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1.
Mayo Clin Proc ; 96(7): 2012-2013, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34218874

RESUMO

Stamp Vignettes focus on biographical details and accomplishments related to science and medicine, and not individual views and prejudices except when they had a major impact on the subject's life. The authors of Stamp Vignettes do not intend to imply any endorsement of such views when discussing a Stamp Vignette on Medical Science.


Assuntos
Fixação Interna de Fraturas , Fixadores Internos/história , Ortopedia/história , Bélgica , Fixação Interna de Fraturas/história , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , História do Século XIX , História do Século XX , Humanos , Procedimentos Ortopédicos
2.
Medicine (Baltimore) ; 100(24): e26392, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128903

RESUMO

ABSTRACT: Although infra-acetabular screws have been used for anterior and posterior column transfixation, a screw penetrating the hip joint can result in harmful complications. However, the most accurate intraoperative radiologic imaging tool for identifying articular penetration has not been established. The purpose of the present study was, therefore, to evaluate the consistency with which standard pelvic radiographs compared with computed tomography (CT) can be used for demonstrating articular penetration.This retrospective review was performed between January 2015 and December 2020. We evaluated the records of patients with acetabular or pelvic fractures who underwent open reduction and internal fixation with infra-acetabular screw placement. We collected demographic data and described infra-acetabular screw placement as follows: ideal placement, articular penetration, and out of the bone. Articular penetration was assessed independently on each pelvic radiograph and compared statistically with the CT scans. Sensitivity, specificity, correct interpretation rate, and prevalence-adjusted bias-adjusted kappa (PABAK) were calculated for each radiograph.Thirty-nine patients underwent infra-acetabular screw placement. The mean age of patients was 55 years (range, 27-90 years); there were 29 men and 10 women. One patient underwent bilateral infra-acetabular screw placement; therefore, 40 infra-acetabular screws were included in total. Six (6/40, 15%) infra-acetabular screws showed articular penetration on CT and two (2/40, 5%) showed infra-acetabular screws extending out of the bone. Hip joint penetration was correctly identified at a rate of 92.5% (95% confidence interval [CI], 79.6-98.4%) on the outlet view and 87.5% (95% CI, 73.2-95.8%) on the anteroposterior (AP) view. The PABAK for the agreement between pelvic radiographs and CT scans was 0.85 in the outlet view and 0.75 in the AP view.The outlet view is an accurate method for detecting articular penetration of infra-acetabular screws. We recommend the insertion of an infra-acetabular screw under fluoroscopic outlet view to avoid articular penetration intraoperatively.


Assuntos
Acetábulo/cirurgia , Parafusos Ósseos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Lesões do Quadril/diagnóstico por imagem , Complicações Intraoperatórias/diagnóstico por imagem , Acetábulo/diagnóstico por imagem , Acetábulo/lesões , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta , Ossos Pélvicos/lesões , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 100(26): e26395, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190155

RESUMO

INTRODUCTION: With the aggravation of population aging, the incidence of intertrochanteric fracture also increases dramatically. Patients are often elderly accompany with severe osteoporosis and various complications. Therefore, we should select an individualized treatment based on the each patient's state. Arthroplasty is recommended for unstable fractures with obvious osteoporosis, ipsilateral femoral head necrosis or arthritis. Rigid fixation of the greater trochanter with arthroplasty is challenging because of the powerful pulling forces created by multiple muscles being transmitted to the greater trochanter. Currently, there are few contemporary literatures on the evaluation of unstable intertrochanteric fracture with efficient fixation of the greater trochanter. Moreover, there is no consensus to choose which implant to immobilize the greater trochanter. The purpose of this study was to review previous literatures and provide a valuable guidance. CONCLUSIONS: The locking plate, which not only provides rigid fixation but also results in lower rate of postoperative complications. However, further prospective randomized and cohort studies are needed.


Assuntos
Artroplastia de Quadril/métodos , Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas do Quadril/cirurgia , Artroplastia de Quadril/instrumentação , Placas Ósseas , Fios Ortopédicos , Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/complicações , Fixação Interna de Fraturas/instrumentação , Fraturas do Quadril/complicações , Fraturas do Quadril/diagnóstico por imagem , Humanos , Osteoartrite do Quadril/complicações , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Radiografia
4.
J Pediatr Orthop ; 41(Suppl 1): S1-S5, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096530

RESUMO

BACKGROUND: While management recommendations for distal radius fractures in both young and skeletally mature patients have been generally well-established, controversy still exists regarding optimal management in adolescent patients approaching skeletal maturity. Thus, the goal of this review is to analyze relevant literature and provide expert recommendations regarding the management of distal radius fractures in this patient population. METHODS: A PubMed search was performed to identify literature pertaining to distal radius fractures in adolescent patients, defined as 11 to 14 years in girls and 13 to 15 years in boys. Relevant articles were selected and summarized. RESULTS: Distal radius fractures demonstrate significant potential for remodeling of angular deformity and bayonet apposition, even in patients older than 12 years of age. Rotational forearm range of motion and functional outcomes are acceptable with up to 15 degrees of residual angulation. Closed reduction and percutaneous pinning reduces fracture redisplacement but has a high associated complication rate. There is no literature comparing plate versus pin fixation of distal radius fractures in the pediatric population, but in adults plate fixation is associated with higher cost with no improvement in long-term functional outcomes. CONCLUSIONS: Remodeling can still be expected to occur in adolescent patients, and even with residual deformity functional outcomes after distal radius fractures are excellent. Up to 15 degrees of residual angulation can be accepted before considering operative management. Smooth pins should be considered over plates as first-line operative management for unstable fractures that fail nonoperative treatment.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Antebraço , Fixação Interna de Fraturas , Fraturas do Rádio/cirurgia , Adolescente , Desenvolvimento do Adolescente , Remodelação Óssea , Feminino , Antebraço/crescimento & desenvolvimento , Antebraço/fisiopatologia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Amplitude de Movimento Articular , Recuperação de Função Fisiológica
5.
J Pediatr Orthop ; 41(Suppl 1): S14-S19, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096532

RESUMO

INTRODUCTION: The transition from pediatric to adolescent fractures can lead to uncertainty on what level of surgical correction is warranted as remodeling is limited in these older patients. DISCUSSION: Adolescent diaphyseal radial shaft fractures present several unique challenges; the radial bow must be restored to preserve forearm rotation and there are several clinical scenarios where plating, even in the skeletally immature child, is strongly recommended and will have more reliable results over flexible intramedullary nails. In addition, judging how much angulation, rotation, and displacement will remodel in the older child can be a challenging decision, even for experienced pediatric orthopaedists. CONCLUSION: This overview discusses parameters for acceptable alignment in these fractures, when surgical fixation should be considered, and circumstances where plating should be considered over flexible nails.


Assuntos
Antebraço , Fixação Interna de Fraturas , Fixação Intramedular de Fraturas , Seleção de Pacientes , Fraturas do Rádio/cirurgia , Rádio (Anatomia) , Adolescente , Fatores Etários , Pinos Ortopédicos , Placas Ósseas , Criança , Desenvolvimento Infantil , Feminino , Antebraço/crescimento & desenvolvimento , Antebraço/fisiopatologia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Rádio (Anatomia)/crescimento & desenvolvimento , Rádio (Anatomia)/cirurgia
6.
J Pediatr Orthop ; 41(Suppl 1): S33-S38, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096535

RESUMO

INTRODUCTION: Tibial shaft fractures are common injuries in the adolescent age group. Potential complications from the injury or treatment include infection, implant migration, neurovascular injury, compartment syndrome, malunion, or nonunion. METHODS: Published literature was reviewed to identify studies which describe the management options, complications, and outcome of tibial shaft fractures in adolescents. RESULTS: Acceptable alignment parameters for tibial shaft fractures have been defined. Operative indications include open fractures and other severe soft tissue injuries, vascular injury, compartment syndrome, ipsilateral femoral fractures, and polytrauma. Relative indications for operative treatment are patient/family preference or morbid obesity. Closed reduction and cast immobilization necessitates radiographic observation for loss of reduction over the first 3 weeks. Cast change/wedging or conversion to operative management may be required in 25% to 40%. Flexible nailing provides relative fracture stability while avoiding the proximal tibial physis, but the fracture will still benefit from postoperative immobilization. Rigid nailing provides greater fracture stability and allows early weight bearing but violates the proximal tibial physis. Plate and screw osteosynthesis provide stable anatomic reduction, but there are concerns with delayed union and wound complications related to the dissection. External fixation is an excellent strategy for tibia fractures associated with complex wounds but also requires observation for loss of reduction. DISCUSSION AND CONCLUSIONS: The majority of adolescent tibia shaft fractures can be successfully managed with closed reduction and cast immobilization. Unstable fractures that have failed cast treatment should be treated operatively. Flexible intramedullary nailing, rigid intramedullary nailing, plate and screw osteosynthesis, and external fixation are acceptable treatment options that may be considered for an individual patient depending upon the clinical scenario.


Assuntos
Redução Fechada , Fixação Interna de Fraturas , Traumatismo Múltiplo/terapia , Tíbia/lesões , Fraturas da Tíbia , Adolescente , Pinos Ortopédicos , Placas Ósseas , Redução Fechada/efeitos adversos , Redução Fechada/instrumentação , Redução Fechada/métodos , Fixadores Externos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Seleção de Pacientes , Fatores de Risco , Fraturas da Tíbia/diagnóstico , Fraturas da Tíbia/cirurgia
7.
Acta Orthop Traumatol Turc ; 55(3): 201-207, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100359

RESUMO

OBJECTIVE: The aim of this study was to present mid-term functional and radiological outcomes of patients with physeal closure who underwent arthroscopic or open internal fixation with headless cannulated compressive screws due to unstable Osteochondritis Dissecans (OCD) lesions of the knee. METHODS: With a diagnosis of unstable OCD of the knee, ten consecutive patients (seven male, three female) with physeal closure (mean age: 23 years; range: 17-40), underwent arthroscopic or open internal fixation with headless cannulated compressive screws. The patients were retrospectively reviewed based on functional and radiological data, with a mean follow-up of 42 months (range: 27-61). The average size of the defects was 4.2 cm2 with a range from 1.7 to 8 cm2 . The study protocol consisted of the Range of Motion (ROM), Tegner-Lysholm Score, Modified Cincinnati Rating System Questionnaire, Short Form-12 (SF-12) in addition to the plain radiograph and Computed Tomography (CT). Any development of arthrosis was assessed at the final follow-up according to the Internation Knee Documention Committee score (IKDC). RESULTS: At the final follow-up, control plain radiographs and CT showed complete union of the fragments in nine patients; however, CT imaging illustrated nonunion of the fragment in one patient. The main Tegner-Lysholm Score increased from 59 (range: 11-63) preoperatively to 97 (range: 88-100) at the final follow-up. Modified Cincinnati Rating System Questionnaire and IKDC score were 97 (range: 93-100) and 96 (range: 92-100), respectively, at the final follow-up. In addition, in terms of SF-12, the mean physical component score was 47.5 (range: 42-49), and the mean mental component score was 57.25 (range: 48-63). CONCLUSION: In patients with physeal closure, internal fixation using cannulated compressive screws may be an influential procedure for the OCD lesions of the knee ranging in size from medium to large. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Fixação Interna de Fraturas , Lâmina de Crescimento , Articulação do Joelho , Osteoartrite , Osteocondrite Dissecante , Complicações Pós-Operatórias , Adulto , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Lâmina de Crescimento/diagnóstico por imagem , Lâmina de Crescimento/patologia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Osteoartrite/diagnóstico , Osteoartrite/etiologia , Osteoartrite/fisiopatologia , Osteocondrite Dissecante/diagnóstico , Osteocondrite Dissecante/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
8.
Acta Orthop Traumatol Turc ; 55(3): 258-264, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100368

RESUMO

OBJECTIVE: The aim of this study was to compare clinical and radiological outcomes of screw fixation alone versus screw with small locking plate fixation techniques in the management of intra-articular calcaneal fractures by minimal invasive surgery. METHODS: A total of 42 patients treated with minimally invasive surgery because of an intra-articular calcaneal fracture were retrospectively reviewed and included in the study. The patient were then divided into two groups based on the implemented surgical technique: Group A, 20 patients (16 male, 4 female; mean age = 43.41 ± 15.50) receiving screw fixation alone and group B, 22 patients (17 male, 5 female; mean age = 43.38 ± 14.00) receiving screw with small locking plate fixation. The radiographic assessment included Bohler's, Gissane, joint line parallel, and calcaneal varus angles at immediate post-operative and 2-year follow up period through the calcaneal axial and lateral foot radiographs. RESULTS: There was a significant increase in joint line parallel angle from post-operative period to 2-year follow up in Group A compared to Group B, mean (SD) 3.27 (2.15) degrees versus (vs) 0.44 (3.00) degrees, P = 0.025. No statistical significant difference of the immediate, 2-year post-operative period and the change in Bohler's-Gissane angle, calcaneal varus, and FAAM of ADL between groups were observed, P > 0.05. For time-point comparisons in each group, there was a significant loss of calcaneal varus and increase in joint line parallel angle from post-operative period to 2-year follow up in Group A, from mean (SD) 1.82 (11.22) to 4.41 (9.73) degrees and 4.09 (5.32) to 7.36 (5.24) degrees, P = 0.047 and <0.0001, respectively. Group A had statistical significant less complications as zero vs 5, P = 0.049. CONCLUSION: The screw fixation alone seems to provide inferior stability of posterior facet fixation and calcaneal varus reduction with lower complication rates compared to screw with small-locking plate fixation. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Calcâneo , Traumatismos do Pé , Fixação Interna de Fraturas , Fraturas Intra-Articulares , Complicações Pós-Operatórias , Adulto , Placas Ósseas , Parafusos Ósseos , Calcâneo/diagnóstico por imagem , Calcâneo/lesões , Calcâneo/cirurgia , Feminino , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/fisiopatologia , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Radiografia/métodos , Estudos Retrospectivos
9.
Acta Orthop Traumatol Turc ; 55(3): 265-270, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100369

RESUMO

OBJECTIVE: This study aimed to determine the effectiveness of calcium phosphate cementing in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach. METHODS: In this retrospective study, 85 feet of 84 patients (74 males, 10 females; mean age 43 [17-61] years) in whom screw fixation was performed using the sinus tarsi approach for Sanders type II or III calcaneal fractures were included. The mean follow-up was 28 (14-39) months. Patients were categorized into 2 groups on the basis of whether calcium phosphate cement (CPC) was used. Group 1 had 37 patients with CPC (38 calcaneal fractures) and group 2 had 47 patients without CPC (47 calcaneal fractures). In the clinical assessment, the American Orthopedic Foot Ankle Society (AOFAS) hind foot score and the Maryland Foot Score (MFS) were used at the final follow-up. In the radiological assessment, Bohler's angle on plain radiograph and posterior facet step-off on computed tomography were measured pre-and postoperatively. RESULTS: At the final follow-up, the mean Bohler's angle was 26.2° (20°-33°) in group 1 and 26° (17°-30°) in group 2 (P = 0.85). The mean posterior facet step-off was 1.6 (0-5) mm in group 1 and 1.5 (0-5) mm in group 2 (P = 0.85). The mean AOFAS score was 83.8 (59-100) in group 1 and 85.8 (60-100) in group 2 (P = 0.5). The mean MFS was 86.3 (66-100) in group 1 and 87.7 (66-100) in group 2 (P = 0.62). CONCLUSION: Evidence from this study have shown that CPC may have no significant effect on clinical and radiological outcomes in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach.


Assuntos
Calcâneo , Fosfatos de Cálcio/farmacologia , Fixação Interna de Fraturas , Fraturas Ósseas , Adulto , Cimentos Ósseos/farmacologia , Parafusos Ósseos , Calcâneo/diagnóstico por imagem , Calcâneo/lesões , Calcâneo/cirurgia , Cimentação/métodos , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Calcanhar/lesões , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
10.
Acta Orthop Traumatol Turc ; 55(3): 271-276, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100370

RESUMO

Complex tibial plateau fractures in elderly patients exhibiting severe osteoporosis and articular surface collapse are challenging. Decision-making is difficult when the posterior column is involved. Open reduction and internal fixation of complex tibial plateau fractures in patients with severe osteoporosis are prone to failure. In this paper, we describe a new method for the maintenance of the articular surface of complex tibial plateau fractures in elderly patients. An anterior horizontal rafting plate (3.5-mm-thick reconstruction and locking plate [Zimmer Inc., Warsaw, IN, USA]) is placed via conventional posteromedial and anterolateral incisions. The plate is inserted between the anterior bony surface of the proximal tibia and the subpatellar fat pad; plate positioning is checked under direct vision. The patient is encouraged to begin functional recovery soon after operation. Progressive weight-bearing begins at 10 weeks postoperatively and is gradually increased during fracture healing. Clinical follow-up was performed at 4, 8, and 12 weeks, 6 and 12 months, and yearly thereafter. No articular collapse or fragment displacement was evident on three-dimensional computed tomography performed 6 months after surgery. The knee range of motion was 5-130º at the last follow-up (4 years after surgery). This technique may be a good option for treating complex tibial plateau fractures, especially in elderly patients with severe osteoporosis.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Traumatismos do Joelho , Articulação do Joelho/fisiopatologia , Fraturas por Osteoporose , Tíbia , Fraturas da Tíbia , Idoso , Deambulação Precoce/métodos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Processamento de Imagem Assistida por Computador/métodos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Tíbia/lesões , Tíbia/patologia , Tíbia/cirurgia , Fraturas da Tíbia/diagnóstico , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Suporte de Carga
11.
Medicine (Baltimore) ; 100(23): e26282, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115029

RESUMO

ABSTRACT: Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are 2 main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots vs traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing, and complications were assessed at a follow-up of 12 to 40 months.The mean age of all the patients was 50.8 years. There were 52 and 49 patients in the Nice knot group and traditional group respectively, and no differences between 2 groups were found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (P < .01) than the traditional group (mean and standard deviation [SD], 78.6 ±â€Š19.0 compared with 94.4 ±â€Š29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there were no significant differences between groups, despite the Nice knot group had slightly better results.Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.


Assuntos
Clavícula , Fixação Interna de Fraturas , Fraturas Ósseas , Redução Aberta , Técnicas de Sutura , Suturas , Placas Ósseas , Parafusos Ósseos , Clavícula/diagnóstico por imagem , Clavícula/lesões , Clavícula/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Fraturas Cominutivas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta/efeitos adversos , Redução Aberta/instrumentação , Redução Aberta/métodos , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Recuperação de Função Fisiológica
12.
Medicine (Baltimore) ; 100(23): e26284, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115031

RESUMO

ABSTRACT: To investigate the clinical outcomes of arthroscopy-assisted transosseous fixation of tibial eminence fractures with the Versalok suture anchor in adults.A total of 23 adult cases of tibial eminence fractures treated between June 2016 and March 2019 were retrospectively analyzed. The results of the preoperative drawer test and Lachman test were positive. Radiography and computed tomography were performed before and after the procedure. Magnetic resonance imaging was performed in every patient after admission. Arthroscopy-assisted fracture reduction and Orthocord high-strength suture fixation with two Versalok anchors were performed in all the patients. The International Knee Documentation Committee scale and the Lysholm Knee Scoring Scale were used to evaluate outcomes during the follow-up period. Additionally, the KT-2000 knee stability test was performed.At the final follow-up, all the fractures had proceeded to bony union and no wound infection was observed. The average Lysholm Knee Score of the affected knees was 93.1 (range, 90-98), which was not significantly different from that of the healthy knees (t = 0.732, P = .132). Based on the International Knee Documentation Committee scale results, 21 patients were graded as normal and the other 2 patients were graded as nearly normal. The KT-2000 test showed that the anterior displacement of the affected side and the healthy side was less than 3.6 mm in all cases.The outcomes indicated firm fixation and good fracture healing with minimal trauma. Thus, arthroscopy-assisted transosseous fixation with Versalok suture anchors for adult tibial eminence fractures seems to have satisfactory clinical outcomes.


Assuntos
Artroscopia , Fixação Interna de Fraturas , Articulação do Joelho/cirurgia , Tíbia , Fraturas da Tíbia , Adulto , Artroscopia/efeitos adversos , Artroscopia/instrumentação , Artroscopia/métodos , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Radiografia/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Cirurgia Assistida por Computador/métodos , Âncoras de Sutura , Tíbia/diagnóstico por imagem , Tíbia/lesões , Tíbia/cirurgia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia
13.
Vet Surg ; 50(5): 1076-1086, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33955036

RESUMO

OBJECTIVE: To determine the influence of plating systems on the clinical outcomes in dogs treated for ilial fractures. DESIGN: Retrospective study. ANIMALS: Fifty-nine dogs (63 hemipelves). METHODS: Radiographs and medical records of dogs with ilial fractures presented to Iowa State University between 2003 and 2019 were reviewed. After fracture reduction, fractures were fixed with a locking plate system (LPS) or non-locking plate system (NLS). Perioperative, long-term complications, and follow-up data were recorded. The frequency of implant failure and pelvic collapse were compared using a logistic and linear regression analysis, respectively. Where the univariate test was statistically significant, a multivariate analysis across categories was performed to identify statistically different categories. RESULTS: LPS and NLS implants were used in 25/63 and 38/63 hemipelves, respectively. Median follow-up time was 8 weeks (3-624 weeks). Implant failure occurred in 18/63 (29%) of fracture repairs, consisting of 17 with NLS and 1 with LPS. Revision surgery was recommended in five cases of implant failure, all with NLS. The probability of implant failure was higher when fractures were fixed with NLS (p = .0056). All other variables evaluated did not seem to influence outcome measures. CONCLUSION: The variable with the most influence on the outcomes of dogs treated for ilial fractures consisted of the fixation method (NLS vs. LPS). Fractures repaired with NLS were nearly 20 times more likely to fail than those repaired with LPS. CLINICAL RELEVANCE: Surgeons should consider repairing ilial body fractures in dogs with LPS to reduce the risk of short-term implant failure.


Assuntos
Placas Ósseas/veterinária , Doenças do Cão/cirurgia , Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Ílio/lesões , Animais , Cães , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Ílio/cirurgia , Masculino , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
14.
Orthopedics ; 44(3): 134-140, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34039216

RESUMO

The authors assessed the occurrence and severity of cement leakage (CL) following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) performed using front-opening cannulas (FOCs) vs side-opening cannulas (SOCs). This retrospective cohort study included 811 patients with single-level OVCFs who underwent PVP between March 2016 and September 2018. The 264 patients who met the inclusion criteria were divided into two groups according to whether the procedure was performed using a FOC (n=128) or a SOC (n=136). Visual analog scale score, Oswestry Disability Index, local kyphotic angle, vertebral height, amount of bone cement injected, and rate of CL were compared between the groups. Types of CL were classified according to postoperative computed tomography. The CL types were further classified according to severity (mild and severe). Visual analog scale score, Oswestry Disability Index, local kyphotic angle, and vertebral height were all significantly improved after surgery. The total incidence of CL was significantly higher for FOCs than for SOCs (P=.001). Similarly, the occurrence of the CL subtypes was significantly higher for FOCs than for SOCs (B type, P=.033; C type, P=.01; and S type, P=.015). Analysis of CL type severity revealed that the rates of severe D type (intradiskal leakage category of the C type) and severe S type were significantly lower for SOCs than for FOCs (P=.001), while the incidence of severe B type leaks was not significantly different between the groups (P=.443). Percutaneous vertebroplasty performed using SOCs decreases the incidence and severity of D type and S type CL compared with FOCs. Secondary classification of CL could help physicians better understand the severity of leakage and select a more appropriate surgical approach to reduce CL. [Orthopedics. 2021;44(3):134-140.].


Assuntos
Cimentos Ósseos , Cânula , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/efeitos adversos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos
15.
J Clin Neurosci ; 89: 397-404, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34052072

RESUMO

BACKGROUND: Percutaneous-short segment screw fixation (SSSF) without bone fusion has proven to be a safe and effective modality for thoracolumbar spine fractures (TLSFs). When fracture consolidation is confirmed, pedicle screws are no longer essential, but clear indications for screw removal following fracture consolidation have not been established. METHODS: In total, we enrolled 31 patients with TLSFs who underwent screw removal following treatment using percutaneous-SSSF without fusion. Plain radiographs, taken at different intervals, measured local kyphosis using Cobb' angle (CA), vertebra body height (VBH), and the segmental motion angle (SMA). A visual analogue scale (VAS) and the Oswestry disability index (ODI) were applied pre-screw removal and at the last follow-up. RESULTS: The overall mean CA deteriorated by 1.58° (p < 0.05) and the overall mean VBH decreased by 0.52 mm (p = 0.001). SMA preservation was achieved in 18 patients (58.1%) and kyphotic recurrence occurred in 4 patients (12.9%). SMA preservation was statistically significant in patients who underwent screw removal within 12 months following the primary operation (p = 0.002). Kyphotic recurrence occurred in patients with a CA ≥ 20° at injury (p < 0.001) with a median interval of 16.5 months after screw removal. No patients reported worsening pain or an increased ODI score after screw removal. CONCLUSION: Screw removal within 12 months can be recommended for restoration of SMA with improvement in clinical outcomes. Although, TLSFs with CA ≥ 20° at the time of injury can help to predict kyphotic recurrence after screw removal, the clinical outcomes are less relevant.


Assuntos
Fixação Interna de Fraturas/métodos , Cifose/etiologia , Dor/etiologia , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fraturas da Coluna Vertebral/cirurgia , Adulto , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Cifose/epidemiologia , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Dor/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Vértebras Torácicas/cirurgia
16.
Orthop Clin North Am ; 52(3): 251-256, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34053570

RESUMO

Although the overall complication rate of volar plating approaches 15%, less than 5% require reoperation. Certain factors involving the patient, the fracture, and/or the surgeon may affect the overall complication risk. Patient factors, including body mass index greater than 35 and diabetes mellitus, may increase complication risk with volar plating, but older patient age does not seem to significantly alter risk.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas , Complicações Pós-Operatórias , Fraturas do Rádio/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Rádio (Anatomia)/cirurgia , Reoperação
17.
Medicine (Baltimore) ; 100(20): e25926, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011064

RESUMO

BACKGROUND: Several studies have reported that medical robot-assisted method (RA) might be superior to conventional freehand method (FH) in orthopedic surgery. Yet the results are still controversial, especially in terms of femoral neck fractures surgery. Here, 2 methods were assessed based on current evidence. METHODS: Electronic databases including Cochrane Library, PubMed, Web of Science. and EMBASE were selected to retrieved to identify eligible studies between freehand and RAs in femoral neck fractures, with 2 reviewers independently reviewing included studies as well as collecting data. RESULTS: A total of 5 studies with 331 patients were included. Results indicated that 2 surgical methods were equivalent in terms of surgical duration, Harris score, fracture healing time, fracture healing proportion and complications, while RA showed clinical benefits in radiation exposure, intraoperative bleeding, total drilling times, and screw parallelism. CONCLUSIONS: Current literature revealed significantly difference between 2 techniques and suggested that RA might be beneficial for patients than freehand method.


Assuntos
Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/lesões , Cabeça do Fêmur/cirurgia , Fluoroscopia/efeitos adversos , Fluoroscopia/estatística & dados numéricos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Duração da Cirurgia , Parafusos Pediculares , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/instrumentação , Fatores de Tempo , Resultado do Tratamento
18.
Knee ; 30: 41-50, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33848940

RESUMO

INTRODUCTION: Posterior tibial plateau fractures (PTPF) have a high impact on functional outcome and the optimal treatment strategy is not well established. The goal of this study was to assess the relationship between trauma mechanism, fracture morphology and functional outcome in a large multicenter cohort and define possible strategies to improve the outcome. METHODS: An international retrospective cohort study was conducted in five level-1 trauma centers. All consecutive operatively treated PTPF were evaluated. Preoperative imaging was reviewed to determine the trauma mechanism. Patient reported outcome was scored using the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: A total of 145 tibial plateau fractures with posterior involvement were selected with a median follow-up of 32.2 months (IQR 24.1-43.2). Nine patients (6%) sustained an isolated posterior fracture. Seventy-two patients (49%) sustained a two-column fracture and three-column fractures were diagnosed in 64 (44%) patients. Varus trauma was associated with poorer outcome on the 'symptoms' (p = 0.004) and 'pain' subscales (p = 0.039). Delayed-staged surgery was associated with worse outcome scores for all subscales except 'pain'. In total, 27 patients (18%) were treated with posterior plate osteosynthesis without any significant difference in outcome. CONCLUSIONS: Fracture morphology, varus trauma mechanism and delayed-staged surgery (i.e. extensive soft-tissue injury) were identified as important prognostic factors on postoperative outcome in PTPF. In order to assess possible improvement of outcome, future studies with routine preoperative MRI to assess associated ligamentous injury in tibial plateau fractures (especially for varus trauma) are needed.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Adulto , Placas Ósseas , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Lesões dos Tecidos Moles/etiologia , Fraturas da Tíbia/diagnóstico por imagem , Tempo para o Tratamento , Resultado do Tratamento
19.
Ulus Travma Acil Cerrahi Derg ; 27(3): 344-350, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33884599

RESUMO

BACKGROUND: The aim of this study was to compare two different nail types (i.e., Intertan (IT) and Talon Distal Fix Nail / Lag Screw (TDFN)) used in the treatment of unstable intertrochanteric fractures in mobile patients over 65 years of age in terms of radiological parameters. METHODS: Between June 2013 and August 2018, 106 patients over 65 years old who were operated with closed reduction and internal fixation for intertrochanteric fractures were included in this single-center study. Patients were divided into two groups based on the proximal femoral nail used: IT group and TDFN group. These two groups were compared in terms of age, sex, complication rates and radiological parameters (i.e., reduction quality, tip apex distance (TAD), Parker index, union time, cut-out rate, and varus collapse). RESULTS: There were no differences between the groups in terms of age, sex, fracture union time as well as reduction quality measured on the first postoperative radiograph, Parker index, and collodiaphysial angle. In the first postoperative radiographs, TAD was higher than 25 mm in 12 patients in the IT group and in 5 patients in the TDFN group. Although the number of patients with high TAD was more than that of the IT group, varus collapse and the cut-out complications were higher in TDFN nail. In the IT group, nail-dependent complications emerged in 4 patients (trochanter major fracture in 3 cases, femoral fracture in distal screw in 1 case) while there was no complication in the TDFN group. CONCLUSION: Intertan nail is superior to TDFN in preventing varus collapse and the cut-out complications as well as in maintaining of radiological parameters until fracture union. On the other hand, the higher complication rate is a disadvantage of this nail.


Assuntos
Pinos Ortopédicos , Fêmur/cirurgia , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Idoso , Feminino , Fêmur/diagnóstico por imagem , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/estatística & dados numéricos , Fraturas do Quadril/diagnóstico por imagem , Humanos , Masculino , Radiografia
20.
J Hand Surg Asian Pac Vol ; 26(2): 194-206, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33928845

RESUMO

Background: The DePuy Synthes variable angle LCP® Volar RIM Plate has been designed with its contour to overhang volar rim fragments of the distal radius to prevent secondary displacement after fracture fixation. Therefore, RIM potentially contributes to a risk of flexor tendon rupture due to its plate prominence over the watershed line. This is a retrospective cross-sectional study that aims at describing the occurrence of complications by utilizing RIM as well as three standards VLPs to evaluate the impact of plate design on flexor tendons. Methods: A total of 84 patients with a volar locking plate fixation were analyzed retrospectively (Far-distal; RIM: 14 cases, Juxta-articular; AcuLoc2 (ACUMED): 20 cases, Dual-Loc V7 (MEIRA): 25 cases, Extra-articular; VA-TCP (DePuy Synthes): 25 cases). Tendinous problems were evaluated with a reported adverse event and flexor tendon appearance examined by utilizing ultrasonography and direct observation during hardware removal. Plate prominence was graded according to Soong's classification and the distance to flexor tendons was measured to describe the risk that each plate damage the flexor tendons. Results: The mean follow-up period was 13.0 months. All RIM plates were placed in grade 2 (85.7%) and grade 1 (14.3%). Symptomatic and asymptomatic tendinous problems were barely reported in RIM. The examination of ultrasonography and direct observation during hardware removal showed that tendons smoothly slid without attrition on the curved plate surface of RIM despite their adjacent appositions came from its high and distal plate prominence. Conclusions: Smooth profile of RIM showed an ability to decrease the potential risk of flexor tendon damage regardless of its prominence over the watershed line. RIM can be applied more to challenging far distal fractures when used judiciously and surgeons need to be even more vigilant for symptoms of tendon irritation as usually recommended without being coward more than necessary.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fraturas do Rádio/cirurgia , Tendões/diagnóstico por imagem , Idoso , Estudos Transversais , Feminino , Seguimentos , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Tendões/fisiologia , Ultrassonografia
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