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1.
Zhongguo Gu Shang ; 33(3): 203-8, 2020 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-32233244

RESUMO

OBJECTIVE: To compare clinical effects of calcaneal traction and external fixator fixation of fractional delayed surgery in treating type C Pilon fractures. METHODS: From January 2012 to December 2017, clinical data of 45 patients with tibial Pilon fractures were respectively analyzed. There were 24 patients in traction group, including 16 males and 8 females, aged from 21 to 57 years old with an average age of (38.6 ±10.5) years old; 18 patients caused by falling down, 6 patients caused by traffic accident; 15 patients on the left side and 9 patients on the right side; according to AO/OTA classification, 3 patients classified type C1, 9 patients classified type C2 and 12 patients classified type C3; treated by calcaneal traction on the first stage, and open reduction and internal fixation on the second stage. There were 21 patients in external fixation group, including 15 males and 6 females, aged from 19 to 58 years old with an average age of (37.8 ±11.2) years old; 17 patients caused by falling down, 4 patients caused by traffic accident; 11 patients on the left side and 10 patients on the right side; according to AO/OTA classification, 2 patients classified type C1, 8 patients classified type C2 and 11 patients classified type C3; treated by external fixator on the first stage, and open reduction and internal fixation on the second stage. All patients were closed fracture. Preoperative waiting time, hospital stays, operative time, postoperative complications, fracture reduction and healing time between two groups were compared, VAS score was used to evaluate relief of pain before internal fixation on the second stage, Burwell-Charnley radiological evaluation criteria was applied to evaluate fracture reduction after internal fixation, AOFAS score was used to evaluate recovery of ankle joint function. RESULTS: There were no statistical difference in operative time, following-up time and fracture healing time between two groups. VAS score before internal fixation in traction group was 3.73± 0.87, while in external fixation group was 2.67±0.69, there was statistical difference between two groups. Preoperative waiting time, and hospital stays in traction group were (9.20±1.40) d ,(12.30±3.60) d; while in external fixation group were (7.60± 1.50) d ,(10.80±2.60) d; and had significant difference between two groups. There was no difference in complications between two groups. According to Burwell-Charnley radiological evaluation criteria, 20 patients obtained anatomical reduction, and 4 patients received normal reduction in traction group; 18 patients obtained anatomical reduction, and 3 patients received normal reduction in external fixation group; while without difference between two groups. There was no difference between two groups in AOFAS score. CONCLUSION: For type C Pilon fractures, one-stage calcaneus traction or temporary external fixation also could achieve temporary fixation and provide better soft tissue conditions for the second stage internal fixation, and could receive better ankle joint function after internal fixation. The operation of calcaneus traction is simple, while external fixation may be increase the number of operation times, but external fixation has more advantages in reducing preoperative pain, shortening preoperative waiting days and hospitalization time than traction.


Assuntos
Traumatismos do Tornozelo , Calcâneo , Fraturas da Tíbia , Adulto , Estudos de Casos e Controles , Fixadores Externos , Feminino , Fixação de Fratura , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Tração , Resultado do Tratamento , Adulto Jovem
2.
Zhongguo Gu Shang ; 33(3): 288-92, 2020 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-32233263

RESUMO

Bone transportation technology (Ilizarov technique) effectively solves the clinical problem of chronic osteomyelitis with structural bone defect. The paper combined with own clinical experience and a large number of literatures, the results showed that this method had some complications related to severe bone healing, such as non union of the joint ends and poor mineralization of the extended gap. Maintenance of force line during operation, protection of osteotomy end tissues, appropriate transporting velocity and stress stimulation after operation, and application of "accordion technology" are the keys to reduce such complications. At present, there is still much controversy about the timing of removal of external fixator. Once the re fracture is caused by early removal, it must be treated actively as soon as possible. In addition, it is necessary to reduce the local thermal injury of nail canal during operation and strengthen the nursing of nail canal after operation in order to prevent nail canal infection. Reasonable analgesic regimen combined with active functional exercise is an important method to avoid the occurrence of adjacent joint dysfunction.


Assuntos
Técnica de Ilizarov , Osteomielite , Doença Crônica , Fixadores Externos , Humanos , Osteomielite/complicações , Tíbia , 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.
Zhonghua Yi Xue Za Zhi ; 100(5): 373-377, 2020 Feb 11.
Artigo em Chinês | MEDLINE | ID: mdl-32074782

RESUMO

Objective: To evaluate the postoperatively hidden blood loss of elderly intertrochanteric fracture patients fixed with combined external fixator, and to explore the correlation between hidden blood loss and age. Methods: A retrospective analysis was conducted on 60 elderly intertrochanteric fracture patients who were admitted to the Department of Orthopedics of Hebei Provincial Hospital from January 2016 to May 2019. All the fractures were fixed with combined external fixators. The patients were divided into two groups according to the age: there were 31 cases in group A (60-80 years old) and 29 cases in group B (≥80 years old). The Gross equation and the Nandler formula were used to evaluate the amount of hidden blood loss based on changes in hematocrit (Hct) at the day preoperatively, 3 days postoperatively and the weight. The data were compared between the two groups by independent-sample t test. Results: The decreased Hct, hemoglobin(Hb) and the dominant blood loss and hidden blood loss in group A and B was 3.4%±1.7%, (13±7) g/L, (25±6) ml, (186±7) ml and 3.8%±1.2%, (13±3) g/L, (24±8) ml, (194±7) ml, respectively. There was no significant differences in the dominant and hidden blood loss between the groups (t=0.309, 0.883, both P>0.05). Conclusion: The age doesn't affect the hidden blood loss in elderly intertrochanteric fracture patients fixed with combined external fixator, which indicated that the operation is safe and reliable for such patients.


Assuntos
Fraturas do Quadril , Idoso , Idoso de 80 Anos ou mais , Fixadores Externos , Hemorragia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
PLoS One ; 15(1): e0227975, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31968005

RESUMO

OBJECTIVES: Knee joint distraction (KJD) has been evaluated as a joint-preserving treatment to postpone total knee arthroplasty in knee osteoarthritis patients in three clinical trials. Since 2014 the treatment is used in regular care in some hospitals, which might lead to a deviation from the original indication and decreased treatment outcome. In this study, baseline characteristics, complications and clinical benefit are compared between patients treated in regular care and in clinical trials. METHODS: In our hospital, 84 patients were treated in regular care for 6 weeks with KJD. Surgical details, complications, and range of motion were assessed from patient hospital charts. Patient-reported outcome measures were evaluated in regular care before and one year after treatment. Trial patients (n = 62) were treated and followed as described in literature. RESULTS: Patient characteristics were not significantly different between groups, except for distraction duration (regular care 45.3±4.3; clinical trials 48.1±8.1 days; p = 0.019). Pin tract infections were the most occurring complication (70% regular care; 66% clinical trials), but there was no significant difference in treatment complications between groups (p>0.1). The range of motion was recovered within a year after treatment for both groups. WOMAC questionnaires showed statistically and clinically significant improvement for both groups (both p<0.001 and >15 points in all subscales) and no significant differences between groups (all differences p>0.05). After one year, 70% of patients were responders (regular care 61%, trial 75%; p = 0.120). Neither regular care compared to clinical trial, nor any other characteristic could predict clinical response. CONCLUSIONS: KJD as joint-preserving treatment in clinical practice, to postpone arthroplasty for end-stage knee osteoarthritis patient below the age of 65, results in an outcome similar to that thus far demonstrated in clinical trials. Longer follow-up in regular care is needed to test whether also long-term results remain beneficial and comparable to trial data.


Assuntos
Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Osteogênese por Distração/métodos , Osteogênese por Distração/normas , Adulto , Antibacterianos/administração & dosagem , Artroplastia do Joelho , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/fisiopatologia , Cartilagem Articular/cirurgia , Ensaios Clínicos como Assunto/normas , Fixadores Externos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/normas , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(4): e18636, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977853

RESUMO

RATIONALE: Knee osteoarthritis (KOA) is a common disease. It has long been believed that the main causes of KOA are knee degenerative diseases, trauma, overwork, and labor habits. However, long-term deformity leads to uneven stress on the surface of the knee joint, and the cause of lower limb force line damage has not been taken seriously. Comprehensive application of high tibial osteotomy (HTO), chronic distraction tissue regeneration, and computer-assisted external fixation for the treatment of severe KOA has many advantages over total knee arthroplasty, such as lasting and thorough orthopedic effects, a lower cost, and a faster recovery. PATIENT CONCERNS: The patient was a 48-year-old male with KOA caused by long-term genu varus, resulting in pain in both knees, especially in the right knee. The right knee pain had been aggravated for 2 years, and he was admitted to the hospital for left knee pain for 1 month. DIAGNOSES: X-ray: The patient has right KOA and varus deformity INTERVENTIONS: Comprehensive application of HTO, chronic distraction tissue regeneration technology, and computer-assisted external fixation technology has a good therapeutic effect for patients with KOA and varus. OUTCOMES: The patient's severe genu varus was corrected, the bone and soft tissue regeneration was good, the lower limb force line was improved, lower limb function was restored well, and the treatment was satisfactory. CONCLUSION: For the treatment of KOA patients with genu varus, the combination of HTO, chronic distraction tissue regeneration, and computer-assisted adjustment of external fixation technology have a good effect on the correction of genu varus deformity and the recovery of the lower limb force line. This treatment method is also conducive to preventing postoperative infection and avoiding secondary trauma caused by the removal of internal fixation plates.


Assuntos
Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Fixadores Externos , Regeneração Tecidual Guiada/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tíbia/cirurgia
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1521-1526, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823551

RESUMO

Objective: To investigate the effectiveness of internal and external lysis combined with Ilizarov external fixation technology for severe knee pathological flexion contracture deformity in children. Methods: A retrospective analysis was made on 12 children (12 knees) with severe knee pathological flexion contracture deformity who were treated with internal and external lysis and Ilizarov external fixation between August 2012 and January 2017. There were 9 boys and 3 girls with an age of 3-12 years (mean, 8.4 years). There were 8 cases of tuberculosis, 3 cases of haemophilia A, and 1 case of residual deformity after extensive hemangioma drug injection. The disease duration ranged from 5 months to 4 years, with an average of 20.3 months. The degree of knee contracture was (67.42±23.30)°, and the range of motion of knee was (38.33±14.98)°. The preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score was 78.42±15.57. The complication was observed after operation, and the degree of knee contracture, range of motion, and WOMAC score at 3 months and 1 year after operation were recorded and compared with those before operation. Results: The operations completed successfully in all children. All the 12 cases were followed up 9-24 months (mean, 14.5 months). All incisions healed by first intention after operation. The knee function of all children improved significantly and the weight-bearing walking function of the lower limbs restored. The degree of knee contracture, range of motion, and WOMAC score were significantly improved at 3 months and 1 year after operation (P<0.05), but there was no significant difference between 3 months and 1 year after operation (P>0.05). Conclusion: For severe knee pathological flexion contracture deformity in children, application of internal and external lysis combined with Ilizarov external fixation has advantages, such as small trauma, rapid recovery, and early postoperative knee function training, and good effectiveness.


Assuntos
Fixadores Externos , Articulação do Joelho , Criança , Contratura , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
8.
Zhonghua Yi Xue Za Zhi ; 99(45): 3592-3596, 2019 Dec 03.
Artigo em Chinês | MEDLINE | ID: mdl-31826577

RESUMO

Objective: To observe the effect of traditional and modified Ilizarov transverse tibial bone transport on microvascular regeneration of lower limbs in dogs. Methods: After general anesthesia on 10 experimental dogs, traditional and modified transverse tibial bone transport were performed on both tibias respectively. The control group was treated with the traditional method (the periosteum and bone flap were completely isolated), while the experimental group was treated with the modified method (the fibular periosteum of the open window bone flap was retained). All the external fixators were pulled outwards at a speed of 1 mm every day from 5 days after operation;after one week, the external fixators were moved back every 3 days for one week. The situation of wounds and activity of lower limbs were observed. Simultaneously, the angiogenesis was observed by digital subtraction angiography (DSA) through femoral artery at different stages, and the density of vascular endothelial cells measured by local tissue sections. The data before and after the operation were compared with paired t test. Results: The operation was successfully completed in 10 experimental dogs, and all wounds healed about 1 week after the operation. There was no significant abnormality in lower limb movements in all dogs. Peripheral blood vessel area in middle leg of lower limb in 4 weeks and 8 weeks after operation was (5.9±0.4) mm(2) and (6.9±0.6) mm(2) in control group and it was (6.2±0.6) mm(2) and (8.0±0.6) mm(2) in experimental group, respectively; all were significantly improved than those before the operation ((5.0±0.4) mm(2), (4.9±0.4) mm(2), respectively) (F=446.457, 829.192, both P<0.05). There was no significant differences in vessel area between the two groups at the 4th week after operation (t=1.216, P=0.240), but there was significant difference at the 8th week after operation between the two groups (t=4.423, P=0.000). The percentage of vascular endothelial cells in stained cells under endoscopy was 4.42%±0.28% and 5.63%±0.53% in the control group at the 8th week; and in the experimental group, it was 5.35%±0.26% and 7.18%±0.25%, respectively;all were significantly elevated than those before the operation; and there were significant differences between the two groups (t=7.35, 8.30, both P<0.05). Conclusion: Transverse tibial bone transport and microvascular network regeneration technology can reconstruct the microvasculature below the calf of dogs; the method of window-opening osteotomy is improved to "door" type window-opening, it can retain the lateral periosteum of tibial crest and regenerate the microvasculature network more abundantly.


Assuntos
Tíbia , Animais , Cães , Células Endoteliais , Fixadores Externos , Microcirculação , Osteotomia
9.
Zhongguo Gu Shang ; 32(12): 1173-1176, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870082

RESUMO

The posterior condylar fracture of the tibial plateau refers to the fracture of the posterior 1/3 area of the tibial plateau. Compared with other clinical types such as Schatzker and AO, the three-column theory is more widely used in the diagnosis and treatment of the posterior condylar fracture of the tibial plateau. There are advantages and disadvantages in learning curve, intraoperative risk and therapeutic effect of minimally invasive methods such as posterior and lateral related approaches, circular external fixator and balloon dilatation, which are commonly used in open surgery. There is no consensus on the best surgical method. This article reviews the diagnosis, classification and treatment of posterior condylar fracture of tibial plateau.


Assuntos
Fraturas da Tíbia , Fixadores Externos , Fixação Interna de Fraturas , Humanos , Curva de Aprendizado , Tíbia , Fraturas da Tíbia/diagnóstico , Fraturas da Tíbia/terapia
10.
BMC Musculoskelet Disord ; 20(1): 621, 2019 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-31878910

RESUMO

BACKGROUND: The purpose of this study was to evaluate a new method for treating neglected hip dislocation with limb length discrepancy by using external fixation-assisted pre-reduction. METHODS: Thirteen patients admitted between January 2010 to February 2018 with a mean duration from injury to surgery of 5.0 ± 2.1 months and an average preoperative leg-length discrepancy of 7.7 ± 2.3 cm were enrolled in this study. The dislocation and associated acetabular fracture type, clinical outcomes and residual limb length discrepancy were evaluated. RESULTS: All patients had posterior dislocations, and nine patients presented with acetabular fractures and were followed-up for at least 12 months. The average traction duration of external fixators was 28.8 ± 8.0 days and all patients received second-stage open reduction and internal fixation. Six patients showed residual limb length discrepancy within 2 cm. Patients showed significant improvement in hip function and pain relief. Complications including avascular femoral head necrosis and osteoarthritis occurred in three patients. CONCLUSION: Effective correction of limb length discrepancy and improved function were observed in patients with neglected hip dislocations and limb equality using traction by external fixation combined with second-stage open reduction. Further follow-up is required to determine long-term outcomes.


Assuntos
Fixadores Externos , Luxação do Quadril/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tempo para o Tratamento , Adulto Jovem
11.
Acta Chir Orthop Traumatol Cech ; 86(5): 358-361, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748112

RESUMO

PURPOSE OF THE STUDY Arthrodesis of interphalangeal joints of the hand is a method used to treat conditions associated with joint destruction, instability and pain. Our study aims to evaluate the outcomes of the treatment of sequelae of septic arthritis of interphalangeal joints by arthrodesis with external fixation. This topic is hardly covered in literature. Moreover, it compares the outcomes of application of this method in diabetic patients and non-diabetic population. MATERIAL AND METHODS Arthrodesis by means of Stellbrink external fixator was performed in 17 patients who had suffered septic arthritis of interphalangeal joints of the hand. The following parameters were followed in patients in our group: age, sex, etiology of disease, smoking, diabetes, affected fingers and joints of the hand, side, microbial culture finding, wound healing, postoperative ATB therapy and its duration, radiographic signs of the union of arthrodesis and potential complications. RESULTS The group included 8 men and 9 women. The mean age was 66.2 years. 5 patients in the group were diabetic. In 16 patients the wound healed per primam, in 1 case per secundam. The average duration of postoperative ATB therapy was 4.3 weeks. The X-ray showed the union of fused articular surfaces at 6.9 weeks on average. Complications occurred in 3 patients, namely 1 case of secondary wound healing, 1 case of nail bed damage and 1 case of flexor tenosynovitis of the operated finger. The arthrodesis was successfully healed in all the patients and a no difference was detected between diabetic and nondiabetic patients. DISCUSSION When arthrodesis of interphalangeal joints of the hand is performed using an external fixator, the metal material is introduced outside the area of inflammation, or the field potentially at risk of infection, therefore this method is predetermined for surgeries in the terrain changed by inflammation or potentially at risk of inflammation. Compared to the other methods such as arthrodesis by inserting K-wires intramedullary, there is no risk of migration of the metal material and the associated soft tissue irritation. CONCLUSIONS Our study confirms the safety and efficiency of arthrodesis of interphalangeal joints of the hand by means of an external fixator in treating the sequelae of septic arthritis. The union of arthrodesis with no complications was observed even in all the diabetic patients. Ranking among the main advantages of this method are the easy care for the surgical wound, achievement of easy and firm fixation with the possibility to apply an external fixator outside the area of the original infection. Key words:arthrodesis, external fixator, septic arthritis, interphalangeal joint.


Assuntos
Artrite Infecciosa/cirurgia , Artrodese/instrumentação , Articulações dos Dedos/cirurgia , Idoso , Artrite Infecciosa/complicações , Artrodese/métodos , Fios Ortopédicos , Complicações do Diabetes/complicações , Fixadores Externos , Feminino , Humanos , Masculino , Resultado do Tratamento
12.
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
13.
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
14.
Tech Hand Up Extrem Surg ; 23(4): 176-181, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31738739

RESUMO

Digital external fixation is often used for the management of complex injuries involving the proximal interphalangeal joint, including pilon fractures of the middle phalanx base and unstable fracture-dislocations. Several dynamic "homemade" constructs have been described which utilize only K-wires and rubber bands and allow early range of motion within the construct. Although these constructs are inexpensive and their application is fairly straightforward, their designs pose a few potential problems when the construct is stressed during rehabilitation efforts. These designs utilize a blocking K-wire which relies on pin-to-pin contact to maintain reduction and creates unnecessary friction that can impede motion and result in pin loosening in bone. Furthermore, rubber band rupture can occur and destabilizes the construct. Here we present a novel technique which utilizes only K-wires and K-wire caps, provides adequate joint distraction and stabilization throughout the arc of motion, and avoids the aforementioned pitfalls of existing designs.


Assuntos
Fixadores Externos , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Adulto , Fios Ortopédicos , Traumatismos dos Dedos/diagnóstico por imagem , Articulações dos Dedos/diagnóstico por imagem , Fluoroscopia , Humanos , Masculino
15.
Facial Plast Surg ; 35(6): 614-622, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31783417

RESUMO

Internal rigid fixation is the gold-standard treatment for facial fractures, but there are some specific cases that are more amenable to external fixation (ex-fix) application. Herein, we discuss advantages and disadvantages to ex-fix in the modern treatment of comminuted mandible fractures, infected mandible fractures, fractures of the condylar region, oncologic mandibular resection, pediatric mandible fractures, and fractures in the edentulous patient.


Assuntos
Fixadores Externos , Fraturas Cominutivas , Fraturas Mandibulares , Placas Ósseas , Criança , Fixação Interna de Fraturas , Humanos , Mandíbula , Fraturas Mandibulares/terapia
16.
J Bone Joint Surg Am ; 101(18): 1654-1661, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31567802

RESUMO

BACKGROUND: The treatment of a displaced proximal humeral fracture is still a matter of controversy. Minimally invasive techniques are considered promising options. The purpose of this study was to report outcomes at medium to long-term follow-up after surgical treatment with pins stabilized with an external fixator. METHODS: A total of 235 patients (average age, 64 years [95% confidence interval (CI), 62 to 65 years]) were treated with closed or open reduction and fixation with pins stabilized by an external fixator specifically designed for proximal humeral fractures. The pins were inserted using a "pins-crossing-fracture" or a "pins-bridging-fracture" technique. One hundred and eighty-eight patients had a minimum radiographic and clinical follow-up of 2 years. Outcomes were assessed using the Oxford Shoulder Score (OSS), the subjective shoulder value (SSV), a visual analog scale (VAS) for pain, and, for 155 patients, the Constant score. RESULTS: Eighty-one (43%) of the 188 patients had a 2-part fracture, 60 (32%) had a 3-part fracture, and 47 (25%) had a 4-part fracture. The reduction was performed with percutaneous maneuvers in 120 shoulders or a deltopectoral approach, in 68. The external fixator was applied using a "pins-crossing-fracture" technique in 133 shoulders and using a "pins-bridging-fracture" technique in 55. At last follow-up, mean clinical scores were as follows: OSS, 42.6 (95% CI, 42 to 44); SSV, 85.5 (95% CI, 83 to 88); and VAS for pain, 1 (95% CI, 0.7 to 1.2). The complication rate at 3 months was 16% (37 of 235). The most frequent complication was pin-track infection (19 of 235, 8%). A total of 50 patients had ≥1 complication (50 of 188, 27%) and 6 (3%) underwent revision surgery. More complications were observed with the "pins-crossing-fracture" technique. CONCLUSIONS: In our experience, the use of the external fixator has been a valuable option in the treatment of proximal humeral fractures. The complication and revision rates were acceptable. Most of the complications encountered were manageable without revision surgery. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fixadores Externos , Fixação de Fratura/instrumentação , Fraturas do Ombro/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Feminino , Seguimentos , Fixação de Fratura/métodos , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
18.
J Bone Joint Surg Am ; 101(19): 1724-1731, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577677

RESUMO

BACKGROUND: Subcutaneous fixation of the anterior pelvic ring is an emerging surgical technique for trauma patients. The aim of this study was to biomechanically evaluate 2 internal fixation devices for stabilizing a disrupted pelvic ring and compare them with traditional external fixation. METHODS: Thirty-six synthetic pelvises with a simulated unstable ring fracture (anteroposterior compression type III) were divided into 3 groups. Group A underwent fixation with a supra-acetabular external fixator; group B, with an internal fixator using the USS II polyaxial system; and group C, with an internal fixator using the Click'X polyaxial system. Biomechanical testing included measurement of peak-to-peak displacement at 300, 400, and 500 N; total displacement; plastic deformation; stiffness; and fracture-line displacement. RESULTS: Statistical analysis of all measured parameters revealed no significant differences among the groups. However, vertical displacement of the preshaped connecting rod within the screw heads occurred as a result of inadequate stability of the internal fixation at the rod-screw interface. CONCLUSIONS: Although internal fixator devices are placed close to the bone and should therefore maintain greater stiffness, our data did not support the hypothesis of superior stability. Special attention is required when using a curved connecting rod as the rod is easily displaced, placing relevant anatomical structures at risk. These devices require further refinement to avoid potential patient injury.


Assuntos
Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Ossos Pélvicos/lesões , Fenômenos Biomecânicos , Parafusos Ósseos , Desenho de Equipamento , Fixadores Externos/normas , Fixação Interna de Fraturas/normas , Humanos , Fixadores Internos/normas , Modelos Anatômicos , Ossos Pélvicos/cirurgia , Distribuição Aleatória , Instrumentos Cirúrgicos
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(11): 1333-1339, 2019 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-31650744

RESUMO

Objective: To investigate the characteristics and corrective strategies of various limb deformities treated by QIN Sihe orthopaedic team in the past 40 years, so as to provide a large sample for understanding the causes, types, and treatment methods of limb deformity and disability in China. Methods: A clinical data of 35 075 cases who were treated by QIN Sihe orthopaedic team between May 1978 and December 2018 was summarized. The age, gender, deformity characteristics, etiological and pathological composition, regional distribution, and surgical methods of the patients were analyzed. Results: There were 20 458 males (58.33%) and 14 617 females (41.67%). The age ranged from 1 to 82 years (mean, 20.5 years). The majority people (19 363 cases, 55.20%) were 11-25 years old. Of which, 33 259 cases (94.82%) were operated on lower extremity. The geographical distribution of patients covered 33 regions in China and 12 foreign countries. There were 202 etiologies involved neurological, heredity, metabolism, traumatic sequelae, congenital, vascular, lymphoid, skin, endocrine, iatrogenic, and so on. The disease covered all subsubjects of orthopaedics. The top six deformities secondary to poliomyelitis sequelae, cerebral palsy, traumatic sequelae, spondylolysis sequelae, genu varum and genu valgum, and congenital talipes equinovarus. There were 280 kinds of surgical methods, the majority of which were Achilles tendon lengthening, supracondylar osteotomy, subtalar joint arthrodesis, tibiofibular osteotomy, metatarsal aponeurosis, and Achilles tendon replacement of peroneal longus muscle, etc. Orthopaedic surgery combined with external fixation were applied in 8 702 cases, including Ilizarov fixator in 3 696 cases and Hybrid fixator in 5 006 cases. Conclusion: QIN Sihe orthopaedic database with 40 years is the largest one of limb deformity and disability in China. It reflects the etiology, type, population characteristics, surgical methods and strategy of limb disability and deformity which can be treated by orthopaedic surgery. The data needs to be further excavated and deeply studied in future because of its important academic value and historical significance.


Assuntos
Deformidades Congênitas dos Membros/epidemiologia , Ortopedia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Pé Torto Equinovaro , Fixadores Externos , Feminino , Humanos , Técnica de Ilizarov , Lactente , Deformidades Congênitas dos Membros/cirurgia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Eklem Hastalik Cerrahisi ; 30(3): 224-32, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650918

RESUMO

OBJECTIVES: The aim of this study was to evaluate both clinical and radiological results of intraarticular comminuted distal radius fractures treated with volar locking plate (VLP), non-bridging external fixator (NbEF), and bridging external fixator (BEF). PATIENTS AND METHODS: 95 patients (44 males, 51 females; median age 49 years; interquartile range (IQR), 37 to 60 years) who were treated with VLP, NbEF, or BEF due to intraarticular comminuted distal radius fractures between January 2010 and April 2014 were evaluated retrospectively. 34 of these patients were treated with a VLP (VLP group), 30 with a NbEF (NbEF group) and 31 with a BEF (BEF group). In the final follow-up, all patients were evaluated according to clinical and radiological parameters. RESULTS: The median follow-up was 5 (IQR, 4 to 6) years. The VLP and NbEF groups had better results than the BEF group in terms of wrist range of motion, loss of grip strength, Green O'Brien, Mayo Modified Wrist, The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and VAS scores. The VLP group had the most significant radiological improvement. CONCLUSION: Although clinical and radiological results for intraarticular comminuted distal radius fractures are more significantly improved in patients treated with VLP, favorable results close to VLP can be also obtained with NbEF. The BEF seems to be the least effective treatment option among the three surgical methods.


Assuntos
Placas Ósseas , Fixadores Externos , Fixação de Fratura/métodos , Fraturas Cominutivas/cirurgia , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/cirurgia , Adulto , Avaliação da Deficiência , Feminino , Fraturas Cominutivas/diagnóstico por imagem , Força da Mão , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular , Estudos Retrospectivos
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