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1.
J Pediatr Orthop ; 40(9): 487-491, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32931690

RESUMO

BACKGROUND: The vast majority of pediatric distal-third tibial shaft fractures can be treated with closed reduction and casting. If conservative measures fail, then these fractures are usually treated with 2 antegrade flexible intramedullary nails. A postoperative cast is usually applied because of the tenuous fixation of the 2 nails. Recent studies have described the use of 4 nails to increase the stability of the fixation, a technique that may preclude the need for postoperative casting. The purpose of this biomechanical study is to quantify the relative increase in stiffness and load to failure when using 4 versus 2 nails to surgically stabilize these fractures. METHODS: Short, oblique osteotomies were created in the distal third of small fourth-generation tibial sawbones and stabilized with 2 (double) or 4 (quadruple) flexible intramedullary nails. After pilot testing, 5 models per fixation method were tested cyclically in axial compression, torsion, and 4-point bending in valgus and recurvatum. At the end of the study, each model was loaded to failure in valgus. Stiffness values were calculated, and yield points were recorded. The data were compared using Student's t tests. Results are presented as mean±SD. The level of significance was set at P≤0.05. RESULTS: Stiffness in valgus 4-point bending was 624±231 and 336±162 N/mm in the quadruple-nail and double-nail groups, respectively (P=0.04). There were no statistically significant differences in any other mode of testing. CONCLUSIONS: The quadruple-nail construct was almost 2 times as stiff as the double-nail construct in resisting valgus deformation. This provides biomechanical support for a previously published study describing the clinical success of this fixation construct.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/instrumentação , Tíbia/lesões , Fraturas da Tíbia/cirurgia , Fenômenos Biomecânicos , Criança , Diáfises/lesões , Diáfises/cirurgia , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Desenho de Prótese , Tíbia/cirurgia , Fraturas da Tíbia/fisiopatologia
2.
Medicine (Baltimore) ; 99(37): e21862, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925723

RESUMO

This study aimed to compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) in elderly intertrochanteric fractures (ITFs) patients aged 85 years or more.This is a prospective cohort study, and we analyzed 120 elderly patients aged 85 years or more presented with ITFs who underwent BPH and PFNA between January 2017 and July 2018. 84 patients treated with PFNA were set as Group A, and 36 patients treated with BPH were set as Group B. Data such as gender, age, period of follow-up, fracture classification (according to Evans-Jensen classification), preoperative ASA (American Society of Anesthesiologists) physical status, interval between injury and operation, method of anaesthesia, duration of operation time, blood loss during surgery, time of weight bearing after operation, incidence of complications 2 weeks after operation, mortality rates and Harris Hip Score 12 months after operation were recorded and compared.There are no statistically significant differences when compared general data in patients from group A and B (P > .05). Operation time in Group A is less than Group B (103.33, 40-230 min vs 122.64, 75-180 minute, P < .01). Blood loss during surgery in Group A is less than Group B (70.24, 50-100 mL vs 194.44, 100-500 mL, P < .01). Time of weight bearing after operation in Group A is longer than Group B (50.70, 7-100 days vs 6.67, 4-14 days, P < .01). Incidence of complications 2 weeks after operation in Group A is less than Group B (14.12% vs 36.11%, P < .01). Mortality rates 12 months after operation in Group A is similar with Group B (13.10% vs 19.44%, P > .05). Harris Hip Score 12 months after operation in Group A is similar with Group B (64.64,0-91 points vs 64.41, 0-90 points, P > .05).Although BPH and PFNA have similar functional outcome and mortality rates 12 months after operation, BPH has more postoperative complications in elderly patients aged 85 years or more with ITFs, Bipolar Hemiarthroplasty should not be selected as the primary option for ITFs in elderly patients aged 85 years or more.


Assuntos
Fixação Intramedular de Fraturas/mortalidade , Hemiartroplastia/mortalidade , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/mortalidade , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Feminino , Fixação Intramedular de Fraturas/métodos , Avaliação Geriátrica , Hemiartroplastia/métodos , Fraturas do Quadril/mortalidade , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(33): e21779, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872079

RESUMO

BACKGROUND: Currently, both minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing are the two most commonly used methods of treatment in distal tibial fractures, but controversy still exists regarding the clinical effects of 2 techniques. Our purposes were to compare MIPO and intramedullary nailing for distal tibia shaft fractures by assessing functional outcomes and complications. METHODS: Data were collected retrospectively from the charts of patients treated for distal tibial extra-articular fractures between May 2012 and July 2018. All cases were performed by a single surgeon. Institutional review board approval in the Second Affiliated Hospital of Army Medical University was obtained prior to conducting chart review and analysis. The criteria for inclusion in the study were being aged at least 18 years at the time of diagnosis and having a closed or type I open fracture of the distal third of the tibial diaphysis. The primary outcome compared between the 2 groups was the American Orthopedic Foot and Ankle surgery score. The secondary outcome measures in this trial included Olerud and Molander Ankle Score, radiographic outcomes, and complications. Statistical analysis was performed using SPSS version. P values < .05 were considered statistically significant. RESULTS: We hypothesized that MIPO would be associated with better functional outcomes and fewer complications. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5808).


Assuntos
Fixação Intramedular de Fraturas/métodos , Fraturas da Tíbia/cirurgia , Estudos de Coortes , Humanos
4.
Medicine (Baltimore) ; 99(32): e21648, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769934

RESUMO

RATIONALE: Autosomal dominant type II (AD II) osteopetrosis is a rare inheritable metabolic bone disease characterized by hard but brittle bone and a narrow medullary canal. Intramedullary nailing (IMN) is a difficult but attractive option for the treatment of subtrochanteric fractures in patients with AD II osteopetrosis. PATIENT CONCERNS AND DIAGNOSIS: Two patients with AD II osteopetrosis sustained subtrochanteric fractures after a fall. INTERVENTIONS: IMN was performed through the sequential use of instruments such as a 4.9-mm drill bit, small reamer, and larger reamer for over-reaming. OUTCOMES: In the first case, IMN left some gap at the fracture site. Dynamization was performed to treat the delayed union at 6 months postoperatively. The fracture healed at 10 months after the dynamization. In the second case, IMN was successful without a gap, and the fracture healed at 8 months. LESSONS: Although IMN is difficult to perform owing to partial obliteration of the medullary canal in AD II osteopetrosis, it can be performed with sequential widening of the medullary canal using various instruments. In addition, the fracture gap should not be left uncorrected during IMN to attain fracture union.


Assuntos
Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/prevenção & controle , Osteopetrose/cirurgia , Adulto , Idoso , Feminino , Fraturas do Quadril/cirurgia , Humanos , Masculino , Osteopetrose/complicações , Resultado do Tratamento
5.
J Pediatr Orthop ; 40(8): e690-e696, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32776771

RESUMO

PURPOSE: The debate on the treatment of type IIa supracondylar humerus fractures has yet to be resolved. The purpose of this study was to assess the factors associated with successful closed reduction and immobilization and to assess the efficacy of a novel radiographic "hourglass" angle measurement in the management of type IIa supracondylar humerus fractures within the pediatric population. METHODS: An institutional review board-approved retrospective review of all children who underwent closed reduction and casting or splinting of an isolated type IIa supracondylar humerus fractures treated at 2 pediatric hospitals from January 1, 2009 to August 31, 2016. Analyzed radiographic parameters included Baumann angle (BA), humerocondylar angle (HCA), perpendicular distance (PD) from the anterior humeral line to the capitellum, and the hourglass angle (HGA). These parameters were measured on injury radiographs (XR), postreduction XR, and at the first and final follow-up XR. The success of closed reduction was defined as maintenance of an acceptable reduction without a secondary procedure. The interobserver reliability was calculated. RESULTS: There were 77 elbows treated with closed reduction and long-arm cast or splint immobilization. Of those closed reductions, 76.62% of elbows (59/77) maintained their reduction alignment and did not require surgical treatment for percutaneous pinning. In this series, the BA was not significantly different following closed reduction ([INCREMENT]1.04 degrees; P=0.081); however, the PD ([INCREMENT]1.89 mm), HGA ([INCREMENT]7.38 degrees), and HCA ([INCREMENT]5.07 degrees) had significant improvement following closed reduction (P<0.001 for all). The use of procedural sedation during reduction was strongly associated with success, 83.05% (49/59) with sedation compared with 55.56% (10/18) success without sedation (P=0.025). Furthermore, fractures that underwent a secondary procedure had 6.20 degrees less HGA following a closed reduction (P=0.016) and required additional follow-up visits (P=0.0037). The success of type IIa supracondylar humerus fractures did not significantly differ based on sex (P=0.5684), laterality (P=0.6975), mechanism of injury (P>0.9999), location of care-emergency department versus clinic (P=0.1160), or type of fracture immobilization (P=0.7411). The mean HGA in normal elbows was 177.8 degrees. The interobserver reliability for HCA was poor [intraclass correlation coefficient (ICC)=0.342]; fair for BA (ICC=0.458); and excellent for both PD and HGA (ICC=0.769 and 0.805, respectively) (P<0.001 for all). CONCLUSIONS: Improved and acceptable radiographic parameters were achieved by a closed reduction in the majority of minimally displaced type IIa fractures treated by closed reduction and immobilization in this series. HCA upon presentation was significantly greater in successful cases, and failure to improve and maintain HGA and PD following closed reduction was associated with loss of reduction. Procedural sedation during reduction was strongly associated with success. The HGA and PD were consistent parameters used to determine effective management of type IIa fractures. This study adds support for a nonoperative closed reduction under sedation with immobilization of selected type IIa supracondylar humerus fractures.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Úmero , Úmero , Criança , Cotovelo/cirurgia , Feminino , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Humanos , Fraturas do Úmero/diagnóstico , Fraturas do Úmero/cirurgia , Úmero/diagnóstico por imagem , Úmero/cirurgia , Masculino , Radiografia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
6.
Bone Joint J ; 102-B(8): 1056-1061, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731819

RESUMO

AIMS: Current American Academy of Orthopaedic Surgeons (AAOS) guidelines for treating femoral fractures in children aged two to six years recommend early spica casting although some individuals have recommended intramedullary stabilization in this age group. The purpose of this study was to compare the treatment and family burden of care of spica casting and flexible intramedullary nailing in this age group. METHODS: Patients aged two to six years old with acute, non-pathological femur fractures were prospectively enrolled at one of three tertiary children's hospitals. Either early closed reduction with spica cast application or flexible intramedullary nailing was accomplished under general anaesthesia. The treatment method was selected after discussion of the options by the surgeon with the family. Data were prospectively collected on patient demographics, fracture characteristics, complications, pain medication, and union. The Impact on Family Scale was obtained at the six-week follow-up visit. In all, 75 patients were included in the study: 39 in the spica group and 36 in the nailing group. The mean age of the spica group was 2.71 (2.0 to 6.9) years and the mean age of the nailing group was 3.16 (2.0 to 6.9) years. RESULTS: All fractures healed without evidence of malunion or more than 2.0 cm of shortening. The mean Impact on Family score was 70.2 for the spica group and 63.2 (55 to 99) for the nailing group, a statistically significant difference (p = 0.024) in a univariate analysis suggesting less impairment of the family in the intramedullary nailing group. There was no significant difference between pain medication requirements in the first 24 hours postoperatively. Two patients in the spica group and one patient in the intramedullary nailing group required additional treatment under anaesthesia. CONCLUSION: Both early spica casting and intramedullary nailing were effective methods for treating femoral fractures in children two to six years of age. Intramedullary stabilization provides an option in this age group that may be advantageous in some social situations that depend on the child's mobility. Fracture treatment should be individualized based on factors that extend beyond anatomical and biological factors. Cite this article: Bone Joint J 2020;102-B(8):1056-1061.


Assuntos
Moldes Cirúrgicos , Fraturas do Fêmur/terapia , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Manejo da Dor/métodos , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Seguimentos , Fixação de Fratura/métodos , Hospitais Pediátricos , Humanos , Masculino , Seleção de Pacientes , Estudos Prospectivos , Medição de Risco , Fatores de Tempo
7.
Bone Joint J ; 102-B(8): 1048-1055, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731828

RESUMO

AIMS: The Fassier Duval (FD) rod is a third-generation telescopic implant for children with osteogenesis imperfecta (OI). Threaded fixation enables proximal insertion without opening the knee or ankle joint. We have reviewed our combined two-centre experience with this implant. METHODS: In total, 34 children with a mean age of five years (1 to 14) with severe OI have undergone rodding of 72 lower limb long bones (27 tibial, 45 femoral) for recurrent fractures with progressive deformity despite optimized bone health and bisphosphonate therapy. Data were collected prospectively, with 1.5 to 11 years follow-up. RESULTS: A total of 24 patients (33%) required exchange of implants (14 femora and ten tibiae) including 11 rods bending with refracture. Four (5%) required reoperation with implant retention. Loss of proximal fixation in the femur and distal fixation in the tibia were common. Four patients developed coxa vara requiring surgical correction. In total, 13 patients experienced further fractures without rod bending; eight required implant revision. There was one deep infection. The five-year survival rate, with rod revision as the endpoint, was 63% (95% confidence interval (CI) 44% to 77%) for femoral rods, with a mean age at implantation of 4.8 years (1.3 to 14.8), and 64% (95% CI 36% to 82%) for tibial rods, with a mean age at implantation of 5.2 years (2.0 to 13.8). CONCLUSION: FD rods are easier to implant but do not improve on the revision rates reported for second generation T-piece rods. Proximal femoral fixation is problematic in younger children with a partially ossified greater trochanter. Distal tibial fixation typically fails after two years. Future generation implants should address proximal femoral and distal tibial fixation to avoid the majority of complications in this series. Cite this article: Bone Joint J 2020;102-B(8):1048-1055.


Assuntos
Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Osteogênese Imperfeita/cirurgia , Reoperação/métodos , Fraturas da Tíbia/cirurgia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/etiologia , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Humanos , Fixadores Internos , Masculino , Osteogênese Imperfeita/complicações , Osteogênese Imperfeita/diagnóstico por imagem , Estudos Prospectivos , Recidiva , Reoperação/estatística & dados numéricos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/etiologia , Fatores de Tempo
8.
Bone Joint J ; 102-B(8): 1082-1087, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731834

RESUMO

AIMS: Osteopetrosis (OP) is a rare hereditary disease that causes reduced bone resorption and increased bone density as a result of osteoclastic function defect. Our aim is to review the difficulties, mid-term follow-up results, and literature encountered during the treatment of OP. METHODS: This is a retrospective and observational study containing data from nine patients with a mean age of 14.1 years (9 to 25; three female, six male) with OP who were treated in our hospital between April 2008 and October 2018 with 20 surgical procedures due to 17 different fractures. Patient data included age, sex, operating time, length of stay, genetic type of the disease, previous surgery, fractures, complications, and comorbidity. RESULTS: The mean follow-up period was 92.5 months (25 to 140). Bony union was observed in all of our patients. Osteomyelitis developed in two patients with femoral shaft fractures, and two patients had peri-implant stress fractures. CONCLUSION: Treatment of fractures in OP patients is difficult, healing is protracted, and the risk of postoperative infection is high. In children and young adults with OP who have open medullary canal and the epiphyses are not closed, fractures can be treated with surgical techniques such as intramedullary titanium elastic nail (TENS) technique or fixation with Kirschner (K)-wire. Cite this article: Bone Joint J 2020;102-B(8):1082-1087.


Assuntos
Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Ósseas/cirurgia , Osteopetrose/complicações , Adolescente , Pinos Ortopédicos , Fios Ortopédicos , Criança , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Osteopetrose/diagnóstico por imagem , Osteopetrose/cirurgia , Estudos Retrospectivos , Medição de Risco , Amostragem , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Medicine (Baltimore) ; 99(28): e21234, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664178

RESUMO

BACKGROUND: Traditional intramedullary nailing (IMN) for tibial shaft fractures through an infrapatellar approach is typically performed in the supine position and requires a specially designed operative table and an experienced assistant throughout the surgery. We attempted to perform IMN for tibial fractures in the lateral decubitus position to make the process easier both for surgeons and radiographers. METHODS: A total of 36 tibial IMN procedures were performed with the patient in the lateral position from May 1, 2014 to April 30, 2016. The technical feasibility and early results were evaluated. RESULTS: The mean time to complete the nailing procedure during surgery was 78.4 ±â€Š1.1 min. The mean intraoperative time for fluoroscopy was 36.7 ±â€Š1.1 min. No radiographic angular malalignment or bone non-union was reported. No surgical site infections or other surgery-related complications occurred in our series. CONCLUSION: Tibial IMN through an infrapatellar approach in the lateral decubitus position may be a valuable alternative as it simplifies the procedure for both surgeons and radiographers. This technique is highly effective for surgical operation and fluoroscopy compared to traditional supine position. This technique also seems to provide satisfactory clinical and radiographic outcomes in our preliminary clinical outcomes.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/métodos , Posicionamento do Paciente/métodos , Fraturas da Tíbia/cirurgia , Adulto , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Masculino , Estudos Retrospectivos , Tíbia/cirurgia , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(27): e21053, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629731

RESUMO

Internal fixation such as elastic stable intramedullary(ESIN) nail and submuscular plate (SMP) is gaining popularity for femoral shaft fractures in school-aged children. However, external fixation (ExFix) might be a valuable option for the distal third femoral shaft fractures, where the fracture heals rapidly, but it is crucial to avoid angular malunion. This study aims to compare the clinical outcomes, postoperative complications of distal third femoral shaft fractures in school-aged children treated by ESIN versus ExFix.Patients aged 5 to 11 years with distal third femoral shaft fractures treated at our institute from January 2014 to January 2016 were included and categorized into ESIN (n = 33) and ExFix (n = 38) group. The preoperative data, including baseline information of the patients, radiographic parameters, and type of surgical procedure, were collected from the hospital database, and postoperative data, including complications, were collected during the follow-up visit.In all, 33 patients (average, 8.0 ±â€Š2.1 years, male 20, female 13) in the ESIN group and 38 patients (average, 8.3 ±â€Š2.3 years, male 23, female 15) in the ExFix group were included in this study. There was significantly less operative time for the ExFix group (45.4 ±â€Š7.8 min) as compared to the ESIN group (57.8 ±â€Š11.3 min) (P < .01), reduced estimated blood loss (EBL) in the ExFix group (9.9 ±â€Š3.5) as compared to the ESIN group (16.4 ±â€Š6.5) (P < .01). As for the frequency of fluoroscopy, there was a significant difference between the ExFix group (13.9 ±â€Š2.4) and the ESIN group (15.5 ±â€Š3.2) (P = .02). The rate of major complications was not significantly different between the 2 groups (P = .19). The rate of implant irritation was significantly higher in the ExFix group (28/38, 73.7%) than the ESIN group (12/33, 36.4%) (P < .01). The rate of surgical site infection (SSI) is significantly higher in the ExFix group (18/38, 47.4%)) than the ESIN group (1/33, 3%) (P < .01). The rate of scar concern was significantly higher in the ExFix (9/38, 23.7%) than the ESIN (2/33, 6.1%), (P = .04). According to the Flynn scoring system, 30(90.9%) patients in the ESIN group and 24(89.5%) patients in the ExFix group were rated as excellent. None of the patients had poor outcomes.Both ESIN and ExFix produced satisfactory outcomes in distal third femoral shaft fractures. ExFix remains a viable choice for selected cases, especially in resource-challenged and austere settings.


Assuntos
Pinos Ortopédicos/efeitos adversos , Placas Ósseas/efeitos adversos , Fixadores Externos/efeitos adversos , Fraturas do Fêmur/cirurgia , Assistência ao Convalescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pinos Ortopédicos/normas , Placas Ósseas/normas , Criança , Pré-Escolar , China/epidemiologia , Diáfises/diagnóstico por imagem , Diáfises/patologia , Fixadores Externos/normas , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fluoroscopia/estatística & dados numéricos , Fixação de Fratura/métodos , Fixação de Fratura/tendências , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
11.
Acta Orthop Traumatol Turc ; 54(3): 255-261, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32544061

RESUMO

OBJECTIVE: The aim of this study was to evaluate clinical and functional outcomes in diabetic patients undergoing tibiocalcaneal arthrodesis using a retrograde nail. METHODS: A total of 12 diabetic patients [8 men and 4 women; mean age at intervention: 56.8 years (range: 27-76 years)] who underwent tibiocalcaneal arthrodesis by a retrograde nail were enrolled in this study. The indication for surgery was massive talar osteonecrosis in four patients, Charcot arthropathy in another four patients, and various severe ankle/hindfoot derangements in four patients. All surgeries were performed by the same surgeon. All patients were evaluated by their American Orthopedic Foot and Ankle Score (AOFAS) score, and radiographic follow-up was performed. RESULTS: The mean follow-up time was 59.5 months (range: 27-121 months). Ten patients (83.3%) healed and were able to walk with full weight bearing without crutches. Among them, nine patients (75%) achieved union with solid bone healing. The mean overall improvement in the AOFAS score was 72.5% (preoperatively: 40 points vs postoperatively: 69 points; p<0.001). We observe a complication in 50% of our patients. Minor complications included two cases of dehiscence of the surgical wound, one case of soft tissue irritation owing to hardware protrusion, and one cause of lymphedema. Two patients had deep infection and underwent surgical removal of hardware, debridement, and antibiotic treatment: one healed after the treatment but never recovered full weight bearing and the other one died from other complications. These two deep infections occurred after 23 months of follow-up. CONCLUSION: Tibiocalcaneal arthrodesis using retrograde nails is a salvage technique extremely effective in ankle and hindfoot disorders in a diabetic patient. This procedure allows good functional outcomes and pain relief. When correctly indicated, it is a safe procedure with good clinical outcomes and low risk of below-knee amputation. LEVEL OF EVIDENCE: Level IV, Therapeutic study.


Assuntos
Artrodese , Calcâneo/cirurgia , Diabetes Mellitus/epidemiologia , Fixação Intramedular de Fraturas/métodos , Artropatias , Complicações Pós-Operatórias , Reoperação , Tíbia/cirurgia , Artrodese/efeitos adversos , Artrodese/métodos , Artrodese/reabilitação , Artrodese/estatística & dados numéricos , Calcâneo/diagnóstico por imagem , Comorbidade , Feminino , Humanos , Artropatias/diagnóstico , Artropatias/epidemiologia , Artropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Radiografia/métodos , Recuperação de Função Fisiológica , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tíbia/diagnóstico por imagem
12.
Acta Orthop Traumatol Turc ; 54(3): 320-329, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32544068

RESUMO

OBJECTIVE: This study aimed to determine the effects of a natural diterpenoid, kirenol, on fracture healing in vivo in an experimental rat model of femur fracture and investigate its potential mechanism of action via the Wnt/ß-catenin pathway. METHODS: In this study, 64 male Wistar albino rats aged 5-7 weeks and weighing 261-348 g were randomly divided into 8 groups from A to L, with eight rats in each group. Standardized fractures were created in the right femurs of the rats and then fixed with an intramedullary Kirschner wire. Four experimental groups were administered 2 mg/kg/day kirenol (Groups C and G) and 4 mg/kg/day (Groups D and H) kirenol by oral gavage.Thereafter, the animals were sacrificed at two time points as follows: on the 10th day (Groups B, C and D) and on the 21st day (Groups F, G and H) after the surgery; fracture healing in each group was assessed radiologically and histopathologically. The Radiographic Union scale of tibia fracture scoring system was used in the radiological examination; callus volume and density were measured using computed tomography. In the histopathologic examination, the scoring system described by Huo et al. was used. Additionally, the mechanism of action was evaluated based on the analyses of protein expression of Wnt3a, LRP5, TCF-LEF1, ß-catenin, and Runx-2 proteins using western blot analysis. RESULTS: Among the animals sacrificed on the 10th day after the surgery, the highest histopathological and radiological scores were observed in Group D (p<0.05). Furthermore, the callus density (p<0.05) was highest in Group D. Among the animals sacrificed on the 21st day, the highest histopathological and radiological scores were found in Group H, although the differences among the groups were not significant (p>0.05). The callus volume and density were the highest in Groups G and H, respectively, although the differences among groups were not significant. CONCLUSION: Kirenol may improve fracture healing in a dose-dependent manner with the early activation of the Wnt/ß-catenin pathway and the activation of the Runx-2 pathway.


Assuntos
Calo Ósseo , Subunidade alfa 1 de Fator de Ligação ao Core/metabolismo , Diterpenos/farmacologia , Fraturas do Fêmur , Consolidação da Fratura , Fator 1 de Ligação ao Facilitador Linfoide/metabolismo , Via de Sinalização Wnt/efeitos dos fármacos , Animais , Antirreumáticos/farmacologia , Calo Ósseo/diagnóstico por imagem , Calo Ósseo/efeitos dos fármacos , Calo Ósseo/metabolismo , Fraturas do Fêmur/metabolismo , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/efeitos dos fármacos , Consolidação da Fratura/fisiologia , Masculino , Ratos , Ratos Wistar , Resultado do Tratamento
13.
J Pediatr Orthop ; 40(6): e479-e486, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501920

RESUMO

BACKGROUND: Lengthening of the humerus has traditionally been accomplished by the use of external fixation. Intramedullary motorized lengthening nails are now frequently used for lower limb lengthening, and this technology is slowly being adopted for use in the humerus. METHODS: A retrospective, single-surgeon experience of pediatric humeral lengthenings was performed. The time period surveyed included use of external fixation (EF) for lengthening, and the use of a motorized nail (MN) for lengthening. The primary outcome measures were lengthening magnitude achieved, duration of lengthening, frequency and type of complications encountered, or further procedures required, during each lengthening. RESULTS: From 1999 to 2018, 13 humeral lengthenings were performed in 9 patients. Six lengthenings were performed using the MN technique and 7 using the EF technique. The average absolute lengthening achieved was 8.5±1.3 cm in the EF group and 6.6±2.3 cm in the MN group. The duration of lengthening averaged 114 days in the MN group and 103 days in the EF group. The average duration of EF time was 215 days. Two patients underwent an initial EF lengthening of a humerus and then underwent a second lengthening using the MN technique. Two of 6 (33%) MN lengthenings and 3 of 7 (43%) EF lengthenings experienced complications during treatment. Two patients in the MN group underwent planned reversal and redeployment of their motorized nails to attain the planned lengthening magnitude. CONCLUSIONS: Humeral lengthening using motorized intramedullary nails is a safe technique that mitigates some of the complications of EF including pin site infection. It is well tolerated by patients. For lengthenings of a large magnitude, reversal and reuse of MN can be considered.


Assuntos
Alongamento Ósseo/métodos , Pinos Ortopédicos , Fixadores Externos , Fixação Intramedular de Fraturas/métodos , Úmero/cirurgia , Adolescente , Criança , Feminino , Humanos , Desigualdade de Membros Inferiores/cirurgia , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
14.
Jt Dis Relat Surg ; 31(2): 312-319, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584731

RESUMO

OBJECTIVES: This study aims to assess the functional outcomes, static-dynamic postural stability of patients and evaluate electromyographic activity of gluteus medius (GMed) muscle during gait and spatiotemporal parameters of gait in patients after antegrade intramedullary nailing (IMN) of femoral shaft fractures with trochanter tip entry. PATIENTS AND METHODS: Sixteen patients (15 males, 1 female; mean age 34.8±15.2 years; range, 18 to 58 years) who were treated with an antegrade trochanteric IMN between January 2009 and July 2013 and eight healthy male controls (mean age 39.3±9.8 years; range, 27 to 57 years) were included in this retrospective study. Muscle strength, static and dynamic postural stability and fall risk were evaluated. In addition, spatiotemporal parameters of gait were assessed using a validated wireless inertial sensing device and a wireless electromyography (EMG) device was used to measure electromyographic activity of GMed muscle in both groups. RESULTS: There were significant differences in muscle strength, functional and dynamic balance test scores between operated and intact sides (one-leg hop test score p=0.009, balance test scores p<0.001-0.033). There were significant differences in functional and quality of life physical function test scores between groups (one-leg hop test score p=0.014). However, no significant differences were found in EMG results, dynamics balance, and statics postural stability test scores between groups (p>0.05). CONCLUSION: After isolated femur fracture, patients treated with antegrade trochanteric IMN demonstrated good static and dynamic stability and poor functional outcomes compared to controls. In conclusion, patients with antegrade trochanteric IMN have good balance but poor functional performance; however, further studies are needed to find out the primary reason for these results.


Assuntos
Pinos Ortopédicos/efeitos adversos , Nádegas , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas do Quadril/cirurgia , Músculo Esquelético , Complicações Pós-Operatórias , Adulto , Nádegas/diagnóstico por imagem , Nádegas/lesões , Eletromiografia/métodos , Feminino , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Marcha , Humanos , Masculino , Força Muscular , Músculo Esquelético/lesões , Músculo Esquelético/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Desempenho Físico Funcional , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Equilíbrio Postural , Estudos Retrospectivos , Análise Espaço-Temporal
15.
Rev Col Bras Cir ; 47: e20202508, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32555970

RESUMO

Our objective is to describe the technique of intramedullary (IM) nailing of lateral malleolus in the surgical management of ankle fractures. Fracture reduction is performed either percutaneously with a small pointed reduction clamp in simple oblique fractures or using longitudinal traction and rotation for comminuted fractures, thus reducing complications related to open reduction and internal fixation with a plate. The technique has been shown to be simple and reproducible. In addition, the technique allows early weight bearing, which accelerates rehabilitation and potentially fasten fracture healing. IM nailing is a viable option for the fixation of the of lateral malleolus in ankle fractures and should be considered in the surgeon's armamentarium.


Assuntos
Fraturas do Tornozelo/cirurgia , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Fraturas do Tornozelo/diagnóstico por imagem , Humanos
16.
Acta Biomed ; 91(4-S): 122-127, 2020 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-32555087

RESUMO

BACKGROUND AND AIM OF THE WORK: The worldwide incidence of fractures of the proximal end of the femur is increasing as the average age of the population rises. The current surgical gold treatment standard is intramedullary nail fixation. The Authors present their experience with the D-Nail system for intertrochanteric femur fractures. METHODS: From January 1st to February 21st 2020 (breakout of COVID-19 pandemic) 34 patients were treated with the D-Nail system: 11 with basicervical fractures, 16 with intertrochanteric stable fractures and 7 with intertrochanteric unstable fractures. In 11 cases, a single cephalic screw was used; in 23 cases, two of them were used. Distal locking was executed in 7 patients. Follow-up time ranged from 2 to 3 months. RESULTS: None of the reported intra- or post-operative complication was linked to the fixation device or the surgical technique. Patients were monitored with clinical and radiological checkups using modified Harris Hip Score to accurately evaluate the fluctuations in the rehabilitation period. CONCLUSION: The main advantages of this synthesis device are the proximal hole's peculiar shape, which allows the possibility to position one or two cephalic screws on the same nail, and the silicon coating, which provides numerous biological advantages. Distal locking was executed in selected cases only, based on fracture type. Optimum treatment involves rapid execution of surgery, minimal trauma during surgery, maximum mechanical stability, and rapid weight-bearing. Although our case number is small and follow-up time brief, our results are encouraging.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação Intramedular de Fraturas/efeitos adversos , Humanos , Masculino
17.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(2): 99-106, jun. 2020. []
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1125546

RESUMO

Objetivo: El enclavado endomedular de las fracturas metafisarias de tibia se asocia con algunas complicaciones relacionadas con la necesidad de flexionar la rodilla durante la introducción del clavo endomedular con la técnica infrarrotuliana clásica. Es por ello, que se han diseñado diferentes abordajes para la colocación del clavo en una posición de semiextensión de rodilla. El objetivo fue evaluar nuestros resultados, de forma retrospectiva, con el abordaje pararrotuliano medial en semiextensión, para el tratamiento de las fracturas metafisarias proximales y distales de tibia con clavo endomedular. Materiales y Métodos: Se incluyó a 23 pacientes con un seguimiento posoperatorio mínimo de un año. Doce eran fracturas distales de tibia; 9, proximales y 2, segmentarias. Se evaluaron el rango de movilidad de la rodilla, el dolor posoperatorio con la escala de Lysholm, el eje posoperatorio y la tasa de consolidación. Resultados: El arco de movilidad de la rodilla fue de 125° (rango 110-140). Al año de la cirugía, 16 de 23 pacientes no tenían dolor, 5 de 23 refirieron un leve dolor durante la actividad física y 2, dolores intensos durante la actividad física. En todos los casos, se consiguió un eje posoperatorio aceptable y la consolidación ósea. Un paciente requirió un aumento con una placa e injerto óseo. Conclusión: La colocación de un clavo de tibia a través de un abordaje pararrotuliano medial con la rodilla en semiextensión es una técnica segura y simple para el tratamiento de las fracturas metafisarias de tibia. Nivel de Evidencia: IV


Objective: To review the results of a series of metaphyseal tibial fractures treated with intramedullary nailing (IMN) in a semiextended position using a medial parapatellar approach. To report reduction quality, bone consolidation, range of motion (ROM) and postoperative knee pain at final follow-up. Materials and Methods: Twenty-three metaphyseal tibia fractures were treated with IMN. Twelve were distal tibial fractures (AO/OTA 43A), nine were proximal tibial fractures (AO/OTA 41A2/3), and two had segmental tibia fractures (AO/OTA 42C2). The minimum follow-up was 1 year. Results: Radiograph angulation at the fracture site was <5 degrees. All patients achieved bone healing. One patient (AO/OTA 42C2) required plate augmentation and bone autografting. Twenty-one out of 23 patients had knee pain scores of >20 according to the Lysholm scale. Conclusion: The parapatellar approach in a semi-extended position is a safe and useful technique for IMN of metaphyseal tibia fracture with no associated increased postoperative knee pain. Level of Evidence: IV


Assuntos
Adulto , Pessoa de Meia-Idade , Dor Pós-Operatória , Patela/cirurgia , Fraturas da Tíbia/cirurgia , Amplitude de Movimento Articular , Resultado do Tratamento , Fixação Intramedular de Fraturas/métodos , Traumatismos da Perna
18.
Medicine (Baltimore) ; 99(25): e20796, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569225

RESUMO

The utilization of elastic stable intramedullary nail (ESIN) in length unstable femoral shaft fractures in children remains controversial, and the results in different studies vary a lot. This study aims to investigate the clinical outcomes of ESINs versus submuscular plate (SMP) in length unstable femoral shaft fractures.Patients aged 5 to 11 years old with length unstable femoral shaft fractures treated at our institute from January 2008 to January 2018 were included and categorized into ESIN and SMP group. The preoperative data and operative variables were collected from the hospital database, and postoperative data including complications were collected at follow-up visits.In all, 77 patients (8.1 ±â€Š1.9 years old, male 45, female 32) in ESIN group and 45 patients (8.0 ±â€Š2.2 years old, male 26, female 19) in SMP group were included in this study. Comparing operative variables, there was significantly less operative time, reduced estimated blood loss (EBL) and shortened hospital stay for ESINs as compared with SMP (P < .001). However, the fluoroscopy frequency was not significantly different between these 2 fixation methods (P = .42). As for elective removal surgery, there was significantly reduced operative time, EBL and shortened hospital stay for ESINs as compared with SMP (P < .001).Both ESIN and SMP are safe and effective choices for length unstable femoral shaft fractures in children aged 5 to 11 years. In ESIN, extra care is required to provide additional immobilization using spica cast or brace. Compared with SMP, ESIN is able to deliver comparable clinical outcomes with less EBL, operative time and shorter hospital stay.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Criança , Pré-Escolar , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Masculino , Estudos Retrospectivos
19.
Acta Orthop Traumatol Turc ; 54(3): 245-254, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32442122

RESUMO

OBJECTIVE: This study investigated the clinical and functional results of treating congenital pseudarthrosis of the tibia (CPT) using the combined techniques of hamartoma resection, periosteal grafting, circular external fixator application, and intramedullary rodding. METHODS: The clinical and radiological data of 17 patients (mean age at the treatment time: 7.6 months (range: 4.6-9.7 months) with CPT, treated by a single surgeon between 1997 and 2017, were retrospectively analyzed. All data regarding surgical interventions, complications, deformity analysis parameters, limb length discrepancy (LLD), ankle joint range of motion, and residual deformities were reviewed. All the patients were followed up at least two years after the last surgical intervention. The mean follow-up time was 8.5 years (range: 2.2 to 15.7 years). RESULTS: Union was achieved with the index treatment in 15 of the 17 cases (88.2%). The mean age of the patients at the last follow-up visit was 14.2 years (range: 7.6 to 22.1). The mean LLD was 2.1 cm. Nine patients had radiological ankle valgus at the last follow-up. In the entire series, eight patients did not display any complications, four cases reported minor complications, and five cases were complicated by refractures. CONCLUSION: Circular external fixator application combined with periosteal grafting is a superior method of CPT treatment. This method provides a healthy biological healing environment while correcting the mechanical problems. The combination of periosteal and cancellous bone grafts with intramedullary rods and an external fixator addresses issues that complicate obtaining and maintaining a union during the CPT treatment. LEVEL OF EVIDENCE: Level IV, Therapeutic study.


Assuntos
Transplante Ósseo/métodos , Fixação Intramedular de Fraturas/métodos , Técnica de Ilizarov , Pseudoartrose/congênito , Tíbia , Adolescente , Feminino , Seguimentos , Humanos , Lactente , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Pseudoartrose/diagnóstico , Pseudoartrose/reabilitação , Pseudoartrose/cirurgia , Radiografia/métodos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tíbia/cirurgia
20.
Int J Comput Assist Radiol Surg ; 15(6): 1001-1012, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32436133

RESUMO

PURPOSE: Minimally invasive surgery is widely used for managing fractures; however, it is difficult to determine the exact screwing position of intramedullary nails inserted into bone. To address this problem, we developed the aiming and targeting system by laser (ATLAS) using two line lasers to mark the position of the surgical tool directly on the skin. METHODS: ATLAS consists of a laser module, controller, personal computer, and display device. The laser module is fixed to the intensifier side of the C-arm. Calibration with dedicated markers is required prior to using the system. After calibration, the laser modules can mark the selected point on a fluoroscopic image acquired with the C-arm as the intersection of the two line lasers on the skin. RESULTS: To verify the effectiveness of ATLAS, marking accuracy was measured. The average control error of the device itself was 0.57 mm. In the experimental setting using C-arm fluoroscopy, the accuracy was within 1.5 mm at 23 of the 25 measurement points and within 3 mm at the remaining two points. CONCLUSION: ATLAS shows the corresponding points in real space with respect to fluoroscopic images using cross-points of lasers. The proposed method is clinically useful to aid the insertion of interlocking screws in minimally invasive surgeries for bone fractures. We believe that ATLAS enables more accurate marking through C-arm fluoroscopy and is more convenient, and it can thus be applied in various orthopedic surgeries.


Assuntos
Fluoroscopia/métodos , Fixação Intramedular de Fraturas/métodos , Fraturas Ósseas/cirurgia , Cirurgia Assistida por Computador/métodos , Humanos , Lasers , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
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