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1.
Eur Radiol ; 30(1): 141-150, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31350586

RESUMO

OBJECTIVES: To evaluate the diagnostic accuracy of dual-energy computed tomography (CT) virtual non-calcium (VNCa) reconstructions for the depiction of traumatic knee bone marrow edema. METHODS: Fifty-seven patients (mean age, 50 years; range, 20-82 years) with acute knee trauma further divided into 30 women and 27 men, who had undergone third-generation dual-source dual-energy CT and 3-T magnetic resonance imaging (MRI) within 7 days between January 2017 and May 2018, were retrospectively analyzed. Six radiologists, blinded to clinical and MRI information, independently analyzed conventional grayscale dual-energy CT series for fractures; after 8 weeks, readers evaluated color-coded VNCa reconstructions for the presence of bone marrow edema in six femoral and six tibial regions. Quantitative analysis of CT numbers on VNCa reconstructions was performed by a seventh radiologist. Two additional radiologists, blinded to clinical and CT information, analyzed MRI series in consensus to define the reference standard. Sensitivity, specificity, and the area under the curve (AUC) were the primary metrics of diagnostic accuracy. RESULTS: MRI revealed 197 areas with bone marrow edema (91/342 femoral, 106/342 tibial). In the qualitative analysis, VNCa showed high overall sensitivity (1108/1182 [94%]) and specificity (2789/2922 [95%]) for depicting bone marrow edema. The AUC was 0.96 (femur) and 0.97 (tibia). A cutoff value of - 51 Hounsfield units (HU) provided high sensitivity (102/106 [96%]) and specificity (229/236 [97%]) for differentiating tibial bone marrow edema. CONCLUSIONS: In both quantitative and qualitative analyses, dual-energy CT VNCa reconstructions yielded excellent diagnostic accuracy for depicting traumatic knee bone marrow edema compared with MRI. KEY POINTS: • Dual-energy CT (DECT) virtual non-calcium (VNCa) reconstructions are highly accurate in depicting bone marrow edema of the femur and tibia. • Diagnostic confidence, image noise, and image quality were rated as equivalent in VNCa reconstructions and MRI (magnetic resonance imaging) series. • VNCa images may serve as an alternative imaging approach to MRI.


Assuntos
Doenças da Medula Óssea/patologia , Edema/patologia , Fraturas Ósseas/patologia , Traumatismos do Joelho , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Cálcio , Feminino , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/patologia , Articulação do Joelho/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Tíbia/patologia , Adulto Jovem
2.
J Orthop Surg Res ; 14(1): 310, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31514742

RESUMO

BACKGROUND: Quadrilateral plate fractures are a challenging group of acetabular fractures to manage. However, there is little literature that describes the fracture lines of the quadrilateral plate. The aim of this study was to explore the fracture lines of the quadrilateral plate and relevant clinical significance. METHODS: CT data from a series of acetabular fractures were retrospectively analyzed. According to the X-ray, CT, and operative records of the patients, Judet-Letournel classification was carried out for acetabular fractures involving quadrilateral plate. Then, the fracture maps of different types of acetabular fractures in the quadrilateral plate were drawn. To facilitate the characterization of fracture maps, we defined six basic fracture lines. RESULTS: The fracture lines of the three types of acetabular fractures (double-column fracture, T-type fracture, and anterior column with posterior hemitransverse fracture) mainly included upper transverse lines and upper oblique lines. Although the fracture lines of posterior wall fracture and anterior column fracture were mainly upper transverse lines, the fracture lines of the former were in a low position. The fracture lines of transverse fracture and transverse with posterior wall fracture were similar, both of which were mainly upper oblique lines. The fracture lines of posterior column fractures mainly included posterior vertical lines. CONCLUSIONS: The fracture lines of different types of acetabular fractures have certain regularity respectively. Observation of the fracture lines of the quadrilateral plate based on fracture mapping can help orthopedic surgeons to enhance the understanding of the Judet-Letournel classification, which may have some significant guidance on the choice of operation approach and the design of internal fixation devices.


Assuntos
Acetábulo/lesões , Fraturas Ósseas/patologia , Acetábulo/patologia , Acetábulo/cirurgia , Adolescente , Adulto , Idoso , Feminino , Fixação de Fratura/métodos , Fraturas Ósseas/classificação , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
Forensic Sci Int ; 302: 109893, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31419593

RESUMO

Differentiating traumatic injuries in bone from taphonomic damage in the postmortem period is a complex process requiring a systematic approach. Trauma by definition occurs while the individual is still living, but bone characteristics usually do not allow delineation of the moment of death. Thus, the anthropologist seeks characteristics that will associate a skeletal defect with the perimortem period, at or about the time of death. However, the anthropological designation of perimortem time period does not have precise boundaries. It refers to remains that lack any sign of remodeling or healing on the one hand, and which have not lost biomechanical elasticity and plasticity on the other hand, i.e., it refers to the condition of skeletal remains when they sustained the suspected injury. Fracture patterns that reflect biomechanical plasticity are lost gradually as the time since death increases, and this pace will depend on the environmental context. There are additional clues to identify postmortem status, including when the damaged feature fits a taphonomic pattern of scavenger modification or weathering, or physically overlies obvious postmortem modifications, or when the feature fits a known pattern of sharp force instruments or weapons. Damage due to recovery or the examination process must be ruled out. The timing of occurrence of a suspected perimortem injury can therefore extend for days or weeks into the time before the actual death, and it can extend for days to months after death. The anthropologist responds to the challenge of differentiating trauma and taphonomic modification by knowing the characteristics of healing bone, the features of biomechanical plasticity reflected in fracture morphology, the taphonomic patterns of scavenging and weathering, the environmental context of discovery and recovery, and the characteristics of the relevant regional taphonomy.


Assuntos
Restos Mortais , Osso e Ossos/patologia , Animais , Dessecação , Exposição Ambiental , Comportamento Alimentar , Fogo , Antropologia Forense , Fraturas Ósseas/patologia , Humanos , Mudanças Depois da Morte
4.
Indian J Med Microbiol ; 37(1): 19-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424005

RESUMO

Background: Culture-negative infections in open long bone fractures are frequently encountered in clinical practice. We aimed to identify the rate and outcome of culture-negative infections in open long bone fractures of lower limb. Methodology: A prospective cohort study was conducted from November 2015 to May 2017 on Gustilo and Anderson Grade III open long bone fractures of the lower limb. Demographic data, injury details, time from injury to receiving antibiotics and index surgical procedure were noted. Length of hospital stay, number of additional surgeries and occurrence of complications were also noted. Patients with infected open fractures were grouped as culture positive or culture negative depending on the isolation of infecting microorganisms in deep intraoperative specimen. The clinical outcome of these two groups was statistically analysed. Results: A total of 231 patients with 275 open fractures involving the femur, tibia or fibula were studied. There was clinical signs of infection in 84 patients (36.4%) with 99 fractures (36%). Forty-three patients (51.2%) had positive cultures and remaining 41 patients had negative cultures (48.8%). The rate of culture-negative infection in open type III long bone fractures in our study was 17.7%. There was no statistical difference in the clinical outcome between culture-negative and culture-positive infections. Conclusion: Failure to identify an infective microorganism in the presence of clinical signs of infection is routinely seen in open fractures and needs to be treated aggressively.


Assuntos
Antibacterianos/uso terapêutico , Fraturas Ósseas/microbiologia , Fraturas Expostas/microbiologia , Extremidade Inferior/microbiologia , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/epidemiologia , Adolescente , Adulto , Idoso , Técnicas de Tipagem Bacteriana , Ciprofloxacino/uso terapêutico , Cloxacilina/uso terapêutico , Desbridamento , Feminino , Fêmur/lesões , Fêmur/microbiologia , Fíbula/lesões , Fíbula/microbiologia , Fraturas Ósseas/patologia , Fraturas Ósseas/cirurgia , Fraturas Expostas/patologia , Fraturas Expostas/cirurgia , Gentamicinas/uso terapêutico , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Estudos Prospectivos , Tíbia/lesões , Tíbia/microbiologia , Resultado do Tratamento , Infecção dos Ferimentos/microbiologia , Adulto Jovem
5.
J Shoulder Elbow Surg ; 28(12): 2334-2342, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31300369

RESUMO

BACKGROUND: Rapidly destructive arthropathy (RDA) of the shoulder is rare. Consequently, there are very few studies that have reported the characteristic findings of this disease. This study aimed to analyze the clinical, radiographic, and histologic features of patients with RDA of the shoulder. METHODS: In total, 9 cases (8 patients) were enrolled in this study. All patients were elderly women, with a mean age of 72.7 years (range, 57-78 years). The mean duration of symptoms was 4.1 months (range, 1.2-5.9 months). Reverse total shoulder arthroplasty and total shoulder arthroplasty were performed in 5 cases with massive rotator cuff tears and 4 without them, respectively. RESULTS: The mean duration of radiologically evident joint destruction after negative results on radiography was 3.1 months (range, 1.0-5.9 months). On plain radiography, humeral head flattening and collapse that appeared like cut grass were observed (100%). Relatively good preservation of the glenoid with a normal joint space was observed in 7 cases, whereas glenoid erosion was observed in 2 (22.2%). T1-weighted magnetic resonance imaging showed a subchondral fracture (100%) of low signal intensity with associated bone marrow edema. Histologically, chronic inflammation of the synovium and osteocytes in the lacunae, as well as callus formation, were observed along the subchondral fracture. CONCLUSION: Flattening and collapse of the humeral head within an average of 4 months of symptom onset are characteristic of RDA of the shoulder. Bone marrow edema, joint effusion, and subchondral fracture on magnetic resonance imaging and fracture fragments and callus formation on histopathologic analysis were observed. Glenoid erosion was observed in 2 cases with arthrosis progression.


Assuntos
Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Artropatias/patologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologia , Idoso , Artroplastia do Ombro , Doenças da Medula Óssea/complicações , Edema/complicações , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/patologia , Cavidade Glenoide/diagnóstico por imagem , Humanos , Cabeça do Úmero/diagnóstico por imagem , Artropatias/complicações , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Radiografia
6.
Int J Mol Sci ; 20(14)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31336890

RESUMO

The normal bone regeneration process is a complex and coordinated series of events involving different cell types and molecules. However, this process is impaired in critical-size/large bone defects, with non-unions or delayed unions remaining a major clinical problem. Novel strategies are needed to aid the current therapeutic approaches. Mesenchymal stem/stromal cells (MSCs) are able to promote bone regeneration. Their beneficial effects can be improved by modulating the expression levels of specific genes with the purpose of stimulating MSC proliferation, osteogenic differentiation or their immunomodulatory capacity. In this context, the genetic engineering of MSCs is expected to further enhance their pro-regenerative properties and accelerate bone healing. Herein, we review the most promising molecular candidates (protein-coding and non-coding transcripts) and discuss the different methodologies to engineer and deliver MSCs, mainly focusing on in vivo animal studies. Considering the potential of the MSC secretome for bone repair, this topic has also been addressed. Furthermore, the promising results of clinical studies using MSC for bone regeneration are discussed. Finally, we debate the advantages and limitations of using MSCs, or genetically-engineered MSCs, and their potential as promoters of bone fracture regeneration/repair.


Assuntos
Regeneração Óssea , Consolidação da Fratura , Fraturas Ósseas/terapia , Engenharia Genética , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Animais , Biomarcadores , Diferenciação Celular , Estudos Clínicos como Assunto , Modelos Animais de Doenças , Fraturas Ósseas/etiologia , Fraturas Ósseas/patologia , Engenharia Genética/métodos , Humanos , Transplante de Células-Tronco Mesenquimais/métodos , Osteogênese , Resultado do Tratamento
7.
BMC Endocr Disord ; 19(1): 81, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349845

RESUMO

BACKGROUND: Elderly patients with type 2 diabetes mellitus (T2DM) experience fractures more frequently than elderly individuals without diabetes. Fractures requiring hospitalization greatly affect quality of life, and although elderly patients with T2DM have several risk factors associated with fractures, only a few studies have evaluated these in detail in the Asian population. We conducted a retrospective study of elderly patients with T2DM for evaluating factors associated with fracture risk. METHODS: We conducted a retrospective study using electronic medical records (EMR) of patients aged ≥65 years with T2DM who were admitted to a public general medical institute in central Tokyo, Japan. We evaluated factors associated with fractures necessitating hospitalization in elderly patients with T2DM characteristics and hypoglycemic agent use. Factors associated with fracture risk were identified using multivariable logistic regression analysis. RESULTS: A total of 2,112 elderly patients (age ≥ 65 years) with T2DM were analyzed. Among them, 69 (3.3%) patients had been hospitalized for fractures. Factors associated with fractures were female sex (OR, 3.46), eGFR < 60 ml / min / 1.73 m2 (OR, 0.55), and thiazolidine use (OR, 4.28). Further, a separate analysis based on sex revealed that the use of thiazolidines was significantly associated with fracture risk in both sexes. CONCLUSIONS: In elderly patients with T2DM, the key factor associated with fractures was the use of thiazolidines in both males and females. In this study, the use of thiazolidines was newly identified as a factor which increased the risk of fractures requiring hospitalization in elderly males. The study findings should be considered when hypoglycemic agents are selected for treating elderly patients with T2DM. Information bias, selection bias, and the effect of concomitant drugs may be the underlying reasons for why eGFR < 60 mL / min / 1.73 m2 reduced the fracture risk. However, details are unknown, and additional investigations are needed.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Fraturas Ósseas/etiologia , Hospitalização/estatística & dados numéricos , Idoso , Feminino , Seguimentos , Fraturas Ósseas/patologia , Humanos , Japão , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco
8.
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
9.
J Forensic Sci ; 64(6): 1796-1802, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31237695

RESUMO

This pilot study provides a conceptual framework for the application of the anthropological analysis of skeletal features and surgical interventions for the purpose of identification in cases of unknown deceased individuals with unavailable fingerprint, genetic or odontological antemortem data. The study sample includes 276 individuals with known demographic and clinical information from the Italian CAL Milano Cemetery Skeletal Collection. In the sample, 124 (45%) individuals showed one or more skeletal features that may be potentially individualizing. Of these, 79% showed two and more features, which occurred in a multitude of different combinations. Skeletal findings may provide useful postmortem information that can be compared with antemortem witness statements and clinical imaging. However, more research into the utility of dry bone findings and the availability of comparative material, including imaging, and epidemiological data needs to be undertaken before skeletal features can be implemented into identification protocols and databases.


Assuntos
Osso e Ossos/patologia , Osso e Ossos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Ósseas/patologia , Restauração Dentária Permanente , Feminino , Antropologia Forense/métodos , Odontologia Legal/métodos , Fraturas Ósseas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Marca-Passo Artificial , Projetos Piloto , Adulto Jovem
10.
Curr Med Sci ; 39(3): 426-430, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31209814

RESUMO

Restoration of fracture alignment by osteotomy is crucial for the management of humeral nonunion. In the present study, we introduced a new way of osteotomy (Z-shaped) in treating humeral shaft nonunion secondary to failed plate osteosynthesis. Clinical data of 24 patients with humeral shaft nonunion following implant failure (from 2010 to 2014) were retrospectively evaluated. These patients underwent Z-shaped osteotomy in revision surgery after the initial surgery, plate osteosynthesis, was failed. Outcomes were evaluated using visual analogue scale (VAS) and Constant and Murley score. Repeated analysis of variance (ANOVA) was used for statistical analysis. Patients were followed up for a minimum of 24 months (26.83±4.33 months). The operative time was 102.33±10.16 min, and hospital stay averaged 9.75±2.13 days. All patients achieved clinical union at the latest follow-up. Complications included radial palsy (n=1) and superficial wound infection (n=1). The postoperative VAS scores decreased significantly compared to preoperative score (F=257.99, P<0.01). Constant and Murley score increased and reached 81.33±0.95 at 24 months' follow-up (F=247.35, P<0.01). Among all the cases, 15 cases were graded as "excellent", and 9 as "good". In conclusion, Z-shaped osteotomy was easy to perform, and it provided additional medial support with more bone contact areas. Revision surgery using locking plate and Z-shaped osteotomy achieved high union rate and improved functional outcome. It was a reasonable and safe option for treating humeral nonunion following implant failure.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Úmero/cirurgia , Osteotomia/métodos , Adulto , Análise de Variância , Placas Ósseas , Feminino , Seguimentos , Fraturas Ósseas/patologia , Humanos , Úmero/lesões , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Neuropatia Radial/diagnóstico , Neuropatia Radial/etiologia , Neuropatia Radial/fisiopatologia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/fisiopatologia , Falha de Tratamento , Resultado do Tratamento
11.
PLoS One ; 14(5): e0216733, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150420

RESUMO

In archaeological assemblages the presence of percussion marks, on the surface of long bones, is an indicator of long bone marrow extraction. The form, quantity and distribution of percussion marks are analysed to gain a better understanding of the marrow extraction process. Patterns of bone percussion damage in archaeological assemblages may highlight standardized actions, possibly related to butchery traditions. However, additional factors could underlie these patterns and should also be considered. In this article we test intuitiveness as a factor in appearance of percussion mark patterns, to see if patterns can appear when bones are being fractured without prior experience with bone fracture properties. To test this hypothesis, for this study we selected a sample of 40 cattle (Bos taurus) long limb bones from a large bone breakage experiment (400 long limb bones), where participants had no previous experience in bone breakage and may thus have broken bones intuitively. We used Geographic Information System (GIS) software to analyse the distribution of percussion marks. Using ArcGIS Spatial Analysts tools, we identified and quantified significant concentrations of percussion marks. Results show that percussion mark patterns emerge for the same bone element, and that specific sides and zones were recurrently selected by experimenters. The distribution of patterns varies among the different long bone elements, and we attribute this variance to an adjustment to bone morphology. In addition, we calculated and identified bone damage patterns resulting from hammerstone percussion. Crossing bone survivorship with percussion mark patterns enabled us to recognise and evaluate the effects of fragmentation and surface visibility in controlled experimental conditions. The GIS method facilitates comparisons between different variables and provides a sophisticated visual representation of results. Enlarging the sample will allow to constitute a more substantial analogous model for fossil assemblages.


Assuntos
Medula Óssea , Fósseis/patologia , Fraturas Ósseas , Sistemas de Informação Geográfica , Matadouros , Animais , Arqueologia/métodos , Medula Óssea/anatomia & histologia , Medula Óssea/diagnóstico por imagem , Carnivoridade , Bovinos , Manipulação de Alimentos/história , Manipulação de Alimentos/métodos , Fósseis/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/história , Fraturas Ósseas/patologia , História Antiga , Humanos , Modelos Anatômicos
12.
Forensic Sci Int ; 302: 109856, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31247451

RESUMO

The assessment and interpretation of the timing of skeletal trauma can be of extreme difficulty in post-mortem specimens, especially because of post-mortem processes and taphonomic events. The chronological diagnosis of bone trauma, consisting usually in the gross distinction between antemortem, perimortem and post-mortem, is based almost uniquely on macroscopic and morphologic parameters in the anthropological field. However, both the interference of taphonomy and the scarce persistence of specific features indicating vitality (meaning etymologically "produced in life") and/or some very early bone healing reactions, make it extremely difficult. In this perspective, it is important not only to distinguish between peri and post-mortem lesions, but also to interpret perimortem lesions with respect to vitality and time elapsed since the trauma which may change the course of the investigations. And techniques of forensic pathology applied to forensic anthropology can come in extremely handy. If any traces of vital blood extravasation, haemorrhage, hematoma, inflammation, and biomarkers of early healing reaction are found in the bone tissue of a skeletal lesion (regardless the state of preservation of the body), then can they be used as a diagnostic tool or marker of vitality for that lesion? In these terms, vital reactions like bleeding or any early sign of bone healing can be the only evidence for demonstrating that a traumatic event was prior the death. Nevertheless, very little information, or research for that matter, is available in literature concerning persistence and detectability of vitality markers during the bone decomposition process. A fundamental point for properly determining the vitality of a fracture and estimating the post-traumatic time interval in skeletal lesions is the physio-pathological picture of the very initial healing process. This article attempts to provide a review of the physiopathological current knowledge available and applicable to osteology.


Assuntos
Remodelação Óssea/fisiologia , Fraturas Ósseas/patologia , Osteogênese/fisiologia , Biomarcadores/metabolismo , Coagulação Sanguínea/fisiologia , Citocinas/fisiologia , Hematoma/patologia , Hemorragia/patologia , Humanos , Imuno-Histoquímica , Peptídeos e Proteínas de Sinalização Intercelular/fisiologia , Neovascularização Fisiológica/fisiologia , Osteoblastos/fisiologia , Osteoclastos/fisiologia
13.
J Forensic Leg Med ; 65: 68-75, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31108434

RESUMO

The aim of this work is to discuss the frequency of traumatic bone injuries in a quite unique skeletal assemblage of enslaved people from Valle da Gafaria, Lagos, Portugal (15th-17th centuries). In all, 30 males, 58 females, and 15 individuals of unknown sex were included in the study. The skeletal remains were macroscopically observed for traumatic lesions. When present, the traumatic bone injuries were classified as having occurred ante or perimortem. The antemortem lesions were also studied through radiological analysis. Traumatic lesions were identified in 11 men (36.7%), 23 women (39.7%) and two individuals of unknown sex (13.3%). From these 36 individuals, 61.1% presented antemortem trauma, 25.0% perimortem trauma and 13.9% exhibited simultaneously ante and perimortem trauma. The mechanism of all traumatic injuries was blunt force trauma. From the 9965 analysed bones, 186 exhibited traumatic lesions (87 antemortem, 97 perimortem, and two with both ante and perimortem lesions). The bone more affected by antemortem trauma was the 5th right intermediate foot phalange (40.0%) and by perimortem trauma was the skull (11.4%), probably related to accidents and interpersonal violence, respectively. When analysed by sex, the only significant differences were found in the skull and the right 5th proximal foot phalanges, men (57.1%) presenting more lesions than women (15.4%). The obtained results are consistent with an arduous life, corroborating historical sources which document labour accidents, physical punishments and hard work in the populations of slaves.


Assuntos
Grupo com Ancestrais do Continente Africano/história , Osso e Ossos/lesões , Osso e Ossos/patologia , Escravização/história , Fraturas Ósseas/patologia , Adolescente , Adulto , Feminino , Antropologia Forense , História do Século XV , História do Século XVI , História do Século XVII , Humanos , Masculino , Pessoa de Meia-Idade , Portugal , Adulto Jovem
14.
Injury ; 50(6): 1223-1226, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31036365

RESUMO

INTRODUCTION: Posttraumatic pelvic deformity is associated with pain and loss of function. This study aimed to test the correlation of functional outcome in patients with pelvic fractures with the postoperative radiographic quality of reduction. METHODS: Consecutive patients with an isolated traumatic pelvic fracture that required closed or open reduction between 07/2015 and 07/2017 and had a completed follow-up of at least 6 months were included (N = 31, mean age 50 years, SD 21 years, range, 16 to 88 years). Majeed and Timed Up & Go were obtained from a prospective outcome database at 6 months and last follow-up (mean 10 months, SD 5 months). Quality of pelvic ring reduction was determined on postoperative radiographs as described by Matta, Sagi and Keshishyan/Lefaivre. RESULTS: Clinical outcome at 6 months as measured by the Majeed and the Timed Up & Go correlated moderately with Keshishyan/Lefaivre's pelvic asymmetry value (Pearson R: -0.520 and 0.585, p ≤ 0.003) and the pelvic deformity index (-0.527 and 0.503, p ≤ 0.004). There was a weak correlation between the Timed Up & Go and the radiographic grading system as described by Matta/Tournetta at 6 months (0.408, p = 0.023) and at last follow-up (0.380, p = 0.035). CONCLUSIONS: This study showed a moderate correlation of the clinical outcome at 6 months with postoperative quality of radiographic reduction when measured with the method described by Keshishyan and Lefaivre. Although having only descriptive value due to the small cohort, our findings underline the importance of anatomic reduction and restoration of pelvic symmetry in patients with pelvic trauma. Future studies with more patients and more investigators are required and reliability and validity of functional outcome scores needs to be further assessed to predict outcome in patient with fractures of the pelvic ring. LEVEL OF EVIDENCE: Level IV (case series).


Assuntos
Redução Fechada , Consolidação da Fratura/fisiologia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Redução Aberta , Ossos Pélvicos/cirurgia , Radiografia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas Ósseas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/patologia , Estudos Prospectivos , Recuperação de Função Fisiológica/fisiologia , Reprodutibilidade dos Testes , Resultado do Tratamento , Adulto Jovem
15.
Injury ; 50 Suppl 1: S24-S29, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31036366

RESUMO

BACKGROUND: Between the different options in pelvic external fixation, the supra-acetabular pin placement is considered the best option by many authors. The aim of this study is to describe the surgical technique of the ultrasound-guided supra-acetabular pelvic external fixator (US-SA FIX). SURGICAL TECHNIQUE: Description of the steps to perform the US-SA FIX technique. DISCUSSION: The supra-acetabular pin placement is considered the best option and it is the most wildly used because it combines three crucial qualities: safety, simplicity, and effectiveness. Notwithstanding, when a severely multiple injured patient arrives at the emergency room we need to perform an emergency external fixation, however trained x-ray technicians or pelvic surgeons are not always present, making it difficult to perform the surgery with the proper intra-operative imaging, increasing the surgical time with potentially serious repercussions, a case scenario where the ultrasound can be a very helpful tool. Ultrasound-guided supra-acetabular pelvic external fixator pin placement is feasible without compromising the reliability of its placement, and the application of this new technique in clinical practice in our centre brings encouraging results.


Assuntos
Acetábulo/diagnóstico por imagem , Fixadores Externos , Fixação de Fratura , Fraturas Ósseas/diagnóstico por imagem , Ultrassonografia de Intervenção , Acetábulo/lesões , Acetábulo/cirurgia , Fenômenos Biomecânicos , Pinos Ortopédicos , Fixação de Fratura/métodos , Fraturas Ósseas/patologia , Fraturas Ósseas/cirurgia , Humanos , Estudos Retrospectivos
16.
PLoS One ; 14(5): e0216483, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31067285

RESUMO

As a reaction to widespread poverty, a system of coercive welfare developed in Switzerland during the 19th century. Poverty was often thought to result from an individual's misconduct rather than from structural, economic or political circumstances. People whose lifestyle deviated from the desired norm or who were unable to make a living for themselves were subjected to so-called administrative detention at institutions such as workhouses and poorhouses. The excavation of the cemetery of the correctional facility/workhouse and asylum «Realta¼ in Cazis offered the opportunity to gain insight into the living conditions of a marginalized group of people and to shed light on aspects of coercive welfare that have hardly been addressed in historical studies. A comprehensive study of pathological alterations was used to assess possible physical causes and effects of administrative detention. Skeletal samples from regular contemporaneous cemeteries provided data for the general population and thus allowed us to detect peculiarities in the «Realta¼ assemblage. Possible cases of Stickler Syndrome, microcephaly, congenital syphilis, endemic hypothyroidism and disabilities secondary to trauma may have been the reason for the affected individuals' institutionalisation. The high prevalence of tuberculosis was linked to the socioeconomic status and the living conditions at the facility. Several cases of scurvy and osteomalacia may have resulted from various risk factors such as poverty, alcoholism, mental illness or institutionalisation. The fracture rates, especially of ribs, were extremely high. A large proportion of the fractures were incompletely healed and most likely occurred during detention due to interpersonal violence. Underlying diseases further contributed to the high fracture rates. This first study on skeletons from an institution of administrative detention in Switzerland demonstrated how pre-existing health conditions and the socioeconomic background contributed to the chance of being detained, and how detention led to further deterioration of health.


Assuntos
Cemitérios , Doenças Transmissíveis , Pessoas com Deficiência/história , Fraturas Ósseas , Nível de Saúde , Institucionalização/história , Prisões/história , Esqueleto , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/história , Doenças Transmissíveis/patologia , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/história , Fraturas Ósseas/patologia , História do Século XIX , História do Século XX , Humanos , Masculino , Fatores Socioeconômicos , Suíça/epidemiologia
17.
Injury ; 50 Suppl 1: S62-S65, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31130210

RESUMO

Fractures in the elderly represent a significant and rising socioeconomic problem. Although aging has been associated with delays in healing, there is little direct clinical data isolating the effects of aging on bone healing from the associated comorbidities that are frequently present in elderly populations. Basic research has demonstrated that all of the components of fracture repair-cells, extracellular matrix, blood supply, and molecules and their receptors-are negatively impacted by the aging process, which likely explains poorer clinical outcomes. Improved understanding of age-related fracture healing should aid in the development of novel treatment strategies, technologies, and therapies to improve bone repair in elderly patients.


Assuntos
Envelhecimento/fisiologia , Regeneração Óssea/fisiologia , Consolidação da Fratura/fisiologia , Fraturas Ósseas/patologia , Inflamação/fisiopatologia , Osteoporose/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/imunologia , Comorbidade , Consolidação da Fratura/imunologia , Fraturas Ósseas/imunologia , Humanos , Inflamação/imunologia
18.
Injury ; 50(7): 1306-1308, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31138483

RESUMO

BACKGROUND: The "missed" scaphoid fracture is a common cause of litigation. This study investigates why a series of scaphoid fractures involved in medical negligence litigation were missed. It also assesses how many might have been detected if MRI had been used to assess all suspected scaphoid fractures with normal X-rays, as suggested by National Institute for Health and Care Excellence (NICE). METHODS: Medical reports on 52 medical negligence cases of missed scaphoid fractures were reviewed. Complete sets of hospital and GP records and X-rays had been reviewed in every case. RESULTS: The recorded mechanism of injury was consistent with a scaphoid fracture in 41 (79%) cases. There was no record of an examination for scaphoid tenderness in 37 (71%) cases. Scaphoid tenderness was assessed and not found in 10 of 15 cases. No X-rays were obtained in 13 (25%) cases, and a scaphoid fracture was only suspected, resulting in scaphoid series X-rays being performed, in only 3 (6%) cases. In only 5 (10%) cases was there a record of the patient being advised to return if the wrist remained painful. CONCLUSIONS: Most of these scaphoid fractures were missed due to failure to consider the possibility of a scaphoid fracture and search for clinical signs of this injury. Some were missed due to failure to detect (or absence of) tenderness over the scaphoid bone. As a scaphoid fracture was never considered, or excluded by clinical examination, in 49 of the 52 cases, a policy of obtaining MRI for all suspected scaphoid fractures would only have detected three of 52 (6%) fractures. Improved awareness through better education is required to reduce the number of missed scaphoid fractures.


Assuntos
Fraturas Ósseas/diagnóstico por imagem , Osso Escafoide/diagnóstico por imagem , Adolescente , Adulto , Feminino , Fraturas Ósseas/patologia , Fraturas Ósseas/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Erros Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Adulto Jovem
19.
Biomed Res Int ; 2019: 6872948, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949505

RESUMO

The previous anterior approach to the elbow provides a limited exposure of the coronoid process. The aim of this study was to identify the optimal exposure interval for coronoid fractures from the anterior aspect of elbow. We exposed the coronoid process on twelve fresh-frozen cadaveric elbows from the anteromedial aspect of the elbow. The dissection intervals used were the novel brachial artery-median nerve interval (B-M interval) and the previously reported biceps tendon-brachial artery interval (B-B interval). Access to key anatomic landmarks around the coronoid process was assessed and the exposed surface area of coronoid process was calculated in each specimen. The average exposed surface area of coronoid process was 2.26 times greater with the B-M interval (4.58 cm2) compared with the B-B interval (2.03 cm2) (p < 0.05). All key anatomic landmarks around the coronoid process were directly visualised via the B-M interval in each specimen. In conclusion, the anteromedial approach through the B-M interval provides a more extensive exposure of the coronoid process than the traditional B-B interval. This new approach can be useful for the fixation of coronoid fractures.


Assuntos
Articulação do Cotovelo , Fraturas Ósseas , Cadáver , Articulação do Cotovelo/patologia , Articulação do Cotovelo/cirurgia , Feminino , Fraturas Ósseas/patologia , Fraturas Ósseas/cirurgia , Humanos , Masculino , Nervo Mediano/patologia , Nervo Mediano/cirurgia
20.
Forensic Sci Int ; 298: 351-358, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30928775

RESUMO

For this study all autopsy reports of non-natural deaths performed at the Institute of Legal Medicine at the University of Cologne from a 10-year period (2008-2017) were examined in regards to the manner of non-natural death and their frequency and distribution of bone injuries (BI). 2026 cases (220 homicides, 421 suicides, 760 accidents, 393 possible suicides, 232 possible accidents) were reviewed. The highest frequency of BI was registered within homicides with 89.1%, second being accidents (79.3%), while suicides and poss. suicides were at 53.4% and 43.3%. Gunshots/explosions split between 52% for suicides and 33.6% for homicides, sharp force was to 56% found within homicides and with 29.8% in suicides. 63.7% of all blunt force was found in the accident category. The highest participation of BI and injuries across all body regions was found with gunshot homicides (100% BI, over every region). Intoxication showed the lowest BI over all with only 19.9% of all cases. Albeit several distinctive patterns were found, e.g. distinction between gunshots in suicides and homicides or high amount of BI in decayed corpses in homicides, a close examination on case by case basis, utilizing the forensic toolkit to its fullest, should always be attempted when examining decomposed or skeletal remains.


Assuntos
Acidentes/mortalidade , Fraturas Ósseas/patologia , Homicídio/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Alemanha/epidemiologia , Humanos , Estudos Retrospectivos , Ferimentos e Lesões
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