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1.
Medicine (Baltimore) ; 98(42): e17611, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626138

RESUMO

There is no consensus regarding the references to determine the exact location of the skin incision to minimize iatrogenic sural nerve injury in the sinus tarsi approach for calcaneal fracture.The purpose of this cadaveric study was to describe the anatomical course of the sural nerve in relation to easily identifiable landmarks during the sinus tarsi approach and to provide a more practical reference for surgeons to avoid sural nerve injury.Twenty-four foot and ankle specimens were dissected. The bony landmarks used in the following reference points were the tip of the lateral malleolus (point A), lateral border of the Achilles tendon on the collinear line with point A (point B), posteroinferior apex of the calcaneus (point C), inferior margin of the calcaneus on the plumb line through point A (point D), and tip of the fifth metatarsal base (point E). After careful dissection, the distances of the sural nerve to points A and B in the horizontal direction (lines D1 and D2), points A and C in the diagonal direction (lines D3 and D4), points A and D in the vertical direction (lines D5 and D6), and points A and E in the diagonal direction (lines D7 and D8) were measured.The median ratio of D1 to D1+D2, D3 to D3+D4, D5 to D5+D6, and D7 to D7+D8 were 0.37 (range, 0.26-0.50), 0.23 (range, 016-0.33), 0.35 (range, 0.25-0.45), and 0.32 (range, 0.20-0.45), respectively.The distance ratios from this study can be helpful to avoid sural nerve injury during the sinus tarsi approach for calcaneal fractures. Established standard incision may have to be modified to minimize sural nerve injury.


Assuntos
Traumatismos do Tornozelo/cirurgia , Calcâneo/lesões , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Complicações Intraoperatórias/prevenção & controle , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervo Sural/lesões , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Tornozelo/diagnóstico , Cadáver , Calcâneo/cirurgia , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Ossos do Tarso/cirurgia
2.
Bone Joint J ; 101-B(10): 1263-1271, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564142

RESUMO

AIMS: The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires. PATIENTS AND METHODS: This was a multicentre, parallel group, randomized controlled noninferiority trial conducted at 12 tertiary trauma centres in Germany. A total of 290 patients with acute displaced fractures of the fifth metacarpal neck were randomized to either intramedullary single-wire (n = 146) or dual-wire fixation (n = 144). The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire six months after surgery, with a third of the minimal clinically important difference (MCID) used as the noninferiority threshold. Secondary outcomes were pain, health-related quality of life (EuroQol five-dimensional questionnaire (EQ-5D)), radiological measures, functional deficits, and complications. RESULTS: Overall, 151/290 of patients (52%) completed the six months of follow-up, leaving 83 patients in the single-wire group and 68 patients in the dual-wire group. In the modified intention-to-treat analysis set, mean DASH scores six months after surgery were 3.8 (sd 7.0) and 4.4 (sd 9.4), respectively. With multiple imputation (n = 288), mean DASH scores were estimated at 6.3 (sd 8.7) and 7.0 (sd 10.0). Upper (1 - 2α)) confidence limits consistently remained below the noninferiority margin of 3.0 points in the DASH instrument. While there was a statistically nonsignificant trend towards a higher rate of shortening and rotational malalignment in the single wire group, no statistically significant differences were observed across groups in any secondary outcome measure. CONCLUSION: A single thick K-wire is sufficient for intramedullary fixation of acute displaced subcapital fractures of the fifth metacarpal neck. The less technically demanding single-wire technique produces noninferior clinical and radiological outcomes compared with the dual-wire approach. Cite this article: Bone Joint J 2019;101-B:1263-1271.


Assuntos
Fios Ortopédicos , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Ossos Metacarpais/lesões , Adulto , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Alemanha , Força da Mão/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Ossos Metacarpais/cirurgia , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Amplitude de Movimento Articular/fisiologia , Medição de Risco
3.
Oper Orthop Traumatol ; 31(5): 422-432, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31486853

RESUMO

OBJECTIVE: Anatomic reduction and stabile fixation for immediate mobilisation and restoration of unrestricted function. INDICATIONS: Instabile metacarpal fractures with or without malrotation, dislocated metacarpal fractures with malrotation or finger extension deficit, longitudinally shortened metacarpal fractures with finger extension deficit. CONTRAINDICATIONS: Persistent infections (empyema, osteomyelitis, phlegmon) SURGICAL TECHNIQUE: Longitudinal intermetacarpal incision along the fracture zone, debridement of the fracture zone with retainment of periost, anatomic reduction and retention of spiral fractures with at least two lag screws or retention of comminuted or transverse fractures with locking plate osteosynthesis while retaining periost. POSTOPERATIVE MANAGEMENT: Buddy splinting of the corresponding finger to enable immediate mobilisation without weight bearing for 6 weeks. RESULTS: Locking plate osteosynthesis and compression screw osteosynthesis after anatomic reduction of metacarpal fractures proved to be very reliable with a low complication rate and a good functional outcome (modified Mayo Wrist Score [MMWS]: mean 88 (20-100); Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire: mean 41(24-86)).


Assuntos
Fraturas Ósseas , Ossos Metacarpais , Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Humanos , Ossos Metacarpais/lesões , Ossos Metacarpais/cirurgia , Redução Aberta , Resultado do Tratamento
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1133-1140, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512455

RESUMO

Objective: To explore the application of individualized transiliac crest nail-grafting guide plate prepared by computer-aided design and three-dimensional (3D) printing technology in deep pelvic external fixator implantation. Methods: Five patients with pelvic fractures were collected between May 2017 and February 2018. There were 4 females and 1 male with an average age of 52 years (range, 29-68 years). Pelvic fractures were classified as type B in 3 cases and type C in 2 cases by Tile classification. The interval between injury and operation was 6-14 days (mean, 9 days). The preoperative CT images of pelvic fractures were collected. The data was reconstructed by 3D imaging reconstruction workstation. An individualized transiliac crest nail-grafting guide plate was designed on the virtual 3D model. The individualized transiliac crest nail-grafting guide plate and the solid pelvic model were produced with the 3D printing technology. The individualized transiliac crest nail-grafting guide plate was used for intraoperative deep pin position on iliac crest after the preoperative simulation. The follow-up CT scans were used to determine the differences in distance from anterior superior iliac spine, convergence angle, and caudal angle between the preoperative plan and postoperative measurement. Results: During the operation, the individualized transiliac crest nail-grafting guide plate was used to guide the placement of 20 pins. X-ray film and CT examination showed that all pins were well positioned. The average depth of pins was 83.16 mm (range, 70.13-100.53 mm). Fitted 3D reconstruction images showed that the entry point and orientation of the pins were all consistent with preoperative schemes. Compared with the planned nail path, there was no significant difference in the distance from anterior superior iliac spine, convergence angle, and caudal angle in the actual nail path ( P>0.05). No loosening and rupture of pin, no damage of blood vessels and nerve, and shallow or deep infection occurred during 3 months follow-up, and the incisions healed by first intention. All patients were satisfied with the treatment process. The ranges of motion of hip and knee were normal, and the visual analogue scale (VAS) score was 0-3 (mean, 0.5). Conclusion: The individualized transiliac crest nail-grafting guide plate technique is the improvement of traditional technique. It can increase accuracy and effective depth of pin position, enable patients to obtain pelvic mechanical stability quickly after operation, and reduce the risk of complications related to nail path.


Assuntos
Pinos Ortopédicos , Fixadores Externos , Fixação de Fratura , Fraturas Ósseas , Ossos Pélvicos , Adulto , Idoso , Feminino , Fixação de Fratura/instrumentação , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
5.
Schweiz Arch Tierheilkd ; 161(9): 509-521, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31488392

RESUMO

INTRODUCTION: The present retrospective study investigated the localization, cause, treatment and healing of long bone fractures in cattle. Over a period of ten years, medical records of 194 cattle of all ages with a long bone fracture, presented at the Clinic for Ruminants with Ambulatory and Herd Health Services at LMU Munich, were evaluated. The majority of patients (n = 131, 67.5%) were younger than two weeks of age. Of these, 118 calves sustained the fracture on the day of birth (60.8%). An obstetrical assistance was found in 57.4% (n = 58) of birth-related cases as a fracture cause. The femur was most frequently affected in calves aged up to two weeks (n = 35; 26.7%). The second most frequent fractures occurred in the metacarpus (n = 31; 22.9%) in this age group, followed by metatarsus (n = 28; 21.4%) and tibia (n = 27; 20.6%). Fractures of the antebrachium (n = 9; 6.9%) and the humerus were rare (n = 1; 0.8%). A total of 194 patients were diagnosed with 50 femur fractures (25.8%), 53 metacarpal fractures (27.3%), 43 metatarsal fractures (22.2%), 30 tibial fractures (15.5%), 11 antebrachial fractures (5.7%) and 7 humeral fractures (3.6%). Of the 194 animals, 78 (40.2%) had to be euthanized, 42 of them (53.8%) without treatment. In 150 patients, treatment was initiated, of which 110 patients (73.3%) were dismissed healthy from the clinic. Among the conservative treatment methods were stall rest, casts, casts combined with a U-shaped metal rail (walking casts) and the Thomas splint. Surgical therapy (internal fixation with plates or screws, transfixation pin casts) was used to treat 65 animals (33.5%). While 86.9% (74 out of 85) of the conservatively treated animals left the clinic alive, it were only 58.1% (36 out of 65) animals after surgical treatment. In the newborn calves, colostrum supply had a significant effect on the success of the treatment. If the gamma-glutamyl transferase concentration was below 200 IU/L in the calves aged under 4 days, the healing rate was significantly different from the cure rate of sufficiently immunized patients (26.9% (7 out of 26) vs. 65.3% (47 out of 72), P = 0.001).


Assuntos
Ossos da Extremidade Inferior/lesões , Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Animais , Ossos da Extremidade Inferior/cirurgia , Bovinos , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Alemanha , Estudos Retrospectivos , Resultado do Tratamento
6.
Acta Cir Bras ; 34(7): e201900702, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531537

RESUMO

PURPOSE: To investigate the effect of intermittent vibration at different intervals on bone fracture healing and optimize the vibration interval. METHODS: Ninety sheep were randomized to receive no treatment (the control group), incision only (the sham control group), internal fixation with or without metatarsal fracture (the internal fixation group), and continuous vibration in addition to internal fixation of metatarsal fracture, or intermittent vibration at 1, 2, 3, 5, 7 and 17-day interval in addition to internal fixation of metatarsal fracture (the vibration group). Vibration was done at frequency F=35 Hz, acceleration a=0.25g, 15 min each time 2 weeks after bone fracture. Bone healing was evaluated by micro-CT scan, bone microstructure and mechanical compression of finite element simulation. RESULTS: Intermittent vibration at 7-day interval significantly improved bone fracture healing grade. However, no significant changes on microstructure parameters and mechanical properties were observed among sheep receiving vibration at different intervals. CONCLUSIONS: Clinical healing effects should be the top concern. Quantitative analyses of bone microstructure and of finite element mechanics on the process of fracture healing need to be further investigated.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas Ósseas/diagnóstico por imagem , Ossos do Metatarso/lesões , Vibração/uso terapêutico , Animais , Análise de Elementos Finitos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/normas , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Distribuição Aleatória , Ovinos , Microtomografia por Raio-X
7.
Medicine (Baltimore) ; 98(34): e16898, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441868

RESUMO

Both spiral plate and Herbert screw fixations have been clinically adopted for treating midshaft displaced clavicle fractures. However, the biomechanical properties of the 2 implant fixations have not yet been thoroughly evaluated. Here we report the results of a finite element analysis of the biomechanical properties of midshaft clavicle fractures treated with Herbert screw and spiral plate fixation. Hebert screw fixation showed stress distribution similar to intact clavicle under all loading conditions, but provided less stability than did spiral plate fixation. Postoperatively, excessive shoulder activities and weight-bearing should be avoided. Spiral plate fixation provides greater stability, but is associated with stress shielding. These results demonstrate that Herbert screw fixation is suitable for the treatment of simple displaced clavicluar fractures, but excessive shoulder activity and weight-bearing should be avoided after the operation. Therefore, spiral plate fixation may be preferred for patients requiring an early return to activity.


Assuntos
Clavícula/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Adulto , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Clavícula/anatomia & histologia , Clavícula/diagnóstico por imagem , Feminino , Humanos , Imagem Tridimensional , Modelos Anatômicos , Melhoria de Qualidade , Adulto Jovem
8.
Bone Joint J ; 101-B(8): 995-1001, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362556

RESUMO

AIMS: The primary aim of this study was to establish the cost-effectiveness of the early fixation of displaced midshaft clavicle fractures. PATIENTS AND METHODS: A cost analysis was conducted within a randomized controlled trial comparing conservative management (n = 92) versus early plate fixation (n = 86) of displaced midshaft clavicular fractures. The incremental cost-effectiveness ratio (ICER) was used to express the cost per quality-adjusted life-year (QALY). The Six-Dimension Short-Form Health Survey (SF-6D) score was used as the preference-based health index to calculate the cost per QALY at 12 months after the injury. RESULTS: The mean 12-month SF-6D was 0.9522 (95% confidence interval (CI) 0.9355 to 0.9689) following conservative management and 0.9607 (95% CI 0.9447 to 0.9767) following fixation, giving an advantage for fixation of 0.0085, which was not statistically significant (p = 0.46). The mean cost per patient was £1322.69 for conservative management and £5405.32 for early fixation. This gave an ICER of £480 309.41 per QALY. For a threshold of £20 000 per QALY, the benefit of fixation would need to be present for 24 years to be cost-effective compared with conservative treatment. Linear regression analysis identified nonunion as the only factor to adversely influence the SF-6D at 12 months (p < 0.001). CONCLUSION: Routine plate fixation of displaced midshaft clavicular fractures is not cost-effective. Nonunion following conservative management has an increased morbidity with comparable expense to early fixation. This may suggest that a targeted approach of fixation in patients who are at higher risk of nonunion would be more cost-effective than the routine fixation of all displaced fractures. Cite this article: Bone Joint J 2019;101-B:995-1001.


Assuntos
Clavícula/lesões , Tratamento Conservador/economia , Análise Custo-Benefício/estatística & dados numéricos , Fixação Interna de Fraturas/economia , Fraturas Ósseas/cirurgia , Custos de Cuidados de Saúde/estatística & dados numéricos , Adulto , Placas Ósseas , Clavícula/cirurgia , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/economia , Humanos , Masculino , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento , Reino Unido
9.
Medicine (Baltimore) ; 98(33): e16900, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415435

RESUMO

RATIONALE: Spontaneous closed extensor tendon rupture is a rare complication of Kienböck disease with only 23 cases reported in the English literature. PATIENT CONCERNS: We present a case of painless attritional rupture of the extensor tendons of the right fourth finger in a 69-year-old woman with Kienböck disease and review reported cases of Kienböck disease with subcutaneous closed tendon rupture. DIAGNOSES: Physical examination had shown mild painless swelling of the dorsum of the right hand. Plain radiographs showed a dorsally displaced fragment of collapsed lunate bone fracture (Lichtman grade IIIb). Although surgery was recommended, the patient did not desire surgery because she had no pain and no interference with the activities of daily living. Six months later, however, the patient returned to our hospital with complaints of loss of spontaneous extension of the fourth finger. CT and MRI showed aseptic necrosis and large dorsally displaced fragments of the lunate under the extensor tendons of the fingers, suggesting a subcutaneous fourth extensor tendon rupture. INTERVENTIONS: Surgery was performed to achieve functional recovery of the ring extensor and to prevent further subcutaneous tendon rupture. The extensor digitorum communis (EDC) of the ring finger was found to be ruptured and the EDCs to the third and fifth fingers were frayed due to attrition from the protrusion of the dorsal fragmented lunate bone. Inspection of the floor of the compartment revealed that the dorsally displaced fragment of the lunate bone had perforated the wrist capsule and protruded into the fourth compartment. The dorsal and volar fragments of the lunate bone were excised completely and scaphocapitate arthrodesis followed by the reconstruction of the fourth extensor tendon was performed. OUTCOMES: A year after the surgery, radiography showed complete union of the scaphocapitate arthrodesis. The joint motion reached 45% of normal without any pain and there was full active extension of the fourth finger. LESSONS: Because dorsally displacement of collapsed lunate bone fragments is a risk factor for attritional closed rupture of tendons, radiography, and MRI are essential to diagnose and to treat any closed tendon rupture.


Assuntos
Fraturas Ósseas/etiologia , Osso Semilunar/lesões , Osteonecrose/complicações , Ruptura Espontânea/etiologia , Idoso , Doenças Assintomáticas , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Osteonecrose/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Tendões/cirurgia , Tomografia Computadorizada por Raios X
10.
Oper Orthop Traumatol ; 31(5): 384-392, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31346631

RESUMO

OBJECTIVE: Reconstruction of intra-articular impression fractures of the middle phalanx by percutaneous reduction over a small dorsal cortical window. Stabilization by lattice-like arranged K­wires. INDICATIONS: Impression fractures of the base of the middle phalanx with or without dislocation in the proximal interphalangeal joint. CONTRAINDICATIONS: Fractures extending to the shaft of the middle phalanx. SURGICAL TECHNIQUE: By a cortical window at the dorsum of the middle phalanx (through the tendon free triangle) the impression fracture is reduced from the medullary cavity. Reduction is secured and the articular surface is supported by lattice-like arranged K­wires. POSTOPERATIVE MANAGEMENT: Thermoplastic splint for the finger for 6 weeks, subsequently K­wire removal, active range of motion exercises and hand occupational therapy. RESULTS: In two case series already published, good clinical and radiological results were reported. No complications were detected in either series.


Assuntos
Traumatismos dos Dedos , Falanges dos Dedos da Mão/cirurgia , Fraturas Ósseas , Luxações Articulares , Fios Ortopédicos , Traumatismos dos Dedos/cirurgia , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/cirurgia , Amplitude de Movimento Articular , Resultado do Tratamento
11.
Eklem Hastalik Cerrahisi ; 30(2): 106-11, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291857

RESUMO

OBJECTIVES: This study aims to compare mechanical stability of osteosynthesis (plate and screw fixation) alone versus the same method supplemented with hip arthroplasty (hybrid solution) for double column fractures in elderly. PATIENTS AND METHODS: Mechanical investigations were performed on an advanced finite element pelvis model developed for double column fractures. The following simulated implant combinations were analyzed: modular acetabular basket with a ring with polyaxial screws and U-plate; plates with polyaxial screws placed on the medial-horizontal (linea terminalis) and quadrilateral bone surfaces; modular acetabular cup with U-plates; and polyaxial screws in sizes optimized based on a finite element model (FEM). Using the models, the possible shifts in peak load positions arising in different movement patterns caused by load and tension and implant deformation were measured. RESULTS: Hybrid systems resulted in minimal deformation of the implants already available on the market. We observed less possible shifts and greater stability in the acetabular fracture zones, compared to conventional osteosynthesis alone. Optimization with available and compatible implant sizes led to a further significant increase in stability. CONCLUSION: Hybrid method combining osteosynthesis and prosthesis implantation provide more stability in biomechanical models in the treatment of double column fractures in elderly.


Assuntos
Acetábulo/lesões , Acetábulo/cirurgia , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Análise de Elementos Finitos , Fixação Interna de Fraturas/métodos , Humanos , Modelos Biológicos
12.
Eklem Hastalik Cerrahisi ; 30(2): 130-6, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291861

RESUMO

OBJECTIVES: This study aims to evaluate the clinical and radiological results of patients with multiple dorsal carpometacarpal (CMC) joint fracture dislocations treated with open reduction and internal fixation (ORIF). PATIENTS AND METHODS: We evaluated 14 patients (12 males, 2 females; mean age 35.1 years; range, 22 to 64 years) between January 2013 and December 2017. Our main outcome measurements were the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, loss of grip strength, limitation of range of motion (ROM), and Kellgren-Lawrence osteoarthritis classification identified with radiographs and computed tomography images. RESULTS: The mean QuickDASH scores at seventh week and third month were 73.57 (range, 65-90) and 29.11 (range, 25-42.5), respectively. The mean QuickDASH score at seventh, ninth, and 12th month, and final follow-up was 4.64 (range, 0-30) and the QuickDASH score at these follow-up points was not 0 for only three patients. The mean loss of grip strength was 32.14% and two patients (14.29%) had limitation of ROM in third proximal interphalangeal joint at final follow-up. Four patients had grade I, nine patients had grade II, and one patient had grade III osteoarthritis according to Kellgren-Lawrence classification at final follow-up. CONCLUSION: Although functional results demonstrated that multiple CMC joint fracture dislocations can be treated with ORIF, the high rate of osteoarthritis is a disadvantage.


Assuntos
Articulações Carpometacarpais/cirurgia , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Adulto , Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/fisiopatologia , Feminino , Seguimentos , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/fisiopatologia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta , Osteoartrite/diagnóstico por imagem , Osteoartrite/etiologia , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
Medicine (Baltimore) ; 98(27): e16286, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277159

RESUMO

Patients with rheumatoid arthritis (RA) have a high risk of cardiovascular diseases and fractures. This retrospective cohort study explored whether patients with RA face higher complication risks or longer hospital stays than other patients when they had a lower limb fracture that required the surgery. Patients aged >45 years who received lower limb fracture surgeries between 2005 and 2012 were selected from the National Health Insurance Research Database, and 10 related variables including sex and age were used in propensity score matching to pair RA patients with non-RA patients in a 1:4 ratio. The final study sample comprised 1109 patients with RA and 4436 non-RA patients. The results indicated that 5.57% of the study sample had postoperative complications, accounting for 5.05% of patients with RA and 5.70% of the control group. After conditional logistic regression analysis was performed, the risk of major complications has no significant differences between patients with RA and the control group (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.61-1.24; P > .05). However, the comorbidity severity score exerted a significant effect on complications; patients with scores ≥3 were 2.78 times more likely to experience complications (OR = 2.78; 95% CI 1.52-5.07). When considering different types of complications, patients with RA were less likely to be exposed to the risk of stroke (OR = 0.48). After controlling all related factors, no significant differences were observed in the complication risks or deaths between the 2 groups (P > .05). Regarding hospitalization length, the average stay for all patients was 8.12 days; after controlling related factors, the hospitalization length for patients with RA was 0.97 times that of the control group, which was nonsignificant (P > .05). These results may provide some information to healthcare professionals when providing treatments.


Assuntos
Artrite Reumatoide/complicações , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Tempo de Internação/tendências , Extremidade Inferior/lesões , Complicações Pós-Operatórias/diagnóstico , Pontuação de Propensão , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Fraturas Ósseas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
14.
Medicine (Baltimore) ; 98(28): e16359, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305431

RESUMO

RATIONALE: Asymmetrical bilateral sternoclavicular joint (SCJ) dislocation consists of posterior SCJ dislocation on one side and anterior SCJ dislocation on the other side. This is an extremely rare injury and only a few cases have been reported in the literature. If not been diagnosed timely and accurately, asymmetrical bilateral SCJ dislocation can be life-threatening. PATIENTS CONCERNS: We experienced a patient who has a life-threatening posterior dislocation of right SCJ and anterior dislocation on the left SCJ combined with bilateral clavicular fracture after a traffic accident. DIAGNOSES: A computed tomography (CT) scan with three-dimensional reconstructions of SCJ showed potentially life-threatening posterior dislocation of right SCJ and anterior dislocation on the left SCJ combined with bilateral clavicular fracture. INTERVENTIONS: Because of failed attempts at closed reduction, electively surgical intervention was made. We repaired the ruptured joint capsule and ligaments and fixed bilateral SCJ by Kirschner wire during the operation. OUTCOMES: Three-dimensional CT scans confirmed bilateral SCJ reduction and alignment after operation 1 week as well as at the 2-month follow-up. LESSONS: SCJ dislocation is an extremely rare and life-threatening injury. The aim of the operation is to repair the ruptured joint capsule and its ligaments and to fix the dislocated joints.


Assuntos
Clavícula/lesões , Fraturas Ósseas/complicações , Luxações Articulares/complicações , Articulação Esternoclavicular/lesões , Acidentes de Trânsito , Adulto , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/cirurgia , Articulação Esternoclavicular/diagnóstico por imagem , Articulação Esternoclavicular/cirurgia
15.
Lakartidningen ; 1162019 Jun 18.
Artigo em Sueco | MEDLINE | ID: mdl-31211404

RESUMO

This article suggests algorithms for diagnosis and treatment of scaphoid fractures. A clinical suspected scaphoid fracture without signs of fracture on conventional radiographs should have a supplementary MRI done within 5-7 days. Displaced fractures and all proximal fractures should be classified by CT. Fracture union should be evaluated by CT. 90 procent of non- or minimally displaced waist fractures are healed after 6 weeks of conservative treatment. Non- or minimally displaced fractures with signs of instability can be treated conservatively, but require prolonged immobilisation. Fractures with a displacement ≥1,5 mm as well as the majority of proximal scaphoid fractures should be treated surgically with internal fixation.


Assuntos
Fraturas Ósseas , Guias de Prática Clínica como Assunto , Osso Escafoide , Doença Aguda , Algoritmos , Consolidação da Fratura , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Humanos , Imagem por Ressonância Magnética , Radiografia , Volta ao Esporte , Retorno ao Trabalho , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/lesões , Tomografia Computadorizada por Raios X
16.
J Shoulder Elbow Surg ; 28(7): 1308-1315, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31230782

RESUMO

BACKGROUND: Iatrogenic supraclavicular nerve injury is frequent during surgical repair of clavicle fractures through a transverse incision. The use of an oblique incision may be a potential approach to avoiding this complication. This study compared the clinical effectiveness of oblique and transverse incisions in the treatment of fractures in the middle and outer thirds of the clavicle. METHODS: This prospective observational study included patients with fracture of the mid-to-outer third of the clavicle between August 2011 and August 2016. We allocated the patients into 2 groups based on their choice of treatment: oblique incision (n = 62) and transverse incision (n = 64). We compared the following parameters between the 2 groups: operative time, intraoperative blood loss, postoperative fracture healing time, incision size, clinical complications, postoperative subjective satisfaction, and shoulder function. RESULTS: Operative time, postoperative fracture healing time, postoperative shoulder function (Constant-Murley and disabilities of the arm, shoulder and hand [DASH] scores), and clinical complications did not differ significantly between groups (all P > .05). The oblique incision group had less intraoperative blood loss (41.4 ± 16.4 vs. 65.3 ± 10.4 mL, P < .001) and smaller surgical incisions (3.6 ± 1.6 vs. 10.3 ± 2.6 cm, P < .001). The oblique incision group showed better outcomes for postoperative satisfaction (85.5% vs. 64.1%, P = .015), absence of shoulder numbness at the last follow-up (89.3% vs. 70.3%, P = .010), and satisfaction with the scar (90.3% vs. 3.1%, P < .001). CONCLUSION: Oblique incisions have several advantages over transverse incisions: less bleeding, smaller incisions, less iatrogenic injury to supraclavicular nerves, and higher patient satisfaction. These 2 approaches have equivalent effects on recovery of shoulder joint function.


Assuntos
Clavícula/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Traumatismos dos Nervos Periféricos/prevenção & controle , Adulto , Perda Sanguínea Cirúrgica , Clavícula/lesões , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Traumatismos dos Nervos Periféricos/etiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Prospectivos , Ombro/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
17.
Pan Afr Med J ; 32: 57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223349

RESUMO

Fracture of the talar body is rare, it reaches articular congruence and determines the ankle's functional prognosis. The authors report a case of a combination of a sagittal talar body fracture with fracture of the medial malleolus in a 52-year-old following a road traffic accident. The association talus body fracture with a medial malleolus fracture is exceptional. Stable internal fixation can yield good functional results.


Assuntos
Fraturas do Tornozelo/patologia , Fraturas Ósseas/patologia , Tálus/lesões , Acidentes de Trânsito , Fraturas do Tornozelo/etiologia , Fraturas do Tornozelo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/etiologia , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tálus/patologia , Tálus/cirurgia
18.
Medicine (Baltimore) ; 98(24): e16011, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192948

RESUMO

RATIONALE: Upper pole sleeve fractures of the patella are rare in adolescents; however, they are serious injuries that require early diagnosis and treatment. PATIENT CONCERNS: We present a rare case of a 15-year-old girl who suffered a sleeve fracture at the superior pole of the right patella. The patient had a history of dislocation of the patella 2 weeks ago. Physical examination showed tenderness on palpation over the upper pole of the patella and absence of active movement of the knee accompanied by swelling and joint effusion. A plain radiograph showed an avulsed fragment of the superior pole of the patella. DIAGNOSES: Magnetic resonance imaging showed a superior pole patellar avulsion fracture and dysfunction of the knee extensor mechanism. INTERVENTIONS: Under general anesthesia, the patient underwent open surgery for reduction of the patellar fracture and reconstruction of the knee extension apparatus through an anterior approach. OUTCOMES: Six months after the operation, the knee function was fully restored, there was absence of pain and swelling, and the patient was able to return to sports. LESSONS: Upper pole sleeve fracture of the patella is usually serious and it needs to be diagnosed and treated as soon as possible, the sports medicine practitioner must be aware of this type of injury.


Assuntos
Fraturas Ósseas/cirurgia , Patela/lesões , Patela/cirurgia , Luxação Patelar/complicações , Luxação Patelar/cirurgia , Adolescente , Diagnóstico Diferencial , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Patela/diagnóstico por imagem , Luxação Patelar/diagnóstico por imagem
19.
Niger J Clin Pract ; 22(6): 862-868, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187774

RESUMO

Background: Many factors are known to affect the functional outcomes of the acetabular surgery. The aim of this study is to evaluate the effects of incision preferences and number of incision on scores and clinical functional outcomes. Patients and Methods: Forty-seven adult patients who had undergone acetabular surgery and had been followed up for at least 1 year in our clinic were included in the study. Demographic data, trauma type, acetabular fracture type based on the Judet ve Letournel classification, presence of any additional traumatic fractures, time to surgery, operation duration, surgical technique, and postoperative complications were recorded. Range of motion measurements, SF-36 and Harris Hip function scale score, and full weight-bearing times were evaluated on the postoperative first year follow-up and reviewed retrospectively. Results: Our study suggests that use of double incisions in the surgery of associated fractures shortens the full weight-bearing time. The localization and the number of incisions were found to be unrelated with the Harris Functional Hip scale, SF-36 (PCS, physical component score), and SF-36 (mental component score, MCS) scores. Conclusion: Incision type and number of incisions must be determined based on the fracture type and fracture localization for better functional outcomes. The factors that have the most effects on the functional outcomes are the type and the localization. In associated fractures, performing multiple incisions reduces the time for full weight bearing and enables patients to return to their daily routine early but have no effect on the functional outcomes.


Assuntos
Acetábulo/lesões , Acetábulo/cirurgia , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Adulto , Idoso , Feminino , Articulação do Quadril/fisiopatologia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Amplitude de Movimento Articular , Estudos Retrospectivos , Ferida Cirúrgica/complicações , Resultado do Tratamento , Suporte de Carga
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(6): 676-680, 2019 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-31197992

RESUMO

Objective: To investigate the effectiveness of arthroscopic treatment for irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions. Methods: Between February 2008 and August 2016, 11 patients with irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions, were treated with arthroscopic reduction and fixation of bony Bankart lesions. There were 7 males and 4 females, with an average age of 23.7 years (mean, 15-36 years). The injury was caused by traffic accident in 8 cases and falling from height in 3 cases. The interval between hip dislocation and the first manual reduction was 2-8 hours (mean, 5.3 hours) and between the first manual reduction and arthroscopic surgery was 6-31 days (mean, 12.8 days). The preoperative visual analogue scale (VAS) was 5.2±0.9, the modified Harris score was 32±8, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was 30±5. Results: The operative time was 90-150 minutes (mean, 120.9 minutes), with no hip arthroscopic surgery related complications. All incisions healed by first intention. All patients were followed up 26-68 months (mean, 42.7 months). Postoperative X-ray films showed that all hip joints were reduction; CT showed that the reduction of posterior acetabular wall fracture was satisfactory. And all fractures healed at last follow-up with no avascular necrosis of the femoral head or osteoarthritis. At last follow-up, the VAS score was 0.5±0.5, the modified Harris score was 94±5, and the WOMAC score was 95±4. There were significant differences in those indexes between pre- and post-operation ( P<0.05). Conclusion: The irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions is rare. Arthroscopic therapy has the advantages of less trauma, quick recovery, and less complications.


Assuntos
Artroscopia , Lesões de Bankart , Fraturas Ósseas , Luxação do Quadril , Acetábulo , Adolescente , Adulto , Lesões de Bankart/complicações , Lesões de Bankart/cirurgia , Feminino , Fraturas Ósseas/cirurgia , Luxação do Quadril/etiologia , Luxação do Quadril/cirurgia , Articulação do Quadril , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
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