk factors of postoperative femoral head necrosis were analyzed by logistic regression model. The value of serum indexes in predicting postoperative femoral head necrosis was analyzed by ROC curve. RESULTS: There was no significant difference in the levels of serum PINP and ß-CTX between necrotic group and non necrotic group before operation and 1, 3 and 5 days after operation(P>0.05). There was no significant difference in the levels of serum NO and ET-1 before operation and 5 days after operation(P>0.05). There were significant differences in the levels of serum NO and ET-1(P<0.05), fracture type, preoperative traction ratio and reduction quality (P<0.05). Logistic regression analysis showed that the decrease of serum NO content and the increase of ET-1 content at 1 day after operation, Ⅲ-Ⅳ fracture and Ⅲ-Ⅳ reduction were the risk factors of femoral head necrosis;ROC curve analysis showed that serum NO and ET-1 content at 1 day after operation had predictive value for femoral head necrosis, and the best cut-off points were 26.55 µmol / L and 7.785 µg / L, respectively. CONCLUSION: The content of serum NO and ET-1 on the first day after operation can predict the necrosis of femoral head.


Assuntos
Fraturas do Colo Femoral , Necrose da Cabeça do Fêmur , Osteonecrose , Feminino , Fraturas do Colo Femoral/cirurgia , Cabeça do Fêmur , Necrose da Cabeça do Fêmur/etiologia , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
6.
Medicine (Baltimore) ; 100(13): e25328, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787628

RESUMO

ABSTRACT: Different methods have been used throughout the years for syndesmotic injury but there is no consensus on the ideal treatment. Some methods are expensive and some have more complications. The aim of this study is to compare single suture endobutton with double suture endobutton and screw fixation for syndesmotic injury.Sixty nine patients with syndesmotic injury with fibular fractures whom were treated with a single interosseous suture endobutton system (ZipTightTM, Zimmer Biomet), a double interosseous suture endobutton system (ZipTightTM, Zimmer Biomet) and 1 syndesmotic screw (TST, Istanbul, Turkey) were included in this study. Functional and radiological results from patient records between 2015 and 2018 were retrospectively evaluated.Twenty patients were treated with the double interosseous suture endobutton, 23 were treated with the single interosseous suture endobutton, and 26 were treated with traditional AO screw fixation. Three patients from the screw fixation group (11.5%) required revision surgery (P < .05). All the radiologic and clinical outcomes were statistical similar in all 3 groups.Our findings showed that the interosseous suture endobutton system is at least as safe as the screw fixation technique for treatment of syndesmosis joint injuries and can be used as an alternative to the screw method. The interosseous suture endobutton system eliminates the need for a second surgery to remove the hardware, which minimizes the probability of re-diastasis. Since our results showed no statistical difference between single and double interosseous suture endobutton systems, the less costly single endobutton system may be the better alternative.


Assuntos
Traumatismos do Tornozelo/cirurgia , Parafusos Ósseos/efeitos adversos , Fixação Interna de Fraturas/métodos , Complicações Pós-Operatórias/epidemiologia , Técnicas de Sutura/efeitos adversos , Adulto , Traumatismos do Tornozelo/diagnóstico , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Medicine (Baltimore) ; 100(7): e24791, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607836

RESUMO

RATIONALE: Despite significant advances in surgical techniques and implants, the clinical outcome of high-energy pilon fractures remains unsatisfactory, which continues to represent numerous challenges for orthopedic trauma surgeons. PATIENT CONCERNS: A 62-year-old man injured his right ankle after falling from a 3 m high place. There were no open wounds or other complications. DIAGNOSES: According to the X-ray and CT scans, the patient was diagnosed with pilon fracture (type AO-43-C2) and lateral malleolus fracture of the right limb. INTERVENTIONS: The patient was initially treated with calcaneal traction upon admission to a primary hospital. Five days after the injury, the patient underwent open reduction and internal fixation (ORIF) of the fracture and vacuum sealing drainage (VSD) for wound closure. OUTCOMES: The patient presented to our hospital on the 9th day after the first ORIF operation because of critical ischemia of the affected foot and distal lower leg. Blood circulation did not improve after a series of salvage treatments, and below-knee amputation was ultimately performed. LESSONS: This is a rare case of complete ischemic necrosis following ORIF surgery of a closed pilon fracture due to iatrogenic damage. Standardized treatment that strictly follows the guidelines, instructions, or expert consensus should be promoted in this kind of complicated pilon fracture.


Assuntos
Amputação/métodos , Fraturas do Tornozelo/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Redução Aberta/efeitos adversos , Fraturas da Tíbia/cirurgia , Angiografia Digital , Fraturas do Tornozelo/complicações , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Lesões dos Tecidos Moles/etiologia , Fraturas da Tíbia/complicações , Lesões do Sistema Vascular/etiologia
8.
Khirurgiia (Mosk) ; (2): 53-57, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570355

RESUMO

OBJECTIVE: To assess the possibilities of omentoplasty for prevention of complications after redo sternum osteosynthesis for traumatic rupture. MATERIAL AND METHODS: The study included 53 patients with recurrent sternal diastasis. Greater omentum was additionally implanted in 19 (35.8%) cases to improve healing and reduce the risk of infectious complications. In 34 patients, redo osteosynthesis was carried out using a metal wire and deployment of irrigation-aspiration system. In 19 patients, omentoplasty was additionally used to close the wound. RESULTS: Omentoplasty was characterized by less duration of lavage (7.4±1.5 vs. 4.2±3.3 days, p<0.0001) and no cases of arrosive bleeding (p=0.04). CONCLUSION: Omentoplasty reduces duration of treatment and risk of arrosive bleeding.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Fixação Interna de Fraturas/métodos , Mediastinite/cirurgia , Omento , Esterno/cirurgia , Cicatrização , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Mediastinite/etiologia , Mediastinite/prevenção & controle , Omento/cirurgia , Omento/transplante , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Recidiva , Irrigação Terapêutica
10.
Int Orthop ; 45(3): 721-729, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33416908

RESUMO

BACKGROUND: The purpose of this retrospective study was to evaluate the usefulness of ankle arthroscopy at the time of ORIF or after six months in patients with residual symptoms. The hypothesis was that in patients treated arthroscopically at the time of ORIF, there were faster and better clinical results than those treated after or untreated with arthroscopy. METHODS: In this retrospective study, we compared three homogeneous groups of selected patients with specific inclusion criteria (144 in total, mean age 38.2 years). They have been surgically treated for an ankle fracture (bimalleolar or trimalleolar without frank syndesmotic injuries) with open technique (ORIF) or arthroscopic ORIF (AORIF), between 2013 and 2017. The AO classification system was used for each patient. The clinical assessment was based on the Foot and Ankle Outcome Score (FAOS). RESULTS: At the final follow-up (mean 38 months), both patients treated with ankle arthroscopic debridement at the time of ORIF and patients treated with arthroscopic debridement after ORIF showed a significant improvement of the FAOS, which reported 84 and 85 respectively at final follow-up. CONCLUSION: Through minimally invasive visualization of intra-articular structures, ankle arthroscopy can offer an essential option for selected patients both in acute and in sequelae after an ankle fracture. More studies are needed to understand the real effectiveness of the procedure, especially in acute at the same time of osteosynthesis.


Assuntos
Fraturas do Tornozelo , Adulto , Tornozelo , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Artroscopia , Desbridamento , Fixação Interna de Fraturas/efeitos adversos , Humanos , Estudos Retrospectivos , Resultado do Tratamento
11.
Int Orthop ; 45(3): 731-741, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33517475

RESUMO

PURPOSE: Despite modern operative techniques and a considerable number of studies in the literature, the best treatment for calcaneal fractures remains an enigma for orthopaedic surgeons. The purpose of the study was to compare clinical and radiographic outcomes between anatomic calcaneal plate (ACP) fixation and crossed Schanz pin (CSP) fixation in the treatment of Sanders type II and III displaced intra-articular calcaneus fractures (DICFs). METHODS: Consecutive 65 patients (49 males, 16 females) who underwent surgery for DCIFs between January 2009 and February 2013 were retrospectively evaluated. The patients were divided into two groups as ACP and CSP according to the operative technique. The groups were compared in terms of demographic features, injury mechanism, operation time, fluoroscopy exposure, complications, full weight-bearing time, functional, and radiological outcomes. RESULTS: VAS-rest score did not differ significantly between the groups while the VAS-activity score was significantly higher in the CSP group (p = 0.001 and p = 0.645, respectively). Foot Function Index (FFI) was significantly lower, Maryland Foot Score (MFS) and the American Orthopaedic Foot and Ankle Society-hindfoot score (AOFAS) were significantly higher in the ACP group (p = 0.047, p = 0.016, and p < 0.001, respectively). While no difference was observed between the preoperative and the early post-operative (1st day) Böhler angle and Gissane angle, both were significantly higher in the ACP group at the post-operative last control (p < 0.001 and p < 0.001, respectively). CONCLUSION: Although crossed Schanz pin fixation shortens the operation time in displaced intra-articular calcaneus fractures compared to anatomic calcaneal plate, increased fluoroscopy exposure rates and low functional and radiological outcomes are disadvantageous of crossed Schanz pin. Anatomic calcaneal plate is still a better technique for preserving the alignment and elevating the displaced intra-articular segment for good to excellent mid-term results.


Assuntos
Calcâneo , Fraturas Ósseas , Fraturas Intra-Articulares , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
Instr Course Lect ; 70: 121-138, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438908

RESUMO

Tibial plafond fractures include a wide spectrum of injuries that show their complexity. Soft-tissue injury in tibial plafond fractures is much more important than bony injury. Commonly, a staged treatment, that is, temporary external fixation followed by definitive surgery when the soft tissue is ready, is performed. Knowledge of multiple surgical approaches is a prerequisite for open reduction and internal fixation of tibial plafond fractures because of the large variation of fracture patterns.


Assuntos
Lesões dos Tecidos Moles , Fraturas da Tíbia , Fixação de Fratura/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Consolidação da Fratura , Humanos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
13.
Plast Reconstr Surg ; 147(1): 82e-93e, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370060

RESUMO

BACKGROUND: Fractures of the orbital roof require high-energy trauma and have been linked to high rates of neurologic and ocular complications. However, there is a paucity of literature exploring the association between injury, management, and visual prognosis. METHODS: The authors performed a 3-year retrospective review of orbital roof fracture admissions to a Level I trauma center. Fracture displacement, comminution, and frontobasal type were ascertained from computed tomographic images. Pretreatment characteristics of operative orbital roof fractures were compared to those of nonoperative fractures. Risk factors for ophthalmologic complications were assessed using univariable/multivariable regression analyses. RESULTS: In total, 225 patients fulfilled the inclusion criteria. Fractures were most commonly nondisplaced [n = 118 (52.4 percent)] and/or of type II frontobasal pattern (linear vault involving) [n = 100 (48.5 percent)]. Eight patients underwent open reduction and internal fixation of their orbital roof fractures (14.0 percent of displaced fractures). All repairs took place within 10 days from injury. Traumatic optic neuropathy [n = 19 (12.3 percent)] and retrobulbar hematoma [n = 11 (7.1 percent)] were the most common ophthalmologic complications, and led to long-term visual impairment in 51.6 percent of cases. CONCLUSIONS: Most orbital roof fractures can be managed conservatively, with no patients in this cohort incurring long-term fracture-related complications or returning for secondary treatment. Early fracture treatment is safe and may be beneficial in patients with vertical dysmotility, globe malposition, and/or a defect surface area larger than 4 cm2. Ophthalmologic prognosis is generally favorable; however, traumatic optic neuropathy is major cause of worse visual outcome in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Tratamento Conservador/estatística & dados numéricos , Fixação Interna de Fraturas/estatística & dados numéricos , Redução Aberta/estatística & dados numéricos , Fraturas Orbitárias/terapia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador/efeitos adversos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Hematoma/diagnóstico , Hematoma/epidemiologia , Hematoma/etiologia , Hematoma/prevenção & controle , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Redução Aberta/efeitos adversos , Traumatismos do Nervo Óptico/diagnóstico , Traumatismos do Nervo Óptico/epidemiologia , Traumatismos do Nervo Óptico/etiologia , Traumatismos do Nervo Óptico/prevenção & controle , Órbita/irrigação sanguínea , Órbita/diagnóstico por imagem , Órbita/lesões , Órbita/cirurgia , Fraturas Orbitárias/complicações , Fraturas Orbitárias/diagnóstico , Fraturas Orbitárias/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Tempo para o Tratamento/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
14.
J Pediatr Orthop ; 41(1): 11-16, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33017335

RESUMO

BACKGROUND: Acute sternoclavicular fractures and dislocations (SCFDs) are a rare but important injury in pediatric patients. SCFDs are either true dislocations, or more commonly, physeal fractures in children. The reduction is advised given the proximity to surrounding vascular structures, and some authors advocate for routine fixation given rates of redisplacement after closed reduction. The purpose of the current study was to provide validated long-term functional outcome data following open reduction and surgical fixation of pediatric SCFDs, as well as provide injury and demographic information. METHODS: This is a retrospective observational study with a subset of patients reporting functional outcomes. Patients under the age of 18 that had surgically managed acute posterior SCFD from 1990 to 2018 were included. A retrospective chart review was performed to obtain demographic, clinical, and surgical details. Patients with a minimum of 6-month follow-up were contacted to assess outcomes. Functional outcomes of interest included QuickDash, Visual Analog Scale pain rating, Single Assessment Numeric Evaluation of shoulder function, and PROMIS Upper Extremity questionnaire. Statistical analysis included descriptive statistics. RESULTS: A total of 37 patients that sustained an acute posterior SCFD during the study period were included. The average age at the time of injury was 15.2±2.1 years and 89% were male. Patient-reported outcomes were obtained for 14 patients with a mean follow-up of 4.5 years. The mean QuickDash score was 5.1/100 with 0 being normal, and the mean Visual Analog Scale pain rating was 0.7/10. The mean Single Assessment Numeric Evaluation score was 96% with 100% being completely normal. The mean PROMIS score was 55 with 50 being the mean of the relevant reference population. Approximately 29% (4/14 patients) stated that their injury negatively affected their ability to participate in sports. CONCLUSIONS: There is a paucity of literature on functional outcomes after surgical management of pediatric acute posterior SCFD. Functional outcomes after surgery were satisfactory in this cohort with most patients being able to perform major activities of daily living. Additional future studies with larger cohorts and comparative groups are needed to better understand outcomes in this population. LEVEL OF EVIDENCE: Level IV.


Assuntos
Atividades Cotidianas , Fixação Interna de Fraturas , Luxações Articulares/cirurgia , Dor Pós-Operatória/diagnóstico , Articulação Esternoclavicular , Adolescente , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/reabilitação , Fraturas Ósseas/cirurgia , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Articulação Esternoclavicular/lesões , Articulação Esternoclavicular/cirurgia
15.
J Pediatr Orthop ; 41(1): 51-55, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33027231

RESUMO

BACKGROUND: Open physeal fractures of the distal phalanx of the hallux are analogous to Seymour fractures of the hand. When missed, these injuries can result in long-term sequelae including infection, pain, nail deformity, and physeal arrest. Nevertheless, there is a paucity in the literature regarding optimal surgical treatment for these challenging injuries. We present a novel technique and case series for suture-only stabilization of Seymour fractures of the great toe. METHODS: Billing records were used to identify all children aged 18 years or younger who underwent operative treatment open distal phalanx fracture of the hallux with an associated nail bed injury. Electronic medical records and plain imaging were reviewed to identify mechanism of injury, surgical technique, results, complications, and follow-up. RESULTS: Five boys with a mean age of 10.3 years (range, 5 to 13 y) met inclusion criteria. Forty percent (2/5) of injuries were missed by the initial treating providers. Only 2 patients presented to our institution primarily; 60% (3/5) patients were transferred from other facilities. The mechanism of injury was variable but generally involved "stubbing" the toe. The mean time from injury to surgical treatment was 2.6 days (range, 0 to 6 d). Median follow-up was 2 months (range, 1 to 96 mo). No patient complications (including infection) or reoperations were reported. On follow-up imaging, no physeal bars were evident on patients treated with suture-only technique. CONCLUSIONS: Seymour fracture of the hallux are uncommon, and there is frequently a delay in both presentation and diagnosis. Providers should have increased suspicion for these injuries when a physeal fracture of the great toe is associated with bleeding or nail bed injury. Currently, no consensus exists for treatment of these injuries. Suture-only stabilization represents a simple, reliable alternative to pin fixation. LEVEL OF EVIDENCE: Level IV-retrospective case series.


Assuntos
Traumatismos dos Dedos , Fixação Interna de Fraturas , Hallux , Unhas , Técnicas de Sutura , Criança , Traumatismos dos Dedos/diagnóstico , Traumatismos dos Dedos/cirurgia , Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Hallux/lesões , Hallux/cirurgia , Humanos , Masculino , Unhas/lesões , Unhas/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Radiografia/métodos , Estudos Retrospectivos
16.
Z Orthop Unfall ; 159(1): 98-100, 2021 02.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33336331

RESUMO

Torsional deformity is a frequent complication following nail osteosynthesis of a subtrochanteric fracture. This complication is difficult to assess intraoperatively, but can cause major functional restrictions. The authors consider that a clinical assessment should be complemented by a postoperative radiological control standardised with torsion CT. Thus, torsion deformity can be recognised immediately and easily corrected if necessary. This can help to avoid long-term damage that requires considerable surgery. The video shows details of torsion correction after a ca. 5-week old subtrochanteric femoral fracture, which had been initially treated with a femur nail. Before torsion correction, the internal torsion on the right femur was 22° and the external torsion on the left femur was 2°. Thus, the total deformation of the external torsion on the left side was 24°. We note the indication for removal of the nail, torsion correction and reosteosynthesis with long PFNA. The postoperative CT control confirmed that the torsion correction was adequate with internal torsion of 25° on the operated left side.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Anormalidade Torcional/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Reoperação , Tomografia Computadorizada por Raios X , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/etiologia
17.
BMC Musculoskelet Disord ; 21(1): 845, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33339519

RESUMO

BACKGROUND: Surgical site infections (SSI) after distal radius fracture (DRF) surgery have not previously been studied as the primary outcome in a large population with comparative data for different surgical methods. The aims of this study were 1) to compare SSI rates between plate fixation, percutaneous pinning and external fixation, and 2) to study factors associated with SSI. METHODS: We performed a nation-wide cohort study linking data from the Swedish national patient register (NPR) with the Swedish prescribed drug register (SPDR). We included all patients ≥18 years with a registration of a surgically treated DRF in the NPR between 2006 and 2013. The primary outcome was a registration in the SPDR of a dispensed prescription of peroral Flucloxacillin and/or Clindamycin within the first 8 weeks following surgery, which was used as a proxy for an SSI. The SSI rates for the three main surgical methods were calculated. Logistic regression was used to study the association between surgical method and the primary outcome, adjusted for potential confounders including age, sex, fracture type (closed/open), and a dispensed prescription of Flucloxacillin and/or Clindamycin 0-8 weeks prior to DRF surgery. A classification tree analysis was performed to study which factors were associated with SSI. RESULTS: A total of 31,807 patients with a surgically treated DRF were included. The proportion of patients with an SSI was 5% (n = 1110/21,348) among patients treated with plate fixation, 12% (n = 754/6198) among patients treated with percutaneous pinning, and 28% (n = 1180/4261) among patients treated with external fixation. After adjustment for potential confounders, the surgical method most strongly associated with SSI was external fixation (aOR 6.9 (95% CI 6.2-7.5, p < 0.001)), followed by percutaneous pinning (aOR 2.7 (95% CI 2.4-3.0, p < 0.001)) (reference: plate fixation). The classification tree analysis showed that surgical method, fracture type (closed/open), age and sex were factors associated with SSI. CONCLUSIONS: The SSI rate was highest after external fixation and lowest after plate fixation. The results may be useful for estimation of SSI burdens after DRF surgery on a population basis. For the physician, they may be useful for  estimating the likelihood of SSI in individual patients.


Assuntos
Fraturas do Rádio , Infecção da Ferida Cirúrgica , Adolescente , Adulto , Idoso , Placas Ósseas , Estudos de Coortes , Feminino , Fixação de Fratura/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/epidemiologia , Suécia/epidemiologia , Resultado do Tratamento , Adulto Jovem
19.
Rev. cuba. ortop. traumatol ; 34(2): e302, jul.-dic. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1156593

RESUMO

RESUMEN Introducción: La cobertura de dispositivos ortopédicos expuestos y las infecciones en el hueso con colgajos es un tema controvertido. No existe un consenso claro sobre el tratamiento de esta complicación. En los últimos años se aprecia una tendencia a mantener el material de osteosíntesis y a controlar la infección aportando tejido bien vascularizado en forma de colgajo muscular o fasciocutáneo. Objetivo: Evaluar el éxito reconstructivo con colgajos de defectos de partes blandas en miembros que han precisado de una osteosíntesis, en función de la presencia de infección y el estado de los dispositivos de implante en el momento de la reconstrucción. Métodos: Estudio retrospectivo de una serie de 15 casos con un defecto de partes blandas en las extremidades inferiores secundario a la implantación de dispositivos ortopédicos en el hueso. Todos los casos recibieron cobertura con un colgajo muscular o fasciocutáneo con o sin retirada de los implantes. Se estudió la presencia o ausencia de infección previa a la reconstrucción (signos clínicos, resultado del cultivo microbiológico y exposición del material ortopédico), la retirada o mantenimiento del implante durante la reconstrucción, y la presencia de complicaciones posoperatorias. Se relacionaron estas variables con el éxito reconstructivo posoperatorio. El análisis de las variables se realizó con los estadísticos chi cuadrado, Wilcoxon y U de Mann Whitney, según el tipo de variable, y para una significación de 0,05. Resultados: La frecuencia de éxito reconstructivo fue mayor en aquellos pacientes con cultivo negativo sin exposición de material óseo (p = 0,038). Se encontró menor tasa de complicaciones en los pacientes que presentaban infección antes de la reconstrucción (p = 0,039), y en aquellos con cultivo positivo y exposición del material previos a la cirugía, cuyos implantes habían sido retirados durante la reconstrucción (p = 0,032). Conclusiones: El aporte de tejido bien vascularizado en forma de colgajo permite el mantenimiento del material ortopédico con una frecuencia de éxito de 66,67 %, y resultados favorables de mediano a largo plazo. La exposición y el resultado del cultivo son indicadores predictivos de los resultados de la cirugía(AU)


ABSTRACT Introduction: The covering of exposed orthopedic devices and bone infections with flaps are a controversial issue. There is no clear consensus concerning the treatment of this complication. In recent years, there has been a trend to maintain the osteosynthesis material and to control the infection by providing well vascularized tissue in the form of a muscular or fasciocutaneous flap. Objective: To assess the reconstructive success with flaps of soft tissue defects in limbs that have required osteosynthesis, based on the presence of infection and the status of the implant devices at the time of reconstruction. Methods: Retrospective study of a series of 15 cases with soft tissue defect in the lower limbs after implantation of orthopedic devices to the bone. All the cases were covered with muscle or fasciocutaneous flap, with or without removal of the implants. The presence or absence of infection prior to reconstruction (clinical signs, results of microbiological culture, and exposure of the orthopedic material), removal or maintenance of the implant during reconstruction, and the presence of postoperative complications were studied. These variables were associated with postoperative reconstructive success. The analysis of the variables was performed using the chi-square, as well as Wilcoxon and Mann Whitney U tests, according to the type of variable, and for a significance of 0.05. Results: The frequency of reconstructive success was higher in those patients with negative culture and without exposure of bone material (P=0.038). A lower rate of complications was found in patients with infection before reconstruction (P=0.039), and in those with positive culture and exposure of the material prior to surgery, whose implants had been removed during reconstruction (P=0.032). Conclusions: The provision of well vascularized tissue in the form of flap allows maintenance of the orthopedic material with a success rate of 66.67%, as well as favorable outcomes in the mid to long terms. The results of exposure and culture are predictive indicators of surgery outcomes(AU)


Assuntos
Humanos , Artroplastia/efeitos adversos , Retalhos Cirúrgicos/transplante , Extremidade Inferior/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Estudos Retrospectivos
20.
Medicine (Baltimore) ; 99(50): e23612, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327331

RESUMO

RATIONALE: Greenstick fractures most commonly occur in the pediatric population, especially in those under 10 years of age. Greenstick fractures are "extremely" rare in adults. This report presents the case of a greenstick fracture of the ulnar shaft in an adult following physical therapy for a radial neck fracture and ulnar shaft fracture post-internal fixation. Greenstick fracture can occur during physical therapy near the drill holes created during surgery. PATIENT CONCERNS: A 23-year-old man without any past medical history had sustained a greenstick fracture of the ulnar shaft after rehabilitation for a left radial and ulnar fracture that had been previously treated with internal fixation. DIAGNOSES: Five months after removal of the implants, the patient complained of left elbow tenderness and a "breaking" sound that occurred during physical therapy. The results of a subsequent X-ray revealed a greenstick fracture of the left ulnar shaft. INTERVENTIONS: Splinting of the fracture. OUTCOMES: After 2 months of splint fixation, the pain and range of motion in the affected arm were improved, and sequential X-rays showed callus formation and increased density of the ulnar shaft. LESSONS: Greenstick fractures occur not only in children but also in adults in specific circumstances. The cortex of long bones may be further weakened by drill holes created during surgery, and fractures may occur during physical therapy. During treatment, physicians, and therapists should pay more attention to the patient who has undergone implant removal to avoid greenstick fractures, especially in the locations near drill holes.


Assuntos
Modalidades de Fisioterapia/efeitos adversos , Fraturas da Ulna/diagnóstico , Diagnóstico Diferencial , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Fraturas do Rádio/reabilitação , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Contenções , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/etiologia , Adulto Jovem
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