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1.
Orthop Clin North Am ; 51(2): 189-205, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138857

RESUMO

Hip fractures are of great interest worldwide as the geriatric population continues to increase rapidly. Currently, surgeons prefer to use cephalomedullary nail for internal fixation of pertrochanteric/intertrochanteric fractures. This article summarizes 10 concepts in hip fracture treatment over the past 20 years, including fracture line mapping, proximal lateral wall and anterior cortex, posteromedial lesser trochanter-calcar fragment, anteromedial cortex support reduction, changes of fracture reduction after sliding and secondary stability, nail entry point and wedge-open deformity, tip-apex distance and calcar-referenced tip-apex distance, femoral anterior bowing and nail modification, long nails for wide medullary canal and large posterior coronal fragment, and postoperative stability score.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Quadril/cirurgia , Ásia , Fixação de Fratura , Fixação Interna de Fraturas/educação , Fixação Interna de Fraturas/instrumentação , Fraturas do Quadril/diagnóstico por imagem , Humanos
2.
Medicine (Baltimore) ; 99(9): e19328, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118764

RESUMO

We assessed factors associated with premature physeal closure (PPC) and outcomes after closed reduction of Salter-Harris type II (SH-II) fractures of the distal tibia. We reviewed patients with SH-II fractures of the distal tibia treated at our center from 2010 to 2015 with closed reduction and a non-weightbearing long-leg cast. Patients were categorized by immediate postreduction displacement: minimal, <2 mm; moderate, 2 to 4 mm; or severe, >4 mm. Demographic data, radiographic data, and Lower Extremity Functional Scale (LEFS) scores were recorded.Fifty-nine patients (27 girls, 31 right ankles, 26 concomitant fibula fractures) were included, with a mean (±SD) age at injury of 12.0 ±â€Š2.2 years. Mean maximum fracture displacements were 6.6 ±â€Š6.5 mm initially, 2.7 ±â€Š2.0 mm postreduction, and 0.4 ±â€Š0.7 mm at final follow-up. After reduction, displacement was minimal in 23 patients, moderate in 21, and severe in 15. Fourteen patients developed PPC, with no significant differences between postreduction displacement groups. Patients with high-grade injury mechanisms and/or initial displacement ≥4 mm had 12-fold and 14-fold greater odds, respectively, of PPC. Eighteen patients responded to the LEFS survey (mean 4.0 ±â€Š2.1 years after injury). LEFS scores did not differ significantly between postreduction displacement groups (P = .61).The PPC rate in this series of SH-II distal tibia fractures was 24% and did not differ by postreduction displacement. Initial fracture displacement and high-grade mechanisms of injury were associated with PPC. LEFS scores did not differ significantly by postreduction displacement.Level of Evidence: Level IV, case series.


Assuntos
Fixação de Fratura/normas , Fraturas Salter-Harris/terapia , Adolescente , Criança , Feminino , Fixação de Fratura/métodos , Fixação de Fratura/estatística & dados numéricos , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Tíbia/anatomia & histologia , Tíbia/lesões , Tíbia/fisiopatologia , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(10): e19449, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150100

RESUMO

Radial external fixator has been proposed to treat delayed irreducible Gartland type III supracondylar humeral fracture, and this study aims to compare its effects with crossed pinning in a retrospective fashion. Delayed supracondylar humeral fracture is defined as more than 72 hours after injury, 2 or more than 2 times failed attempts of closed reduction can be deemed as irreducible fracture.Between January 2010 and January 2017, patients of Gartland type III supracondylar fractures of the humerus receiving surgery were all selected and reviewed. Overall, 39 patients fitting the inclusion criteria were chosen for the External Fixator Group and patients for control group of crossed pinning with matched age, sex, and clinical parameters (fracture location, injured side, and fracture type) were selected from the database. Surgery duration, number of intraoperative X-ray images, incidence of ulnar nerve injury, postoperative redisplacement, and function of the elbow joint were recorded and analyzed.In this study, 39 patients treated with radial external fixator had significantly shorter surgery duration, fewer intraoperative X-ray images, and lower incidence of ulnar nerve injury, and postoperative redisplacement than those receiving crossed pinning. Patients in 2 groups displayed similar range of motion for elbow joint at follow-up.Radial external fixator is an effective and safe method to treat Gartland type III supracondylar fractures that were diagnosed late.


Assuntos
Pinos Ortopédicos , Fixadores Externos , Fixação de Fratura/instrumentação , Fraturas do Úmero/cirurgia , Criança , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(7): e17763, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049775

RESUMO

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


Assuntos
Fixação de Fratura/instrumentação , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Fios Ortopédicos , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Masculino , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Fraturas da Ulna/diagnóstico por imagem
5.
Instr Course Lect ; 69: 449-464, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017745

RESUMO

Proximal tibia fractures including intra-articular plateau fractures are complex injuries that benefit from an algorithmic approach in terms of treatment to optimize outcomes and minimize complications. Certainly, nonsurgical treatment will be an option for some injuries; however, this chapter will focus on those injuries best addressed with surgicalsurgical treatment. Indications for surgical treatment include joint incongruity, joint instability and limb malalignment. In regard to surgical treatment, important considerations include appropriate management of the soft-tissue envelope, staged provisional reduction and stabilization versus immediate definitive fixation, single versus multiple surgical approaches, unilateral versus bicondylar fixation, and treatment of concomitant fracture-dislocation. This chapter describes surgical approaches to the proximal tibia ranging from the standard anterolateral to complex dual approaches or posterior approaches. Soft-tissue management becomes important due to the high-energy nature of these injuries with trauma both at the time of injury and then the surgical insult. Learning to identify and minimize these risks as well as addressing the soft-tissue defects that may require treatment is highlighted. Implant selection and fixation options for bicondylar plateau fractures will be discussed. Finally, use of nails, especially suprapatellar nails for proximal extra-articular proximal tibia fractures is described.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Fraturas da Tíbia , Fixação de Fratura , Fixação Interna de Fraturas , Humanos , Tíbia
6.
Bone Joint J ; 102-B(1): 26-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888373

RESUMO

AIMS: Open fractures of the tibia are a heterogeneous group of injuries that can present a number of challenges to the treating surgeon. Consequently, few surgeons can reliably advise patients and relatives about the expected outcomes. The aim of this study was to determine whether these outcomes are predictable by using the Ganga Hospital Score (GHS). This has been shown to be a useful method of scoring open injuries to inform wound management and decide between limb salvage and amputation. METHODS: We collected data on 182 consecutive patients with a type II, IIIA, or IIIB open fracture of the tibia who presented to our hospital between July and December 2016. For the purposes of the study, the patients were jointly treated by experienced consultant orthopaedic and plastic surgeons who determined the type of treatment. Separately, the study team (SP, HS, AD, JD) independently calculated the GHS and prospectively collected data on six outcomes for each patient. These included time to bony union, number of admissions, length of hospital stay, total length of treatment, final functional score, and number of operations. Spearman's correlation was used to compare GHS with each outcome. Forward stepwise linear regression was used to generate predictive models based on components of the GHS. Five-fold cross-validation was used to prevent models from over-fitting. RESULTS: The mean follow-up was 11.4 months (3 to 31). The mean time to union was 9.7 months (3 to 21), the mean number of operations was 2.8 (1 to 11), the mean time in hospital was 17.7 days (5 to 84), the mean length of treatment was 92.7 days (5 to 730), the mean number of admissions was 1.7 (1 to 6), and the mean functional score (Lower Extremity Functional Score (LEFS)) was 60.13 (33 to 80). There was a significant correlation between the GHS and each of the outcome measures. A predictive model was generated from which the GHS could be used to predict the various outcome measures. CONCLUSION: The GHS can be used to predict the outcome of patients who present with an open fracture of the tibia. Our model generates a numerical value for each outcome measure that can be used in clinical practice to inform the treating team and to advise patients. Cite this article: Bone Joint J 2020;102-B(1):26-32.


Assuntos
Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fixação de Fratura/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
7.
Bone Joint J ; 102-B(1): 33-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888365

RESUMO

AIMS: The aim of this study was to explore whether time to surgery affects functional outcome in displaced proximal humeral fractures. METHODS: A total of 250 patients presenting within three weeks of sustaining a displaced proximal humeral fracture involving the surgical neck were recruited at 32 acute NHS hospitals in the United Kingdom between September 2008 and April 2011. Of the 125 participants, 109 received surgery (fracture fixation or humeral head replacement) as per randomization. Data were included for 101 and 67 participants at six-month and five-year follow-up, respectively. Oxford Shoulder Scores (OSS) collected at six, 12, and 24 months and at three, four, and five years following randomization was plotted against time to surgery. Long-term recovery was explored by plotting six-month scores against five-year scores and agreement was illustrated with a Bland-Altman plot. RESULTS: The mean time from initial trauma to surgery was 10.5 days (1 to 33). Earlier surgical intervention did not improve OSS throughout follow-up, nor when stratified by participant age (< 65 years vs ≥ 65 years) and fracture severity (one- and two-part vs three- and four-part fractures). Participants managed later than reported international averages (three days in the United States and Germany, eight days in the United Kingdom) did not have worse outcomes. At five-year follow-up, 50 participants (76%) had the same or improved OSS compared with six months (six-month mean OSS 35.8 (SD 10.0); five-year mean OSS 40.1 (SD 9.1); r = 0.613). A Bland-Altman plot demonstrated a positive mean difference (3.3 OSS points (SD 7.92)) with wide 95% limits of agreement (-12.2 and 18.8 points). CONCLUSION: Timing of surgery did not affect OSS at any stage of follow-up, irrespective of age or fracture type. Most participants had maximum functional outcome at six months that was maintained at five years. These findings may help guide providers of trauma services on surgical prioritization. Cite this article: Bone Joint J 2020;102-B(1):33-41.


Assuntos
Fraturas do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Seguimentos , Fixação de Fratura/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Tempo para o Tratamento
8.
J Trauma Acute Care Surg ; 88(2): 249-257, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31804414

RESUMO

BACKGROUND: The efficacy of surgical stabilization of rib fracture (SSRF) in patients without flail chest has not been studied specifically. We hypothesized that SSRF improves outcomes among patients with displaced rib fractures in the absence of flail chest. METHODS: Multicenter, prospective, controlled, clinical trial (12 centers) comparing SSRF within 72 hours to medical management. Inclusion criteria were three or more ipsilateral, severely displaced rib fractures without flail chest. The trial involved both randomized and observational arms at patient discretion. The primary outcome was the numeric pain score (NPS) at 2-week follow-up. Narcotic consumption, spirometry, pulmonary function tests, pleural space complications (tube thoracostomy or surgery for retained hemothorax or empyema >24 hours from admission) and both overall and respiratory disability-related quality of life (RD-QoL) were also compared. RESULTS: One hundred ten subjects were enrolled. There were no significant differences between subjects who selected randomization (n = 23) versus observation (n = 87); these groups were combined for all analyses. Of the 110 subjects, 51 (46.4%) underwent SSRF. There were no significant baseline differences between the operative and nonoperative groups. At 2-week follow-up, the NPS was significantly lower in the operative, as compared with the nonoperative group (2.9 vs. 4.5, p < 0.01), and RD-QoL was significantly improved (disability score, 21 vs. 25, p = 0.03). Narcotic consumption also trended toward being lower in the operative, as compared with the nonoperative group (0.5 vs. 1.2 narcotic equivalents, p = 0.05). During the index admission, pleural space complications were significantly lower in the operative, as compared with the nonoperative group (0% vs. 10.2%, p = 0.02). CONCLUSION: In this clinical trial, SSRF performed within 72 hours improved the primary outcome of NPS at 2-week follow-up among patients with three or more displaced fractures in the absence of flail chest. These data support the role of SSRF in patients without flail chest. LEVEL OF EVIDENCE: Therapeutic, level II.


Assuntos
Fixação de Fratura/métodos , Fraturas Múltiplas/cirurgia , Hemotórax/epidemiologia , Dor Pós-Operatória/diagnóstico , Fraturas das Costelas/cirurgia , Adolescente , Adulto , Idoso , Feminino , Fraturas Múltiplas/complicações , Fraturas Múltiplas/diagnóstico , Hemotórax/etiologia , Hemotórax/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/terapia , Estudos Prospectivos , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico , Índices de Gravidade do Trauma , Resultado do Tratamento , Adulto Jovem
9.
J Surg Res ; 246: 123-130, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31569034

RESUMO

BACKGROUND: National changes in health care disparities within the setting of trauma care have not been examined within Accountable Care Organizations (ACOs) or non-ACOs. We sought to examine the impact of ACOs on post-treatment outcomes (in-hospital mortality, 90-day complications, and readmissions), as well as surgical intervention among whites and nonwhites treated for spinal fractures. MATERIALS AND METHODS: We identified all beneficiaries treated for spinal fractures between 2009 and 2014 using national Medicare fee for service claims data. Claims were used to identify sociodemographic and clinical criteria, receipt of surgery and in-hospital mortality, 90-day complications, and readmissions. Multivariable logistic regression analysis accounting for all confounders was used to determine the effect of race/ethnicity on outcomes. Nonwhites were compared with whites treated in non-ACOs between 2009 and 2011 as the referent. RESULTS: We identified 245,704 patients who were treated for spinal fractures. Two percent of the cohort received care in an ACO, whereas 7% were nonwhite. We found that disparities in the use of surgical fixation for spinal fractures were present in non-ACOs over the period 2009-2014 but did not exist in the context of care provided through ACOs (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.44, 1.28). A disparity in the development of complications existed for nonwhites in non-ACOs (OR 1.09; 95% CI 1.01, 1.17) that was not encountered among nonwhites receiving care in ACOs (OR 1.32; 95% CI 0.90, 1.95). An existing disparity in readmission rates for nonwhites in ACOs over 2009-2011 (OR 1.34; 95% CI 1.01, 1.80) was eliminated in the period 2012-2014 (OR 0.85; 95% CI 0.65, 1.09). CONCLUSIONS: Our work reinforces the idea that ACOs could improve health care disparities among nonwhites. There is also the potential that as ACOs become more familiar with care integration and streamlined delivery of services, further improvements in disparities could be realized.


Assuntos
Organizações de Assistência Responsáveis/estatística & dados numéricos , Fixação de Fratura/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Organizações de Assistência Responsáveis/economia , Idoso , Idoso de 80 Anos ou mais , Grupos de Populações Continentais/estatística & dados numéricos , Redução de Custos/economia , Redução de Custos/estatística & dados numéricos , Grupos Étnicos , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/economia , Gastos em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/organização & administração , Mortalidade Hospitalar , Humanos , Masculino , Medicare/economia , Medicare/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade/estatística & dados numéricos , Fatores Socioeconômicos , Fraturas da Coluna Vertebral/economia , Estados Unidos/epidemiologia
10.
World Neurosurg ; 133: 227-236, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574326

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is a common public health problem. The optimal timing of fracture fixation in patients with TBI has remained controversial. We conducted a meta-analysis to quantitatively discuss the effects of fixation timing on the prognosis of patients with extremity fracture and concomitant TBI. METHODS: A systematic search was performed in PubMed, EMBASE, the Cochrane Library and 4 Chinese databases from the inception date to May 19, 2019. Randomized controlled trials and cohort studies comparing early and late fracture fixation in adults with TBI concomitant with extremity fractures were selected. The risk ratio (RR) and standardized mean difference were calculated. RESULTS: A total of 14 cohort studies involving 1046 patients fulfilled our criteria. No statistically significant association was found between fixation timing and mortality rate (RR, 1.34; 95% confidence interval [CI], 0.89-2.01). No significant association was found between fracture fixation timing and the incidence of death among the patients with severe TBI (RR, 1.82; 95% CI, 0.50-6.66), moderate or more serious TBI (RR, 3.78; 95% CI, 0.53-26.78), and unrestricted TBI type (RR, 0.80; 95% CI, 0.38-1.68). No significant association was found between fracture fixation timing and neurologic complications (RR, 0.71; 95% CI, 0.45-1.11). When the cutoff for fixation timing was set at 14 days, the incidence of nonunion or malunion in the earlier fixation group was lower than that in the later fixation group (RR, 0.39; 95% CI, 0.17-0.91). CONCLUSION: Late fracture fixation conducted >14 days after injury was associated with nonunion or malunion. Fixation performed within 24 hours did not influence mortality or adverse neurologic events.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Fixação de Fratura/efeitos adversos , Fraturas Ósseas/complicações , Humanos , Prognóstico , Fatores de Tempo , Resultado do Tratamento
11.
Vet Clin North Am Small Anim Pract ; 50(1): 1-15, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31635916

RESUMO

This article reviews the biomechanical parameters of fracture repair that influence construct stiffness and strength. The stiffness influences the relative motion between fracture fragments, known as gap strain, and, thus, callus development. Construct strength determines the magnitude and number of load events that the repair can resist before failure. Surgeons must optimize these parameters in order to achieve satisfactory outcomes for the patients.


Assuntos
Fixação de Fratura/veterinária , Fraturas Ósseas/veterinária , Animais , Fenômenos Biomecânicos , Osso e Ossos/fisiologia , Consolidação da Fratura/fisiologia
12.
BMJ ; 367: l6395, 2019 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801725

RESUMO

OBJECTIVE: To investigate whether remote ischaemic preconditioning (RIPC) prevents myocardial injury in patients undergoing hip fracture surgery. DESIGN: Phase II, multicentre, randomised, observer blinded, clinical trial. SETTING: Three Danish university hospitals, 2015-17. PARTICIPANTS: 648 patients with cardiovascular risk factors undergoing hip fracture surgery. 286 patients were assigned to RIPC and 287 were assigned to standard practice (control group). INTERVENTION: The RIPC procedure was initiated before surgery with a tourniquet applied to the upper arm and consisted of four cycles of forearm ischaemia for five minutes followed by reperfusion for five minutes. MAIN OUTCOME MEASURES: The original primary outcome was myocardial injury within four days of surgery, defined as a peak plasma cardiac troponin I concentration of 45 ng/L or more caused by ischaemia. The revised primary outcome was myocardial injury within four days of surgery, defined as a peak plasma cardiac troponin I concentration of 45 ng/L or more or high sensitive troponin I greater than 24 ng/L (the primary outcome was changed owing to availability of testing). Secondary outcomes were peak plasma troponin I and total troponin I release during the first four days after surgery (cardiac and high sensitive troponin I), perioperative myocardial infarction, major adverse cardiovascular events, and all cause mortality within 30 days of surgery, length of postoperative stay, and length of stay in the intensive care unit. Several planned secondary outcomes will be reported elsewhere. RESULTS: 573 of the 648 randomised patients were included in the intention-to-treat analysis (mean age 79 (SD 10) years; 399 (70%) women). The primary outcome occurred in 25 of 168 (15%) patients in the RIPC group and 45 of 158 (28%) in the control group (odds ratio 0.44, 95% confidence interval 0.25 to 0.76; P=0.003). The revised primary outcome occurred in 57 of 286 patients (20%) in the RIPC group and 90 of 287 (31%) in the control group (0.55, 0.37 to 0.80; P=0.002). Myocardial infarction occurred in 10 patients (3%) in the RIPC group and 21 patients (7%) in the control group (0.46, 0.21 to 0.99; P=0.04). Statistical power was insufficient to draw firm conclusions on differences between groups for the other clinical secondary outcomes (major adverse cardiovascular events, 30 day all cause mortality, length of postoperative stay, and length of stay in the intensive care unit). CONCLUSIONS: RIPC reduced the risk of myocardial injury and infarction after emergency hip fracture surgery. It cannot be concluded that RIPC overall prevents major adverse cardiovascular events after surgery. The findings support larger scale clinical trials to assess longer term clinical outcomes and mortality. TRIAL REGISTRATION: ClinicalTrials.gov NCT02344797.


Assuntos
Fixação de Fratura/efeitos adversos , Traumatismos Cardíacos/prevenção & controle , Fraturas do Quadril/cirurgia , Precondicionamento Isquêmico Miocárdico/métodos , Complicações Pós-Operatórias/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Tratamento de Emergência , Feminino , Traumatismos Cardíacos/etiologia , Humanos , Análise de Intenção de Tratamento , Masculino , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , Complicações Pós-Operatórias/etiologia , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento
14.
Bone Joint J ; 101-B(12): 1512-1519, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31787006

RESUMO

AIMS: The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. PATIENTS AND METHODS: A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible. RESULTS: The mean MEPS was 88.9 (40 to 100), mean OES was 40.1 (25 to 48), mean MMWS was 88.1 (50 to 100), mean DASH score was 14.7 (0 to 60.2), and mean movement was 114° (sd 27) in extension/flexion and 155° (sd 37) in pronation/supination. Mason III fractures, particularly those with an associated coronoid fracture treated with RHA, had a significantly poorer outcome. Suboptimal results were also identified in patients who had degenerative changes or heterotopic ossification on their latest radiograph. In contrast, all patients with successful radial head reconstruction or excision had a good outcome. CONCLUSION: Good outcomes can be achieved in Monteggia-like lesions with Mason II and III fractures, when reconstruction is possible. Otherwise, RHA is a reliable option with satisfactory outcomes, especially in patients with ligamenteous instability. Whether the radial head should be excised remains debatable, although good results were achieved in patients with ligamentous stability and in those with complications after RHA. Cite this article: Bone Joint J 2019;101-B:1512-1519.


Assuntos
Fixação de Fratura/métodos , Fratura de Monteggia/cirurgia , Rádio (Anatomia)/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fratura de Monteggia/diagnóstico por imagem , Avaliação de Resultados da Assistência ao Paciente , Rádio (Anatomia)/lesões , Estudos Retrospectivos , Resultado do Tratamento
15.
Zhongguo Gu Shang ; 32(11): 1044-1047, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870054

RESUMO

OBJECTIVE: To investigate clinical effect of minimally invasive osteotomy and external fixation with the center of roration of angulation (CORA) in treating cubitus varus in adolescents. METHODS: From August 2013 to August 2017, 15 patients with cubitus varus caused by supracondylar fracture of humerus were treated with minimally invasive osteotomy and external fixation with the CORA. Among them, including 9 males and 6 females; 11 patients on the left side and 4 patients on the right side; aged from 13 to 16 years old with an average of 14.5 years old. The time from injury to operation was for 6 to 10 years with an average of 7.5 years. Five patients had a history of recurrence after cubitus varus surgery. Correction time. fracture healing time, carrying angle were observed, Laupattarakasem standard was used to evaluate clinical effect. RESULTS: All patients were followed up from 12 to 30 months with an average of 24 months; correction time ranged from 3 to 5 weeks with an average of 4 weeks; fracture healing time ranged from 4 to 6 months with an average of 5 months; carrying angle before operation ranged from -12° to -23°, and improved 9° to 14° after operation. According to Laupattarakasem evaluation criteria, 11 patients got an excellent result, 3 good and 1 fair. CONCLUSIONS: Minimally invasive osteotomy and external fixation with CORA in treating cubitus varus deformity in adolescents has advantages of less trauma, less blood loss, earlier exercise, speed and angle of correction could controlled without hospitalized for fixation.


Assuntos
Articulação do Cotovelo , Fixação de Fratura , Fraturas do Úmero , Adolescente , Feminino , Humanos , Fraturas do Úmero/cirurgia , Úmero , Masculino , Rotação
16.
J Surg Orthop Adv ; 28(4): 250-256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886759

RESUMO

Pathologic fractures are associated with poor outcomes. This article investigated the prevalence of underestimation of risk by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Surgical Risk Calculator (SRC) in patients with pathologic humerus fractures. Two hundred seven (207) patients were identified and analyzed using the ACS-NSQIP SRC. Predicted and actual outcomes were then compared. Average hospitalization was 6 ± 10 days. Ten patients (5%) had a mild adverse event (AE), and 15 (7%) had a serious AE. The ACS-NSQIP SRC underestimated hospitalizations (p < 0.001), but not serious AE (p = 0.601), mild AE (p = 0.948), cardiac complications (p = 0.817), pneumonia (p = 0.713), surgical site infection (p = 0.692), urinary tract infection (p = 0.286), venous thromboembolism (p = 0.554), acute renal failure (p = 0.191), discharge to acute care facility (p = 0.865), readmission (p = 1.0), reoperation (0.956) or mortality (p = 0.872). Negative outcomes were limited in this cohort, and the SRC demonstrated acceptable accuracy. Future investigation of the calculator in other orthopaedic populations is warranted. (Journal of Surgical Orthopaedic Advances 28(4):250-256, 2019).


Assuntos
Fraturas Espontâneas , Melhoria de Qualidade , Fixação de Fratura , Humanos , Úmero , Complicações Pós-Operatórias , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
17.
Pan Afr Med J ; 33: 234, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692766

RESUMO

Introduction: Management of open fractures poses a constant challenge to Orthopaedic surgeons in Nigeria. Our aim is to determine the epidemiological pattern of open fractures in our centre and share our experiences on the initial management and problems encountered. Methods: This was an 18 month prospective study of patients that presented with open fractures at our emergency room. Already prepared data collection sheets were used to collect relevant data directly from patients and patients' files. Results: There were 58 open fractures in 52 patients (31 males and 21 females). Mean age of patients was 36.4 ± 12.2 years. Most patients (82.7%) fell within the age group of 20-49 years. Traders (28.9%) and students (19.6%) were mostly affected. Most open fractures (88.5%) were due to road traffic accidents. The tibia and fibula were the most frequently affected (44.4%). Most injuries were Gustilo et al. types IIIA & IIIB (79.3%) open fractures. Patients had initial resuscitation followed by debridement in 42 cases (72%). Fractures were initially stabilized with external fixators in 23 cases (39.7%) and cast slabs in 19 cases (32.8%). The average time between presentation and debridement was 30 hours and average hospital stay was 36 days. Forty two point five per cent of wounds were infected. Conclusion: Open fractures were mostly due to road traffic accidents and affected the tibia and fibula most frequently with Gustilo et al. types IIIA and IIIB forming the bulk of the injuries. Management was challenging with late presentations, scarcity of resources and consequent high rate of infections, prolonged morbidity and hospital stay. These problems were worsened by delay in antibiotic commencement and initial debridement, sub-optimal treatment at peripherial hospitals and mis-management by traditional bone setters.


Assuntos
Desbridamento/métodos , Fixadores Externos , Fixação de Fratura/métodos , Fraturas Expostas/cirurgia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Serviço Hospitalar de Emergência , Feminino , Fraturas Expostas/epidemiologia , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Estudos Prospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Fatores de Tempo , Adulto Jovem
18.
Bone Joint J ; 101-B(11): 1416-1422, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674252

RESUMO

AIMS: In this randomized study, we aimed to compare quality of regenerate in monolateral versus circular frame fixation in 30 patients with infected nonunion of tibia. PATIENTS AND METHODS: Both groups were comparable in demographic and injury characteristics. A phantom (aluminium step wedge of increasing thickness) was designed to compare the density of regenerate on radiographs. A CT scan was performed at three and six months postoperatively to assess regenerate density. A total of 30 patients (29 male, one female; mean age 32.54 years (18 to 60)) with an infected nonunion of a tibial fracture presenting to our tertiary institute between June 2011 and April 2016 were included in the study. RESULTS: The regenerate mineralization on radiographs was comparable in both groups at two, four, six, and ten months' follow-up but the rail fixator group had statistically significant higher grades of mineralization when compared with the circular frame group at eight and 12 months' follow-up. The regenerate mineralization was also higher in the rail fixator group than in the circular frame group on CT at three and six months, although this difference was not statistically significant. CONCLUSION: Overall, the regenerate mineralization was higher in the monolateral than the circular frame group. A monolateral fixator may be preferred in patients with infected nonunion of the tibia with bone defects up to 7 cm. Cite this article: Bone Joint J 2019;101-B:1416-1422.


Assuntos
Fraturas não Consolidadas/cirurgia , Osteogênese por Distração/métodos , Fraturas da Tíbia/cirurgia , Infecção dos Ferimentos/cirurgia , Adolescente , Adulto , Densidade Óssea/fisiologia , Desenho de Equipamento , Fixadores Externos , Feminino , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese por Distração/instrumentação , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Radiografia , Fraturas da Tíbia/diagnóstico por imagem , Infecção dos Ferimentos/diagnóstico por imagem , Adulto Jovem
19.
Medicine (Baltimore) ; 98(44): e10281, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689741

RESUMO

BACKGROUND: It is unclear whether surgery or conservative treatment is more suitable for elderly patients with type II and type III odontoid fractures. We performed this meta-analysis to compare the efficacy of surgical and conservative treatments for type II and type III odontoid fractures. METHODS: A literature search was performed in PubMed, Embase, Web of Science, and Cochrane Library in January 2017. Only articles comparing surgery with conservative treatment in elderly patients with type II and type III odontoid fractures were selected. After 2 authors independently assessed the retrieved studies, 18 articles were included in this meta-analysis, and the primary endpoints were the nonunion rate and mortality rate. The secondary outcomes were patient satisfaction, complications, and the length of the hospital stay. The quality of the included studies was evaluated using the modified Newcastle-Ottawa scale. Sensitivity analyses were performed for high-quality studies, and the publication bias was evaluated using a funnel plot. RESULTS: Lower nonunion (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.18-0.40, P < .05) and mortality rates (OR: 0.52, 95% CI: 0.34-0.79, P < .05) confirmed the superiority of surgery in treating type II and type III fractures. The secondary outcomes differed. Patients in the surgery group felt more satisfied with the outcome (OR: 3.44, 95% CI: 1.19-9.95, P < .05), and the complications were similar in the 2 groups (OR: 1.14, 95% CI: 0.78-1.68, P = .5), whereas patients in conservative groups spent less time in the hospital (OR: 5.10, 95% CI: 2.73-7.47, P < .05). The results of the subgroup analyses and sensitivity analysis were similar to the original outcomes, and no obvious publication bias was observed in the funnel plot. CONCLUSION: Most elderly (younger than 70 years) patients with type II or type III odontoid fractures should be considered candidates for surgical treatment, due to the higher union rate and lower mortality rate, while statistically significant differences were not observed in the population with an advanced age (older than 70 years). Therefore, the selection of the therapeutic approach for elderly patients with odontoid fractures requires further exploration. Simultaneously, based on our meta-analysis, a posterior arthrodesis treatment was significantly superior to the anterior odontoid screw treatment.


Assuntos
Tratamento Conservador/mortalidade , Fixação de Fratura/mortalidade , Processo Odontoide/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador/efeitos adversos , Tratamento Conservador/métodos , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Humanos , Tempo de Internação/estatística & dados numéricos , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Fraturas da Coluna Vertebral/classificação
20.
Medicine (Baltimore) ; 98(46): e17973, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725661

RESUMO

To elucidate the clinical outcomes of nonsurgical treatment for transcondylar fractures of the humerus.From April 2010 to March 2018, 32 elbows with AO classification 13A-2.3 transcondylar fractures of the humerus (extra-articular fracture, metaphyseal simple, transverse, transmetaphyseal) in adult patients were treated in our hospital and related facilities. Fifteen of 32 elbows were treated nonsurgically by immobilization with a long-arm cast or splint. Of these, 14 elbows that were followed up for >3 months were investigated. The patients comprised 6 men and 8 women with a mean age at the time of injury of 78 years. We investigated the follow-up period, duration until bone union, complications at final follow-up, radiological evaluation, elbow range of motion (ROM), total elbow joint range (Arc), and clinical outcome (Mayo Elbow Performance Score [MEPS]).The mean follow-up period was 8 months. The mean duration until bone union was 7 weeks. No significant complications were observed at the final examination. The ROM of the injured elbow joint was obtained in 13 patients. At the final follow-up, the mean extension and flexion of the injured elbow was -19.2° and 121.2°, respectively. The mean Arc of the injured elbow joint was 102.3°. Joint contracture (<120° flexion) was observed in 6 of the 13 elbows for which ROM was obtained. No patients complained of residual pain of the elbow joint. The mean MEPS was 93.1 points.There is no objection to the fact that displaced transcondylar fractures of the humerus should be treated surgically. However, significant numbers of intraoperative and postoperative complications of plate osteosynthesis have been reported. Until recently, although few clinical reports regarding nonsurgical treatment for these fractures have been published, several studies have indicated that nonsurgical treatment might be an alternative option for these fractures caused by low-energy trauma. In this study, we presented the radiographic and clinical outcomes of nonsurgical treatment for transcondylar fractures of the humerus. Our study suggests that nonsurgical treatment can be a good option for transcondylar fractures of the humerus.


Assuntos
Articulação do Cotovelo/cirurgia , Fixação de Fratura/métodos , Fraturas do Úmero/cirurgia , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Amplitude de Movimento Articular , Estudos Retrospectivos
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