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1.
Bone Joint J ; 103-B(9): 1457-1461, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34465150

RESUMO

AIMS: The aim of this study was to identify the origin and development of the threshold for surgical intervention, highlight the consequences of residual displacement, and justify the importance of accurate measurement. METHODS: A systematic review of three databases was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. This search identified papers investigating functional outcome, including presence of arthritis, following injury. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. RESULTS: Knirk and Jupiter (1986) were the first to quantify a threshold, with all their patients developing arthritis with > 2 mm displacement. Some papers have discussed using 1 mm, although 2 mm is most widely reported. Current guidance from the British Society for Surgery of the Hand and a Delphi panel support 2 mm as an appropriate value. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, radiological arthritis does not correlate with the clinical presentation. Function following injury has been shown to be equivalent to an uninjured population, with arthritis progressing slowly or not at all. Joint space narrowing has also been shown to often be benign. CONCLUSION: Knirk and Jupiter originated the threshold value of 2 mm. The lack of correlation between the radiological and clinical presentations warrants further modern investigation. Measurement often varies between observers, calling a threshold concept into question and showing the need for further development in this area. The principle of treatment remains restoration of normal anatomical position. Cite this article: Bone Joint J 2021;103-B(9):1457-1461.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/cirurgia , Artrite/prevenção & controle , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Complicações Pós-Operatórias/prevenção & controle , Fraturas do Rádio/diagnóstico por imagem
2.
Pan Afr Med J ; 38: 363, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367442

RESUMO

Introduction: the dynamic condylar screw (DCS) plate is an angular stable fixation (95°) system for distal femur fractures that allows for the ability to apply compression across the femoral condyles. The aim of this study was to evaluate our experience treating distal femur fractures with this device and give the long-term outcome. Methods: a retrospective study was undertaken in our institution during the period from January 2002 to December 2016. A total number of 240 patients with distal femur fractures were managed using DCS plate system and included in the study. The mean follow-up period was 33 months (26 - 62 months). Clinico-radiological progression of fracture union as well as the functional outcome was studied. Results: most of the fractures were closed injuries in young male patients resulting from traffic accidents. The average time to union was 12.6 weeks (range 11 - 23). Eight patients (3.3%) suffered superficial infection. Five patients (2.1%) developed deep venous thrombosis. Delayed union was observed in nine cases (3.7%) and non union in six cases (2.5%). At final follow-up, the mean range of motion (ROM) of knee was 115.7° (100°-148°). The mean Knee Society Score (KSS) was 84.5 (59 - 94) and the mean Lysholm score was 88.6 (range, 61 - 96), translating to good clinical results. Conclusion: our study conclusively establishes that excellent functional outcome can be achieved with DCS plate inserted with skilled surgical technique in distal femur fractures including the ones that are communited or occurring in osteoporotic bone with a negligible complication rates.


Assuntos
Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Adulto , Idoso , Placas Ósseas , Parafusos Ósseos , Feminino , Seguimentos , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
3.
Isr Med Assoc J ; 23(8): 494-496, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392624

RESUMO

BACKGROUND: Proximal femoral fractures (PFF) are among the most common injuries in the elderly population treated by orthopedic surgeons. Postoperative complications, especially infections, are of great importance due to their effect on patient mortality and morbidity and healthcare costs. OBJECTIVES: To assess the main causes for postoperative infection among PFF patients. METHODS: We conducted a retrospective analysis of PFF patients in our medical center between 2015 and 2017. Patients were divided into two groups based on whether there was postoperative infection during immediate hospitalization and 30 days after surgery. Factors such as time from admission to surgery, duration of surgery, and length of stay were analyzed. Groups were analyzed and compared using a t-test, chi-squared and Fisher's exact tests. RESULTS: Of 1276 patients, 859 (67%) underwent closed reduction internal fixation, 67 (5%) underwent total hip arthroplasty, and 350 (28%) underwent hemiarthroplasty. Of the total, 38 patients (3%) were diagnosed with postoperative infection. The demographics and co-morbidities were similar between the two study groups. The incident of infection was the highest among patients undergoing hemiarthroplasty (6%, P < 0.0001). Length of hospitalization (15 vs. 8 days, P = 0.0001) and operative time (117 vs. 77 minutes, P = 0.0001) were found to be the most significant risk factors for postoperative infection. CONCLUSIONS: Predisposition to postoperative infections in PPF patients was associated with prolonged length of surgery and longer hospitalization. We recommend optimizing fast discharge, selecting the appropriate type of surgery, and improving surgical planning to reduce intraoperative delays and length of surgery.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur , Fixação Interna de Fraturas , Hemiartroplastia , Duração da Cirurgia , Infecção da Ferida Cirúrgica , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Causalidade , Feminino , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Necessidades e Demandas de Serviços de Saúde , Hemiartroplastia/efeitos adversos , Hemiartroplastia/métodos , Humanos , Israel/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/epidemiologia
4.
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
5.
Medicine (Baltimore) ; 100(28): e26666, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34260574

RESUMO

BACKGROUND: To investigate the feasibility of using cortical bone trajectory (CBT) screws for bridging fixation in revision surgery for lumbar adjacent segment degeneration and to provide a reference for clinical practice. METHODS: Computed tomography scans of the lumbar spines of 36 patients in our hospital were used. Sixteen males and 20 females with an average age of 65.5 ±â€Š10.5 years (range: 46 to 83 years) were included. Three-dimensional reconstruction was performed using computer software. Screws with appropriate sizes were selected for the L1 to L5 vertebral segments, and traditional pedicle screws were placed using the standard method. After completing screw placement, simulated placement of CBT screws was performed separately. No overlap occurred between the two screws in the process of CBT screw placement, and the placement point and direction were adjusted until screw placement completion. After all screw placement simulations were complete, according to the contact area of the cortical bone of the screw trajectory and the screw puncture position and distance through the trajectory, the screw placement results were categorized as excellent, good, general, and failure. Excellent and good ratings were considered successful, while a general rating was regarded as acceptable. Then, the success rate and acceptable rate of each segment of the lumbar spine were calculated. RESULTS: Three hundred and sixty screw placement simulations were performed in lumbar pedicles, and 72 CBT screws were implanted in each vertebral body of the lumbar spine. The success rates in the L1 to L5 segments were 73.6%, 80.6%, 83.3%, 88.9%, and 77.8%, respectively, and the acceptable rates were 91.7%, 97.2%, 97.2%, 100%, and 91.7%, respectively. The overall success rate and acceptable rate of CBT screw placement in the lumbar spine were 80.8% and 95.6%, respectively. CONCLUSION: CBT screws are feasible for bridging fixation in lumbar adjacent segment degeneration revision surgery, and the accuracy of screw placement in different lumbar vertebrae varies.


Assuntos
Parafusos Ósseos , Osso Cortical/fisiopatologia , Fixação Interna de Fraturas/métodos , Vértebras Lombares/cirurgia , Reoperação/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
6.
Bone Joint J ; 103-B(7): 1222-1230, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192924

RESUMO

AIMS: We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty. METHODS: We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty. Decision to perform internal fixation for B2 PFFs was based on specific radiological (polished femoral components, intact bone-cement interface) and clinical criteria (low-demand patient). Median follow-up was 36.4 months (24 to 60). Implant survival and mortality over time were estimated with the Kaplan-Meier method. Adverse events (measured with a modified Dindo-Clavien classification) and 90-day readmissions were additionally compared between groups. RESULTS: In all, nine (8.01%) surgical failures were detected. All failures occurred within the first 24 months following surgery. The 24-month implant survival was 95.4% (95% confidence interval (CI) 89.13 to 100) for B1 fractures treated with internal fixation, 90% (95% CI 76.86 to 100) for B2 PFFs treated with osteosynthesis-only, and 85.8% (95% CI 74.24 to 97.36) for B2 fractures treated with revision THA, without significant differences between groups (p = 0.296). Readmissions and major adverse events including mortality were overall high, but similar between groups (p > 0.05). The two-year patient survival rate was 87.1% (95% CI 77.49 to 95.76), 66.7% (95% CI 48.86 to 84.53), and 84.2% (95% CI 72.63 to 95.76), for the B1 group, B2 osteosynthesis group, and B2 revision group, respectively (p = 0.102). CONCLUSION: Implant survival in Vancouver B2 PFFs treated with internal fixation was similar to that of B1 fractures treated with the same method and to B2 PFFs treated with revision arthroplasty. Low-demand, elderly patients with B2 fractures around well-cemented polished femoral components with an intact bone-cement interface can be safely treated with internal fixation. Cite this article: Bone Joint J 2021;103-B(7):1222-1230.


Assuntos
Artroplastia de Quadril/métodos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Prótese de Quadril , Fraturas Periprotéticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cimentação , Feminino , Fraturas do Fêmur/classificação , Fraturas do Fêmur/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Readmissão do Paciente/estatística & dados numéricos , Fraturas Periprotéticas/classificação , Fraturas Periprotéticas/mortalidade , Complicações Pós-Operatórias/mortalidade , Desenho de Prótese , Falha de Prótese , Estudos Retrospectivos
7.
Bone Joint J ; 103-B(7): 1176-1186, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192937

RESUMO

AIMS: The aim of this study was to assess the effect of time to surgical intervention from admission on mortality and morbidity for patients with hip fractures. METHODS: MEDLINE and Embase were searched from inception to June 2020. Reference lists were manually assessed to identify additional papers. Primary comparative research studies that recruited patients aged over 60 years, with non-pathological primary proximal femoral fractures that were treated surgically, were included. Studies that did not include a group operated on within 24 hours or which reported time to surgery in calendar days were excluded. Two investigators extracted data on study characteristics, methods, and outcomes. The pre-defined primary outcome was 30-day mortality. Secondary outcomes were complications and mortality at other time points. Relative risks (RRs) with 95% confidence intervals (CIs) were aggregated and were grouped by study-level characteristics. RESULTS: This review included 46 studies (January 1991 to June 2020), comprising 521,857 hip fractures with 64,047 postoperative deaths. No randomized controlled trials were eligible for inclusion. In a pooled analysis of 15 studies, RR of mortality at 30 days comparing time to surgery < 24 hours with > 24 hours was 0.86 (95% CI 0.82 to 0.91; I 2 = 69%; 95% CI 50% to 81%; p-value for heterogeneity < 0.001). The association was stronger in observational studies that did not adjust for confounders than in those that adjusted for multiple covariates. In a pooled analysis of six studies, the RR of mortality at 30 days comparing time to surgery < 24 hours with 24 to 36 hours was 0.87 (95% CI 0.81 to 0.93; I 2 = 65%; 95% CI 16% to 85%; p-value for heterogeneity = 0.014). CONCLUSION: This meta-analysis indicates reduced mortality for patients operated within 24 hours compared with those operated on beyond 24 hours or within 24 to 36 hours. Where resources allow and there is no specific reversible contraindication to early surgery, we recommend that hip fractures should be surgically treated within 24 hours. Cite this article: Bone Joint J 2021;103-B(7):1176-1186.


Assuntos
Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Tempo para o Tratamento , Artroplastia de Quadril , Fixação Interna de Fraturas/métodos , Mortalidade Hospitalar , Humanos
8.
J Clin Neurosci ; 89: 26-32, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119278

RESUMO

OBJECTIVE: To evaluate the results of Type II odontoid fractures management in the elderly, according to the Grauer classification. METHODS: Consecutive patients with type II odontoid fracture, age > 65 years and follow-up longer than 3 months were included. Fracture management was proposed according to Grauer classification. Peri-surgical risk factors, NDI, VAS and rate of fusion were evaluated according to the treatment modality and compared between conservative and surgical groups. RESULTS: Thirty-four patients were considered eligible for the study; 2 patients showed a Type IIa fracture, 30 patients a type IIb, and 2 patients a type IIc. Type IIa patients underwent conservative treatment that resulted in failure. A conservative management was adopted in 9 cases with type IIb due to patient preference or anaesthesiologic reasons with a treatment success at 6 months of 11%. Trans-odontoid stabilization was adopted in 21 type IIb cases with an evidence of bony or fibrous union at 6 months of 95% and a median NDI of 20%. A posterior approach was reserved for 2 type IIc fracture patients and in 6 cases as rescue surgery (bony union at 6 months of 100%; median NDI 37%). Higher Lakshmanan grade, gap and displacement of the fracture were found as significant risk factor for fracture non-union (p < 0.05). CONCLUSIONS: The surgical group presented better clinical and radiological outcome and the anterior approach proved to achieve the best results in type IIb fractures. The presence of osteoporosis and fracture spatial features should be duly considered in the decision-making process.


Assuntos
Gerenciamento Clínico , Processo Odontoide/lesões , Processo Odontoide/cirurgia , Avaliação de Resultados da Assistência ao Paciente , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador/métodos , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Processo Odontoide/diagnóstico por imagem , Prognóstico , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
9.
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
10.
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
11.
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
12.
Jt Dis Relat Surg ; 32(2): 377-382, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145814

RESUMO

OBJECTIVES: In this mechanical study, we aimed to compare two different screw trajectories in terms of durability against axial loads on oblique scaphoid fractures using composite bone models. MATERIALS AND METHODS: Oblique osteotomies were made along the dorsal sulcus of 14 composite scaphoid bone models. Following this, all bone models were randomly classified. One group of bones were fixed with a screw placed perpendicular to the osteotomy line and the other group was fixed with a screw placed centrally down the long axis of the scaphoid bone. Each scaphoid bone model was positioned on a mechanical testing machine. Subsequently, axial loading tests were applied on each bone model to measure the amount of loading required to cause 2-mm displacement and failure on the osteotomy side and maximum displacement at the time of failure on scaphoid bone models. RESULTS: There was no statistically significant difference in load to 2-mm displacement and failure between the two groups (p>0.05). Also, there was no statistically significant difference between the two groups in terms of maximum displacement seen on failure (p>0.05). CONCLUSION: In our study, we found that the stability of the screws which laid perpendicular to the fracture line and parallel to the long axis of the scaphoid was the same in fixing oblique scaphoid fractures.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Osso Escafoide/cirurgia , Humanos , Modelos Anatômicos , Osteotomia , Distribuição Aleatória , Osso Escafoide/lesões , Suporte de Carga
13.
Bone Joint J ; 103-B(6): 1040-1046, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058883

RESUMO

AIMS: We report the long-term outcomes of the UK Heel Fracture Trial (HeFT), a pragmatic, multicentre, two-arm, assessor-blinded, randomized controlled trial. METHODS: HeFT recruited 151 patients aged over 16 years with closed displaced, intra-articular fractures of the calcaneus. Patients with significant deformity causing fibular impingement, peripheral vascular disease, or other significant limb injuries were excluded. Participants were randomly allocated to open reduction and internal fixation (ORIF) or nonoperative treatment. We report Kerr-Atkins scores, self-reported difficulty walking and fitting shoes, and additional surgical procedures at 36, 48, and 60 months. RESULTS: Overall, 60-month outcome data were available for 118 patients (78%; 52 ORIF, 66 nonoperative). After 60 months, mean Kerr-Atkins scores were 79.2 (SD 21.5) for ORIF and 76.4 (SD 22.5) for nonoperative. Mixed effects regression analysis gave an estimated effect size of -0.14 points (95% confidence interval -8.87 to 8.59; p = 0.975) in favour of ORIF. There were no between group differences in difficulty walking (p = 0.175), or on the type of shoes worn (p = 0.432) at 60 months. Additional surgical procedures were conducted on ten participants allocated ORIF, compared to four in the nonoperative group (p = 0.043). CONCLUSION: ORIF of displaced intra-articular calcaneal fractures, not causing fibular impingement, showed no difference in outcomes at 60 months compared to nonoperative treatment, but with an increased risk of additional surgery. Cite this article: Bone Joint J 2021;103-B(6):1040-1046.


Assuntos
Calcâneo/lesões , Tratamento Conservador , Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Redução Aberta/métodos , Adulto , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Reino Unido
14.
Medicine (Baltimore) ; 100(22): e26073, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087852

RESUMO

ABSTRACT: Treatments for proximal humerus fractures (PHFs) often fail to achieve anatomical reduction. The purpose of this study was to evaluate the role of positive medial cortical support (PMCS) in the nonanatomical reduction of PHFs.A retrospective analysis was performed of 78 patients with PHFs who underwent surgery from August 2014 to September 2017 and whose treatments did not achieve anatomical reduction. Based on the results of standard AP radiographs of the shoulders 3, 6, and 12 months after surgery, the patients were divided into PMCS or negative medial cortical support (NMCS) groups. The postsurgical change in head-shaft angle (HSA) between the 2 groups was compared. Shoulder joint function and visual analog scale (VAS) scores of the 2 groups were also compared at the same time.Of the 78 patients analyzed, 37 were in the PMCS group and, 41 in the NMCS group. There was no statistically significant difference in any of the characteristics of the 2 groups (P > .05), or in postsurgical HSA. However, the HSA of the 2 groups had become significantly different (P < .05) 3, 6, and 12 months following surgery. The changes in HSA of the 2 groups were different at various time points (P < .05). One year after surgery, the shoulder function score of the PMCS group was significantly better than that of the NMCS group, as was the VAS score (both P < .05).Patients whose surgery for PHF does not achieve anatomical reduction during surgery can undergo PMCS to achieve improved results, postoperatively. NMCS should be avoided as far as possible.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Ombro/cirurgia , Adulto , Placas Ósseas , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Medicine (Baltimore) ; 100(22): e26173, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087880

RESUMO

ABSTRACT: Closed reduction with percutaneous pin fixation is commonly used to treat pediatric supracondylar humerus fractures. Various pin configurations of varying biomechanical strength have been described. However, to our knowledge, no biomechanical study has focused on pin alignment in the sagittal plane. Our goal was to compare the stability of fixation using 3 different pin constructs: 3 lateral pins diverging in the coronal plane but parallel in the sagittal plane (3LDP), 3 lateral pins diverging in the coronal and sagittal planes (3LDD), and 2 crossed pins (1 medial and 1 lateral).Transverse fractures were made through the olecranon fossa of 48 synthetic humeri, which were then reduced and pinned in the 3LDP, 3LDD, and crossed-pin configurations (16 specimens per group) using 1.6-mm Kirschner wires. The sagittal plane pin spread was significantly greater in the 3LDD group than in the 3LDP group, whereas we found no difference in the coronal plane. Sagittal extension testing was performed from 0° to 20° at 1°/s for 10 cycles using a mechanical torque stand. The torque required to extend the distal fragment 20° from neutral was compared between groups using one-way analysis of variance with multiple comparison post-hoc analysis. P values ≤.05 were considered significant.The 3LDD configuration was more stable than the 3LDP and crossed-pin configurations. The mean torque required to displace the pinned fractures was 5.7 Nm in the 3LDD group versus 4.1 Nm in the 3LDP group and 3.7 Nm in the crossed-pin group (both, P < .01). We found no difference in stability between the 3LDP and crossed-pin groups (P = .45).In a synthetic biomechanical model of supracondylar humerus fracture, sagittal alignment influenced pin construct stability, and greater pin spread in the sagittal plane increased construct stability when using 3 lateral pins. The lateral pin configurations were superior in stability to the crossed-pin configuration.Level of Evidence: Level V.


Assuntos
Pinos Ortopédicos/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Nervo Ulnar/lesões , Adulto , Fenômenos Biomecânicos/fisiologia , Pinos Ortopédicos/estatística & dados numéricos , Fios Ortopédicos , Criança , Redução Fechada/métodos , Fixação Interna de Fraturas/efeitos adversos , Humanos , Doença Iatrogênica , Modelos Anatômicos , Torque
16.
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
17.
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
18.
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
19.
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
20.
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
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