Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.420
Filtrar
1.
Unfallchirurg ; 123(1): 76-79, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31915877

RESUMO

A 60-year-old patient suffered an ankle distortion resulting in a comminuted fracture of the fifth metatarsal. On the same day the accident occurred the patient presented to an emergency department and immediate operative treatment of the fracture was performed by intramedullary Kirschner wires with closed reduction and internal fixation. The aftercare was carried out on an outpatient basis by a registered orthopedist in accordance with the surgeon's instructions. In the radiological control 14 days after surgery a dislocation of the fracture was detected and 1 week later a rectification operation was carried out in a second clinic with removal of the Kirschner wires, open reduction and internal fixation with a locking plate. The patient suspected inadequate treatment by the first clinic, which in turn did not accept any inadequacies in the surgical treatment or the aftercare. In the subsequent legal dispute the appointed experts came to the conclusion that an initial good fracture position was achieved but that the aftercare treatment with a forefoot relief shoe was inadequate for the type of internal fixation chosen. The arbitration board came to the conclusion that the multifragmented fracture situation was treated by a questionably stable osteosynthesis using Kirschner wires. This should have required a very strict aftercare with partial weight bearing on crutches and immobilization in a stable orthosis or cast.


Assuntos
Assistência ao Convalescente , Fraturas Ósseas , Ossos do Metatarso , Placas Ósseas , Fios Ortopédicos , Fixação Interna de Fraturas , Fraturas Ósseas/terapia , Humanos , Ossos do Metatarso/lesões , Pessoa de Meia-Idade , Resultado do Tratamento
2.
J Trauma Acute Care Surg ; 88(2): 314-319, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31804417

RESUMO

BACKGROUND: Timely angioembolization (AE) is known to improve outcomes of patients with hemorrhage resulting from pelvic fracture. The hybrid emergency room system (HERS) is a novel trauma resuscitation room equipped with a computed tomography scanner, fluoroscopy equipment, and an operating room setup. We hypothesized that the HERS would improve the timeliness of AE for pelvic fracture. METHODS: A retrospective medical record review of patients who underwent AE for pelvic fracture at our institution from April 2015 to December 2018 was conducted. Patients' demographics, location of AE, Injury Severity Score, Revised Trauma Score, probability of survival by the trauma and injury severity score (TRISS Ps) method, presence of interventional radiologists (IRs) upon patient arrival, time from arrival to AE, and in-hospital mortality were analyzed. These data were compared between patients who underwent AE in the HERS (HERS group) and in the regular angio suite (non-HERS group). RESULTS: Ninety-six patients met the inclusion criteria. The HERS group comprised 24 patients, and the non-HERS group, 72 patients. Interventional radiologists were more frequently present upon patient arrival in the HERS than non-HERS group (IRs, 79% vs. 22%, p < 0.01). The time from arrival to AE was shorter in the HERS than non-HERS group (median [range], 46 [5-75] minutes vs. 103 [2-690] minutes, p < 0.01). There were no differences in the rate of in-hospital mortality (13% vs. 15%, p = 0.52) between the two groups. Survivors in the HERS group had a lower probability of survival by the trauma and injury severity score (median [range], 61% [1%-98%] vs. 93% [1%-99%], p < 0.01) than survivors in the non-HERS group. CONCLUSION: The HERS improved the timeliness of AE for pelvic fracture. More severely injured patients were able to survive in the HERS. The new team building involving the addition of IRs to the traditional trauma resuscitation team will enhance the benefit of the HERS. LEVEL OF EVIDENCE: Therapeutic, level IV.


Assuntos
Embolização Terapêutica/métodos , Serviço Hospitalar de Emergência/organização & administração , Fraturas Ósseas/complicações , Hemorragia/terapia , Ossos Pélvicos/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Procedimentos Clínicos/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/terapia , Hemorragia/etiologia , Hemorragia/mortalidade , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/organização & administração , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
3.
Emerg Med Clin North Am ; 38(1): 125-142, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757246

RESUMO

Traumatic injuries of the hip and pelvis are commonly encountered in the emergency department. This article equips all emergency medicine practitioners with the knowledge to expertly diagnose, treat, and disposition these patients. Pelvic fractures occurring in young patients tend to be associated with high-energy mechanisms and polytrauma. Pelvic and hip fractures in the elderly are often a result of benign trauma but are associated with significant morbidity and mortality.


Assuntos
Gerenciamento Clínico , Emergências , Fraturas Ósseas/diagnóstico , Traumatismo Múltiplo , Procedimentos Ortopédicos/métodos , Ossos Pélvicos/lesões , Radiografia/métodos , Fraturas Ósseas/terapia , Humanos , Ossos Pélvicos/diagnóstico por imagem
4.
Emerg Med Clin North Am ; 38(1): 31-59, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757254

RESUMO

Approximately one-third of children sustain a fracture before the age of 16 years; however, their unique anatomy and healing properties often result in a good outcome. This article focuses on the diagnosis and management of pediatric extremity injuries. The article describes the anatomic features and healing principles unique to children and discusses pediatric upper and lower extremity fractures and presents evidence-based and standard practice for their management. Finally, the article describes the conditions under which emergency physicians are likely to miss pediatric fractures by highlighting specific examples and discussing the general factors that lead to these errors.


Assuntos
Traumatismos do Braço/diagnóstico , Emergências , Serviço Hospitalar de Emergência , Fraturas Ósseas/diagnóstico , Traumatismos da Perna/diagnóstico , Procedimentos Ortopédicos/métodos , Radiografia/métodos , Traumatismos do Braço/terapia , Criança , Gerenciamento Clínico , Fraturas Ósseas/terapia , Humanos , Traumatismos da Perna/terapia
5.
Emerg Med Clin North Am ; 38(1): 61-79, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757255

RESUMO

Injury patterns of the hand and wrist can be complex and challenging for the emergency physician to diagnose and treat. The ability of the hand to perform delicate maneuvers requires a very intricate interplay of bones, ligaments, and tendons. Unfortunately, due to the omnipresence of the hand, the hand and wrist are commonly injured. These injuries can be debilitating if not treated correctly and can be both time-consuming and fraught with medicolegal risk. This article provides the necessary knowledge to diagnose and treat common hand and wrist injuries encountered in the emergency department.


Assuntos
Gerenciamento Clínico , Emergências , Fraturas Ósseas , Traumatismos da Mão , Procedimentos Ortopédicos/métodos , Radiografia , Traumatismos do Punho , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/terapia , Saúde Global , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/terapia , Humanos , Incidência , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/terapia
6.
J Shoulder Elbow Surg ; 29(1): 27-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31563507

RESUMO

BACKGROUND: Conventional treatment of displaced midshaft clavicular fractures is nonoperative. Recent studies have implied that operative treatment might result in a faster return to work, resulting in a decreased productivity loss for society. The cost utility of plate fixation vs. nonoperative treatment of displaced midshaft clavicular fractures has not previously been investigated using a societal perspective. METHODS: Decision analytical modeling of incremental costs and quality-adjusted life-years (QALYs) was performed. Data on utility, hospitalization, and productivity costs were retrieved from a Danish randomized controlled trial. Supplementary data were taken from randomized controlled trials identified in the literature. A 1-year time horizon was applied, and all prices were reported with respect to a 2016 level. RESULTS: Operative treatment was associated with a larger QALY gain in patients and a higher cost compared with nonoperative treatment. The incremental cost-effectiveness ratio (ICER) was estimated in Danish currency (Danish krone [kr]) at kr1,360,000 (€182,306) per QALY from a health-sector perspective and kr1,388,738 (€186,158) per QALY from a societal perspective. Considering a subgroup analysis of patients with a high-load shoulder profession, operative treatment was dominated by nonoperative treatment from a health-sector perspective. Considering a societal perspective, the ICER was estimated at -kr889,091 (-€119,181) per reduction of 1 QALY. One-way and probabilistic sensitivity analyses showed that the results were subject to uncertainty. CONCLUSION: Operative treatment is not cost-effective when considering a threshold of €34,000/QALY. However, for a subgroup of patients with a high-load shoulder profession, operative treatment might be cost-effective compared with nonoperative treatment.


Assuntos
Clavícula/lesões , Tratamento Conservador/economia , Efeitos Psicossociais da Doença , Fraturas Ósseas/economia , Fraturas Ósseas/terapia , Procedimentos Ortopédicos/economia , Placas Ósseas , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Dinamarca , Diáfises/lesões , Eficiência , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Hospitalização/economia , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Zhongguo Gu Shang ; 32(11): 982-986, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870043

RESUMO

OBJECTIVE: To observe clinical effects of acupressure combined with activating blood and dissipating blood stasis prescription for the treatment of early swelling of calcaneal fractures. METHODS: From June 2016 to April 2018, 78 patients with calcaneus were divided into observation group and control group. There were 39 patients in observation group, including 36 males and 3 females aged from 28 to 61 years old with an average of(41.7±13.3) years old; 20 patients were caused by falling down, 10 patients were caused by traffic accident and 9 patients were caused by other injuries; The time from injury to medical treatment ranged from 0.5 to 10.5 h with an average of(4.6±3.2) h; 15 patients were type II, 17 patients were type III and 7 patients were type IV according to Sanders classification; the patients began to be pressed the three points of "Xuehai(SP 10)" "Sanyinjiao(SP 6)" "Zusanli(ST 36)" for 10 min from the day of hospital admission to the day of operation, 3 times a day, and taken prescription of activating blood and dissipating blood stasis prescription orally for 5 days, one dose per day and twice a day. There were 39 patients in control group, including 34 males and 5 females aged from 26 to 62 years old with an average of (43.3±12.3) years old; 19 patients were caused by falling down, 12 patients were caused by traffic accident and 8 patients were caused by other injuries; the time from injury to medical treatment ranged from 1 to 11 h with an average of (4.4±3.7) h; 15 patients were typeII, 18 patients were type III and 6 patients were type IV according to Sanders classification; patients were given 20% mannitol intravenously for 5 days, twice a day, 125 ml each time from hospital admission. During the 5 days of admission, the degree of swelling of the affected ankle was measured and calculated by water spillover method every day. The result which was measured and calculated on the first day of admission without treatment was the degree of swelling before treatment, compared degree of swelling before operation and 1st, 2nd, 3rd and 4th day after treatment; the time needed for the first positive skin fold sign in the affected ankle and the number of cases of tension blisters between two groups before operation were observed. RESULTS: The swelling of the affected ankle on the1st, 2nd, 3rd and 4th day after treatment in the observation group separately were(12.67±0.82)%, (11.87±0.88)%, (10.65±0.92)%, (9.47±0.96)%, and lower than control group which separately were(13.31±0.98)%, (13.51±0.84)%, (12.22±0.94)%, (11.38±1.01)%; The time for the first appearance of the skin fold sign was (6.41±1.74) days in the observation group was earlier than that of the control group (8.15±2.01) days; There was no significant difference in occurrence of tension blisters between observation group(3 patients) and control group(9 patients). CONCLUSIONS: Acupressure combined with activating blood and dissipating blood stasis prescription for the treatment of early swelling of calcaneal fractures could accelerate the decline of swelling of the affected ankle, shorten the time of the first skin fold sign, reduce the incidence of tension blisters in the ankle, shorten the waiting time of operation, and the surgical treatment as soon as possible.


Assuntos
Acupressão , Calcâneo , Fraturas Ósseas , Adulto , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Zhongguo Gu Shang ; 32(11): 987-990, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870044

RESUMO

OBJECTIVE: To explore clinical effect of external application of No.II prescription on preoperative detumescence for the treatment of calcaneal fracture through tarsal sinus approach. METHODS: From November 2016 to June 2018, 67 patients with calcaneal fracture were divided into control group(32 patients with ice compress) and research group(35 patients with external application of No.II prescription) according to different methods of preoperative detumescence. There were 21 males and 14 females in research group, aged from 36 to 52 years old with an average of (44.07±7.31) years old; the time from injury to clinic ranged from 2 to 6 h with an average of(4.32±1.68) h; 9 patients on the left side and 26 patients on the right side; 20 patients were type II, 15 patients were type III according to Sanders classification; treated with external application of No.II prescription. There were 32 patients in control group, including 22 males and 10 females aged from 40 to 52 years old with an average of (46.79±5.47) years old; the time from injury to clinic ranged from 2 to 5 h with an average of (3.89±1.03) h; 14 patients on the left side and 18 patients on the right side; 19 patients were type II and 13 patients were type III according to Sanders classification; treated by ice compress from admission to the first time of occurrence of skin fold. After disappearance of swelling, patients were treated with open reduction and internal fixation through tarsal sinus approach. Cross-section diameter of foot and ankle between admission and the first time of occurrence of skin fold were recorded and calculated the difference value. VAS score on the 2nd, 4th and 7th day after admission, preoperative prepare time, operative time, period of hospitalization and fracture healing time between two groups were compared. RESULTS: Difference value of cross-section diameter of foot and ankle in research group were (1.72±0.29) cm and (1.69±0.18) cm respectively, while in control group were (1.08±0.21) cm and (0.91±0.37) cm, the level of swelling in research group was better than that of in control group. VAS score on the 2nd, 4th and 7th day after admission in research group were 8.91±0.33, 6.47±1.09, 4.52±0.91 respectively; while in control group were 6.21±0.19, 3.67±1.18, 2.12±1.17 respectively; VAS score in research group was lower than control group. Preoperative prepare time, period of hospitalization and fracture healing time in research group were shorter than control group, while there was no statistical difference in operative time between two groups. CONCLUSIONS: During the perioperative period, rational application of No.IIfor the treatment of calcaneal fracture through tarsal sinus approach could effectively relieve wound swelling, shorten preoperative preparation and fracture healing time, alleviate pain, improve patient satisfaction, and achieve remarkable clinical results.


Assuntos
Traumatismos do Tornozelo , Calcâneo , Fraturas Ósseas , Adulto , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
9.
West J Emerg Med ; 20(6): 857-864, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31738712

RESUMO

INTRODUCTION: Musculoskeletal injuries (MSI) comprise a large portion of the trauma burden in low- and middle-income countries (LMIC). Rwanda recently launched its first emergency medicine training program (EMTP) at the University Teaching Hospital-Kigali (UTH-K), which may help to treat such injuries; yet no current epidemiological data is available on MSI in Rwanda. METHODS: We conducted this pre-post study during two data collection periods at the UTH-K from November 2012 to July 2016. Data collection for MSI is limited and thus is specific to fractures. We included all patients with open, closed, or mixed fractures, hereafter referred to as MSI. Gathered information included demographics and outcomes including death, traumatic complications, and length of hospital stay, before and after the implementation of the EMTP. RESULTS: We collected data from 3609 patients. Of those records, 691 patients were treated for fractures, and 674 of them had sufficient EMTP data measured for inclusion in the analysis of results (279 from pre-EMTP and 375 from post-EMTP). Patient demographics demonstrate that a majority of MSI cases are male (71.6% male vs 28.4% female) and young (64.3% below 35 years of age). Among mechanisms of injury, major causes included road traffic accidents (48.1%), falls (34.2%), and assault (6.0%). There was also an observed association between EMTP and trends of the three primary outcomes: a reduction of death in the emergency department (ED) from those with MSI by 89.9%, from 2.51% to 0.25% (p = 0.0077); a reduction in traumatic complications for MSI patients by 71.7%, from 3.58% to 1.01% (p = 0.0211); and a reduction in duration of stay in the ED among those with MSI by 52.7% or 2.81 days on average, from 5.33 to 2.52 days (p = 0.0437). CONCLUSION: This study reveals the current epidemiology of MSI morbidity and mortality for a major Rwandan teaching hospital and the potential impacts of EM training implementation among those with MSI. Residency training programs such as EMTP appear capable of reducing mortality, complications, and ED length of stay among those with MSI caused by fractures. Such findings underscore the efficacy and importance of investments in educating the next generation of health professionals to combat prevalent MSI within their communities.


Assuntos
Medicina de Emergência/educação , Fraturas Ósseas/terapia , Internato e Residência , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Hospitais de Ensino/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Ruanda/epidemiologia , Resultado do Tratamento
10.
J S Afr Vet Assoc ; 90(0): e1-e7, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31588759

RESUMO

A definitive diagnosis of extensive suture line exostoses affecting the nasofrontal, nasolacrimal, nasomaxillary, frontolacrimal, lacrimozygomatic and lacrimomaxillary suture lines in a 7-year-old Thoroughbred mare with chronic bilateral epiphora and facial deformation was achieved using standing computed tomography (CT) examinations. Positive contrast dacryocystorhinography using CT revealed partial bilateral obstruction of the nasolacrimal ducts. Minimally displaced depression fractures of the right nasal bone, the right maxillary bone and right frontal bone were also demonstrated. The cosmetic appearance of the periosteal reaction associated with the suture line exostosis and epiphora significantly improved within 3 months of diagnosis and treatment.


Assuntos
Exostose/veterinária , Fraturas Ósseas/veterinária , Traumatismos Cranianos Fechados/veterinária , Doenças dos Cavalos/etiologia , Cavalos/lesões , Obstrução dos Ductos Lacrimais/veterinária , Animais , Exostose/etiologia , Exostose/terapia , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Traumatismos Cranianos Fechados/complicações , Doenças dos Cavalos/diagnóstico por imagem , Doenças dos Cavalos/terapia , Obstrução dos Ductos Lacrimais/complicações , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Ducto Nasolacrimal/lesões , África do Sul , Resultado do Tratamento
11.
Eur J Radiol ; 120: 108694, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31593844

RESUMO

PURPOSE: To evaluate the clinical, radiological and periprocedural features associated with the occurrence or worsening of acetabular fracture (OWAF) following percutaneous cementoplasty of the acetabulum (PCA) in cancer patients. METHOD: All patients who underwent PCA in our comprehensive cancer center for an acetabular metastasis between January 2008 and December 2015 were included. Clinical features, characteristics of the metastasis on computed tomography (CT-scan) (location [roof, quadrilateral surface, anterior and posterior columns], number of locations, matrix, extra/intra-articular fractures, extra-osseous or subchondral extensions) and of the procedure (extra- or intra-articular cement leakage (IACL), percentage of filling of each location, complications) were reported as well as prior, concomitant or post-PCA treatments. The endpoint was OWAF on CT-scan during post-PCA follow-up. Log-rank tests and Cox models were used to identify prognostic factors. RESULTS: 140 PCA were identified in 129 patients (11 bilateral procedures, median age: 66.6). Eighteen (18/140, 12.9%) had an initial articular fracture. IACL was seen in 12/140 (8.6%) PCA. The only feature associated with IACL was a pre-existing articular fracture (p = 0.009). Of the 111 patients with imaging follow-ups, 18 (16.2%) showed OWAF. In multivariate analysis, the presence of cement filling (even partial) of all acetabular metastatic locations was the only feature predictive of OWAF-free survival (hazard ratio = 3.8, p = 0.031). CONCLUSIONS: Injecting cement in all areas affected by acetabular metastases could prevent OWAF. Because survival following PCA is not negligible, completing an insufficient first PCA could help preserve patients' quality of life.


Assuntos
Acetábulo/lesões , Neoplasias Ósseas/complicações , Neoplasias Ósseas/terapia , Cementoplastia/efeitos adversos , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Acetábulo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Cementoplastia/métodos , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
J Coll Physicians Surg Pak ; 29(10): 993-995, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564276

RESUMO

Although there are a lot of data on intrathoracic and extrathoracic injuries associated with adult sternal fractures and how to manage them; but there is not much data on diagnosis and treatment protocols, since they are rare in children. If the child patient has a sternal fracture, he/she probably had a high-energy trauma, so it should be carefully examined whether if there is an accompanying intrathoracic or extrathoracic injury. In this study, we aimed to determine the demographic data, accompanying injuries, treatment modalities and results in children who were admitted to the emergency trauma unit of our hospital and diagnosed with sternal fracture.


Assuntos
Fraturas Ósseas/diagnóstico , Fraturas Ósseas/terapia , Esterno/lesões , Adolescente , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino
13.
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
14.
BMC Res Notes ; 12(1): 590, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533796

RESUMO

OBJECTIVE: Despite the access and availability of modern health care, Traditional Bone Setting (TBS) has a big place as alternative health care. Hence, this study was aimed to assess the preference of Traditional Bone Setting and associated factors among patients with a fracture. RESULTS: A total of 224 patients known to have fractured at Black Lion Hospital, Addis Ababa was included in the study. This study revealed that 29.9% of the study participants had a preference for the Traditional Bone Setting. Hospital admission (AOR = 8.158, 95% CI 1.179, 56.439), Traditional Bone Setting center as first port of call after injury (AOR = 0.004, 95% CI 0.001, 0.090), knowledge (AOR = 9.448, 95% CI 1.481, 60.251) and perception (AOR = 0.026, 95% CI 0.003, 0.215) were statistically significant. The preference for the Traditional Bone Setting is high. Hospital admission, Traditional Bone Setting center as a first port of call after injury, knowledge, and perception were significantly associated with the preference of Traditional Bone Setting. In addition to deployment of trained in trauma professionals, working more on awareness creation and training are recommended.


Assuntos
Fraturas Ósseas/terapia , Hospitais , Admissão do Paciente/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Ferimentos e Lesões/terapia , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Fraturas Ósseas/diagnóstico , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Inquéritos e Questionários , Ferimentos e Lesões/diagnóstico , Adulto Jovem
15.
J Mater Sci Mater Med ; 30(9): 105, 2019 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-31494718

RESUMO

Bioactive glasses (BG) are known for their ability to bond to bone tissue. However, in critical situations, even the osteogenic properties of BG may be not enough to induce bone consolidation. Thus, the enrichment of BG with polymers such as Poly (D, L-lactic-co-glycolic) acid (PLGA) and associated to photobiomodulation (PBM) may be a promising strategy to promote bone tissue healing. The aim of the present study was to investigate the in vivo performance of PLGA supplemented BG, associated to PBM therapy, using an experimental model of cranial bone defect in rats. Rats were distributed in 4 different groups (Bioglass, Bioglass/PBM, Bioglas/PLGA and BG/PLGA/PBM). After the surgical procedure to induce cranial bone defects, the pre-set samples were implanted and PBM treatment (low-level laser therapy) started (808 nm, 100 mW, 30 J/cm2). After 2 and 6 weeks, animals were euthanized, and the samples were retrieved for the histopathological, histomorphometric, picrosirius red staining and immunohistochemistry analysis. At 2 weeks post-surgery, it was observed granulation tissue and areas of newly formed bone in all experimental groups. At 6 weeks post-surgery, BG/PLGA (with or without PBM) more mature tissue around the biomaterial particles. Furthermore, there was a higher deposition of collagen for BG/PLGA in comparison with BG/PLGA/PBM, at second time-point. Histomorphometric analysis demonstrated higher values of BM.V/TV for BG compared to BG/PLGA (2 weeks post-surgery) and N.Ob/T.Ar for BG/PLGA compared to BG and BG/PBM (6 weeks post-surgery). This current study concluded that the use of BG/PLGA composites, associated or not to PBM, is a promising strategy for bone tissue engineering.


Assuntos
Substitutos Ósseos/uso terapêutico , Cerâmica/uso terapêutico , Fraturas Ósseas/terapia , Luz , Ácido Poliglicólico/uso terapêutico , Crânio/lesões , Cicatrização/efeitos dos fármacos , Animais , Substitutos Ósseos/química , Substitutos Ósseos/efeitos da radiação , Transplante Ósseo/métodos , Cimentação/métodos , Cerâmica/química , Terapia Combinada , Masculino , Teste de Materiais , Osteogênese/efeitos dos fármacos , Osteogênese/efeitos da radiação , Fototerapia/métodos , Ácido Poliglicólico/química , Ratos , Ratos Wistar , Crânio/efeitos dos fármacos , Crânio/efeitos da radiação , Engenharia Tecidual
16.
BMC Musculoskelet Disord ; 20(1): 389, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31470828

RESUMO

BACKGROUND: Lithium, an established psychiatric medication, has recently been shown to enhance new bone formation in preclinical fracture models. Current research is focused on evaluating the efficacy of low-dose, short-term lithium treatment to improve long bone fracture healing through a Phase II randomized clinical trial (LiFT NCT02999022). In working towards future applications of lithium for fracture management, this study aimed to understand the current perceptions of lithium as a psychiatric drug and the potential barriers to its orthopaedic adoption. METHODS: Three questionnaires, evaluating knowledge about lithium and willingness to embrace its use in fracture healing were disseminated among the general population, fracture patients eligible for the LiFT (Lithium for Fracture Treatment) trial and orthopaedic surgeons across Canada. RESULTS: Of the 768 public respondents, 84% were willing to take a medication that would aid fracture healing but only 62.6% if the medication was lithium. Willingness dropped to 44.6% among the 168 respondents who knew about the psychiatric use of lithium. Lack of sufficient knowledge (n = 50) and concerns about side effects including effects on the brain (n = 74) were the main reasons cited by those who were unwilling to use lithium. Of the 29 fracture patients, only 20 patients had previously heard of lithium. Of these, 40% were willing to take lithium for fracture healing with an additional 10% if the dose was low or if the intake duration was short. Only 50% knew that lithium has side effects. Of the 43 orthopaedic surgeons, 38 surgeons knew about clinical use of lithium. Of these, 68% knew that lithium has side effects and 29% knew that it interacts with other drugs. While most agreed that new strategies are needed to improve fracture management, only 68% were willing to prescribe lithium for fractures with an additional 16% if there is scientific evidence and/or a standard dosing protocol. CONCLUSIONS: This study identified a lack of knowledge about uses and side effects of lithium among all three cohorts. A robust educational framework for orthopaedic surgeons, their patients and the members of their clinical care teams will be essential to widespread repurposing of lithium for fracture care.


Assuntos
Competência Clínica/estatística & dados numéricos , Consolidação da Fratura/efeitos dos fármacos , Fraturas Ósseas/terapia , Conhecimentos, Atitudes e Prática em Saúde , Carbonato de Lítio/administração & dosagem , Adolescente , Adulto , Encéfalo/efeitos dos fármacos , Canadá , Relação Dose-Resposta a Droga , Esquema de Medicação , Reposicionamento de Medicamentos , Feminino , Fixação de Fratura , Humanos , Carbonato de Lítio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Cirurgiões Ortopédicos/psicologia , Cirurgiões Ortopédicos/estatística & dados numéricos , Percepção , Placebos/administração & dosagem , Placebos/efeitos adversos , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
17.
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
18.
J Med Ultrason (2001) ; 46(4): 377-388, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31377938

RESUMO

PURPOSE: Low-intensity pulsed ultrasound (LIPUS) is effective in promoting bone healing, and a myostatin deficiency also has a positive effect on bone formation. In this study, we evaluated the effects of LIPUS on bone healing in rats in vivo and investigated the mechanisms in vitro, aiming to explore whether LIPUS promotes bone healing through inhibition of the myostatin signaling pathway. METHODS: Rats with both drill-hole defects and MC3T3-E1 cells were randomly assigned to a LIPUS group and a control group. The LIPUS group received LIPUS treatment (1.5 MHz, 30 mW/cm2) for 20 min/day. RESULTS: After 21 days, the myostatin expression in quadriceps was significantly inhibited in the LIPUS group, and remodeling of the newly formed bone in the drill-hole site was significantly better in the LIPUS group than that in the control group, which was confirmed by micro-CT analysis. After 3 days, LIPUS significantly promoted osteoblast proliferation; inhibited the expression of AcvrIIB (the myostatin receptor), Smad3, p-Smad3, and GSK-3ß; and increased Wnt1 and ß-catenin expression. Moreover, translocation of ß-catenin from the cytolemma to the nucleus was observed in the LIPUS group. However, these effects were blocked by treatment with myostatin recombinant protein. CONCLUSIONS: The results indicate that LIPUS may promote bone healing through inhibition of the myostatin signal pathway.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas Ósseas/terapia , Miostatina/metabolismo , Transdução de Sinais/fisiologia , Terapia por Ultrassom/métodos , Animais , Western Blotting , Técnicas de Cultura de Células , Modelos Animais de Doenças , Feminino , Fraturas Ósseas/diagnóstico por imagem , Reação em Cadeia da Polimerase , Ratos , Ratos Sprague-Dawley , Tomografia Computadorizada por Raios X , Ondas Ultrassônicas
19.
Sensors (Basel) ; 19(16)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31412550

RESUMO

In order to fix a fracture in osteosynthesis, it is necessary to attach screws bicortically to the bone. The length of the screws must be selected correctly in 1-mm increments: otherwise, injury to the surrounding tissue structure or insufficient fixation will result. The drill channel length can only be determined preoperatively to a limited extent and with insufficient accuracy and is therefore determined intraoperatively with a mechanical caliper gauge. This length determination is error-prone, which often leads to a false screw selection and at the same time to considerable complications in the healing process. A novel approach based on a sensory drive train was pursued, with which all mechanical drilling parameters were recorded and evaluated in combination with a length measurement that allows for determining the drill channel length. In order to overcome the limitations of previous drill concepts, a precise length measurement of the drill channel was introduced. The amplitude of a stimulated linear oscillation of the drill was monitored for drilling channel length measurements in order to reliably detect the beginning of the drilling process. The method provides the information required for handheld drilling without the limitation of constant drilling parameters. With initial results from laboratory tests with pig bones, the measurement method for the drill channel length has been validated on a test bench of the drilling machine. With the laboratory tests, a measurement uncertainty of 0.3 mm was achieved, so screws with a 1-mm step width can be reliably selected.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Animais , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/terapia , Humanos , Costelas/fisiologia , Suínos
20.
Trials ; 20(1): 510, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31420055

RESUMO

BACKGROUND: Opioids and acetaminophen are both widely used to relieve pain after non-operative treatment of limb fractures, but evidence for the superiority of opioids versus acetaminophen is lacking. In this study, we aim to determine whether acetaminophen is non-inferior to the acetaminophen/oxycodone combination for pain relief after non-operative fixation of an extremity limb fracture. We hypothesize that acetaminophen is non-inferior to the acetaminophen/oxycodone combination. METHODS: A double-blind randomized controlled trial will be conducted. Power analysis determined that 1226 participants will be needed (P <0.05, power 90%). Patients with acute limb fracture who receive non-operative treatment will be recruited and randomly allocated into two groups: the intervention group will receive oral oxycodone (10 mg) and acetaminophen (650 mg), and the control group will receive acetaminophen (650 mg) only. All participants will be instructed to take one pill of study medication on an as-needed basis and no more frequently than once every 8 h. The primary outcome measure will be scores on the 11-point Numeric Rating Scale (NRS-11) over 14 days. Secondary outcome measures are scores on the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), EuroQol five-dimension questionnaire (EQ-5D), self-rated satisfaction with the analgesia produced, self-reported nighttime sleep duration, number of intervention or control pills used, and total duration for taking intervention or control medication. Change of pain scores and the number of times that analgesic drugs were taken in the two groups will be statistically evaluated with Student t tests according to their fracture site. DISCUSSION: This study will be a randomized controlled trial that is adequately powered to test the hypothesis that acetaminophen is non-inferior to the combination of acetaminophen and oxycodone in relieving objectively measured pain after non-operative treatment of limb fractures in adults. It will hopefully provide a safe and effective analgesic plan for such patients. TRIAL REGISTRATION: ChiCTR registry: ChiCTR1800017015 . Registered on July 8, 2018.


Assuntos
Acetaminofen/uso terapêutico , Extremidades/lesões , Fraturas Ósseas/terapia , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acetaminofen/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA