Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 17.362
Filtrar
1.
Bone Joint J ; 103-B(5): 951-957, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33934646

RESUMO

AIMS: The aim of this study was to define the complications and long-term outcome following adolescent mid-shaft clavicular fracture. METHODS: We retrospectively reviewed a consecutive series of 677 adolescent fractures in 671 patients presenting to our region (age 13 to 17 years) over a ten-year period (2009 to 2019). Long-term patient-reported outcomes (abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and EuroQol five-dimension three-level (EQ-5D-3L) quality of life score) were undertaken at a mean of 6.4 years (1.2 to 11.3) following injury in severely displaced mid-shaft fractures (Edinburgh 2B) and angulated mid-shaft fractures (Edinburgh 2A2) at a minimum of one year post-injury. The median patient age was 14.8 years (interquartile range (IQR) 14.0 to 15.7) and 89% were male (n = 594/671). RESULTS: The majority of fractures were mid-shaft (n = 606) with angulation (Edinburgh 2A2, n = 241/606, 39.8%) or displacement (Edinburgh 2B1/2, n = 263/606, 43.4%). Only 7% of the displaced mid-shaft fractures underwent acute fixation (n = 18/263). The incidence of refracture over ten years following nonoperative management of mid-shaft fractures was 3.2% (n = 19/588) and all united without surgery. Fracture type, severity of angulation, or displacement were not associated with refracture. One nonunion occurred following nonoperative management in a displaced mid-shaft fracture (0.4%, n = 1/245). Of the angulated fractures, 61 had angulation > 30°, of which 68.9% (n = 42/61) completed outcome scores with a median QuickDASH of 0.0 (IQR 0.0 to 0.6), EQ-5D-3L 1.0 (1.0 to 1.0), and 98% satisfaction with shoulder function. For the displaced fractures, 127 had displacement beyond one cortical width of bone for which completed outcome scores were provided in 72.4% (n = 92/127). Of these 15 had undergone acute fixation. Following nonoperative treatment, the median QuickDASH was 0.0 (IQR 0.0 to 2.3), EQ-5D-3L 1.0 (1.0 to 1.0), and satisfaction with shoulder function was 95%. There were no significant differences in the patients' demography or functional outcomes between operative and nonoperative treatments. CONCLUSION: Nonoperative management of adolescent mid-shaft clavicle fractures results in excellent functional outcomes at long-term follow-up. Nonunion is exceptionally rare following nonoperative management and the relative indications for surgical intervention in adults do not appear to be applicable to adolescents. Cite this article: Bone Joint J 2021;103-B(5):951-957.


Assuntos
Clavícula/lesões , Fixação de Fratura/métodos , Fraturas Ósseas/terapia , Fraturas não Consolidadas/terapia , Adolescente , Avaliação da Deficiência , Feminino , Seguimentos , Consolidação da Fratura , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias , Qualidade de Vida , Estudos Retrospectivos
3.
Bone Joint J ; 103-B(4): 762-768, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789482

RESUMO

AIMS: To compare the functionality of adults with displaced mid-shaft clavicular fractures treated either operatively or nonoperatively and to compare the relative risk of nonunion and reoperation between the two groups. METHODS: Based on specific eligibility criteria, 120 adults (median age 37.5 years (interquartile range (18 to 61)) and 84% males (n = 101)) diagnosed with an acute displaced mid-shaft fracture were recruited, and randomized to either the operative (n = 60) or nonoperative (n = 60) treatment group. This randomized controlled, partially blinded trial followed patients for 12 months following initial treatment. Functionality was assessed by the Constant score (CS) (assessor blinded to treatment) and Disability of the Arm, Shoulder and Hand (DASH) score. Clinical and radiological evaluation, and review of patient files for complications and reoperations, were added as secondary outcomes. RESULTS: At 12 months, 87.5% of patients (n = 105) were available for analysis. The two groups were well balanced based on demographic and fracture-related characteristics. At six weeks of follow-up a significant difference in DASH score (p < 0.001) was found in favour of operative treatment. The functionality at 12 months of follow-up based on CS and DASH was excellent in both groups (CS > 90 points and DASH < 10 points) with no significant difference (p = 0.277 for DASH and p = 0.184 for CS) between the two groups. The risk of symptomatic nonunion was significantly higher in the nonoperative group (p = 0.014), with a relative risk of 9.47 (95% confidence interval (CI) 1.26 to 71.53) in this group compared to the operative group. The number-needed-to-treat to avoid one symptomatic nonunion was 6.2. Initial treatment and age were factors significantly associated with nonunion in a logistic analysis. There were 26% in both groups (n = 14 in operative group and n = 15 in nonoperative group) who required secondary surgery, with most indications in the nonoperative group mandatory due to nonunion compared to most relative indications in the operative group requiring intervention due to implant irritation. CONCLUSION: Superiority was not identified with either an all-operative or all-nonoperative approach. The functionality at short term (within six weeks) seems igreater following operative treatment but was not found at one year. The risk of nonunion is significantly higher with nonoperative treatment. However, an all-operative approach to lower the nonunion risk may result in unnecessary surgery and is not recommended. Cite this article: Bone Joint J 2021;103-B(4):762-768.


Assuntos
Clavícula/lesões , Fixação de Fratura/métodos , Fraturas Ósseas/terapia , Fraturas não Consolidadas/terapia , Adolescente , Adulto , Dinamarca , Avaliação da Deficiência , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Reoperação
4.
South Med J ; 114(4): 252-259, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33787941

RESUMO

OBJECTIVES: This study aimed to identify factors, including physical functions and activities that affect quality of life (QOL) at discharge among patients with osteoporotic vertebral fractures. METHODS: Patients with osteoporotic vertebral fractures were included in our prospective cohort study. Multiple regression analysis was performed to determine the predictors of QOL at discharge using two models: model 1, basic medical information and physical functions at admission, and model 2, basic medical information, physical function, and activity after 4 weeks of admission. RESULTS: Multiple regression analysis (standard partial regression coefficients) using model 1 identified L2 to L4 bone mineral density (-0.2), Visual Analog Scale for pain during activity at admission (-0.31), and Revised Hasegawa Dementia Scale (HDS-R) score at admission (0.64) as factors affecting QOL at discharge. Multiple regression analysis using model 2 identified HDS-R at admission (0.64), Pain Catastrophizing Scale score at 4 weeks (-0.34), and knee extension muscle strength at 4 weeks (0.28) as factors affecting QOL at discharge. CONCLUSIONS: Our results suggest that if patients have high bone mineral density, intense pain, and low cognitive function at admission, then low QOL at discharge will be predicted; however, improvement of pain catastrophizing and knee extension muscle strength during first the 4 weeks of admission may be able to improve QOL at discharge. Because patients in this study were Japanese only, it is important to exercise caution when applying our results to other populations.


Assuntos
Regras de Decisão Clínica , Fraturas por Osteoporose , Alta do Paciente , Qualidade de Vida , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Demência/complicações , Demência/diagnóstico , Feminino , Seguimentos , Fixação de Fratura , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/fisiopatologia , Fraturas por Osteoporose/psicologia , Fraturas por Osteoporose/cirurgia , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/psicologia , Prognóstico , Estudos Prospectivos , Qualidade de Vida/psicologia , Recuperação de Função Fisiológica , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/psicologia , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral , Escala Visual Analógica
5.
Molecules ; 26(5)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652632

RESUMO

The use of bioresorbable fracture fixation plates made of aliphatic polyesters have good potential due to good biocompatibility, reduced risk of stress-shielding, and eliminated need for plate removal. However, polyesters are ductile, and their handling properties are limited. We suggested an alternative, PLAMA (PolyLActide functionalized with diMethAcrylate), for the use as the matrix phase for the novel concept of the in situ curable bioresorbable load-bearing composite plate to reduce the limitations of conventional polyesters. The purpose was to obtain a preliminary understanding of the chemical and physical properties and the biological safety of PLAMA from the prospective of the novel concept. Modifications with different molecular masses (PLAMA-500 and PLAMA-1000) were synthesized. The efficiency of curing was assessed by the degree of convergence (DC). The mechanical properties were obtained by tensile test and thermomechanical analysis. The bioresorbability was investigated by immersion in simulated body fluid. The biocompatibility was studied in cell morphology and viability tests. PLAMA-500 showed better DC and mechanical properties, and slower bioresorbability than PLAMA-1000. Both did not prevent proliferation and normal morphological development of cells. We concluded that PLAMA-500 has potential for the use as the matrix material for bioresorbable load-bearing composite fracture fixation plates.


Assuntos
Fixação de Fratura/métodos , Fraturas Ósseas/terapia , Lactose/análogos & derivados , Poliésteres/farmacologia , Ácidos Polimetacrílicos/farmacologia , Implantes Absorvíveis/efeitos adversos , Placas Ósseas/efeitos adversos , Proliferação de Células/efeitos dos fármacos , Humanos , Lactose/química , Lactose/farmacologia , Teste de Materiais , Poliésteres/química , Ácidos Polimetacrílicos/química , Estresse Mecânico , Resistência à Tração , Suporte de Carga
6.
Ann R Coll Surg Engl ; 103(4): 302-307, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682433

RESUMO

INTRODUCTION: The epidemiology of acute paediatric orthopaedic trauma managed surgically across the NHS is poorly described. Compliance against national standards for the management of supracondylar humeral fractures is also unknown at a national level. METHODS: Collaborators in 129 NHS hospitals prospectively collected data on surgically managed acute paediatric orthopaedic trauma cases. Data were collected over a seven-day period and included demographics, injury characteristics, operative details and timing of surgery. A national audit was also undertaken to evaluate compliance with the British Orthopaedic Association Standards for Trauma Guideline 11: Supracondylar Fractures of the Humerus in Children. RESULTS: Data were captured on 770 surgically treated cases. The three most common injuries were forearm fractures of both bones (n = 235), distal radius fractures (n = 194) and supracondylar elbow fractures (n = 89). The mode day of injury was Friday (n = 136) and the mode day of surgery was Saturday (n = 138). 88% of supracondylar fractures received surgery on the day of presentation or the following day. Only 14% of supracondylar fractures were treated surgically after 8pm; 33/89 used 2.0mm Kirschner wires, 38/89 used 1.6mm wires and 2/89 used 1.2mm wires. CONCLUSION: Forearm fractures of both bones, distal radius fractures and supracondylar humeral fractures were the three most common injuries treated surgically. There is wide variation in compliance against national standards in the management of supracondylar humeral fractures with 88% undertaking surgery on the day of or the day following presentation but only 37% using the recommended 2.0mm Kirschner wires.


Assuntos
Fixação de Fratura/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Fraturas do Úmero/epidemiologia , Fraturas do Úmero/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/cirurgia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Fixação de Fratura/estatística & dados numéricos , Humanos , Incidência , Masculino , Auditoria Médica , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Medicina Estatal , Reino Unido/epidemiologia
7.
Bone Joint J ; 103-B(5): 902-907, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33709769

RESUMO

AIMS: The management of completely displaced fractures of the distal radius in children remains controversial. This study evaluates the outcomes of surgical and non-surgical management of 'off-ended' fractures in children with at least two years of potential growth remaining. METHODS: A total of 34 boys and 22 girls aged 0 to ten years with a closed, completely displaced metaphyseal distal radial fracture presented between 1 November 2015 and 1 January 2020. After 2018, children aged ten or under were offered treatment in a straight plaster or manipulation under anaesthesia with Kirschner (K-)wire stabilization. Case notes and radiographs were reviewed to evaluate outcomes. In all, 16 underwent treatment in a straight cast and 40 had manipulation under anaesthesia, including 37 stabilized with K-wires. RESULTS: Of the children treated in a straight cast, all were discharged with good range of mo (ROM). Five children were discharged at six to 12 weeks with no functional limitations at six-month follow-up. A total of 11 children were discharged between 12 and 50 weeks with a normal ROM and radiological evidence of remodelling. One child had a subsequent diaphyseal fracture proximal to the original injury four years after the initial fracture. Re-displacement with angulation greater than 10° occurred for 17 children who had manipulation under anaesthesia. Four had a visible cosmetic deformity at discharge and nine had restriction of movement, with four requiring physiotherapy. One child developed over- granulation at the pin site and one wire became buried, resulting in a difficult retrieval in clinic. No children had pin site infections. CONCLUSION: Nonoperative management of completely displaced distal radial fractures in appropriately selected cases results in excellent outcomes without exposing the child to the risks of surgery. This study suggests that nonoperative management of these injuries is a viable and potentially underused strategy. Cite this article: Bone Joint J 2021;103-B(5):902-907.


Assuntos
Anestesia/métodos , Moldes Cirúrgicos , Fixação de Fratura/métodos , Manipulação Ortopédica , Fraturas do Rádio/terapia , Fios Ortopédicos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Fraturas do Rádio/diagnóstico por imagem
8.
BMC Musculoskelet Disord ; 22(1): 306, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33771142

RESUMO

BACKGROUND: Distal radius fractures (DRFs) constitute 15-21% of all fractures. There are no detailed data on the possible changes in the epidemiology and treatment of DRFs in children and adults during the Covid pandemic. The purpose of our study was a comprehensive assessment of the impact of the COVID-19 pandemic on distal radius fractures (DRF) epidemiology, including both children and adults and various fracture fixation methods in two large trauma centers in Poland. METHODS: This study compared the medical data on the treatment of distal radius fractures in Poland in two periods: the period of the COVID-19 pandemic (from March 15 to October 15, 2020) and the corresponding period prior to the pandemic (from March 15 to October 15, 2019). We assessed detailed data from two trauma centers for pediatric and adult patients. Outpatients seeking medical attention at emergency departments and inpatients undergoing surgery at trauma-orthopedic wards were evaluated. We compared epidemiological data, demographic data, treatment type, and hospital stay duration. RESULTS: The total number of patients hospitalized due to DRF during the pandemic was 180, it was 15.1% lower than that from the pre-COVID-19 pandemic period (212). In the case of adult patients, the total number of those hospitalized during the pandemic decreased significantly (by 22%) from 132 to 103 patients. Analysis of the individual treatment methods revealed that the number of adults who underwent conservative treatment was considerably (by 30.3%) significantly lower in the period of the COVID-19 pandemic, from 119 to 83 patients. Compared to 13 patients from the pre-pandemic period, the number of surgically treated adults statistically increased to 20 patients (by 53.8%). Our analyses showed hospitalizations of surgically treated adults to be shorter by 12.7% during the pandemic, with the corresponding hospitalizations of surgically treated pediatric patients to be shorter by11.5%. CONCLUSIONS: Our study showed a significant impact of the COVID-19 pandemic on the epidemiology and treatment of DRFs in children and adults. We found decreased numbers of pediatric and adult patients with DRFs during the COVID-19 pandemic. The pandemic caused an increase in the number of children and significantly increase adults undergoing surgical treatment for DRFs, a decrease in mean patient age, shorter significantly length of hospital stay, and an increased number of men with DRFs.


Assuntos
Fraturas do Rádio/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Tratamento Conservador , Bases de Dados Factuais , Fixação de Fratura , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Admissão do Paciente , Polônia/epidemiologia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Bone Joint J ; 103-B(3): 449-455, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641426

RESUMO

AIMS: To assess the safety of tranexamic acid (TXA) in a large cohort of patients aged over 65 years who have sustained a hip fracture, with a focus on transfusion rates, mortality, and thromboembolic events. METHODS: This is a consecutive cohort study with prospectively collected registry data. Patients with a hip fracture in the Region of Southern Denmark were included over a two-year time period (2015 to 2017) with the first year constituting a control group. In the second year, perioperative TXA was introduced as an intervention. Outcome was transfusion frequency, 30-day and 90-day mortality, and thromboembolic events. The latter was defined as any diagnosis or death due to arterial or venous thrombosis. The results are presented as relative risk (RR) and hazard ratio (HR) with 95% confidence intervals (CIs). RESULTS: A total of 3,097 patients were included: 1,558 in the control group and 1,539 in the TXA group.31% (n = 477) of patients had transfusions in the control group compared to 27% (n = 405) in the TXA group yielding an adjusted RR of 0.83 (95% CI 0.75 to 0.91). TXA was not associated with increased 30-day mortality with an adjusted HR of 1.10 (95% CI 0.88 to 1.39) compared to the control group as well as no association with increased risk of 90-day mortality with a per protocol adjusted HR of 1.24 (95% CI 0.93 to 1.66). TXA was associated with a lower risk of thromboembolic events after 30 days (RR 0.63 (95% CI 0.42 to 0.93)) and 90 days (RR 0.72 (95% CI 0.52 to 0.99)). A subanalysis on haemoglobin demonstrated a median 17.7 g/L (interquartile range (IQR) 11.3 to 27.3) decrease in the control group compared to 17.7 g/L (IQR 9.7 to 25.8) in the per protocol TXA group (p = 0.060 on group level difference). CONCLUSION: TXA use in patients with a hip fracture, was not associated with an increased risk of mortality but was associated with lower transfusion rate and reduced thromboembolic events. Thus, we conclude that it is safe to use TXA in this patient group. Cite this article: Bone Joint J 2021;103-B(3):449-455.


Assuntos
Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Tromboembolia/epidemiologia , Ácido Tranexâmico/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Feminino , Fixação de Fratura/métodos , Hemoglobinas/análise , Fraturas do Quadril/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Tromboembolia/mortalidade
10.
Bone Joint J ; 103-B(3): 442-448, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641430

RESUMO

AIMS: The aim of this study was to investigate the hypothesis that a single dose of tranexamic acid (TXA) would reduce blood loss and transfusion rates in elderly patients undergoing surgery for a subcapital or intertrochanteric (IT) fracture of the hip. METHODS: In this single-centre, randomized controlled trial, elderly patients undergoing surgery for a hip fracture, either hemiarthroplasty for a subcapital fracture or intramedullary nailing for an IT fracture, were screened for inclusion. Patients were randomly allocated to a study group using a sealed envelope. The TXA group consisted of 77 patients, (35 with a subcapital fracture and 42 with an IT fracture), and the control group consisted of 88 patients (29 with a subcapital fracture and 59 with an IT fracture). One dose of 15 mg/kg of intravenous (IV) TXA diluted in 100 ml normal saline (NS,) or one dose of IV placebo 100 ml NS were administered before the incision was made. The haemoglobin (Hb) concentration was measured before surgery and daily until the fourth postoperative day. The primary outcomes were the total blood loss and the rate of transfusion from the time of surgery to the fourth postoperative day. RESULTS: Homogeneity with respect to baseline characteristics was ensured between groups. The mean total blood loss was significantly lower in patients who received TXA (902.4 ml (-279.9 to 2,156.9) vs 1,226.3 ml (-269.7 to 3,429.7); p = 0.003), while the likelihood of requiring a transfusion of at least one unit of red blood cells was reduced by 22%. Subgroup analysis showed that these differences were larger in patients who had an IT fracture compared with those who had a subcapital fracture. CONCLUSION: Elderly patients who undergo intramedullary nailing for an IT fracture can benefit from a single dose of 15 mg/kg TXA before the onset of surgery. A similar tendency was identified in patients undergoing hemiarthroplasty for a subcapital fracture but not to a statistically significant level. Cite this article: Bone Joint J 2021;103-B(3):442-448.


Assuntos
Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Ácido Tranexâmico/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação de Fratura/métodos , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade
11.
Zhongguo Gu Shang ; 34(2): 148-52, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33666002

RESUMO

OBJECTIVE: To explore clinical effect of bridge-link combined fixation system(BCFS) in treating open middle and lower tibial fractures by external fixation. METHODS: From October 2016 to September 2017, 11 patients with open middle and lower tibial fractures were treated with BCFS by external fixation, including 7 males and 4 females aged from 23 to 65 years old with an average of 44.2 years old;the course of disease ranged from 7 to 10 days. All fractures were open, middle and lower tibiofibular fractures. According to AO classification, 5 patients were type A, 5 patients were type B, and 1 patient was type C. All fractures were classified as typeⅡaccording to Gustilo-Anderson classification. The time of fracture healing, postoperative complications were observed, Johner-Wruhs standard were used to evaluate clinical effect. RESULTS: All patients were followed up from 7 to 13 months with an average of 10.1 months. Fracture healing time ranged from 4 to 8 months with an average of 6.2 months. The removal time of BCFS ranged from 5 to 11 months with an average of 7.8 months. No screws loosening and BCFS breakage occurred after operation, while 1 patient occurred infection of proximal and distal tibia after operation which was healed by anti-inflammatory treatment and dressing change. According to Johner-Wruhs standard, 8 patients were excellent and 3 patients good at the latest follow-up. CONCLUSION: BCFS could be used to treat open middle and lower tibial fractures by external fixation, which had features of small size, flexible use, solid and elastic fixation. It could not effectively reduce tissue injury and promote fracture healing, but also have advantages of less postoperative complications and better recovery of limb function.


Assuntos
Fraturas Expostas , Fraturas da Tíbia , Adulto , Idoso , Placas Ósseas , Fixadores Externos , Feminino , Fixação de Fratura , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
12.
Zhongguo Gu Shang ; 34(2): 153-6, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33666003

RESUMO

OBJECTIVE: To investigate specific technique and clinical effects of closed folding top consolidation maneuver combined with splint fixation maneuver for consolidation and cedar bark external fixation splint for the treatment of double fractures of distal ulna and radius in children. METHODS: From January 2017 to December 2019, 17 children with double fractures of distal ulna and radius were treated with closed folded apex consolidation maneuver, including 13 males and 4 females, aged from 4 to 11 years old with an average of (7.29±2.34) years old. The fractures were fixed with cedar bark splint and followed up for 6 months, and alignment of fracture was evaluated according to the latest X-rays by follow up, and function of the affected limbs was evaluated by Anderson forearm function evaluation criteria. RESULTS: Fifteen of 17 children were successfully reset immediately, and 2 children were successfully reset again. The average fixed time was (25.00±3.35) days. At 6 months of follow up, 12 patients got excellent results, 3 good, 2 fair, and 0 poor according to Anderson forearm function evaluation criteria. The position of all children were larger than 3/4, and 10 children were received anatomical reduction, alignment of 4 children was less than 10°, 3 children was less than 15°. No complications such as fracture displacement, nonunion, compartment syndrome, and forearm rotation dysfunction occurred. CONCLUSION: Restoration of distal radius double fracture in children with the combination of the closed folding and top fixation maneuver and splint fixation maneuver has advantages of higher success rate, lower complications, which could reduce operating difficultyand pain of patients.


Assuntos
Fraturas do Rádio , Fraturas da Ulna , Idoso , Criança , Pré-Escolar , Feminino , Fixação de Fratura , Fixação Interna de Fraturas , Humanos , Masculino , Rádio (Anatomia) , Fraturas do Rádio/terapia , Contenções , Resultado do Tratamento , Ulna
13.
Zhongguo Gu Shang ; 34(3): 208-14, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787162

RESUMO

OBJECTIVE: To retrospectively analyze the clinical efficacy of external fixation in the treatment of femoral neck fracture with two different pin layout. METHODS: From April 2000 to April 2018, 140 cases of femoral neck fracture were treated with closed reduction and percutaneous pin external fixation, among them 121 cases were followed up for more than 1 year, including 31 cases in traditional group, 12 males and 19 females, aged 45 to 74(65.4±8.4) years;90 cases in modified group, 39 males and 51 females, aged 12 to 75 (64.5±7.8) years. In traditional group, the first needle was put on the femoral talus, the second and third needles were put under the tension line, and the three needles were not on the same line in the lateral phase; in modified group, the first needle was drilled into the lateralcortex of the femur, obliquely penetrating the distal and proximal end of the femoral talus fracture, and the other two needles were drilled into the medial cortex of the femoral neck and the femoral talus, respectively. The operation time, hospital stay, postoperative ambulation time, femoral neck shortening rate, fracture healing time, fracture healing rate and femoral head necrosis rate of the two groups were observed and compared. Harris hip function score was used one year after operation. RESULTS: These 121 patients were followed-up, the follow up time of traditional group was 13 to 45(30.5±11.4) months;the follow-up time of modified group was 14 to 120(34.5±12.5) months. There was no significant difference in operation time, hospital stay and femoral head necrosis rate between two groups (P>0.05). There were significant differences between two groups in the time of going to the ground, shortening rate of femoral neck, fracture healing time, fracture healing rate and Harris functional score of the hip 1 year after operation (P<0.05). CONCLUSION: Compared with the traditional group, the modified group has the advantages of lower femoral neck shortening rate, shorter fracture healing time, higher fracture healing rate and higher Harris hip function score.


Assuntos
Fraturas do Colo Femoral , Adolescente , Adulto , Idoso , Criança , Fixadores Externos , Feminino , Fraturas do Colo Femoral/cirurgia , Fixação de Fratura , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Medicine (Baltimore) ; 100(12): e25151, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761684

RESUMO

ABSTRACT: In 2014, the American College of Cardiology/American Heart Association (ACC/AHA) released guidelines for ordering pre-operative echocardiograms in patients undergoing non-cardiac surgery. The purpose of this study is to determine if pre-operative echocardiograms ordered prior to fragility hip fracture repair are ordered according to these guidelines, change anesthetic management or affect patient outcomes. In addition, we attempted to evaluate the efficacy of the ACC/AHA guidelines.We conducted a 4-year retrospective chart review of acute fragility hip fractures at a single institution. Charts were reviewed to determine which patients met criteria for a pre-operative echocardiogram. Within this group we then compared patients who received a pre-operative echocardiogram to those who did not. Comparisons were made with regard to time to surgery, changes from standard anesthetic management, major adverse cardiac events, length of hospital stay, and 1-year mortality. We also examined which patients received postoperative echocardiograms and the incidence of adverse cardiac events in this group.Of 402 patients, 87 (22%) had ACC/AHA indications for pre-operative echocardiogram, and 42 (48%) of them received one. The indication to order a pre-operative echocardiogram in stable heart failure or valve disease patients if their last echo was greater than 1 year was only followed 23% of the time. In the pre-operative echocardiogram group, anesthetic management was adjusted more frequently (P = .025), and average time to surgery was greater (P < .001). The incidence of a major adverse cardiac event was 10% in the ACC/AHA echocardiogram indicated group and 3% in the non-indicated echocardiogram group. An equal number of echocardiograms were completed postoperatively as were completed under ACC/AHA pre-operative guidelines. Sixty-seven percent of the postoperative echocardiograms did not have ACC/AHA pre-operative indications.Our data demonstrates that pre-operative echocardiograms for "stable heart failure and valvular disease with greater than 1 year from last echocardiogram" is infrequently performed without significant adverse cardiac outcomes. Pre-operative echocardiography was associated with more anesthetic adjustments and longer time to surgery. Postoperative echocardiograms were done for cardiopulmonary complications. Studies need to examine and refine clinical parameters that would improve the selection of patients who would benefit from pre-operative echocardiograms.


Assuntos
Ecocardiografia/normas , Cardiopatias/prevenção & controle , Fraturas do Quadril/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/normas , Idoso de 80 Anos ou mais , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Fraturas do Quadril/cirurgia , Humanos , Incidência , Masculino , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco
15.
Bone Joint J ; 103-B(2): 264-270, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517718

RESUMO

AIMS: Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients. METHODS: This study investigated time to surgery and 60-day post-admission death of patients 70 years and older admitted for acute hip fracture surgery in Norway between 2008 and 2016. The proportion of hospital capacity being occupied by newly admitted surgical patients was used as the exposure. Hip fracture patients admitted during periods of high proportion of recent admissions were compared with hip fracture patients admitted at the same hospital during the same month, on similar weekdays, and times of the day with fewer admissions. RESULTS: Among 60,072 patients, mean age was 84.6 years (SD 6.8), 78% were females, and median time to surgery was 20 hours (IQR 11 to 29). Overall, 14% (8,464) were dead 60 days after admission. A high (75th percentile) proportion of recent surgical admission compared to a low (25th percentile) proportion resulted in 20% longer time to surgery (95% confidence interval (CI) 16 to 25) and 20% higher 60-day mortality (hazard ratio 1.2, 95% CI 1.1 to 1.4). CONCLUSION: A high volume of recently admitted acute surgical patients, indicating probable competition for surgical resources, was associated with delayed surgery and increased 60-day mortality. Cite this article: Bone Joint J 2021;103-B(2):264-270.


Assuntos
Fixação de Fratura/estatística & dados numéricos , Recursos em Saúde/provisão & distribução , Fraturas do Quadril/cirurgia , Hospitalização/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas do Quadril/mortalidade , Humanos , Masculino , Noruega/epidemiologia , Resultado do Tratamento
16.
Cochrane Database Syst Rev ; 2: CD009651, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33625743

RESUMO

BACKGROUND: Fractures of the patella (kneecap) account for around 1% of all human fractures. The treatment of these fractures can be surgical or conservative (such as immobilisation with a cast or brace). There are many different surgical and conservative interventions for treating fractures of the patella in adults. This is an update of a Cochrane Review first published in 2015. OBJECTIVES: To assess the effects (benefits and harms) of interventions (surgical and conservative) for treating fractures of the patella in adults. SEARCH METHODS: We searched CENTRAL (2020, Issue 1), MEDLINE, Embase, LILACS, trial registers and references lists of articles to January 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) or quasi-RCTs that evaluated any surgical or conservative intervention for treating adults with fractures of the patella. The primary outcomes were patient-rated knee function, knee pain and major adverse outcomes. DATA COLLECTION AND ANALYSIS: At least two review authors independently selected eligible trials, assessed risk of bias and cross-checked data extraction. Where appropriate, we pooled results of comparable trials. MAIN RESULTS: We included 11 small trials involving 564 adults (aged 16 to 76 years) with patella fractures. There were 340 men and 212 women; the gender of 12 participants was not reported. Seven trials were conducted in China and one each in Finland, Mexico, Pakistan and Turkey. All 11 trials compared different surgical interventions for patella fractures. All trials had design flaws, such as lack of assessor blinding, which put them at high risk of bias, potentially limiting the reliability of their findings. No trial reported on health-related quality of life, return to previous activity or cosmetic appearance. The trials tested one of seven comparisons. In the following, we report those of the main outcomes for which evidence was available for the three most important comparisons. Four trials (174 participants) compared percutaneous osteosynthesis versus open surgery. Very low-quality evidence means that we are uncertain of the findings of no clinically important difference between the two interventions in patient-rated knee function at 12 months (1 study, 50 participants) or in knee pain at intermediate-term follow-up at eight weeks to three months. Furthermore, very low-quality evidence means we are uncertain whether, compared with open surgery, percutaneous fixation surgery reduces the incidence of major adverse outcomes, such as loss of reduction and hardware complications, or results in better observer-rated knee function scores. Two trials (112 participants) compared cable pin system (open or percutaneous surgery) versus tension band technique. The very low-quality evidence means we are uncertain of the findings at one year in favour of the cable pin system of slightly better patient-rated knee function, fewer adverse events and slightly better observer-rated measures of knee function. There was very low-quality evidence of little clinically important between-group difference in knee pain at three months. Very low-quality evidence from two small trials (47 participants) means that we are uncertain of the findings of little difference between biodegradable versus metallic implants at two-year follow-up in the numbers of participants with occasional knee pain, incurring adverse events or with reduced knee motion. There was very low-quality and incomplete evidence from single trials for four other comparisons. This means we are uncertain of the results of one trial (28 participants) that compared patellectomy with advancement of vastus medialis obliquus surgery with simple patellectomy; of one quasi-RCT (56 participants) that compared a new intraoperative reduction technique compared with a standard technique; of one quasi-RCT (65 participants) that compared a modified tension band technique versus the conventional AO tension band wiring (TBW) technique; and of one trial (57 participants) that compared adjustable patella claws and absorbable suture versus Kirschner wire tension band. AUTHORS' CONCLUSIONS: There is very limited evidence from nine RCTs and two quasi-RCTs on the relative effects of different surgical interventions for treating fractures of the patella in adults. There is no evidence from trials evaluating the relative effects of surgical versus conservative treatment or different types of conservative interventions. Given the very low-quality evidence, we are uncertain whether methods of percutaneous osteosynthesis give better results than conventional open surgery; whether cable pin system (open or percutaneous surgery) gives better results than the tension band technique; and whether biodegradable implants are better than metallic implants for displaced patellar fractures. Further randomised trials are needed, but, to optimise research effort, these should be preceded by research that aims to identify priority questions.


Assuntos
Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Patela/lesões , Adolescente , Adulto , Idoso , Feminino , Fixação de Fratura/instrumentação , Fraturas Cominutivas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
17.
Ann Palliat Med ; 10(1): 194-201, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33545756

RESUMO

BACKGROUND: The incidence of subglottic stenosis is rising year by year. For this difficult clinical problem, the efficacies of surgical and bronchoscopic intervention treatments vary. A simple and effective method to affix silicone stents is needed for the treatment of subglottic stenosis. METHODS: Eight patients suffering from subglottic stenosis underwent straight silicone stent placement with external fixation in the First Affiliated Hospital of Chengdu Medical College between January 2015 and August 2019. All patients received regular postoperative bronchoscopy. A retrospective analysis was conducted to analyze the efficacy and complications of the operation. RESULTS: Straight silicone stent placement was successful in seven patients and the external fixation of stents was completed. Symptoms of dyspnea were resolved in seven cases (87.5%), and the mean diameter of the upper trachea was significantly increased from 3.54±0.59 to 12.71±2.42 mm after the operation (t=15.78, P=0.002). The modified Medical Research Council dyspnea scale score significantly decreased from 3.4 (2.7, 3.8) to 0.8 (0.4, 1.4) after the operation (Z=-6.63, P=0.001). Postoperative complications were observed, including one case of mediastinal emphysema and pneumothorax, two cases of granulation tissue hyperplasia, four cases of intractable cough, six cases of postoperative infection at the external fixation site, one case of postoperative bleeding, and one case of sputum retention. All were promptly treated and quickly controlled. No stent displacement was observed during follow-up. CONCLUSIONS: External fixation of straight silicon stents for the treatment of subglottic stenosis had good short-term outcomes and stable stent fixation. The proportion of postoperative infections was high. Therefore, the advantages and disadvantages of this operation need to be considered.


Assuntos
Estenose Traqueal , Constrição Patológica , Fixadores Externos , Fixação de Fratura , Humanos , Estudos Retrospectivos , Silicones , Stents
18.
J Trauma Acute Care Surg ; 90(3): 451-458, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33559982

RESUMO

BACKGROUND: Surgical stabilization of rib fracture (SSRF) is increasingly used to manage patients with rib fractures. Benefits of performing SSRF appear variable, and the procedure is costly, necessitating cost-effectiveness analysis for distinct subgroups. We aimed to assess the cost-effectiveness of SSRF versus nonoperative management among patients with rib fractures younger than 65 years versus 65 years or older, with versus without flail chest. We hypothesized that, compared with nonoperative management, SSRF is cost-effective only for patients with flail chest. METHODS: This economic evaluation used a decision-analytic Markov model with a lifetime time horizon incorporating US population-representative inputs to simulate benefits and risks of SSRF compared with nonoperative management. We report quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios. Deterministic and probabilistic sensitivity analyses accounted for most plausible clinical scenarios. RESULTS: Compared with nonoperative management, SSRF was cost-effective for patients with flail chest at willingness-to-pay threshold of US $150,000/QALY gained. Surgical stabilization of rib fracture costs US $25,338 and US $123,377/QALY gained for those with flail chest younger than 65 years and 65 years or older, respectively. Surgical stabilization of rib fracture was not cost-effective for patients without flail chest, costing US $172,704 and US $243,758/QALY gained for those younger than 65 years and 65 years or older, respectively. One-way sensitivity analyses showed that, under most plausible scenarios, SSRF remained cost-effective for subgroups with flail chest, and nonoperative management remained cost-effective for patients older than 65 years without flail chest. Probability that SSRF is cost-effective ranged from 98% among patients younger than 65 years with flail chest to 35% among patients 65 years or older without flail chest. CONCLUSIONS: Surgical stabilization of rib fracture is cost-effective for patients with flail chest. Surgical stabilization of rib fracture may be cost-effective in some patients without flail chest, but delineating these patients requires further study. LEVEL OF EVIDENCE: Economic/decision, level II.


Assuntos
Tórax Fundido/complicações , Tórax Fundido/cirurgia , Fixação de Fratura/economia , Fraturas das Costelas/complicações , Fraturas das Costelas/cirurgia , Fatores Etários , Idoso , Análise Custo-Benefício , Feminino , Tórax Fundido/economia , Humanos , Tempo de Internação , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Fraturas das Costelas/economia , Sensibilidade e Especificidade , Resultado do Tratamento
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(2): 144-148, 2021 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-33624464

RESUMO

Objective: To investigate the effectiveness of suspensory external fixation technique in treatment of proximal humeral fractures. Methods: Between August 2013 and October 2018, 14 patients with proximal humeral fractures were treated with suspensory external fixation technique. There were 10 males and 4 females with an average age of 55.9 years (range, 43-76 years). There were 10 cases of falling injury and 4 cases of traffic accident injury. Among them, there were 9 cases of Neer type Ⅲ and 5 cases of Neer type Ⅳ. The time from injury to operation was 3-7 days (mean, 4.6 days). Nine cases were complicated with osteoporosis. The preoperative visual analogue scale (VAS) score was 6.1±1.2. The effectiveness was comprehensively evaluated by hospital stay, fracture healing time, removal time of external fixator, postoperative complications, VAS score, and Neer score of shoulder joint function. Results: All operations were successfully completed, and the hospital stay was 6-14 days, with an average of 9.4 days. All the incisions healed by first intention, and no infection or other complications occurred. All patients were followed up 16-60 months (mean, 35.4 months). X-ray films examination showed that all fractures healed, the healing time was 4-7 months (mean, 4.9 months). The removal time of external fixator was 5-8 months (mean, 6.3 months). VAS scores were 1.5±0.8 at 1 month after operation and 1.0±0.9 at last follow-up, both of which were significantly improved when compared with preoperative score, the differences were significant between different time points ( P<0.05). Neer score of shoulder joint function was 75-100 (mean, 91.1); 9 cases were excellent, 4 cases were good, and 1 case was fair. The excellent and good rate was 92.9%. During follow-up, there was no adverse events such as acromion impingement, nonunion, or pseudoarthrosis. Conclusion: For proximal humeral fractures, the suspensory external fixation technique is a simple and reliable treatment method that can significantly improve joint function.


Assuntos
Fixadores Externos , Fraturas do Ombro , Adulto , Idoso , Feminino , Fixação de Fratura , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Ombro/cirurgia , Resultado do Tratamento
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(2): 195-199, 2021 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-33624473

RESUMO

Objective: To investigate the effectiveness of the nose ring drain (NRD) technique combined with Ilizarov circular external fixation in treatment of Gustilo ⅢA Pilon fracture. Methods: Between March 2017 and December 2019, 17 patients with Gustilo ⅢA Pilon fractures were admitted and treated with NRD technique combined with Ilizarov circular external fixation. Among them, there were 11 males and 6 females; the age ranged from 24 to 63 years, with an average of 38.2 years. There were 3 cases of traffic accident injury, 13 cases of falling injury, and 1 case of penetrating injury. There were 13 cases of emergency admittance and 4 cases of wound infection after surgical treatment. Furthermore, there were 2 cases of fibula fractures and 3 cases of lateral malleolus fractures. Results: All patients were followed up 8-12 months, with an average of 9.9 months. All wounds healed by first intention, and 4 patients with preoperative infection had no recurrence during the follow-up. The external fixator was removed after fracture healing in 17 patients at 3-7 months after operation (mean, 4.5 months). At last follow-up, the pain score of the ankle joint Kofoe score was 40-50, with an average of 44; the functional score was 17-27, with an average of 25; the mobility score was 8-18, with an average of 14; and the effectiveness was rated as excellent in 8 cases, good in 7 cases, and poor in 1 case. Conclusion: For Gustilo ⅢA Pilon fractures, the NRD technique combined with Ilizarov circular external fixation has advantages of good fracture fixation and drainage effects, which greatly reduces the complications of traditional treatment options and the number of operations.


Assuntos
Fraturas do Tornozelo , Adulto , Drenagem , Fixadores Externos , Feminino , Fixação de Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...