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1.
Bone Joint J ; 102-B(3): 394-399, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114812

RESUMO

AIMS: A lack of supporting clinical studies have been published to determine the ideal length of intramedullary nail in fixation of trochanteric fractures of the hip. Nevertheless, there has been a trend to use shorter intramedullary nails for the internal fixation of trochanteric hip fractures. Our aim was to determine if the length of nail affected the outcome. METHODS: We randomized 229 patients with a trochanteric hip fracture between two implants: a 'standard' nail of 220 mm and a shorter nail of 175 mm, which had decreased proximal angulation (4° vs 7°) and a reduced diameter at the level of the lesser trochanter. Patients were followed up for one year by a nurse blinded to the type of implant used to determine if there were differences in mobility and pain with two nail designs. Pain was assessed on a scale of 1 (none) to 8 (severe and constant) and mobility on a scale of 1 (full mobility) to 9 (immobile). RESULTS: The shorter nail did not require any reaming of the femur and was quicker to insert (mean difference 5.1 minutes; p < 0.001, 95% confidence interval (CI) of the difference 3.16 to 7.04). Those treated by the shorter nail were less mobile (mean difference in reduction in mobility score at one year 0.80; p = 0.007, 95% CI 1.38 to 0.22). In addition, there was a trend toward greater residual pain for those treated with the shorter nail, although this was not statistically significant (mean difference in pain score at one year 0.24; p = 0.064, 95% CI -0.01 to 0.49). CONCLUSION: These results suggest that the increasing use of this very short intramedullary nail with its design modification may not be appropriate. Cite this article: Bone Joint J 2020;102-B(3):394-399.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/cirurgia , Articulação do Quadril/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/fisiopatologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Radiografia , Amplitude de Movimento Articular , Resultado do Tratamento
2.
Zhongguo Gu Shang ; 33(1): 20-6, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115920

RESUMO

OBJECTIVE: To analyze and compare the effect of fibular plate fixation on the treatment of tibial and fibular fractures. METHODS: From July 2016 to September 2018, 65 cases of middle and lower 1/3 fractures of tibia and fibula were retrospectively analyzed, including 46 males and 19 females, aged 22 to 61 years old. There were 37 cases in fibular fixation group (27 males and 10 females) , 28 cases in fibular non fixation group (19 males and 9 females) . By comparing the operation time, intraoperative bleeding, fracture healing time, ankle rotation and valgus angle, postoperative complications, last follow-up ankle mobility and Baird Jackson score, the operation effect was evaluated. RESULTS: All patients were followed up for 12 to 16 months with an average of (13.67±1.23) months. There were 3 cases of infection of the fibular incision, all of which healed in the first stage without incision dehiscence, and 4 cases of delayed union without nonunion. In the fibula fixation group, the external rotation of ankle joint increased (7.16±1.36) ° and the valgus angle increased (3.35±1.16) °; while in the non fixation group, the external rotation increased (10.25±1.58) ° and the valgus angle increased (6.46±1.23) ° with statistical significance (P<0.05) . There was no significant difference in ankle joint activity, fracture healing time and complication rate between two groups (P>0.05) ; there was significant difference in operation time, intraoperative hemorrhage and Baird Jackson score at the latest follow-up (P<0.05) . CONCLUSION: The fibular plate fixation can prevent the ankle joint from malrotation and valgus deformity, and can obtain better surgical effect and functional prognosis.


Assuntos
Fixação Intramedular de Fraturas , Fraturas Ósseas , Fraturas da Tíbia , Adulto , Feminino , Fíbula , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tíbia , Fraturas da Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
3.
Medicine (Baltimore) ; 99(7): e17763, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049775

RESUMO

Unstable distal metaphyseal and dia-metaphyseal fractures of the radius may have treated with a variety of operative techniques, Kirschner wires (K-wires), dorsally inserted titanium elastic stable intramedullary nailing (DESIN), and short titanium elastic stable intramedullary nailing (SESIN) in children.The aim of this study was to evaluate the differences in clinical and radiographic outcomes between these methods.Between January 2009 and December 2017 196 children were treated for forearm fractures in the distal third of the distal radius. Gender of the patients, different types of surgical techniques, number of postoperative X-rays, date of metal removal and degree of axis deviation after the metal removal were studied. Distance of the fracture line from the radiocarpal surface, the width of the distal epiphysis of the radius, and the cumulative width of the distal epiphysis of the ulna and radius were analyzed.Out of the 196 children, stabilization of the fracture was achieved by K-wire in 139, by DESIN in 44, and by SESIN in 13 patients. The average time of metal removal was significantly shorter (3.8 months), following stabilization with K-wire. In children treated with K-wire, axial deviation of <5° was seen in 118 patients, 5° to 10° deviation in 15 patients, while deviation was above 10° in 6 children. In the DESIN group, <5° axial deviation was found in 37 patients and 5° to 10° in seven patients. In all 13 children treated with SESIN, axial deviation was measured to be <5°. The fracture distance from the radiocarpal surface was on average 23.7 and 45.6 mm in the children treated with K-wire and DESIN, respectively.Fracture distance from the radiocarpal surface might determine the type of surgical technique required. If the distance of the fracture line is less than the width of the distal radius, osteosynthesis with a K-wire is recommended, while if the distance of the fracture is more than the cumulative width of the radius and the ulna, then DESIN may provide better results. The use of SESIN may be indicated when the area of the growth plate is injured.


Assuntos
Fixação de Fratura/instrumentação , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Fios Ortopédicos , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Masculino , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Fraturas da Ulna/diagnóstico por imagem
4.
Instr Course Lect ; 69: 433-448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017744

RESUMO

Lower extremity fractures, ranging from the proximal femur to the distal tibia, come in a variety of patterns and complexity. Treatment modalities typically consist of using plates and intramedullary nails; however, each has its advantages and disadvantages in each anatomic region. In this instructional course, salient points and nuances in setup and implant choice are reviewed. Furthermore, the essential tips and tricks to avoid pitfalls and achieve a desired clinical result are discussed.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Fixação Intramedular de Fraturas , Fraturas Ósseas , Extremidade Inferior , Humanos , Tíbia
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 32-36, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939231

RESUMO

Objective: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) in the treatment of intertrochanteric fracture of femur in traction bed supine position and non-traction bed lateral position. Methods: A retrospective analysis of 102 elderly patients with intertrochanteric fracture of femur who met the selection criteria between January 2013 and April 2018 was made. According to the different operative positions, the patients were divided into two groups: group A (50 cases, PFNA internal fixation in traction bed supine position) and group B (52 cases, PFNA internal fixation in non-traction bed lateral position). There was no significant difference in age, gender, fracture side, cause of injury, AO classification, complications, and time from injury to operation between the two groups ( P>0.05). The preoperative preparation time, incision length, operation time, intraoperative blood loss, intraoperative X-ray fluoroscopy times, fracture healing time, and complications were recorded and compared between the two groups, and the effectiveness was evaluated by Harris hip score at 1 year after operation. Results: There was no significant difference in incision length between groups A and B ( t=1.116, P=0.268). In addition, the preoperative preparation time, operation time, intraoperative blood loss, and intraoperative X-ray fluoroscopy times in group A were significantly greater than those in group B ( P<0.05). Both groups were followed up 12-14 months, with an average of 13 months. There were 3 postoperative complications in group A and group B respectively. In group A, there were 2 cases of hip joint pain and 1 case of local fat liquefaction (healed after dressing change); in group B, there were 2 cases of hip joint pain and 1 case of deep vein thrombosis in lower extremity; there was no significant difference in the incidence of postoperative complications between the two groups ( P=0.642). The patients of the two groups had a good result of fracture reduction and the internal fixation quality, and there was no main nail loosening, screw fracture, spiral blade cutting, withdrawal, and the nail breakage occurred, and no nonunion of bone, coxa vara, and other complications occurred. X-ray showed that the fracture healed in both groups, and there was no significant difference in fracture healing time between the two groups ( t=1.515, P=0.133). There was no significant difference in Harris hip score between the two groups at 1 year after operation ( t=0.778, P=0.438). Conclusion: Compared with the traction bed supine position, PFNA internal fixation for intertrochanteric fracture of femur in the non-traction bed lateral position has the advantages of short preparation time, short operation time, less intraoperative blood loss, less X-ray fluoroscopy times, and satisfactory postoperative recovery effect.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Pinos Ortopédicos , Humanos , Estudos Retrospectivos , Decúbito Dorsal , Tração , Resultado do Tratamento
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1467-1473, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823542

RESUMO

Objective: To review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation. Methods: The results of the clinical studies about the AP in treatment of femoral shaft nonunion after intramedullary nail fixation in recent years were widely reviewed and analyzed. Results: The AP has been successfully applied to femoral shaft nonunion after intramedullary nail fixation since 1997. According to breakage of the previous nailing, AP is divided into two categories: AP with retaining the previous intramedullary nail and AP with exchanging intramedullary nail. AP is not only suitable for simple nonunion, but also for complex nonunion with severe deformity. Compared with exchanging intramedullary nail, lateral plate, and dual plate, AP has less surgical trauma, shorter healing time, higher healing rate, and faster returning to society. However, there are still some problems with the revision method, including difficulty in bicortical screw fixation, lack of anatomic plate suitable for femoral shaft nonunion, and lack of postoperative function and quality of life assessment. Conclusion: Compared with other revision methods, AP could achieve higher fracture healing rate and better clinical prognosis for patients with femoral shaft nonunion. However, whether patients benefit from AP in terms of function and quality of life remain uncertain. Furthermore, high-quality randomized controlled clinical studies are needed to further confirm that AP are superior to the other revision fixations.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas não Consolidadas , Pinos Ortopédicos , Placas Ósseas , Consolidação da Fratura , Humanos , Qualidade de Vida , Resultado do Tratamento
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1538-1542, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823554

RESUMO

Objective: To analyze the risk factors for postoperative mortality of elder patients with intertrochanteric fractures. Methods: Patients with intertrochanteric fractures who underwent proximal femoral interlocking intramedullary nail fixation between January 2014 and December 2015 were enrolled in the study. Among them, 135 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin, albumin, and total lymphocyte count (TLC), and nutritional status. Univariate analysis and Cox proportional hazards regression model were used to screen the risk factors for postoperative mortality. Results: Twenty-seven patients (20.0%) died within 2 years after surgery, and 16 (11.9%) died within 1 year after surgery. Univariate analysis showed that age, coronary atherosclerotic heart disease, number of comorbidities, preoperative hemoglobin and albumin levels were the influencing factors of postoperative mortality in elder patients with intertrochanteric fractures treated with proximal femoral interlocking intramedullary nail fixation (P<0.05). Multivariate analysis showed that age (≥80 years), combined more than 2 medical diseases, and preoperative albumin (<35 g/L) were the independent risk factors for postoperative mortality (P<0.05). Conclusion: To improve the clinical outcomes, perioperative risk should be comprehensively evaluated and perioperative management strengthened in the elder patients with intertrochanteric fractures, especially those with advanced age, more combined diseases, and low albumin, for the high postoperative mortality.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Pinos Ortopédicos , Fêmur , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Humanos , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco
8.
Zhongguo Gu Shang ; 32(12): 1112-1116, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870069

RESUMO

OBJECTIVE: To evaluate the efficacy of autogenous bone marrow injection and elastic intramedullary injection in the treatment of bone cyst in children. METHODS: From January 2012 to December 2016, 56 children with simple bone cyst were divided into two groups: autogenous bone marrow blood injection group and elastic intramedullary needle group. There were 28 cases in the autogenous bone marrow blood injection group, 16 boys and 12 girls, aged (7.7±1.9) years old, 10 cases of proximal humerus, 8 cases of proximal femur, 6 cases of proximal tibia and 4 cases of femoral shaft. In the elastic intramedullary needle group, there were 28 cases, 18 boys and 10 girls, aged(7.5±2.2) years old, 11 cases of proximal humerus, 7 cases of proximal femur, 5 cases of proximal tibia, 4 cases of femoral shaft and 1 case of distal femur. The treatment effect was evaluated by Capanna standard. RESULTS: All the patients were followed up, including 17 to 35(25.6±4.2) months in the elastic intramedullary needle group and 19 to 35(27.4±4.8) months in the autogenous marrow blood injection group. According to Capanna's evaluation standard of bone cyst, 27 patients in the elastic intramedullary needle group were treated effectively(25 patients cured, 2 patients healed but some remained lesions), 1 patients recurred, 0 patient had no response to treatment; 18 patients in the autogenous bone marrow blood injection group were treated effectively(13 patients cured, 5 patients healed but some remained lesions), 8 patients of cyst recurred, 2 patients had no response to treatment; the difference between the two groups was statistically significant(P<0.01). The overall cure time was calculated by the follow-up of 25 cases in the elastic intramedullary injection group and 13 cases in the autogenous marrow blood injection group. The cure time was(20.2±3.5) months in the elastic intramedullary injection group and(27.7±4.9) months in the autogenous marrow blood injection group. The difference was statistically significant(P<0.05). CONCLUSIONS: For the treatment of bone cyst in children, the therapeutic effect of elastic intramedullary needle is better than that of autogenous bone marrow blood injection, and the cure time is shorter.


Assuntos
Cistos Ósseos , Fixação Intramedular de Fraturas , Medula Óssea , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Resultado do Tratamento
9.
Georgian Med News ; (294): 17-21, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687942

RESUMO

Treatment of pediatric femoral shaft fractures is actual subject of modern traumatology, because of high frequency and different types of treatment. Nowadays Osteosynthesis by Titanium Elastic intramedullary nails (TEN) is the most popular method of treatment for pediatric shaft fractures. As an other methods of treatment Osteosynthesis by TEN also has some complications. In our study we analyzed 119 patients 2 to 15 years of age with pediatric femoral shaft fractures who underwent operative treatment by TEN. According to Flynn's scoring criteria for TEN our patients had in 87 cases (73%) excellent result, in 29 cases (24%) - satisfactory results and in 3 cases (3%) - poor results. For patients with satisfactory and poor outcome (total 32 patients) the main problem was different degree pain and irritation of soft tissues from nail ends. No one patients had the same problem in who was inserted nail "end cup" (total 25 patients). Average operation duration was 50 minutes (from 25 to 100) and in only 5 cases from 119 (4%) was needed open reduction for fracture. Avarage hospital stay for patients was 3 days (from 2 to 7 days). Patients were permitted begin partial weight bearing avarage for 5 week (range from 4 to 8 weeks). We had no one case of infection complication and non or delaied union. We concluded that with opetration by TEN the coplications is mainly minor and don't affects general outcome of treatment for this particullar kind of fracture. the majority of complications are surgery techniques related and can be avoided by using of end cups for the nails. This technique successfully can be used in heavy children (from 40 to 50 kg) and even in children more than 50 kg with fracture type A3. Osteosynthesis by Titanium elanstin intramedullary nail is excellent method for theatment pediatric femoral diaphyseal fractures.


Assuntos
Pinos Ortopédicos , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas , Titânio , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(46): e17952, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725653

RESUMO

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


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Complicações Pós-Operatórias/epidemiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Placas Ósseas , Fixação Interna de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Humanos , Duração da Cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia
12.
J Bone Joint Surg Am ; 101(19): 1761-1767, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577681

RESUMO

BACKGROUND: Isolated femoral and tibial fractures are 2 of the top 5 causes of pediatric orthopaedic hospital admission, yet their simultaneous ipsilateral presentation, the "floating knee" injury, remains rare. Historically, treatment consisted of traction and cast immobilization, which resulted in prolonged periods of immobilization, lengthy hospitalizations, and high rates of malunion. As such, previous authors have recommended fixation of at least 1 bone in the setting of a floating knee injury. This strategy, however, has never been evaluated and the outcomes of modern treatment are unknown. METHODS: We performed a multicenter retrospective review of the records of pediatric patients with ipsilateral femoral and tibial fractures that had been treated at 11 tertiary care level-I pediatric trauma centers from 2004 to 2014. Outcomes and treatment strategies were assessed with standardized means. RESULTS: Over the study period, 130 floating knees in 129 patients met the inclusion criteria for evaluation. The average patient age was 10.2 years, and 63.1% were male. One-third of the patients presented with open injuries, and 83.8% of injuries were related to vehicular trauma. Simple diaphyseal fractures (OTA/AO 32-A and B femoral fractures and OTA/AO 42-A and B tibial fractures) were most common. Intramedullary fixation (rigid or flexible) was the most common treatment strategy for femoral fractures (69.2%). Tibial fractures were treated most commonly with casting (27.7%), followed by flexible intramedullary nailing (24.6%). The mean duration of hospitalization was 9.7 days. Outcomes were excellent in 66.6% of cases and good in 26.4% of cases. CONCLUSIONS: Previous literature on pediatric floating knee injuries consisted of small case series that were published prior to the introduction of flexible intramedullary nailing to North America. This multicenter study of a large cohort demonstrates a change in practice pattern from a largely nonoperative treatment strategy to operative fixation of at least the femoral fracture. In the present study, this approach led to good or excellent results in 93.1% of cases and was associated with a short duration of hospitalization. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Moldes Cirúrgicos , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Traumatismos do Joelho/cirurgia , Fraturas da Tíbia/cirurgia , Acidentes de Trânsito , Criança , Feminino , Fraturas do Fêmur/fisiopatologia , Consolidação da Fratura/fisiologia , Humanos , Traumatismos do Joelho/fisiopatologia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fraturas da Tíbia/fisiopatologia , Resultado do Tratamento
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(11): 1394-1398, 2019 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-31650755

RESUMO

Objective: To investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults. Methods: Between March 2016 and January 2018, 20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing. There were 13 cases and 7 cases, with an average age of 43 years (range, 18-56 years). The causes of injury included the traffic accident in 6 cases, falling in 12 cases, and falling from height in 2 cases. The interval between injury and admission ranged from 1 hour to 2 days (mean, 3.2 hours). The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases. The length of incision, the operation time, the visual analogue scale (VAS) score on the 2nd day after operation, the fracture healing time, the postoperative shoulder function and the Disability of Arm Shoulder and Hand (DASH) score, the complications, and the time of second surgical removal of internal fixator and incision length were recorded. Results: The length of incision was 2-6 cm (mean, 4.7cm). The operation time was 45-120 minutes (mean, 77.2 minutes). The VAS score was 1-5 (mean, 3.2) on the 2nd day after operation. All incisions healed by first intention and no infection or nerve injury occurred. All patients were followed up 12-32 months (mean, 18.6 months). All fractures healed with the healing time of 10-15 weeks (mean, 12.1 weeks). The Constant score was 92-98 (mean, 96.3) and DASH score was 0-6.4 (mean, 3.1). The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation. The internal fixators were removed at 12-26 months (mean, 14.6 months) after operation. And the length of incision was 1-2 cm (mean, 1.3 cm) and the operation time was 5-15 minutes (mean, 9.0 minutes). Conclusion: For the midshaft clavicular fracture in adults, the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision, light pain, rapid fracture healing, small secondary operation injury, and avoiding the risk of clavicular epithelial nerve injury, and can obtain good effectiveness.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas , Fraturas Ósseas , Adolescente , Adulto , Clavícula , Consolidação da Fratura , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
14.
Eklem Hastalik Cerrahisi ; 30(3): 246-51, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650921

RESUMO

OBJECTIVES: This study aims to compare the radiological and functional results of adult patients with isolated ulnar diaphyseal fractures treated with plate and new-generation locked intramedullary nail (IMN). PATIENTS AND METHODS: The study included 57 patients (38 males, 19 females; mean age 39.1 years; range, 18 to 77 years) with isolated ulnar diaphyseal fractures treated with IMN or plate fixation between January 2008 and December 2017. Thirty patients (Plate group) were treated with plate fixation and 27 patients (IMN group) with IMN. Functional results were evaluated according to the Grace-Eversmann evaluation system and the disabilities of the arm, shoulder and hand (DASH) questionnaire. RESULTS: The mean union time was 12.8±1.2 weeks in the IMN group and 13.7±1.4 weeks in the plate group (p=0.092). The mean operation time was significantly shorter in the IMN group (30 minutes) than in the plate group (46 minutes; p<0.001). The mean DASH score was 7.0±4.5 in the IMN group and 7.7±8.6 in the plate group (p=0.766). CONCLUSION: With similar union rates, functional results, and shorter operation times, locked IMNs are a suitable alternative to plate osteosynthesis in adult isolated ulnar diaphyseal fractures.


Assuntos
Placas Ósseas , Diáfises/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas , Fraturas da Ulna/cirurgia , Adolescente , Adulto , Idoso , Diáfises/lesões , Avaliação da Deficiência , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Radiografia , Estudos Retrospectivos , Fraturas da Ulna/diagnóstico por imagem , Adulto Jovem
16.
Zhongguo Gu Shang ; 32(9): 837-841, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31615182

RESUMO

OBJECTIVE: To evaluate the clinical value of accelerated rehabilitation in the treatment of intertrochanteric fracture of femur in the elderly. METHODS: Eighty elderly patients with intertrochanteric fractures were selected from January 2016 to October 2018, and were divided into accelerated rehabilitation group and traditional rehabilitation group according to different treatment schemes, 40 cases in each group. There were 22 males and 18 females in accelerated rehabilitation group with an average age of (78.5±9.1) years old; 19 males and 21 females in traditional rehabilitation group with an average age of (80.6±8.1) years old. The perioperative blood loss, incidence of complications, hospitalization time, hospital stay, Harris hip score and improved BADL scale were compared between the two groups. RESULTS: Eighty patients were followed up for more than 12 months, with an average follow-up time of (15.4±2.6) months. The total perioperative blood loss in the accelerated rehabilitation group was significantly lower than that in the traditional rehabilitation group(P<0.001). Although the incidence of complications in the accelerated rehabilitation group was lower than that in the traditional rehabilitation group, there was no significant difference between the two groups(P>0.05). The time from admission to operation of the accelerated rehabilitation group(1.48±0.51) days was significantly shorter than that of the traditional rehabilitation group(4.35±1.55) days(P<0.01);the hospitalization time of the accelerated rehabilitation group was(6.4±1.1) days was significantly shorter than that of the traditional rehabilitation group (9.9±1.9) days(P<0.01). At 12 months after operation, there was no significant difference in Harris score between the two groups(P>0.05), and there was no significant difference in modified BADL score between the two groups(P>0.05). CONCLUSIONS: The application of accelerated rehabilitation program in elderly intertrochanteric fracture is safe and effective. It can reduce perioperative bleeding, shorten hospitalization time and accelerate the recovery of hip function.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur , Fraturas do Quadril/terapia , Hospitalização , Humanos , Masculino , Resultado do Tratamento
17.
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
18.
J Coll Physicians Surg Pak ; 29(10): 942-945, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564266

RESUMO

OBJECTIVE: To compare the efficacy of intramedullary nailing (IMN) and minimally invasive percutaneous plate osteosynthesis (MIPO) in treatment of humeral shaft fractures. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Orthopedics, Zhejiang Hospital, China, during March 2010 to December 2016. METHODOLOGY: The study included patients with humeral shaft fractures who received surgery by IMN or MIPO. The intraoperative outcomes including operation time, bleeding volume, and the postoperative outcomes were also recorded. The Constant-Murley scores were used for assessment of function of shoulder joint and Mayo score was used for measurement of elbow joint function. RESULTS: Among a total of 436 patients with humeral shaft fractures, 204 cases received MIPO and 232 cases received IMN. The follow-up duration ranged from 16~36 months with a mean duration of 25.8 ±6.1 months. The mean operation time, mean bleeding volume, mean hospitalisation time and mean healing time showed no significant difference between MIPO and IMN groups. No significant difference was observed in Mayo scores, but the Constant-Murley scores of MIPO group was significantly higher that the IMN group. Fracture nonunion was observed for 15 (6.5%) cases in IMN group; however, only 1 (0.5%) case was found to be nonunion in MIPO group. Meanwhile, 9 (4.4%) cases showed radial nerve injury in the MIPO group, with no significant difference compared to the IMN group of 15 (6.5%) cases. CONCLUSION: Both the two methods were effective; however, MIPO method might be better for recovery of shoulder function and might reduce the nonunion rate.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Úmero/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Adulto , Perda Sanguínea Cirúrgica , China , Feminino , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Estudos Retrospectivos
19.
J Orthop Traumatol ; 20(1): 30, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31506759

RESUMO

BACKGROUND: Limb lengthening using an external fixator requires a long period of external fixation and may be associated with several complications such as axial deformity, fracture of the regenerated bone, and joint stiffness. With the goal of reducing the time of external fixation as well as some of these complications, we performed femoral or tibial lengthening over an intramedullary nail, according to Paley's technique, in 28 patients, followed up after a mean period of 8 years. MATERIALS AND METHODS: Twenty-eight patients treated for lower limb discrepancy by limb lengthening over an intramedullary nail were reviewed from 5 to 11 years after healing of regenerated bone. There were 20 femurs and 8 tibiae, with average age at surgery of 14.2 years and average length inequality of 6.1 cm for femurs and 5.3 cm for tibiae. RESULTS: The mean lengthening was 5.8 cm for femurs and 4.8 cm for tibiae. The mean period of radiographic consolidation of the regenerated bone was 6 months for femoral lengthening and 4.5 months for tibial lengthening. At follow-up, we observed 8 excellent results, 15 good results, 4 fair results, and 1 poor result, based on Paley's evaluation criteria. The main complications were one deep infection, one nonunion of the distracted segment, one breakage of the distal fiche of the external fixator, and one breakage of both distal locking screws of the intramedullary nail. DISCUSSION: We believe that limb lengthening over an intramedullary nail still represents a good method to treat limb length discrepancy because it reduces the time of external fixation, prevents axial deformities and fractures of regenerated bone, and allows early rehabilitation. The new intramedullary lengthening nails, which theoretically are the ideal device for treating limb length inequality, are still very expensive and need longer follow-up for definitive evaluation. LEVEL OF EVIDENCE: 4.


Assuntos
Alongamento Ósseo/instrumentação , Pinos Ortopédicos , Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Desigualdade de Membros Inferiores/cirurgia , Tíbia/cirurgia , Adolescente , Criança , Fixadores Externos , Feminino , Seguimentos , Humanos , Masculino , Resultado do Tratamento , Cicatrização , Adulto Jovem
20.
J Orthop Surg Res ; 14(1): 315, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533760

RESUMO

BACKGROUND: This study aimed to investigate the incidence and risk factors of postoperative urinary retention (POUR) among elderly patients who underwent hip fracture surgery and to evaluate the effect of indwelling catheterization on the occurrence of POUR. MATERIALS AND METHODS: From January 2012 to January 2015, consecutive patients aged over 70 years who underwent hip fracture surgery were enrolled in this study. All patients underwent indwelling catheterization due to voiding difficulty upon admission. Demographic data, perioperative variables, and postoperative duration of patient-controlled analgesia and indwelling catheterization, postoperative complications, and mortality were collected. The incidence of POUR was investigated, and the risk factors related to POUR were analyzed using a logistic regression analysis. The cutoff value for the timing of catheter removal was determined using receiver operating characteristic (ROC) curve analysis. RESULTS: POUR developed in 68 patients (31.8%) of the 214 patients. Of these, 24 (35.3%) were male. The indwelling catheter was left in place for an average of 3.4 days (range, 0-7 days) postoperatively. A significant difference was noted in gender and duration of indwelling catheterization between patients with POUR and without. The cutoff value for the timing of catheter removal as determined by ROC curve analysis was 3.5 postoperative day with 51.4% sensitivity and 71.5% specificity. Multiple logistic regression revealed that the duration of the indwelling catheter [odds ratios (OR), 0.31; p = 0.016)] and male gender (OR, 2.22; p = 0.014) were independent risk factors related to the occurrence of POUR. CONCLUSIONS: The significant risk factors of POUR among elderly patients undergoing hip fracture surgery were early indwelling catheter removal and male gender. Therefore, early removal of indwelling catheter in elderly patients following hip fracture surgery may increase the risk of POUR, especially in male patients.


Assuntos
Cateteres de Demora , Remoção de Dispositivo/efeitos adversos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Cateteres Urinários , Retenção Urinária/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Feminino , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Cuidados Pós-Operatórios/métodos , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Cateterismo Urinário , Retenção Urinária/etiologia , Retenção Urinária/terapia
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