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1.
Bone Joint J ; 101-B(10): 1263-1271, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564142

RESUMO

AIMS: The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires. PATIENTS AND METHODS: This was a multicentre, parallel group, randomized controlled noninferiority trial conducted at 12 tertiary trauma centres in Germany. A total of 290 patients with acute displaced fractures of the fifth metacarpal neck were randomized to either intramedullary single-wire (n = 146) or dual-wire fixation (n = 144). The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire six months after surgery, with a third of the minimal clinically important difference (MCID) used as the noninferiority threshold. Secondary outcomes were pain, health-related quality of life (EuroQol five-dimensional questionnaire (EQ-5D)), radiological measures, functional deficits, and complications. RESULTS: Overall, 151/290 of patients (52%) completed the six months of follow-up, leaving 83 patients in the single-wire group and 68 patients in the dual-wire group. In the modified intention-to-treat analysis set, mean DASH scores six months after surgery were 3.8 (sd 7.0) and 4.4 (sd 9.4), respectively. With multiple imputation (n = 288), mean DASH scores were estimated at 6.3 (sd 8.7) and 7.0 (sd 10.0). Upper (1 - 2α)) confidence limits consistently remained below the noninferiority margin of 3.0 points in the DASH instrument. While there was a statistically nonsignificant trend towards a higher rate of shortening and rotational malalignment in the single wire group, no statistically significant differences were observed across groups in any secondary outcome measure. CONCLUSION: A single thick K-wire is sufficient for intramedullary fixation of acute displaced subcapital fractures of the fifth metacarpal neck. The less technically demanding single-wire technique produces noninferior clinical and radiological outcomes compared with the dual-wire approach. Cite this article: Bone Joint J 2019;101-B:1263-1271.


Assuntos
Fios Ortopédicos , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Ossos Metacarpais/lesões , Adulto , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Alemanha , Força da Mão/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Ossos Metacarpais/cirurgia , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Amplitude de Movimento Articular/fisiologia , Medição de Risco
2.
Acta Cir Bras ; 34(7): e201900702, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531537

RESUMO

PURPOSE: To investigate the effect of intermittent vibration at different intervals on bone fracture healing and optimize the vibration interval. METHODS: Ninety sheep were randomized to receive no treatment (the control group), incision only (the sham control group), internal fixation with or without metatarsal fracture (the internal fixation group), and continuous vibration in addition to internal fixation of metatarsal fracture, or intermittent vibration at 1, 2, 3, 5, 7 and 17-day interval in addition to internal fixation of metatarsal fracture (the vibration group). Vibration was done at frequency F=35 Hz, acceleration a=0.25g, 15 min each time 2 weeks after bone fracture. Bone healing was evaluated by micro-CT scan, bone microstructure and mechanical compression of finite element simulation. RESULTS: Intermittent vibration at 7-day interval significantly improved bone fracture healing grade. However, no significant changes on microstructure parameters and mechanical properties were observed among sheep receiving vibration at different intervals. CONCLUSIONS: Clinical healing effects should be the top concern. Quantitative analyses of bone microstructure and of finite element mechanics on the process of fracture healing need to be further investigated.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas Ósseas/diagnóstico por imagem , Ossos do Metatarso/lesões , Vibração/uso terapêutico , Animais , Análise de Elementos Finitos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/normas , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Distribuição Aleatória , Ovinos , Microtomografia por Raio-X
3.
Orthop Clin North Am ; 50(4): 529-537, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466668

RESUMO

Ankle osteoarthritis affects a significant portion of the global adult population. Unlike other joints, arthritis of the ankle often develops as a response to traumatic injury (intra-articular fracture) of the ankle joints. The full mechanism leading to posttraumatic osteoarthritis of the ankle (PTOAA) is poorly understood. These deficits in knowledge pose challenges in the management of the disease. Adequate surgical reduction of fractured ankle joints remains the gold standard in prevention. The purpose of this review is to thoroughly delineate the known pathogenesis of PTOAA, and provide critical updates on this pathology and new avenues to provide therapeutic management of the disease.


Assuntos
Fraturas do Tornozelo/complicações , Fraturas do Tornozelo/cirurgia , Osteoartrite/patologia , Fraturas do Tornozelo/metabolismo , Fenômenos Biomecânicos , Gerenciamento Clínico , Fixação Interna de Fraturas/instrumentação , Humanos , Metabolismo dos Lipídeos , Osteoartrite/metabolismo , Resultado do Tratamento
4.
Bone Joint J ; 101-B(8): 978-983, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362548

RESUMO

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


Assuntos
Placas Ósseas , Fios Ortopédicos , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/instrumentação , Fraturas do Rádio/cirurgia , Traumatismos do Punho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Articulação do Punho/cirurgia
5.
Bone Joint J ; 101-B(8): 995-1001, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362556

RESUMO

AIMS: The primary aim of this study was to establish the cost-effectiveness of the early fixation of displaced midshaft clavicle fractures. PATIENTS AND METHODS: A cost analysis was conducted within a randomized controlled trial comparing conservative management (n = 92) versus early plate fixation (n = 86) of displaced midshaft clavicular fractures. The incremental cost-effectiveness ratio (ICER) was used to express the cost per quality-adjusted life-year (QALY). The Six-Dimension Short-Form Health Survey (SF-6D) score was used as the preference-based health index to calculate the cost per QALY at 12 months after the injury. RESULTS: The mean 12-month SF-6D was 0.9522 (95% confidence interval (CI) 0.9355 to 0.9689) following conservative management and 0.9607 (95% CI 0.9447 to 0.9767) following fixation, giving an advantage for fixation of 0.0085, which was not statistically significant (p = 0.46). The mean cost per patient was £1322.69 for conservative management and £5405.32 for early fixation. This gave an ICER of £480 309.41 per QALY. For a threshold of £20 000 per QALY, the benefit of fixation would need to be present for 24 years to be cost-effective compared with conservative treatment. Linear regression analysis identified nonunion as the only factor to adversely influence the SF-6D at 12 months (p < 0.001). CONCLUSION: Routine plate fixation of displaced midshaft clavicular fractures is not cost-effective. Nonunion following conservative management has an increased morbidity with comparable expense to early fixation. This may suggest that a targeted approach of fixation in patients who are at higher risk of nonunion would be more cost-effective than the routine fixation of all displaced fractures. Cite this article: Bone Joint J 2019;101-B:995-1001.


Assuntos
Clavícula/lesões , Tratamento Conservador/economia , Análise Custo-Benefício/estatística & dados numéricos , Fixação Interna de Fraturas/economia , Fraturas Ósseas/cirurgia , Custos de Cuidados de Saúde/estatística & dados numéricos , Adulto , Placas Ósseas , Clavícula/cirurgia , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/economia , Humanos , Masculino , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento , Reino Unido
6.
J Cardiothorac Surg ; 14(1): 105, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31186011

RESUMO

BACKGROUND: Rib fractures account for a fairly high proportion of chest injuries, ranging from 55 to 80%. The most common mechanisms of injury include: traffic accident, extrusion and falls from significant heights. Besides, the surgical treatment of multiple rib fractures has been accepted by more and more medical professionals. We reported 5 clinical cases of patients with multiple rib fractures undergoing open reduction and internal fixation using 3D printing technology. CASE PRESENTATION: Retrospective analysis of 5 clinical cases of multiple rib fractures from January 2017 to August 2018 in our hospital. A preoperative CT thin slice scan was used to reconstruct the 3D model according to the scanning results, and 3D printing technology was adopted to prepare the rib model. Preoperative reconstruction of the rib's normal shape and lock plate for the shaped ribs was created according to reconstructed model. For multiple fractures especially patients with severely deformed rib shape, it is suggested to intraoperative shape directly to the metal bone plate fixed on the ribs on both ends of the fracture line, in order to establish a basic support frame. The other various fracture section can be fixed on the lock plate respectively. Postoperative chest radiographs of the 5 patients showed that the internal fixations were in good and natural shape. The thoracic contour was well formed and symmetrically with the contralateral side. CONCLUSION: Making the rib model and the pre-shaped titanium alloy rib locking plate using 3D printing technology, provided a more minimally invasive and precisely individualized treatment for some rib fracture operations.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/métodos , Fraturas Múltiplas/cirurgia , Redução Aberta/métodos , Impressão Tridimensional , Fraturas das Costelas/cirurgia , Acidentes por Quedas , Acidentes de Trânsito , Feminino , Fixação Interna de Fraturas/instrumentação , Fraturas Múltiplas/diagnóstico por imagem , Fraturas Múltiplas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta/instrumentação , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/etiologia , Tomografia Computadorizada por Raios X
7.
J Shoulder Elbow Surg ; 28(6S): S131-S137, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31196507

RESUMO

BACKGROUND: Reverse total shoulder arthroplasty is a treatment option for 3- and 4-part proximal humeral fractures in elderly patients. However, arthroplasty has drawbacks in younger patients because of their greater activity level and more likely need for revision surgery. In such patients, an intramedullary cage may allow for reconstruction of the proximal humerus. METHODS: We reviewed the outcomes of patients with proximal humeral fractures treated with expandable intramedullary cages from 2016 to 2017. We included patients with closed 3- or 4-part fractures (Neer classification), no osteoarthritis of the glenohumeral joint, and minimum 12-month follow-up. We assessed range of motion, pain, the American Shoulder and Elbow Surgeons score, and the Subjective Shoulder Value. RESULTS: Eleven patients (mean follow-up, 54 weeks [range, 49-61 weeks]) were included. Two patients had 3-part fractures, and nine had 4-part fractures. At final follow-up, the mean visual analog scale score for pain was 1.4 (range, 0-6), the mean Subjective Shoulder Value was 69 (range, 20-90), and the mean American Shoulder and Elbow Surgeons score was 80 (range, 27-98). Mean forward flexion was 123° (range, 45°-160°), mean abduction was 82° (range, 30°-90°), and mean external rotation in 90° of abduction was 71° (range, 30°-90°). At final radiographic evaluation, all fractures were healed. No wound-related or neurologic complications were noted. Avascular necrosis developed in 1 patient; conversion to shoulder arthroplasty was performed. CONCLUSION: Treatment of 3- and 4-part proximal humeral fractures with an expandable intramedullary cage produced good clinical outcomes and a 100% union rate.


Assuntos
Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Adulto , Idoso , Epífises/lesões , Epífises/cirurgia , Feminino , Seguimentos , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Rotação , Fraturas do Ombro/fisiopatologia , Dor de Ombro/etiologia , Resultado do Tratamento
8.
Bone Joint J ; 101-B(6_Supple_B): 91-96, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31146562

RESUMO

AIMS: Cephalomedullary nails (CMNs) are commonly used for the treatment of intertrochanteric hip fractures. Total hip arthroplasty (THA) may be used as a salvage procedure when fixation fails in these patients. The aim of this study was to analyze the complications of THA following failed intertrochanteric hip fracture fixation using a CMN. PATIENTS AND METHODS: Patients who underwent THA were identified from the 5% subset of Medicare Parts A/B between 2002 and 2015. A subgroup involving those with an intertrochanteric fracture that was treated using a CMN during the previous five years was identified and compared with the remaining patients who underwent THA. The length of stay (LOS) was compared using both univariate and multivariate analysis. The incidence of infection, dislocation, revision, and re-admission was compared between the two groups, using multivariate analysis adjusted for demographic, hospital, and clinical factors. RESULTS: The Medicare data yielded 56 522 patients who underwent primary THA, of whom 369 had previously been treated with a CMN. The percentage of THAs that were undertaken between 2002 and 2005 in patients who had previously been treated with a CMN (0.346%) more than doubled between 2012 and 2015 (0.781%). The CMN group tended to be older and female, and to have a higher Charlson Comorbidity Index and lower socioeconomic status. The mean LOS was 1.5 days longer (5.3 vs 3.8) in the CMN group (p < 0.0001). The incidence of complications was significantly higher in the CMN group compared with the non-CMN group: infection (6.2% vs 2.6%), dislocation (8.1% vs 4.5%), revision (8.4% vs 4.3%), revision for infection (1.1% vs 0.37%), and revision for dislocation (2.2% vs 0.6%). CONCLUSION: The incidence of conversion to THA following failed intertrochanteric hip fracture fixation using a CMN continues to increase. This occurs in elderly patients with increased comorbidities. There is a significantly increased risk of infection, dislocation, and LOS in these patients. Patients with failed intertrochanteric hip fracture fixation using a CMN who require THA should be made aware of the increased risk of complications, and steps need to be taken to reduce this risk. Cite this article: Bone Joint J 2019;101-B(6 Supple B):91-96.


Assuntos
Artroplastia de Quadril/métodos , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Pinos Ortopédicos , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Prótese de Quadril/efeitos adversos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Falha de Prótese , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Fatores de Risco
10.
J Biol Regul Homeost Agents ; 33(2 Suppl. 1): 147-154, 2019 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31172732

RESUMO

Hip fractures are associated with a 20% one-year mortality and a 50% loss of function. Over 700,000 deaths are estimated to occur annually worldwide following hip fractures. Concern exist regarding which is the best implant for extracapsular fractures fixation. For a correct positioning of the cephalic screw, a new plate (O'Nil Anteversa® mini-plate, Intrauma, Torino, Italy) with a fixed 8°of anteversion in the axial plane was developed. A total of 22 patients with an intertrochanteric fracture underwent surgery with Anteversa® mini-plate between October 2016 and April 2017. Data collected included patients' age at surgery, gender, fracture type, operative side, surgeon, type of implant, TAD, CalTAD and TADCalTAD. All patients underwent clinical and radiographic evaluations according to the AO Surgery Reference classification. The mean TAD, CalTAD and TADcalTAD for the entire population of study were, respectively, 20.18±7.5 mm, 20.45±7.25 mm, and 40.62±14.44 mm. The mean TAD, CalTAD and TADcalTAD of those patients who experienced mobilisation of the cephalic screw were, respectively, 20.26±5.87 mm, 19.53±5.47 mm, and 39.8±11.16 mm. Three patients experienced mobilisation of the cephalic screw, and none of these had a TAD greater than 25 mm, a CalTAD greater of 25mm or a TADcalTAD greater than 50 mm. This type of device meets the essential requirements for a correct treatment of intertrochanteric fractures in elderly patients. However, the excessive need of attention in each step, and the consequent increased time of surgery, could be seen as a limitation for its use.


Assuntos
Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Fraturas do Quadril/cirurgia , Humanos , Resultado do Tratamento
11.
Foot Ankle Clin ; 24(2): 325-345, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31036271

RESUMO

Posttraumatic hindfoot varus may result from nonoperative treatment or inadequate reduction and fixation of talar and calcaneal fractures. Adequate visualization of the talar neck via bilateral approaches is essential in avoiding malreduction. In cases of medial comminution of the talar neck, lag screws must be avoided and the use of single or double plates should be considered. A Schanz screw introduced into the calcaneal tuberosity is instrumental in realigning shortening, varus, or valgus deformity of the heel. Special attention should be paid to addressing impaction of the medial facet of both the talus and calcaneus to avoid hindfoot varus.


Assuntos
Calcâneo/lesões , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Pé Cavo/prevenção & controle , Tálus/lesões , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/cirurgia , Calcâneo/cirurgia , Traumatismos do Pé/complicações , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/complicações , Humanos , Pé Cavo/etiologia , Tálus/cirurgia
12.
Unfallchirurg ; 122(8): 587-595, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31123800

RESUMO

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


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/cirurgia , Ossos Metacarpais/fisiopatologia , Ossos Metacarpais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Fios Ortopédicos , Cadáver , Fixadores Externos , Fixação Interna de Fraturas/instrumentação , Humanos , Ossos Metacarpais/lesões , Pessoa de Meia-Idade , Distribuição Aleatória
13.
Mymensingh Med J ; 28(2): 291-297, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086140

RESUMO

Distal third comminuted humerus shaft fractures are challenging injuries to treat because of complex anatomy and fracture patterns. Functional bracing, operative treatment with intramedullary nails or conventional plates also has limitation of inadequate fixation in the distal third comminuted humerus shaft fractures. Locking compression plate (LCP) has been introduced to overcome this problem. Our aim of this study was to assess the effectiveness of osteosynthesis of distal third comminuted humerus shaft fractures by LCP using posterior approach. This prospective observational study was conducted from July 2015 to June 2018 at Mymensingh Medical College Hospital (MMCH) and National Institute of Traumatulogy & Orthopaedic Rehablitation (NITOR), Dhaka, Bangladesh. Thirty three patients were operated on for comminuted fractures of distal third humerus. Two cases were excluded from the evaluation of final out come due to their discontinued follow up. Treatment included open reduction and LCP fixation by posterior mid line approach. The range of motion of the shoulder and elbow were evaluated according to the criteria by modified Constant and Murley scoring system. Union was achieved in all the patients after a mean of 17 weeks (range 12-24 weeks). Deep infection, nonunion, malunion, implant failure or permanent nerve injury did not occur in any of the patients. Three patients had transient radial nerve palsy. Four patients developed superficial infections. All patients were relieved pain postoperatively. Shoulder range of motion was excellent in 20 patients & elbow range of motion was excellent in 21 patients. Functional out come were excellent in 11 & good in 16 patients which constituted 87% satisfactory results. Treatment with open reduction and LCP fixation by posterior approach is a safe and effective option in distal third comminuted humeral fractures.


Assuntos
Fixação Intramedular de Fraturas/instrumentação , Fraturas Cominutivas/cirurgia , Fraturas do Úmero/cirurgia , Redução Aberta/métodos , Bangladesh , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Humanos , Úmero , Estudos Prospectivos , Recuperação de Função Fisiológica , Resultado do Tratamento
14.
Ulus Travma Acil Cerrahi Derg ; 25(3): 281-286, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31135948

RESUMO

BACKGROUND: Extension-block pinning is a popular treatment for mallet fractures, but it is associated with several pitfalls. Of note, transfixation Kirschner wires used to fix the distal interphalangeal (DIP) joint may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine whether a transfixation pin was necessary for extension-block pinning in the treatment of bony mallet fracture. METHODS: Patients were treated with a pin-orthosis extension-block technique if they had been diagnosed with a type IVB mallet fracture according to Doyle's classification. Radiological outcomes were evaluated based on postoperative X-ray results, and functional outcomes were evaluated using Crawford's criteria. RESULTS: Thirteen patients (9 males and 4 females) with a mean age of 26 years were included. The mean time between the injury and surgery was 3.3 days, and the mean follow-up period was 8.2 months (range: 4-12 months). Radiographic bone union was achieved in all patients within an average of 5.1 weeks (range: 5-6 weeks). At the final follow-up, the DIP joint had an average degree of flexion of 76.1° (range: 65°-80°) and an average extension deficit of 3.84° (range: 0°-15°). According to Crawford's criteria, 8 patients had excellent results, 4 patients had good results, and 1 patient had a fair result. No patient reported pain at the final follow-up. CONCLUSION: Satisfactory clinical and radiological outcomes were obtained with the pin-orthosis extension-block technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.


Assuntos
Traumatismos dos Dedos , Fixação Interna de Fraturas , Fratura Avulsão , Adulto , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fratura Avulsão/diagnóstico por imagem , Fratura Avulsão/cirurgia , Humanos , Masculino , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(21): e15591, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124935

RESUMO

RATIONALE: The aim of the present study was to assess the efficacy and safety of percutaneous cannulated screw (PCS) implantation assisted by screw view model of navigation (SVMN) to treat femoral neck fracture (FNF). PATIENT CONCERNS: A 42-year-old male patient suffered from a high falling injury, causing pain, swelling, deformity, and limited mobility on his right hip. DIAGNOSES: He was diagnosed with Garden type I of FNF. INTERVENTIONS: PCS implantation assisted by SVMN was used to treat fracture of femoral neck in this patient. OUTCOMES: The follow up lasted for 48 months. A total of 3 screws were inserted into femoral neck, all exhibiting excellent position. The mean screw deviation was 0.43° and 5.73° of femoral neck-shaft and anteversion angle, respectively. The guide wire drilling attempt of each screw was one-time. The fluoroscopic time lasted 6.3 minutes, the Harris hip scores improved from 67 to 88, and the blood loss was 35 mL. It took 11.7 minutes for designing the screws, 13.9 minutes for implanting the guide wires, and 37.3 minutes for placing the screws. No clinical complications were found during 48-month follow-up visit, including head penetration, implant failure, fracture nonunion, and femoral head osteonecrosis. LESSONS: The study revealed that SVMN is conducive to the PCS insertion for FNF. Our lesson is that the FNF must be well reduction before SVMN assisted PCS placement.


Assuntos
Parafusos Ósseos , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/instrumentação , Neuronavegação/métodos , Adulto , Cânula , Colo do Fêmur/lesões , Colo do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Masculino , Resultado do Tratamento
16.
Orthop Clin North Am ; 50(3): 367-374, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31084839

RESUMO

Shape-memory alloy (SMA) staples are a recent innovation in fracture fixation. These staples have inherent compressive properties that create a stable fracture environment that promotes primary bone healing. They have been used successfully for osteotomies, arthrodesis, and fracture fixation. Understanding where SMA staple compression can be optimized and using proper indications are important for obtaining consistent success and minimizing failures. SMA staples are not a substitute for lag screw fixation or traditional plate and screw constructs.


Assuntos
Ligas , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Suturas , Acetábulo/lesões , Adulto , Fenômenos Biomecânicos , Clavícula/lesões , Força Compressiva , Desenho de Equipamento , Humanos , Masculino , Ossos Pélvicos/lesões , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia
17.
Medicine (Baltimore) ; 98(19): e15357, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083163

RESUMO

Extra-articular screw placement in the true pelvis for fixing quadrilateral plate fractures remains challenging. We aimed to define the "safe zone" on the quadrilateral surface to facilitate safe plate-screw placement.Twenty cadaveric hemipelves were sectioned and assembled to define the projection of the acetabular boundary on the quadrilateral surface. Three lines (X, Y, and Z) were drawn tangent to the projection, with X parallel to the iliopectineal line, Y perpendicular to the iliopectineal line, and Z parallel to the posterior border of the ischial body. Then, the distances between X and the iliopectineal line (D1), Y and the sacroiliac joint (D2), and Z and the posterior border of the ischium (D3) could be used to determine a "safe zone" on the quadrilateral surface for screw insertion. We included 15 patients whose conditions satisfied the definition of a comminuted quadrilateral plate fracture and applied two-ended buttress plates for treatment in accordance with this "safe zone."The average D1 was 50.0 mm, the average D2 was 30.6 mm, and the average D3 was 12.4 mm. For all 15 patients with comminuted quadrilateral fracture who were treated, no intraoperative or postoperative screw penetration of the acetabulum was identified, and no loss of reduction was observed during an average follow up of 17.7 months.The "safe zone" established in this study simplifies extraarticular screw placement for managing quadrilateral plate fractures in the true pelvis. As a result, two-ended buttress plate fixation in the true pelvis becomes safe, therefore, treatment with two-ended buttress plates may represent a viable alternative to single-ended elastic fixation in the management of comminuted quadrilateral fractures.


Assuntos
Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Pelve/lesões , Pelve/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
18.
J Orthop Surg Res ; 14(1): 104, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987654

RESUMO

BACKGROUND: It is believed that direct odontoid screw fixation preserves the physiological cervical range of motion following surgery. However, there are no clinical studies confirming the motion sparing value of this technique. This study aims to (1) to assess active cervical range of motion following types II and III odontoid fracture, successfully treated with anterior odontoid screw fixation, and (2) to examine the relationship between the range of motion of the head and duration of collar usage, neck pain, quality of life, and patients' age. METHODS: The study involved 41 patients subjected to a procedure of direct osteosynthesis of the dens with lag screw. Following the operation all the patients had to wear a cervical collar to protect the osteosynthesis. The control group consisted of 41 individuals with no clinical diagnosis of any cervical spine disorders. The spinal motion was assessed using multi-cervical unit, taking into account bending/extension, left and right lateral flexion, and left and right axial rotation. RESULTS: In the study group, spine mobility correlated with the duration of hard collar usage following the operation, with a longer duration corresponding to poorer spine mobility at the end of the treatment. Statistically significant correlation was observed in the case of extension (p < 0.021) and axial rotation (p < 0.007). In the study group, there was a negative correlation between the range of motion and the patients' age, i.e., the older the patient the poorer his/her spinal mobility (p < 0.001). CONCLUSIONS: Active cervical range of motion in patients following direct osteosynthesis of the dens, augmented with a hard collar, was significantly lower than in the control population, and it correlated negatively with the duration of collar usage, the patients' age, and intensity of spinal pain.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Processo Odontoide/lesões , Processo Odontoide/fisiologia , Amplitude de Movimento Articular/fisiologia , Fraturas da Coluna Vertebral , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Vértebras Cervicais/fisiologia , Vértebras Cervicais/cirurgia , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Adulto Jovem
19.
Int J Surg ; 65: 107-112, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30951872

RESUMO

PURPOSE: Fractures of the distal femur remain challenging to treat, and numerous fixation methods are designed to promote stability and fracture healing. Locking plate constructs have recently become the mainstream fixation method, but debate exists on whether to use locking plates alone or to augment them with interfragmentary screws. This article compares outcomes of distal femur fractures treated with a single locking plate alone versus those treated with a locking plate and interfragmentary screws. METHODS: We retrospectively reviewed 57 patients treated for distal femur fractures from 2010 to 2013. Patients were divided into two groups: Those treated with a locking plate alone utilizing the minimally invasive plate osteosynthesis (MIPO) technique and those treated with combination of a locking plate and interfragmentary screws using an open technique. Postoperative outcomes were obtained via a manual chart review. Fracture healing and callus indices were evaluated from radiographs. RESULTS: 9 patients required revision surgery in the locking plate alone group (6 for persistent nonunion and 3 for varus deformity). Only two patients in the combination group required revisions (both for nonunion). Average time to full weight bearing was 19.54 weeks in the locking plate group versus 14.57 weeks in the combination group (p = 0.004). At the time of full weight bearing, frontal (1.15 versus 1.11, p = 0.004) and sagittal (1.22 versus 1.15, P = 0.008) callus indices were both significantly greater in the locking plate group. CONCLUSIONS: In this study, the combination of a locking plate and interfragmentary screws achieved suitable stability and a faster time to full weight bearing than using a locking plate alone. Surgeons should consider combining a locking plate with interfragmentary screws as an effective method for fixation of distal femur fractures, particularly in cases when plate fixation alone fails to provide adequate fracture stability.


Assuntos
Placas Ósseas , Parafusos Ósseos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Redução Aberta/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/fisiopatologia , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta/instrumentação , Radiografia , Recuperação de Função Fisiológica , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Suporte de Carga , Adulto Jovem
20.
J Knee Surg ; 32(5): 388-391, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30959548

RESUMO

Periprosthetic fractures around total knee arthroplasty have become more common with the increasing incidence of total knee arthroplasty. These fractures are challenging to treat, especially in older patients with poor bone stock. Although open reduction internal fixation remains the most common treatment, revision with distal femoral replacement has become popular in recent years. Careful evaluation and planning are required to have successful outcomes. We present a review of distal femoral replacement in periprosthetic fractures around the total knee arthroplasty, along with surgical technique, and pearls and pitfalls.


Assuntos
Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Periprotéticas/cirurgia , Reoperação/métodos , Artroplastia do Joelho/efeitos adversos , Fraturas do Fêmur/etiologia , Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/mortalidade , Humanos , Prótese do Joelho/efeitos adversos , Reoperação/efeitos adversos , Reoperação/instrumentação , Reoperação/mortalidade
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