Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.838
Filtrar
1.
Unfallchirurg ; 123(6): 479-490, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32399649

RESUMO

Shaft fractures of the tibia and fibula mainly affect younger patients and are therefore of great socioeconomic importance. Due to the high proportion of high-energy direct trauma mechanisms and the thin soft tissue covering layer of the ventromedian tibia, open factures occur in up to 39%. A structured diagnostic and therapeutic approach is essential for successful treatment. Reamed intramedullary nailing is currently the gold standard surgical procedure. The suprapatellar approach, representing an interesting alternative to the popular infrapatellar approach, postoperative complications, such as anterior knee pain as well as the management of non-unions are discussed in this article. Furthermore, the indications and the application of minimally invasive plate osteosynthesis (MIPO) and external fixators are described. Every trauma surgeon should be familiar with the etiology and the surgical treatment of compartment syndrome. A firm knowledge of the classifications of open and closed soft tissue injury is mandatory.


Assuntos
Síndromes Compartimentais/cirurgia , Fíbula/lesões , Fraturas da Tíbia/cirurgia , Adulto , Placas Ósseas , Síndromes Compartimentais/etiologia , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Fixação Intramedular de Fraturas , Consolidação da Fratura , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Fraturas Expostas/diagnóstico , Fraturas Expostas/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Lesões dos Tecidos Moles/classificação , Lesões dos Tecidos Moles/cirurgia , Fraturas da Tíbia/diagnóstico , Resultado do Tratamento
2.
JAMA ; 323(6): 519-526, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-32044942

RESUMO

Importance: Following surgery to treat major trauma-related fractures, deep wound infection rates are high. It is not known if negative pressure wound therapy can reduce infection rates in this setting. Objective: To assess outcomes in patients who have incisions resulting from surgery for lower limb fractures related to major trauma and were treated with either incisional negative pressure wound therapy or standard wound dressing. Design, Setting, and Participants: A randomized clinical trial conducted at 24 trauma hospitals representing the UK Major Trauma Network that included 1548 patients aged 16 years or older who underwent surgery for a lower limb fracture caused by major trauma from July 7, 2016, through April 17, 2018, with follow-up to December 11, 2018. Interventions: Incisional negative pressure wound therapy (n = 785), which involved a specialized dressing used to create negative pressure over the wound, vs standard wound dressing not involving negative pressure (n = 763). Main Outcomes and Measures: The primary outcome measure was deep surgical site infection at 30 days diagnosed according to the criteria from the US Centers for Disease Control and Prevention. A preplanned secondary analysis of the primary outcome was performed at 90 days. The secondary outcomes were patient-reported disability (Disability Rating Index), health-related quality of life (EuroQol 5-level EQ-5D), surgical scar assessment (Patient and Observer Scar Assessment Scale), and chronic pain (Douleur Neuropathique Questionnaire) at 3 and 6 months, as well as other local wound healing complications at 30 days. Results: Among 1548 participants who were randomized (mean [SD] age, 49.8 [20.3] years; 561 [36%] were aged ≤40 years; 583 [38%] women; and 881 [57%] had multiple injuries), 1519 (98%) had data available for the primary outcome. At 30 days, deep surgical site infection occurred in 5.84% (45 of 770 patients) of the incisional negative pressure wound therapy group and in 6.68% (50 of 749 patients) of the standard wound dressing group (odds ratio, 0.87 [95% CI, 0.57 to 1.33]; absolute risk difference, -0.77% [95% CI, -3.19% to 1.66%]; P = .52). There was no significant difference in the deep surgical site infection rate at 90 days (11.4% [72 of 629 patients] in the incisional negative pressure wound therapy group vs 13.2% [78 of 590 patients] in the standard wound dressing group; odds ratio, 0.84 [95% CI, 0.59 to 1.19]; absolute risk difference, -1.76% [95% CI, -5.41% to 1.90%]; P = .32). For the 5 prespecified secondary outcomes reported, there were no significant differences at any time point. Conclusions and Relevance: Among patients who underwent surgery for major trauma-related lower limb fractures, use of incisional negative pressure wound therapy, compared with standard wound dressing, resulted in no significant difference in the rate of deep surgical site infection. The findings do not support the use of incisional negative pressure wound therapy in this setting, although the event rate at 30 days was lower than expected. Trial Registration: isrctn.org Identifier: ISRCTN12702354.


Assuntos
Bandagens , Fixação Interna de Fraturas , Fraturas Expostas/cirurgia , Extremidade Inferior/lesões , Tratamento de Ferimentos com Pressão Negativa , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica/epidemiologia
3.
Bone Joint J ; 102-B(1): 17-25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888370

RESUMO

AIMS: The aim of this study was to develop a psychometrically sound measure of recovery for use in patients who have suffered an open tibial fracture. METHODS: An initial pool of 109 items was generated from previous qualitative data relating to recovery following an open tibial fracture. These items were field tested in a cohort of patients recovering from an open tibial fracture. They were asked to comment on the content of the items and structure of the scale. Reduction in the number of items led to a refined scale tested in a larger cohort of patients. Principal components analysis permitted further reduction and the development of a definitive scale. Internal consistency, test-retest reliability, and responsiveness were assessed for the retained items. RESULTS: The initial scale was completed by 35 patients who were recovering from an open tibial fracture. Subjective and objective analysis permitted removal of poorly performing items and the addition of items suggested by patients. The refined scale consisted of 50 Likert scaled items and eight additional items. It was completed on 228 occasions by a different cohort of 204 patients with an open tibial fracture recruited from several UK orthoplastic tertiary referral centres. There were eight underlying components with tangible real-life meaning, which were retained as sub-scales represented by ten Likert scaled and eight non-Likert items. Internal consistency and test-retest reliability were good to excellent. CONCLUSION: The Wales Lower Limb Trauma Recovery (WaLLTR) Scale is the first tool to be developed from patient data with the potential to assess recovery following an open tibial fracture. Cite this article: Bone Joint J 2020;102-B(1):17-25.


Assuntos
Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Atividades Cotidianas , Adaptação Psicológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Medo/psicologia , Fraturas Expostas/psicologia , Fraturas Expostas/reabilitação , Humanos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Recuperação de Função Fisiológica , Autoeficácia , Índice de Gravidade de Doença , Fraturas da Tíbia/psicologia , Fraturas da Tíbia/reabilitação , Adulto Jovem
4.
Bone Joint J ; 102-B(1): 26-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888373

RESUMO

AIMS: Open fractures of the tibia are a heterogeneous group of injuries that can present a number of challenges to the treating surgeon. Consequently, few surgeons can reliably advise patients and relatives about the expected outcomes. The aim of this study was to determine whether these outcomes are predictable by using the Ganga Hospital Score (GHS). This has been shown to be a useful method of scoring open injuries to inform wound management and decide between limb salvage and amputation. METHODS: We collected data on 182 consecutive patients with a type II, IIIA, or IIIB open fracture of the tibia who presented to our hospital between July and December 2016. For the purposes of the study, the patients were jointly treated by experienced consultant orthopaedic and plastic surgeons who determined the type of treatment. Separately, the study team (SP, HS, AD, JD) independently calculated the GHS and prospectively collected data on six outcomes for each patient. These included time to bony union, number of admissions, length of hospital stay, total length of treatment, final functional score, and number of operations. Spearman's correlation was used to compare GHS with each outcome. Forward stepwise linear regression was used to generate predictive models based on components of the GHS. Five-fold cross-validation was used to prevent models from over-fitting. RESULTS: The mean follow-up was 11.4 months (3 to 31). The mean time to union was 9.7 months (3 to 21), the mean number of operations was 2.8 (1 to 11), the mean time in hospital was 17.7 days (5 to 84), the mean length of treatment was 92.7 days (5 to 730), the mean number of admissions was 1.7 (1 to 6), and the mean functional score (Lower Extremity Functional Score (LEFS)) was 60.13 (33 to 80). There was a significant correlation between the GHS and each of the outcome measures. A predictive model was generated from which the GHS could be used to predict the various outcome measures. CONCLUSION: The GHS can be used to predict the outcome of patients who present with an open fracture of the tibia. Our model generates a numerical value for each outcome measure that can be used in clinical practice to inform the treating team and to advise patients. Cite this article: Bone Joint J 2020;102-B(1):26-32.


Assuntos
Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fixação de Fratura/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
5.
J Foot Ankle Surg ; 59(1): 128-130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882136

RESUMO

Damage to the weightbearing surface of the foot is a challenge for the reconstructive surgeon. The aim is to reconstruct the skeletal tripod and soft tissue, allowing the patient to walk normally. We report the case of a patient admitted with an acute right foot open fracture of the second, third, fourth, and fifth metatarsal bones. After debridement of all nonvital tissues, the patient required reconstruction of the metatarsal heads (third, fourth, and fifth) plus soft tissue coverage. We then performed a reconstruction with a free osteocutaneous fibular flap, insetting the bone perpendicular to the long axis of the metatarsal bones. This configuration allowed the reconstruction of the foot skeletal tripod. A second free flap, a thin radial forearm flap, was added during the revision surgery to improve the venous drainage of the skin paddle of the fibular flap and avoid tension after skin closure. At 1-year follow-up, the patient was able to walk entirely weightbearing on the forefoot, returning to her previous employment with no limitation in physical and recreational activities. To our knowledge, this is the first description of the use of a chimeric osteocutaneous fibular flap, oriented transversely, to reconstruct a complex bone/soft tissue defect after a traumatic loss of multiple metatarsal heads.


Assuntos
Fíbula/transplante , Traumatismos do Pé/cirurgia , Fraturas Expostas/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Ossos do Metatarso/cirurgia , Lesões dos Tecidos Moles/cirurgia , Transplante Ósseo , Desbridamento , Feminino , Seguimentos , Traumatismos do Pé/diagnóstico por imagem , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/cirurgia , Fraturas Expostas/diagnóstico por imagem , Retalhos de Tecido Biológico/cirurgia , Humanos , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/lesões , Rádio (Anatomia)/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Lesões dos Tecidos Moles/diagnóstico por imagem , Suporte de Carga , Adulto Jovem
6.
In Vivo ; 34(1): 291-298, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882491

RESUMO

BACKGROUND: Management of post-traumatic open fractures resulting from severe injuries of the lower extremity continues to challenge orthopedic and reconstructive surgeons. Moreover, post-traumatic osteoarticular infections due to Clostridium species are rare, with few reports in the literature. We describe possible pathomechanisms and propose treatment options for cases of delayed diagnosis of osteoarticular infections with Clostridium spp. CASE REPORTS: Two patients sustained severe osteoarticular infection due to Clostridium spp. after open epi- and metaphyseal fractures of the lower extremity. In combination with radical debridement, ankle arthrodesis and long-term antibiotic treatment, satisfactory results were achieved after a follow-up of 18 months and 24 years. CONCLUSION: Clostridium species are difficult to identify, treatment is usually delayed and most patients have unfavourable outcomes.


Assuntos
Infecções por Clostridium/patologia , Clostridium/isolamento & purificação , Fixação Interna de Fraturas/efeitos adversos , Fraturas Expostas/cirurgia , Extremidade Inferior/cirurgia , Adulto , Antibacterianos/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/microbiologia , Feminino , Fraturas Expostas/patologia , Humanos , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico
7.
J Hand Surg Asian Pac Vol ; 24(4): 488-490, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690204

RESUMO

One of the serious complications of Seymour fractures is infection. A 24-year-old male presented with the open infected distal phalanx fracture of the middle finger. Wound debridement, irrigation, use of antibiotics and external fixation with the aid of mini-Ilizarov provided a resolution to the infectious process and enabled us to achieve a stable osseous union in correct position.


Assuntos
Desbridamento/métodos , Traumatismos dos Dedos/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Expostas/cirurgia , Infecção dos Ferimentos/cirurgia , Traumatismos dos Dedos/complicações , Traumatismos dos Dedos/diagnóstico , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/diagnóstico , Fraturas Expostas/diagnóstico , Humanos , Masculino , Radiografia , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/etiologia , Adulto Jovem
8.
Pan Afr Med J ; 33: 234, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692766

RESUMO

Introduction: Management of open fractures poses a constant challenge to Orthopaedic surgeons in Nigeria. Our aim is to determine the epidemiological pattern of open fractures in our centre and share our experiences on the initial management and problems encountered. Methods: This was an 18 month prospective study of patients that presented with open fractures at our emergency room. Already prepared data collection sheets were used to collect relevant data directly from patients and patients' files. Results: There were 58 open fractures in 52 patients (31 males and 21 females). Mean age of patients was 36.4 ± 12.2 years. Most patients (82.7%) fell within the age group of 20-49 years. Traders (28.9%) and students (19.6%) were mostly affected. Most open fractures (88.5%) were due to road traffic accidents. The tibia and fibula were the most frequently affected (44.4%). Most injuries were Gustilo et al. types IIIA & IIIB (79.3%) open fractures. Patients had initial resuscitation followed by debridement in 42 cases (72%). Fractures were initially stabilized with external fixators in 23 cases (39.7%) and cast slabs in 19 cases (32.8%). The average time between presentation and debridement was 30 hours and average hospital stay was 36 days. Forty two point five per cent of wounds were infected. Conclusion: Open fractures were mostly due to road traffic accidents and affected the tibia and fibula most frequently with Gustilo et al. types IIIA and IIIB forming the bulk of the injuries. Management was challenging with late presentations, scarcity of resources and consequent high rate of infections, prolonged morbidity and hospital stay. These problems were worsened by delay in antibiotic commencement and initial debridement, sub-optimal treatment at peripherial hospitals and mis-management by traditional bone setters.


Assuntos
Desbridamento/métodos , Fixadores Externos , Fixação de Fratura/métodos , Fraturas Expostas/cirurgia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Serviço Hospitalar de Emergência , Feminino , Fraturas Expostas/epidemiologia , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Estudos Prospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Fatores de Tempo , Adulto Jovem
9.
Handchir Mikrochir Plast Chir ; 51(6): 484-491, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698490

RESUMO

BACKGROUND: "Orthoplastics" is a relatively new approach to lower limb reconstruction, where an integration of both plastic and orthopedic expertise is required, together with the availability of well-equipped facilities. Acute shortening and long-term frames for lengthening are generally considered alternatives to length preservation and soft tissue microsurgical reconstruction, but an integration of external fixation and reconstructive microsurgery is gaining an increasing role with refinements of joint approaches. MATERIAL AND METHODS: Data on sixteen patients who underwent microsurgical lower limb reconstruction and external fixation with an orthoplastic approach, following acute or chronic tibial injury, were retrospectively reviewed. All patients presented a post traumatic soft tissue defect associated with a Gustilo III tibial fracture or a tibial septic pseudarthrosis. Data on type and timing of bone and soft tissue reconstruction, outcomes, complications and need for re-operation were extrapolated and compared to an historic group of patients treated with an orthopedic-based approach. RESULTS: In the orthoplastic group, soft tissues were reconstructed with an ALT flap in most cases; a muscle-sparing VL or ALT-VL chimeric flap was necessary in cases with a very extensive defect. In the orthopedic group, soft tissues were left to heal by second intention or patients were lately referred to plastic surgeons. Statistical comparison between the two groups has showed significant differences on the following data: time for soft tissue healing, time to bone union, number of reinterventions, post-operative deep infection rate, time to return to work. CONCLUSION: The orthoplastic approach to complex leg defects yields shorter treatment time and better functional results compared to the orthopedic-based approach. External fixation and microsurgical reconstruction are not necessarily alternative procedures but can integrate in an orthoplastic path to address at best both soft tissue and bone reconstruction.


Assuntos
Fraturas Expostas , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Fraturas da Tíbia , Fixação de Fratura , Fraturas Expostas/cirurgia , Humanos , Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Tíbia , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(43): e17498, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651853

RESUMO

This study aimed to compare the efficacy and safety among Kirschner wire, anatomical plate fixation and cannulated screw treatments in patients with open calcaneal fractures, and to explore the predictive factors for treatment response and complication occurrence.The 142 open calcaneal fracture patients were enrolled in this study, who received fixation procedures of Kirschner wire, anatomical plate fixation or cannulated screw on demand. Treatment efficacy was assessed by AOFAS score and occurrence of complications was recorded.No difference of AOFAS score was observed among Kirschner wire, anatomical plate fixation and cannulated screw groups (P = .792), and the numbers of patients with excellent, good, medium, and poor AOFAS score in Kirschner wire group were 16 (16.2%), 42 (42.4%), 32 (32.3%), and 9 (9.1%), which in anatomical plate fixation group were 4 (16.7%), 11 (45.8%), 7 (29.2%), and (8.3%), and in cannulated screw group were 1 (5.3%), 10 (52.6%), 6 (31.6%), and 2 (10.5%), respectively. No difference of total complication occurrence (P = .709) or specific complications including skin graft (P = .419), flap graft (P = .229), deep infection (P = .644) or amputation (P = .428) was discovered among 3 groups. Logistic regression analysis revealed that fixation options did not affect treatment response and complication occurrence (all P > .05), while higher Gustilo type correlates with decreased treatment response (P < .001) and elevated complication occurrence (P < .001) independently.Kirschner wire, anatomical plate fixation, and cannulated screw are equally efficient and tolerated in treating patients with open calcaneal fractures, and higher Gustilo type correlates with decreased treatment response and increased complication occurrence independently.


Assuntos
Calcâneo/lesões , Fixação Interna de Fraturas/instrumentação , Fraturas Expostas/cirurgia , Fixadores Internos , Adulto , Placas Ósseas , Parafusos Ósseos , Fios Ortopédicos , Calcâneo/cirurgia , Cateterismo , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
11.
Acta Chir Orthop Traumatol Cech ; 86(4): 290-293, 2019.
Artigo em Eslovaco | MEDLINE | ID: mdl-31524592

RESUMO

Vascularized bone grafting was for the first time described in the 1970s. It has become a crucial component in the reconstruction of long bone defects and non-unions in a poorly vascularised environment. Although the vascularized bone is well described for the lower extremity and mandibular reconstructions, it started to be used for the upper extremity bone defects only recently. This publication presents a case of a young man with an open fracture of both the forearm bones. The treatment of the injury has been complicated with anaerobic gas gangrene of the forearm. This resulted in a non-union, radius shortening and necrosis of both the thumb extensors and flexors muscles. Once the acute infection was managed, the patient received a two-step treatment provided jointly by orthopaedic and plastic surgeons at the University Hospital in Bratislava. At the first stage auto transplantation of the vascularized fibula into the defect of radius was performed, with radial artery and radial veins being the recipient vessels. One year later, a tendon transfer was made in order to reconstruct the extension and flexion of the thumb. Donor tendons were the following: extensor indicis proprius and flexor digitorum superficialis for ring finger. The result of the reconstruction is the full incorporation of the fibular transplant (6 months after the primary operation) and the excellent range of motion of the hand and wrist. Thanks to the tendon transfer the function of the thumb, including the opposition, was achieved two months after the secondary surgery. Key words: defect of radius, tendon transfer, anaerobic infection, gas necrosis, microsurgery.


Assuntos
Fíbula/transplante , Traumatismos do Antebraço/cirurgia , Gangrena Gasosa/cirurgia , Fraturas do Rádio/cirurgia , Transferência Tendinosa/métodos , Fraturas da Ulna/cirurgia , Transplante Ósseo , Fíbula/irrigação sanguínea , Antebraço/irrigação sanguínea , Antebraço/cirurgia , Traumatismos do Antebraço/terapia , Fraturas Expostas/cirurgia , Fraturas Expostas/terapia , Gangrena Gasosa/terapia , Humanos , Masculino , Transplante Autólogo
12.
Cir Cir ; 87(S1): 43-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501626

RESUMO

Introducción: Se han publicados pocos informes sobre el seguimiento a largo plazo de la reparación quirúrgica de una amputación parcial. Algunos estudios de largo plazo han registrado tasas similares de discapacidad entre los pacientes con amputaciones y los sometidos a operación reconstructiva. Objetivo: Informar un caso clínico de una amputación traumática parcial de una extremidad superior con recuperación funcional después de 13 años de seguimiento. Caso clínico: Paciente masculino de ocho años con traumatismo grave en la extremidad superior izquierda, desprendimiento de los músculos bíceps y tríceps y una fractura diafisaria oblicua del húmero distal. La fractura se fijó de manera transitoria con alambres de Kirschner de 2.0 mm, seguido de inmovilización con aparato de Sarmiento y al final se realizó reducción abierta y fijación interna con placa de compresión dinámica de 3.5 mm. La integridad muscular y neurovascular permitió la reparación microquirúrgica del nervio radial y la rehabilitación neuromuscular. Conclusiones: Este informe clínico representa un caso de una recuperación funcional excelente atestiguada a través de un periodo de seguimiento de 13 años.


Assuntos
Amputação Traumática/cirurgia , Traumatismos do Braço/cirurgia , Lesões por Esmagamento/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Expostas/cirurgia , Fraturas do Úmero/cirurgia , Placas Ósseas , Fios Ortopédicos , Criança , Seguimentos , Humanos , Imobilização , Masculino , Microcirurgia/métodos , Músculo Esquelético/cirurgia , Nervo Radial/cirurgia , Recuperação de Função Fisiológica
13.
Acta Ortop Mex ; 33(1): 2-7, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31480118

RESUMO

INTRODUCTION: The management of severely traumatized extremity continues to be a matter of debate. Gustilo-Anderson tibial fractures III-B have a wide spectrum of variants, there are no guidelines using this classification for management. MESS has demonstrated functional and prognostic association. OBJECTIVE: To identify the pattern of decision made by surgeons for the prescription of amputations in tibial fractures exposed grade III-B Gustilo-Anderson with MESS scale. Material and methods. RESULTS: There was no association between the variables, with the application of MESS. (2 = 1.28, p = 0.2575). Surgeons of more than 10 years, increased once the possibility of matching the result of experts (OR = 2.088, 95% CI) (p = 0.0066). CONCLUSION: Academic degrees, surgical experience, and frequent clinical practice do not influence the correct application of the MESS scale. Surgeons with more than 10 years of experience have doubled the possibility of a precise decision.


Assuntos
Amputação , Fraturas Expostas , Fraturas da Tíbia , Tomada de Decisões , Fraturas Expostas/cirurgia , Humanos , Prognóstico , Estudos Retrospectivos , Tíbia , Fraturas da Tíbia/cirurgia
14.
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
15.
Orthop Traumatol Surg Res ; 105(5): 1021-1024, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31377130

RESUMO

INTRODUCTION: Treatment of open tibial shaft fracture is controversial due to the risk of infection. We assessed results in a continuous series of open tibial shaft fractures treated by primary intramedullary nailing. HYPOTHESIS: Factors can be determined for non-union and onset of infection following primary intramedullary nailing in open tibial shaft fracture. PATIENTS AND METHOD: A retrospective study assessed open tibial shaft fractures treated by primary intramedullary nailing between January 2007 and December 2013. Fractures were classified on the AO and Gustilo classifications. Infection rates and time to union were compared. RESULTS: Eighty-five patients (85 fractures) were included: 13 Gustilo type I, 43 type II, 19 type III-A and 10 type III-B. Eight patients had infection (9%). Healing and union were obtained after nail exchange and reaming in 5 cases, and after bone transport in 2. One patient showed non-union at last follow-up. Infection risk did not correlate with Gustilo (p=0.55) or AO type (p=0.69). The interval between trauma and wound debridement was significantly longer in infected patients (p=0.048). Eighty-three fractures (97.6%) healed, at a mean 6.9±6.1 months (range, 2-40). Non-union was associated with AO type (p=0.04), and showed a non-significant association with Gustilo type (p=0.06). DISCUSSION: Time to treatment was the only factor influencing risk of infection. Non-union was related to AO comminution grade. Primary intramedullary nailing seemed reliable if treatment was early, with rigorous debridement. The advantages then are early resumption of weight-bearing and low patient burden. LEVEL OF EVIDENCE: V, retrospective study.


Assuntos
Fixação Intramedular de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Cominutivas/diagnóstico , Fraturas Expostas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Fraturas da Tíbia/diagnóstico , Cicatrização , Adulto Jovem
16.
Bone Joint J ; 101-B(8): 1002-1008, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362546

RESUMO

AIMS: Type IIIB open tibial fractures are devastating high-energy injuries. At initial debridement, the surgeon will often be faced with large bone fragments with tenuous, if any, soft-tissue attachments. Conventionally these are discarded to avoid infection. We aimed to determine if orthoplastic reconstruction using mechanically relevant devitalized bone (ORDB) was associated with an increased infection rate in type IIIB open tibial shaft fractures. PATIENT AND METHODS: This was a consecutive cohort study of 113 patients, who had sustained type IIIB fractures of the tibia following blunt trauma, over a four-year period in a level 1 trauma centre. The median age was 44.3 years (interquartile range (IQR) 28.1 to 65.9) with a median follow-up of 1.7 years (IQR 1.2 to 2.1). There were 73 male patients and 40 female patients. The primary outcome measures were deep infection rate and number of operations. The secondary outcomes were nonunion and flap failure. RESULTS: In all, 44 patients had ORDB as part of their reconstruction, with the remaining 69 not requiring it. Eight out of 113 patients (7.1%) developed a deep infection (ORDB 1/44, non-ORDB 7/69). The median number of operations was two. A total of 16/242 complication-related reoperations were undertaken (6.6%), with 2/16 (12.5%) occurring in the ORDB group. CONCLUSION: In the setting of an effective orthoplastic approach to type IIIB open diaphyseal tibial fractures, using mechanically relevant debrided devitalized bone fragments in the definitive reconstruction appears to be safe. Cite this article: Bone Joint J 2019;101-B:1002-1008.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Expostas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Infecção da Ferida Cirúrgica/etiologia , Fraturas da Tíbia/cirurgia , Ferimentos não Penetrantes/cirurgia , Adulto , Idoso , Desbridamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
17.
Chin J Traumatol ; 22(5): 270-273, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31443939

RESUMO

PURPOSE: Open tibia fracture is prone to infection, consequently causing significant morbidity and increasing the hospital stay, occupational loss and onset of chronic osteomyelitis. Intramedullary nailing is one choice for treating tibia shaft fractures. To improve the delivery of antibiotics at the tissue-implant interface, many methods have been proposed as a part of prophylaxis against infection. This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking (IMIL) nail in the prevention of infection in Gustilo type I and II open tibia fractures and to compare the results with regular intramedullary nail. METHODS: The study included 28 patients with open tibia fractures (Gustilo type 1 or type 2); of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing. Randomization was done by alternate allocation of the patients. Follow-up was done postoperatively (day 1), 1 week, 6 weeks, and 6 months for bone union, erythrocyte sedimentation rate (ESR), hemoglobin and C-reactive protein (CRP). Statistical significance was tested using unpaired t-test. A p value less than 0.05 was considered significant. RESULTS: There were 4 cases of infection in controls (regular IMIL nail) and no infection among patients treated with gentamicin-coated nail during the follow up (X2 = 4.66, p = 0.031). At 6 months postoperatively, CRP (p = 0.031), ESR (p = 0.046) and hemoglobin level (p = 0.016) showed significant difference between two groups. The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up (p = 0.016). CONCLUSION: Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo type I and II open tibia fractures.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Pinos Ortopédicos , Fixação Intramedular de Fraturas/métodos , Fraturas Expostas/cirurgia , Gentamicinas/administração & dosagem , Infecção da Ferida Cirúrgica/prevenção & controle , Fraturas da Tíbia/cirurgia , Adulto , Seguimentos , Consolidação da Fratura , Fraturas Expostas/classificação , Fraturas Expostas/fisiopatologia , Humanos , Masculino , Fraturas da Tíbia/classificação , Fraturas da Tíbia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
18.
BMJ Case Rep ; 12(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302613

RESUMO

This is a case of how a polytrauma patient was managed successfully. This 47-year-old woman was a victim of a detonated improvised explosive device in a terror attack. She had multiple injuries and underwent damage control surgery. She suffered significant bone loss with an open distal tibia pilon fracture, which we reconstructed with novel techniques. About 18 months postoperative, she is mobilising without the use of any aids.


Assuntos
Traumatismos por Explosões/cirurgia , Fraturas Expostas/cirurgia , Traumatismo Múltiplo/cirurgia , Fraturas da Tíbia/cirurgia , Fraturas do Tornozelo , Calcâneo/lesões , Fixadores Externos , Feminino , Fíbula/lesões , Fixação Interna de Fraturas/métodos , Humanos , Úmero/lesões , Escala de Gravidade do Ferimento , Pessoa de Meia-Idade
19.
Orthopedics ; 42(4): 219-225, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31323105

RESUMO

The authors aimed to characterize surgical and functional outcomes of open fractures of the distal radius in patients younger than 65 years. At their level I trauma center, the authors conducted a retrospective review of 92 patients (age range, 16-64 years) who had 94 open fractures of the distal radius (average follow-up, 30 months; range, 3-95 months). Sixty-four fractures received definitive treatment at the time of initial débridement; 30 received definitive fixation and soft tissue coverage after staged débridement. Primary surgical outcome was development of deep surgical site infection requiring repeat surgical débridement; secondary surgical outcome was surgical complications requiring reoperation. Functional outcome was assessed by wrist range of motion. Overall infection rate was 15% (14 of 94 fractures). Seven (11%) of 64 fractures in the immediate definitive fixation group developed infection compared with 7 (23%) of 30 fractures in the staged treatment group (P=.13). Twenty-one (33%) of 64 fractures in the immediate definitive fixation group required reoperation compared with 15 (50%) of 30 in the staged treatment group (P=.11). Deep surgical site infections and surgical complications associated with open fractures of the distal radius are driven by soft tissue injury. [Orthopedics. 2019; 42(4):219-225.].


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas Expostas/cirurgia , Fraturas do Rádio/cirurgia , Rádio (Anatomia)/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Adolescente , Adulto , Desbridamento/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Orthopedics ; 42(5): 260-266, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31355903

RESUMO

High-energy open fractures of the tibia are frequently associated with tissue loss, wound contamination, and compromised vascularity that often result in amputation. The management of these severe injuries remains a challenge for orthopedic reconstructive surgeons. Studies have compared the timing of soft tissue coverage of Gustilo type IIIB open tibia fractures with associated outcomes such as rate of deep infection, primary union, length of hospitalization, flap failure, and eventual secondary amputation. These studies often highlight better outcomes with specific time domains that are not always attainable at a large tertiary hospital with multi-system trauma patients. Many studies do not account for delayed patient transfers after initial open fracture management elsewhere. This retrospective analysis of the limb salvage outcomes included 140 consecutive patients with Gustilo type IIIB open tibia fractures who presented to the authors' level I trauma center between 2001 and 2014. The authors included patients who required delayed coverage or who were transferred from outside institutions. The majority (77%) were male, and the mean age was 39.4 years. Motor vehicle accidents were the most common cause of injury, and 83% of patients obtained full weight-bearing status with successful limb salvage. Twenty patients had a secondary amputation, with the cause being refractory osteomyelitis in 52%. This study provides guidance on treating a heterogeneous patient population with severe open tibia fractures typically seen in a large tertiary hospital orthopedic trauma service. [Orthopedics. 2019; 42(5):260-266.].


Assuntos
Fraturas Expostas/cirurgia , Salvamento de Membro/métodos , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação , Criança , Feminino , Fraturas Expostas/complicações , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/transplante , Osteomielite/etiologia , Osteomielite/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Estudos Retrospectivos , Retalhos Cirúrgicos , Fraturas da Tíbia/complicações , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA