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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1243-1247, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063487

RESUMO

Objective: To investigate the effectiveness of non-absorbable suture cerclage combined with patella claw fixation for the treatment of inferior patella fractures. Methods: Between September 2016 and January 2019, 22 patients with inferior patella fractures were treated. There were 12 males and 10 females, with a mean age of 49.1 years (range, 32-67 years). The causes of injury were traffic accident in 8 cases, falling in 12 cases, and other causes in 2 cases. The interval from injury to operation was 3-7 days (mean, 4.4 days). For the operation, 3 or 4 longitudinal tunnels were drilled backward from the surface of the proximal fracture fragment with Kirschner wires; under the guidance of lumbar puncture needles and steel wires, non-absorbable suture passed through the tunnels and encircled the inferior fracture fragment, then tighten to achieve a satisfactory reduction of the fracture; finally, the patella claw was used to strengthen the fixation. During the follow-up, complications were observed, maximum motion range of the knee joint was measured, X-ray examination was performed and fracture healing time was recorded. The knee function was evaluated according to Böstman scores. Results: All the 22 patients were followed up 12-36 months (mean, 19.4 months). No infection, joint stiffness, bone nonunion, loss of reduction, or displacement of internal fixation occurred. All fractures were clinically healed, and the bone healing time was 2-3 months (mean, 2.6 months). At last follow-up, the maxium motion range of knee joint was 130°-135°, with an average of 132.6°. The Böstman score of the affected knee was 28-30 (mean, 29.2). All cases were graded as excellent results. Conclusion: Non-absorbable suture cerclage combined with patella claw fixation for inferior patella fractures has the advantages of simple operation, reliable fixation, and few complications, and the clinical results are satisfactory.


Assuntos
Fraturas Ósseas , Patela , Adulto , Idoso , Fios Ortopédicos , Feminino , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Patela/cirurgia , Suturas , Resultado do Tratamento
2.
Rozhl Chir ; 99(8): 368-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33032443

RESUMO

Fractures of the surgical neck of the scapula combined with a fracture of the coracoid base constitute a specific and rare type of a fracture pattern. When displaced, they present a severe, completely unstable type of surgical neck fracture, requiring a precise CT diagnosis, open reduction and stable internal fixation of the fracture via the Judet approach. The aim of this study is to describe our four cases and discuss three others reported to date.


Assuntos
Fraturas Ósseas , Fraturas da Coluna Vertebral , Artrodese , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Escápula/diagnóstico por imagem , Escápula/lesões , Escápula/cirurgia
3.
J Am Acad Orthop Surg ; 28(20): e878-e887, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33030854

RESUMO

The talus is unique in having a tenuous vascular supply and 57% of its surface covered by articular cartilage. Fractures of the head, neck, or body regions have the potential to compromise nearby joints and impair vascular inflow, necessitating surgical treatment with stable internal fixation in many cases. The widely preferred approach for many talar neck and body fractures is a dual anterior incision technique to achieve an anatomic reduction, with the addition of a medial malleolar osteotomy as needed to visualize the posterior talar body. Percutaneous screw fixation has also demonstrated success in certain patterns. Despite this modern technique, osteonecrosis and osteoarthritis remain common complications. A variety of new treatments for these complications have been proposed, including vascularized autograft, talar replacement, total ankle arthroplasty, and improved salvage techniques, permitting some patients to return to a higher level of function than was previously possible. Despite these advances, functional outcomes remain poor in a subset of severely injured patients, making further research imperative.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Tálus/lesões , Tornozelo/cirurgia , Artroplastia de Substituição , Autoenxertos/irrigação sanguínea , Parafusos Ósseos , Fraturas Ósseas/complicações , Humanos , Osteoartrite/etiologia , Osteoartrite/terapia , Osteonecrose/etiologia , Osteonecrose/terapia , Osteotomia/métodos , Prognóstico , Recuperação de Função Fisiológica , Tálus/irrigação sanguínea
4.
Medicine (Baltimore) ; 99(40): e21755, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019385

RESUMO

RATIONALE: The objective of the present study was to evaluate the accuracy, effectiveness, and safety of screw view model of navigation (SVMN) guided minimal invasive percutaneous pelvic screws (PPSs) insertion for lateral compression pelvic ring injuries (PRI). PATIENT CONCERNS: A female patient experienced a high falling injury, and presented with pain, swelling, deformity, and movement limitation of the left hip for 3 hours. DIAGNOSES: She was diagnosed with pelvic fractures, left iliac fracture, left pubic branch fracture, left ischial branch fracture, and lumbar transverse process fracture. INTERVENTIONS: We used a SVMN technique to guide PPSs insertion, including a percutaneous anterior inferior iliac spine screw, a percutaneous iliac screw (PIS), and a percutaneous sacroiliac screw (PSIS). OUTCOMES: In total, 3 PPSs were inserted and all were presented with excellent position postoperatively. The designing time of all screws was 11.7 minutes, the time of all guide needles insertion was 18.1 minutes, the time of all screws insertion was 32.8 minutes, blood loss was 21 mL, and the time of radiation exposure lasted 7.2 minutes. Moreover, surgical complications, including neurovascular compromise, wound infection, fracture nonunion, and screw loosening, were not observed during the 12 months follow up visit. LESSONS: SVMN technique guided PPSs insertion is an effective and safety approach for the treatment of PRI in selected patients. Besides, it is necessary for surgeons to master the rationale of computer navigation, to familiar with the anatomy of pelvis and to select suitable patients.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Ossos Pélvicos/lesões , Adulto , Lesões por Esmagamento/cirurgia , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos
5.
Khirurgiia (Mosk) ; (10): 73-78, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047589

RESUMO

The need for thromboprophylaxis in traumatological and orthopedic operations is determined by a constant increase in the level of injuries of the population, and as a result, fluctuating coagulation indicators. Risk factors inherent in modern society that correlate primarily with reduced physical activity and excessive consumption of unbalanced (carbohydrate) nutrition, bad habits (nicotinism, alcoholism and other toxic dependencies), increased life expectancy and comorbidity - these and other causes can lead to an increase in the incidence of vascular accidents in patients with large limb bone fractures. The goal is to compare the effectiveness and clinical safety of using parnaparin sodium (Fluxum) and enoxaparin sodium as the prevention of thrombosis in the treatment of lower limb bone fractures. MATERIAL AND METHODS: A comparative assessment of the effectiveness and clinical safety of thrombosis prevention in the treatment of lower limb bone fractures using low-molecular weight heparins: parnaparin sodium (Fluxum) and enoxaparin sodium. RESULTS: Taking into account the literature data on the significant risk of venous thromboembolic complications, we successfully conduct the thromboprophylaxis in patients with the traumatological and orthopedic profile, including in 2019 using the drug parnaparin sodium (Fluxum, «Alfasigma¼). Our own comparative clinical experience has shown that with the convenience of taking enoxaparin sodium and the completeness of the scheme, the prevention of thrombosis with the use of parnaparin sodium shows the tendency to better clinical effectiveness and safety. CONCLUSION: The choice of anticoagulants in traumatological and orthopedic practice, with obvious ease of use, provides the complete scheme for the prevention of thrombosis. Further research is needed on the routine use of sodium parnaparin in order to prevent thronbosis in the treatment of fractures of various localization.


Assuntos
Anticoagulantes/administração & dosagem , Enoxaparina/administração & dosagem , Fixação de Fratura/efeitos adversos , Fraturas Ósseas/cirurgia , Heparina de Baixo Peso Molecular/administração & dosagem , Trombose/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Fraturas Ósseas/complicações , Humanos , Trombose/etiologia , Tromboembolia Venosa/etiologia
6.
J Orthop Trauma ; 34(10): e382-e388, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32947589

RESUMO

Orthopaedic trauma presents a unique and complex challenge in the initial phase of the coronavirus 2019 (COVID-19) global crisis. Little is currently known about the surgical practices in orthopaedic emergencies in the early days of the COVID-19 outbreak (1). This is a retrospective case series of 10 orthopaedic trauma patients who underwent fracture fixation in March 2020. Of the 10 patients testing COVID-19 positive, there were a total of 16 long bone fractures, 5 pelvic ring fractures, and 1 lumbar burst fracture. There were 7 (70%) males in this cohort. Two (20%) of the COVID-positive patients did not develop fever, leukocytosis, respiratory insufficiency, or positive imaging findings and were younger (average age 25.5 years) with fewer comorbidities (average 0.5) compared with the 8 symptomatic COVID-19-positive patients (56.6 years with 1.88 comorbidities). Advancement of COVID-19 pathogenesis with lung opacities and prolonged intubation occurred in all 5 patients who remained on ventilation postoperatively (range 9 hours-11 days). At the time of most recent follow-up, all patients survived, 1 continues to require ventilation support, 1 remains admitted without ventilation support, and 8 (80%) were discharged to home. LEVEL OF EVIDENCE:: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Fixação de Fratura/métodos , Fraturas Ósseas/complicações , Pneumonia Viral/epidemiologia , Medição de Risco/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Feminino , Seguimentos , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
7.
Medicine (Baltimore) ; 99(39): e22284, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991430

RESUMO

BACKGROUND: Plate fixation and intramedullary nail/Knowles pin fixation methods are commonly used to treat displaced midshaft clavicle fractures. However, the differences between these 2 methods are unclear. OBJECTIVE: This meta-analysis aimed to compare plate fixation and intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fractures. METHODS: We searched PubMed, EBM reviews, and Ovid Medline online for studies related to comparison of plate fixation versus intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fracture from inception to June 30, 2019. Relevant literature search, data extraction, and quality assessment will be performed by 2 researchers independently. The methodological quality of all included studies was appraised using the Cochrane system for randomized trials. The RevMan 5.2 software was used for heterogeneity assessment, generating funnel-plots, data synthesis, sensitivity analysis, and determining publication bias. The fixed-effects or random-effects model was used to calculate mean difference (MD)/relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: This meta-analysis included 839 patients from 12 randomized controlled trials. We found that compared to plate fixation, intramedullary nail/Knowles pin fixation yielded a higher shoulder constant score [MD = -2.43, 95% CI (-3.46 to -1.41), P < .00001] and lower disabilities of the arm, shoulder and hand (DASH) score [MD = 2.98, 95% CI (0.16-5.81), P = .04], and lower infection rates [RR = 2.05, 95% CI (1.36-3.09), P = .003], operation time [MD = 20.20, 95% CI (10.80-29.60), P < .0001], incision size [MD = 6.09, 95% CI (4.54-7.65), P < .00001], and hospital stay [MD = 1.10, 95% CI (0.56-1.64), P < .00001] but with a higher removal rate [RR = 0.52, 95% CI (0.41-0.65), P < .00001] compared to plate fixation. There were no significant differences in nonunion, reintervention, or revision and refracture between these two methods. The limitation is that many studies did not demonstrate the random generated details, and only English articles were enrolled in this meta-analysis. CONCLUSIONS: Intramedullary nail/Knowles pin fixation might be an optimum choice for treating displaced midshaft clavicle fractures, with similar performance in terms of the nonunion, reintervention, or revision and refracture, and better shoulder constant and DASH scores, infection rates, and operative parameters.


Assuntos
Placas Ósseas/efeitos adversos , Clavícula/patologia , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Adulto , Pinos Ortopédicos/efeitos adversos , Avaliação da Deficiência , Feminino , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/classificação , Fraturas não Consolidadas/epidemiologia , Humanos , Infecções/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Risco , Sensibilidade e Especificidade , Ferida Cirúrgica/classificação , Ferida Cirúrgica/epidemiologia
8.
Medicine (Baltimore) ; 99(39): e22324, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991442

RESUMO

RATIONALE: Coracoid processes (CPs) fracture with acromioclavicular (AC) joint dislocation are extremely rare. This combined injury has brought many challenges to surgeons, and the mechanism underlying the injury is still not fully understood. There is no clear consensus on its treatment. PATIENT CONCERNS: Here, we describe a CP fracture with AC joint dislocation in a middle-aged manual worker. DIAGNOSIS: Radiographs showed a fracture of the base of the CP and a third-degree AC joint separation. INTERVENTIONS: The patient was treated surgically with open reduction and internal fixation of the AC joint by LCP clavicle hook plate, and the CP was fixed with a 3.5 mm diameter cannulated screw. OUTCOMES: Three months after the operation, shoulder function was completely restored, and the affected shoulder had full mobility with no tenderness. Plain film radiography showed anatomical indications of the healing of these combined injuries. LESSONS: Although AC joint dislocation with CP fractures is extremely rare in adults, it is important to remind and remember that this possibility exists. In unclear cases, special radiographic films and CT are necessary. Surgical treatment of AC joint dislocation with CP fractures can provide solid stability and restore normal shoulder function with an excellent prognosis.


Assuntos
Articulação Acromioclavicular/lesões , Processo Coracoide/lesões , Fraturas Ósseas/cirurgia , Luxações Articulares/cirurgia , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/patologia , Assistência ao Convalescente , Placas Ósseas/normas , Parafusos Ósseos/normas , Processo Coracoide/patologia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Redução Aberta/métodos , Radiografia/métodos , Resultado do Tratamento
9.
Orthop Clin North Am ; 51(4): 541-553, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32950224

RESUMO

Jones fractures in both elite and recreational athletes are best treated with surgical fixation, given superior results as compared to nonoperative management. While screw specifics remain controversial, intramedullary screw fixation is established as the standard surgical technique. Plate fixation also has shown excellent outcomes. Complications of refracture, nonunion, and delayed union require careful evaluation for contributions of early return to play, implant characteristics, and anatomic/metabolic abnormality. Revision fixation with autograft and biologic augmentation is supported in the literature, with ongoing inquiry to optimizing specific implants and adjuvants.


Assuntos
Fixação Intramedular de Fraturas , Fraturas Ósseas/cirurgia , Ossos do Metatarso/lesões , Atletas , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico por imagem , Humanos
10.
Medicine (Baltimore) ; 99(34): e21573, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846766

RESUMO

This study aimed to investigate the effectiveness of tendon suture fixation versus cortical screw fixation for the treatment of distal tibiofibular syndesmosis injury.This study recruited 42 patients with Danis-Weber type B, C1 and C2 fractures concomitant with lower tibiofibular syndesmosis injury, who were randomly assigned to 2 groups according to treatment with cortical screw fixation (n = 21) and tendon suture fixation (n = 21). Operation time, intraoperative blood loss, time to full weight-bearing activity, medical cost, ankle function, and ankle pain were compared between the 2 groups.The operation time was significantly less with cortical screw fixation (57.1 ±â€Š5.3 min) than with tendon suture fixation (63.3 ±â€Š6.3 min; p = 0.01), but there was no significant difference in intraoperative blood loss. The time until full weight-bearing was possible was significantly longer after cortical screw fixation (10.9 ±â€Š2.7 weeks) than after tendon suture fixation (7.1 ±â€Š1.9 weeks; P < .001). The medical cost was much greater for cortical screw fixation (1861.6 ±â€Š187.3 USD) than for tendon suture fixation (1209.6 ±â€Š97.6 USD; P < .01). The rate of excellent and good ankle function at 3 months after surgery was significantly higher with tendon suture fixation (71.4%) than with cortical screw fixation (33.3%; P = .03).Tendon suture fixation is associated with quicker recovery of ankle function, shorter time to full weight-bearing, and lower medical cost to the patient compared with screw fixation. Our findings suggest that tendon suture fixation is an effective method for the treatment of tibiofibular syndesmosis injury.


Assuntos
Traumatismos do Tornozelo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Adulto , Parafusos Ósseos , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Sutura , Adulto Jovem
11.
Bone Joint J ; 102-B(8): 1082-1087, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731834

RESUMO

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


Assuntos
Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Ósseas/cirurgia , Osteopetrose/complicações , Adolescente , Pinos Ortopédicos , Fios Ortopédicos , Criança , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Osteopetrose/diagnóstico por imagem , Osteopetrose/cirurgia , Estudos Retrospectivos , Medição de Risco , Amostragem , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 646-650, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773794

RESUMO

OBJECTIVE: To evaluate the clinical effects and characteristics of combined transperineal and transpubic urethroplasty for patients with complex pelvic fracture urethral distraction defect (PFUDD). METHODS: We retrospectively reviewed the clinical data of 17 male patients with complex posterior PFUDD from January 2010 to December 2019. The complications included urethrorectal fistulas in 2 patients (11.8%), urethroperineal fistula in 1 patient (5.9%). Ten patients had undergone previous treatments: dilatation in 3 patients (17.6%), internal urethrotomy in 1 patient, failed urethroplasty in 6 patients (35.3%), of whom 2 patients had two times of failed urethroplasties. All the patients were performed with urethroplasty by combined transperineal and transpubic approach with removing the entire pubic bone followed by the anastomosis. RESULTS: The mean age of the patients included in this study was 35.5 (range: 21-62) years. The mean length of stricture was 5.5 (range: 4.5-7.0) cm, the mean follow-up was 27 (range: 7-110) months, the mean time of operation was 190 (range: 150-260) min, the mean evaluated blood loss was 460 (range: 200-1 200) mL. There were 5 patients who needed blood transfusion intraoperatively or postoperatively. Wound infection was seen in 4 out of 17 patients and thrombosis of lower extremities in 1 out of 17 patients. The last follow-up showed that the mean postoperative maximum urinary flow rate was 22.7 (range: 15.5-40.7) mL/s. After removing the catheter, one patient presented with decreased urinary flow and symptoms of urinary infection. Cystoscopy showed the recurrent anastomotic stricture, which was cured by internal urethrotomy. In our series, the success rate of the combined transperineal and transpubic urethroplasty was 94.1% (16/17). CONCLUSION: Combined transperineal and transpubic urtheroplasty can achieve a tension free anastomosis after removing the entire wedge of pubis in some patients with complex PFUDD. However, this procedure should be completed in a regional referral hospital due to the complexity of the operation and the high percentage of complications.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Estreitamento Uretral , Adulto , Anastomose Cirúrgica , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Uretra , Adulto Jovem
13.
PLoS One ; 15(8): e0237151, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790794

RESUMO

Fracture to fifth metatarsal's base is one the most common injury experienced at the foot. Studies have for long debated the use of operative and non-operative interventions for the management of the fracture, especially owing to its peculiar vasculature. However, to date, no attempt has been made to synthesize the evidence comparing the efficacy of operative and non-operative interventions for managing the fifth metatarsal's base fracture. To meta-statistically compare the effects of operative and non-operative management of fifth metatarsal base fracture. A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. A meta-analysis evaluated the influence of operative and non-operative interventions on rate of non-union, mean duration of union, duration of return to activity, duration of return to sport, visual analog scale, and the American orthopedic foot & ankle scale. Out of 1,170 records, 11 articles including 404 participants (mean age: 29.8 ± 7.4 years) were included in this review. This systematic review presents a 1b level of evidence supporting the use of operative interventions for enhancing fracture union as compared to non-operative interventions. The meta-analysis reveals beneficial effects for operative interventions by demonstrating medium to large effect reduction of rate of non-union (Hedge's g: -0.66), duration of union (-1.7), duration of return to activity (-2.07), visual analog scale (-0.86), and enhancement of the American orthopedic foot & ankle scale score (0.73) as compared to non-operative intervention. The current systematic review and meta-analysis recommend the use of operative interventions for managing the fifth metatarsal's base fracture. The review reports beneficial effects of operative interventions as compared to non-operative interventions for reducing the rate of non-union, duration of union, duration of return to activity, duration of return to sport, visual analog scale, and increasing the American orthopedic foot & ankle scale score.


Assuntos
Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Fraturas não Consolidadas/epidemiologia , Ossos do Metatarso/lesões , Complicações Pós-Operatórias/epidemiologia , Adulto , Fixação de Fratura/efeitos adversos , Fraturas Ósseas/terapia , Humanos , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade
14.
J Am Acad Orthop Surg ; 28(15): e651-e661, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732656

RESUMO

Fractures of the carpus can be debilitating injuries and often lead to chronic pain and dysfunction when not properly treated. Although scaphoid fractures are more common, fractures of the other carpal bones account for nearly half of all injuries of the carpus. Often missed on initial presentation, a focused physical examination with imaging tailored to the suspected injury is needed to identify these fractures. In addition to plain radiographs, advanced imaging such as CT and MRI are helpful in diagnosis and management. Treatment of carpal fractures is based on the degree of displacement, stability of the fracture, and associated injuries. Those that require surgical fixation often affect the congruency of the articular surfaces, are unstable, are at risk for symptomatic nonunion, are associated with notable ligamentous injury, or are causing nerve or tendon entrapment. Surgical strategies involve percutaneous Kirschner wires, external fixation, screws and/or plates, excision, or fusion for salvage. Owing to the intimate articulations in the hand, small size of the carpal bones, and complex vascular supply, carpal fracture complications include symptomatic nonunion, osteonecrosis, and posttraumatic arthritis.


Assuntos
Ossos do Carpo/lesões , Ossos do Carpo/cirurgia , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Artrite/etiologia , Placas Ósseas , Parafusos Ósseos , Fios Ortopédicos , Ossos do Carpo/irrigação sanguínea , Fraturas Ósseas/complicações , Humanos , Osteonecrose , Terapia de Salvação
15.
PLoS One ; 15(8): e0237812, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817716

RESUMO

Bhutan is one of the biological hotspots in the world where humans and natural flora and fauna co-exist in close proximity. Bhutan is home to two species of bears: Sloth Bear and Himalayan Black Bear. Human conflicts with bears are reported from all over the country. This study describes the profile of the victims and the pattern of injury resulting from bear attacks and circumstances around human conflicts with bears in Bhutan between 2015 and 2019. This was a cross-sectional study with a review of hospital records of patients treated at the National Referral Hospital from 01 January 2015 till 31 December 2019. Data were extracted into a structured pro forma and entered into EpiData Entry 3.1 and analysed in STATA 13.1. There were thirty-four patients who were provided care for bear maul injuries, with an average annual caseload of 6.8 cases per year. The injury prevalence was 100% and the kill prevalence was 0%. Bear attacks were reported from fourteen of twenty districts of the country. The mean age of the victims was 49 (±13) years. Males (26, 76%) and farmers (26, 76%) were the common victims; the risk of bear attacks was 0.16 per 100,000 farmers per year. The commonest region of the body attacked was the face (29, 85%) and victims were provided emergency and rehabilitative care within and outside the country. Thirty-three victims (97%) were provided post-exposure prophylaxis for rabies. All victims received antibiotics despite the lack of national guidelines on the choice of antibiotics post-bear maul. Human-bear conflict is multi-faceted, puts a considerable strain on bear-conservation efforts and requires multi-disciplinary efforts in the prevention of human injury and socioeconomic losses.


Assuntos
Agressão/fisiologia , Comportamento Animal/fisiologia , Mordeduras e Picadas/epidemiologia , Ursidae/fisiologia , Adolescente , Adulto , Agressão/psicologia , Animais , Animais Selvagens/psicologia , Animais Selvagens/virologia , Butão/epidemiologia , Mordeduras e Picadas/fisiopatologia , Mordeduras e Picadas/cirurgia , Mordeduras e Picadas/virologia , Orelha/lesões , Orelha/fisiopatologia , Orelha/cirurgia , Serviço Hospitalar de Emergência , Fazendeiros , Feminino , Florestas , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Raiva/epidemiologia , Raiva/patologia , Raiva/virologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cirurgia Plástica/métodos , Ursidae/psicologia , Adulto Jovem
16.
Lancet ; 396(10248): 390-401, 2020 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-32771106

RESUMO

BACKGROUND: Scaphoid fractures account for 90% of carpal fractures and occur predominantly in young men. The use of immediate surgical fixation to manage this type of fracture has increased, despite insufficient evidence of improved outcomes over non-surgical management. The SWIFFT trial compared the clinical effectiveness of surgical fixation with cast immobilisation and early fixation of fractures that fail to unite in adults with scaphoid waist fractures displaced by 2 mm or less. METHODS: This pragmatic, parallel-group, multicentre, open-label, two-arm, randomised superiority trial included adults (aged 16 years or older) who presented to orthopaedic departments of 31 hospitals in England and Wales with a clear bicortical fracture of the scaphoid waist on radiographs. An independent remote randomisation service used a computer-generated allocation sequence with randomly varying block sizes to randomly assign participants (1:1) to receive either early surgical fixation (surgery group) or below-elbow cast immobilisation followed by immediate fixation if non-union of the fracture was confirmed (cast immobilisation group). Randomisation was stratified by whether or not there was displacement of either a step or a gap of 1-2 mm inclusive on any radiographic view. The primary outcome was the total patient-rated wrist evaluation (PRWE) score at 52 weeks after randomisation, and it was analysed on an available case intention-to-treat basis. This trial is registered with the ISRCTN registry, ISRCTN67901257, and is no longer recruiting, but long-term follow-up is ongoing. FINDINGS: Between July 23, 2013, and July 26, 2016, 439 (42%) of 1047 assessed patients (mean age 33 years; 363 [83%] men) were randomly assigned to the surgery group (n=219) or to the cast immobilisation group (n=220). Of these, 408 (93%) participants were included in the primary analysis (203 participants in the surgery group and 205 participants in the cast immobilisation group). 16 participants in the surgery group and 15 participants in the cast immobilisation group were excluded because of either withdrawal, no response, or no follow-up data at 6, 12, 26, or 52 weeks. There was no significant difference in mean PRWE scores at 52 weeks between the surgery group (adjusted mean 11·9 [95% CI 9·2-14·5]) and the cast immobilisation group (14·0 [11·3 to 16·6]; adjusted mean difference -2·1 [95% CI -5·8 to 1·6], p=0·27). More participants in the surgery group (31 [14%] of 219 participants) had a potentially serious complication from surgery than in the cast immobilisation group (three [1%] of 220 participants), but fewer participants in the surgery group (five [2%]) had cast-related complications than in the cast immobilisation group (40 [18%]). The number of participants who had a medical complication was similar between the two groups (four [2%] in the surgery group and five [2%] in the cast immobilisation group). INTERPRETATION: Adult patients with scaphoid waist fractures displaced by 2 mm or less should have initial cast immobilisation, and any suspected non-unions should be confirmed and immediately fixed with surgery. This treatment strategy will help to avoid the risks of surgery and mostly limit the use of surgery to fixing fractures that fail to unite. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Moldes Cirúrgicos , Fixação Interna de Fraturas , Fraturas Ósseas/terapia , Osso Escafoide/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Parafusos Ósseos , Feminino , Fixação de Fratura , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Osso Escafoide/cirurgia , Tempo para o Tratamento , Adulto Jovem
17.
Medicine (Baltimore) ; 99(30): e21126, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791687

RESUMO

RATIONALE: Bilateral brachial plexus block (BPB) generally requires a relatively large dose of local anesthetic for a successful block, resulting in a high risk of local anesthetic systemic toxicity. It can also result in inadvertent bilateral phrenic nerve palsy, leading to respiratory failure. Hence, it has not been widely used. However, it can be performed in selected patients. In this report, we present a case of ultrasound-guided BPB for bilateral upper extremity surgery in a patient with cervical spinal cord injury (SCI). PATIENT CONCERNS: A 25-year-old woman with SCI secondary to traumatic fifth cervical spine fracture scheduled for surgical treatment of bilateral elbow fracture received bilateral BPB. DIAGNOSES: Due to the complications of SCI, the patient had incomplete sensory loss, loss of motor function, and complete diaphragmatic paralysis on the right side. INTERVENTIONS: Right infraclavicular and left axillary BPB was performed as the sole anesthetic procedure for bilateral upper extremity surgery. OUTCOMES: Bilateral BPB was successful for bilateral upper extremity surgery. The surgery was uneventful and without further complications. LESSONS: Patients with cervical SCI have a high risk of respiratory complications. Bilateral BPB can be a suitable option for bilateral upper extremity surgery in selected patients. It is imperative to select an appropriate anesthetic technique that preserves respiratory function to minimize the potential risk of respiratory complications.


Assuntos
Bloqueio do Plexo Braquial , Articulação do Cotovelo/cirurgia , Fraturas Ósseas/cirurgia , Traumatismos da Medula Espinal/complicações , Adulto , Bloqueio do Plexo Braquial/métodos , Vértebras Cervicais , Articulação do Cotovelo/lesões , Feminino , Humanos , Cuidados Intraoperatórios , Ultrassonografia de Intervenção , Extremidade Superior/lesões , Extremidade Superior/cirurgia
18.
J Am Acad Orthop Surg ; 28(16): e706-e715, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32769719

RESUMO

Fractures of the coracoid process are relatively rare, and current management guidelines remain unclear. Most coracoid fractures occur in conjunction with other shoulder injuries, including dislocations and fractures. Identifying coracoid fractures can be difficult because most fractures are nondisplaced and can be missed on radiographs or may be masked by other injuries. Management is largely guided by fracture location and displacement. Conservative treatment is preferred for fractures that are minimally displaced, whereas indications for surgical fixation include fractures that are displaced (>1 cm), have progressed to a painful nonunion, or are associated with the disruption of the superior shoulder suspensory complex. Although conservative treatment has been historically favored, satisfactory outcomes have been reported for both surgical and nonsurgical treatment. We provide a comprehensive review of diagnosis and management strategies for coracoid fractures.


Assuntos
Tratamento Conservador/métodos , Processo Coracoide/lesões , Fraturas Ósseas/terapia , Processo Coracoide/anatomia & histologia , Processo Coracoide/diagnóstico por imagem , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Imageamento Tridimensional , Procedimentos Ortopédicos/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Medicine (Baltimore) ; 99(30): e20652, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791662

RESUMO

The aim of this study is to explore the clinical outcome and indications in treating anterior ring injury of Tile C pelvic fracture with minimally invasive internal fixation.We retrospectively reviewed 18 patients (aged 25-62, 34.2 ±â€Š7.4) with 26 pelvic anterior ring injuries of Tile C pelvic fracture treated with minimally invasive internal fixation in our hospital were from January 2012 to August 2016. Two cases were pubic symphysis diastasis, 15 were anterior ring fracture (7 were bilateral), and 1 was vertical displacement of pubic symphysis associated with pubic ramus fracture. According to Tile classification, 8, 4, and 6 cases were types C1, C2, and C3, respectively. All patients accepted the operation of pelvic fractures on both rings, while the anterior ring injuries were treated with minimally invasive internal fixation. The period from injury to operation was 5 to 32 days (11.2 ±â€Š3.7). Four patients had pubic symphysis diastasis or pelvic anterior ring fracture medial obturator foramen reduced with modified Pfannenstiel incision and fixed with cannulated screws, 14 patients (22 fractures) had a fractured lateral obturator foramen reduced with modified Pfannenstiel incision associated with small iliac crest incision and fixed with locking reconstruction plates. Clinical data, such as operation time, intraoperative bleeding, Matta standard to assess the reduction quality of fracture, and complications, were collected and analyzed.The operation time ranged from 30 to 65 minutes (42.8 ±â€Š18.7), and the intraoperative bleeding volume was 30 to 150 mL (66.5 ±â€Š22.8). All cases were continuously followed-up for 16 to 42 months (30.2 ±â€Š4.6). All fractures were healed between 3 and 9 months postoperatively (4.9 ±â€Š2.7 months). According to the Matta standard assessment, 18, 7, and 1 cases were excellent, good, and fair, respectively, with a 96.2% (25/26) rate of satisfaction. Neither reduction loss, fixation failure, nor infection occurred; complications included 1 patient with fatal liquefaction, 1 patient had lateral femoral cutaneous nerve injury, and 1 patient complained of discomfort in the inguinal area due to fixation stimulation.Minimally invasive internal fixation for pelvic anterior ring injury in Tile C pelvic fracture has the advantages of less damage, safer manipulation, less complications, and good prognosis.


Assuntos
Fixação Interna de Fraturas/estatística & dados numéricos , Fraturas Ósseas/cirurgia , Ossos Pélvicos/lesões , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Ossos Pélvicos/cirurgia , Estudos Retrospectivos
20.
Orthopade ; 49(8): 702-709, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32671414

RESUMO

BACKGROUND: The high demands that fracture-related infections put on patients, physicians and the healthcare system have led to the establishment of a international group of experts called the Fracture-Related Infection (FRI) Consensus Group, whose aim is to develop evidence-based treatment recommendations. DIAGNOSIS: Fracture-related infections are classified according to the time of occurrence, extent and treatment options. The diagnostic algorithm distinguishes between confirmatory and suggestive diagnostic criteria. If there are indications of an infection, tissue biopsy with microbiological and histological workup is recommended to confirm the diagnosis. THERAPY: The primary objective of FRI treatment is to achieve fracture consolidation, while avoiding osteomyelitis. Therapeutic options are removal of the implant, eradication of the infection with implant retention or suppression of FRI. A multidisciplinary team is recommended to develop a patient-specific, optimized surgical and antimicrobial therapy.


Assuntos
Antibacterianos/uso terapêutico , Desbridamento/métodos , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Osteomielite/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/terapia , Algoritmos , Biofilmes , Fraturas Ósseas/microbiologia , Humanos , Osteomielite/diagnóstico , Osteomielite/microbiologia , Complicações Pós-Operatórias/terapia , Infecção da Ferida Cirúrgica/microbiologia , Traumatologia
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