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1.
Acta Orthop Traumatol Turc ; 55(6): 535-540, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34967743

RESUMO

OBJECTIVE: The aim of this study was to evaluate the success of simultaneous medial and lateral autologous osteochondral transplantation (AOT) in patients with both medial and lateral osteochondral lesions of the talus (OLT) who could not be treated with bone marrow stimulation techniques or whose previous treatments failed. METHODS: Five patients who underwent medial and lateral talus AOT in the same session due to simultaneous OLT on medial and lateral talar dome were included in this retrospective study. All the patients were male, and the mean age was 34.8 (range = 26 - 42) years. Double osteochondral grafts were placed separately to the medial and lateral talar dome at the same session. Location and size of the OLT, additional ligament injuries, and postoperative evaluation of the graft were evaluated through magnetic resonance images (MRIs). The criteria of Berndt and Harty, Single Assessment Numeric Evaluation (SANE), American Orthopedic Foot and Ankle Society Score (AOFAS), visual analogue scale (VAS) score, and Tegner Activity Score were assessed preoperatively and at the last follow-up. RESULTS: All patients had suffered an injury with inversion of the foot while daily or sports activity. Average duration of symptoms from onset to osteochondral grafting was 25.2 months. The mean follow-up time was 61 months. The radiological evaluation showed OLT with Stage 4 or 5, anterior talofibular ligament injury and deltoid ligament strain observed in all of the patients. With the numbers available, pre and post-operative comparisons showed a significant increase in patients' satisfaction rate and significant decrease in VAS scores as well as an increase in AOFAS scores with the numbers available. No complications were encountered. CONCLUSION: Simultaneous AOT for medial and lateral OLT appears to be a reliable surgical procedure with satisfactory clinical results. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Fraturas Intra-Articulares , Tálus , Adulto , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Transplante Ósseo , Humanos , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Tálus/diagnóstico por imagem , Tálus/cirurgia , Transplante Autólogo , Resultado do Tratamento
2.
J Hand Surg Asian Pac Vol ; 26(4): 525-534, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34789110

RESUMO

Background: In the conservative management of distal radial fractures (DRFs), the optimal dorsi-volar angulation of the wrist at cast immobilization and proper cast molding to minimize the risk of redisplacement are unclear. This study identified the predictors of fracture redisplacement during cast immobilization for adult DRFs. Methods: We examined for dorsi-volar angulation, gap index, volar tilt (VT), radial inclination (RI), and radial length (RL) in lateral or posteroanterior radiographs of 90 DRFs. We investigated possible predisposition factors for redisplacement including patient age, sex, extra- or intra-articular fracture, metaphyseal comminution, original displacements, dorsi-volar angulation of the wrist at cast immobilization, restoration of the volar cortex at cast immobilization, and gap index of the cast. Results: Neither dorsi-volar angulation nor gap index had significant association with an unacceptable alignment nor decrease of VT, RI, and RL. In multivariate analysis, patient age, original displacement, and intra-articular fracture were the significant predictors of an unacceptable alignment or decrease of VT and RI. Conclusions: Our findings indicate dorsi-volar angulation and cast molding quality have no clinical effect on preventing fracture redisplacement. The predictive factors of the displacement were patient age, original displacement, and intra-articular fracture.


Assuntos
Fraturas Intra-Articulares , Fraturas do Rádio , Adulto , Moldes Cirúrgicos , Humanos , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/terapia
3.
Tech Hand Up Extrem Surg ; 25(4): 258-263, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-34779423

RESUMO

This article describes our technique of managing highly comminuted intra-articular fracture subluxations at the proximal interphalangeal joint by subchondral buttress fixation followed by early mobilization. This technique has proven to be reliable and all patients have been able to return to their preinjury level of activity.


Assuntos
Traumatismos dos Dedos , Fraturas Cominutivas , Fraturas Intra-Articulares , Luxações Articulares , Deambulação Precoce , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Fixação de Fratura , Fixação Interna de Fraturas , Fraturas Cominutivas/cirurgia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Luxações Articulares/cirurgia
4.
Acta Biomed ; 92(S1): e2021500, 2021 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-34747380

RESUMO

Unicondylar fractures of the femur are uncommon injuries that can occur in the sagittal or, less frequently, in the coronal plane (Hoffa fractures).  Distal femoral fractures are usually described following the AO/OTA Classification system which includes extra-articular, partial articular and intra-articular injuries, further divided in three types based on the pattern and comminution.  Accurate reduction and stable fixation are needed especially in articular injuries in order to allow early mobilization and reduce complications such as knee stiffness, malunion or secondary osteoarthritis. The aim of this paper is to report a case of an unusual articular fracture of the lateral femoral condyle in a 39 years old man. This fracture reminds the pattern of a typical tibial plateau injury, not embedded in the most common descriptions of femoral traumas. Indeed, in most cases, high energy traumas in valgus of the knee result in a damage to the tibial plateau because of the condyles impact on the tibial articular surface, while in the present case the opposite occurred. The patient was successfully treated with an open reduction and fixation with two cannulated leg screws, reporting  good clinical outcome and excellent healing of the fragment evidenced with CT scan at 6 months follow-up.


Assuntos
Fraturas do Fêmur , Fraturas Intra-Articulares , Fraturas da Tíbia , Adulto , Epífises , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fêmur , Fixação Interna de Fraturas , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Articulação do Joelho , Masculino
5.
Ulus Travma Acil Cerrahi Derg ; 27(6): 684-689, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34710224

RESUMO

BACKGROUND: In this study, we aimed to compare the radiological, clinical and functional results of volar radius locking plate, and K-wire augmented bridging external fixator (BEF) treatments that applied in intra-articular distal radius fractures. METHODS: Between May 2016 and January 2019, 162 patients who met the inclusion criteria of 23-C2 and 23-C3 according to the AO/OTA classification who operated in our clinic were evaluated retrospectively. 78 patients (37 males, 41 females, mean age 49.92) were fixated with K wire augmented BEF and 84 patients (41 males, 43 females, mean age 46.81) were fixated with volar locking plate (VLP). Demographic (age, gender, type of trauma, and follow-up time), radiological (radial inclination, radial height, volar tilt, and fracture healing time), and clinical and functional (range of motion [ROM], grip strength, Quick Dash, Green O'Brien and Mayo scores) data of the patient groups were recorded and compared statistically. RESULTS: There was no significant difference between the patient groups in terms of functional scoring systems. Radiologically, radial inclination, and radial length were significantly better in the volar plate group. In terms of joint ROM, flexion, extension, pronation, and supination movements were significantly better in the VLP group. Sudek atrophy incidence and loss of grip strength were higher in BEF group. Mean time of union was significantly shorter in the BEF group. CONCLUSION: Successful results can be obtained in both treatment methods. However, VLP treatment provides better joint ROM and lower complication rates compared to BEF treatment.


Assuntos
Fraturas Intra-Articulares , Fraturas do Rádio , Placas Ósseas , Fios Ortopédicos , Fixadores Externos , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
7.
Zhongguo Gu Shang ; 34(9): 794-800, 2021 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-34569201

RESUMO

OBJECTIVE: To compare clinical efficacy of minimally invasive locking plate and anatomic locking plate in treating intra-articular calcaneal fractures via sinus tarsi approach. METHODS: A retrospective analysis was conducted of 48 patients with intra-articular calcaneal fractures treated with surgery via sinus tarsi approach from July 2016 to June 2017. According to differernt methods of internal fixation, the patients were divided into minimally invasive locking plate group and anatomic locking plate group. In minimally invasive locking plate group, there were 14 males and 10 females, aged from 27 to 46 years old with an average age of (38.70±5.58) years old, 18 patients were typeⅡand 6 patients were type Ⅲ according to Sanders classification. In anatomic locking plate group, there were 17 males and 7 females, aged from 26 to 46 years old with an average age of (37.10±6.44) years old, 16 patients were typeⅡ and 8 patients were type Ⅲ according to Sanders classification. Operative time, visual analogue scale (VAS), postoperative complications between two groups were compared, and Böhler angle, Gissane angal, calcaneal width and height were recorded and compared between two groups at 1 week after operation and final follow up. The functional effect was assessed according to Maryland foot function score at final follow up. RESULTS: All patients were followed up for (14.10±1.94) months (ranged 12 to 18 months). All patients were obtained bone union from 8 to 16 weeks with an average of (10.60±2.25) weeks. Operation time, VAS score and complication rate in minimally invasive locking plate group were (69.50±7.51) min, (2.80±1.07) and 2 cases respectively, and (77.50±7.15) min, (3.80±1.09) and 8 cases in anatomic locking plate group respectively, there were statistical difference between two groups (P<0.05). However, there were no statistically differences in Maryland foot function score, Böhler angle, Gissane angle, calcaneal width and height at 1 week after opertaion and final follow-up between two groups (P>0.05). CONCLUSION: Compare with anatomic locking plate, minimally invasive locking plate via sinus tarsi approach for Sanders typeⅡ and Ⅲ intra-articular calcaneal fractures could obtain similar reliable fixation and functional recovery with more simple operation, shorter operative time, lighter postoperative pain and less complications.


Assuntos
Calcâneo , Fraturas Ósseas , Fraturas Intra-Articulares , Adulto , Idoso , Placas Ósseas , Calcâneo/cirurgia , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Calcanhar , Humanos , Fraturas Intra-Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
Foot (Edinb) ; 49: 101852, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34536818

RESUMO

BACKGROUND: Arthroscopic debridement (AD) for the osteochondral lesions of the talar dome (OLT) was widely documented in the nineties with satisfactory results. However, in modern treatment algorithms, its role is not described. The present systematic review aims to evaluate the current evidence on the clinical outcomes of AD in the management of OLT. METHODS: Two independent reviewers searched PubMed, EMBASE, Scopus, and Virtual Health Library databases evaluating the clinical outcomes of AD of OLT with a minimum 6-month follow-up. The following terms "talus", "chondral", "cartilage", "injury", "lesion", "delamination", "damage", "excision", "curettage", "debridement", "chondrectomy", "chondroplasty", were used alone and in combination with Boolean operators AND and OR. Studies in which surgical technique was not described, an additional procedure was performed after debridement, and/or outcomes were not reported separately when more than one technique was implemented were excluded. The modified Coleman methodology score (mCMS) was used to evaluate the methodological quality of the included studies. A narrative analysis was conducted. Publication bias was assessed using the ROBIS tool. RESULTS: AD showed satisfactory short and medium-term outcomes for the primary treatment of OLT irrespectively of size and depth. However, the heterogeneity of the included studies and the level of available evidence hinders its recommendation. CONCLUSIONS: There is a paucity of evidence evaluating AD alone for OLT treatment in the last two decades. Bone-marrow stimulation techniques remain the first-line surgical strategy for OLT treatment without proven superiority. Adopting AD for OLT treatment instead of MF could represent a paradigm breakthrough in clinical practice given its many potential advantages while preserving the subchondral plate.


Assuntos
Cartilagem Articular , Fraturas Intra-Articulares , Tálus , Artroscopia , Cartilagem Articular/cirurgia , Desbridamento , Humanos , Tálus/cirurgia , Resultado do Tratamento
9.
Orthop Clin North Am ; 52(4): 433-450, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538353

RESUMO

Treatment of calcaneal fractures has to be tailored to the individual pathoanatomy. If operative treatment is chosen, anatomic reconstruction of the calcaneal shape and joint surfaces is mandatory. For most of the displaced, intraarticular fractures, this can be achieved by less invasive reduction and fixation via a sinus tarsi approach, which may be extended along the "lateral utility" line for calcaneocuboid joint involvement or calcaneal fracture-dislocations. Purely percutaneous fixation is the treatment of choice for displaced extraarticular fractures and simple intraarticular fractures with adequate control of joint reduction. Specific approaches are used for rare calcaneal fracture variants.


Assuntos
Calcâneo/lesões , Fraturas Ósseas/terapia , Calcâneo/anatomia & histologia , Calcâneo/cirurgia , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Fraturas Cominutivas/cirurgia , Humanos , Fraturas Intra-Articulares/cirurgia , Lesões dos Tecidos Moles/complicações , Lesões dos Tecidos Moles/cirurgia
10.
Bone Joint J ; 103-B(9): 1457-1461, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34465150

RESUMO

AIMS: The aim of this study was to identify the origin and development of the threshold for surgical intervention, highlight the consequences of residual displacement, and justify the importance of accurate measurement. METHODS: A systematic review of three databases was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. This search identified papers investigating functional outcome, including presence of arthritis, following injury. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. RESULTS: Knirk and Jupiter (1986) were the first to quantify a threshold, with all their patients developing arthritis with > 2 mm displacement. Some papers have discussed using 1 mm, although 2 mm is most widely reported. Current guidance from the British Society for Surgery of the Hand and a Delphi panel support 2 mm as an appropriate value. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, radiological arthritis does not correlate with the clinical presentation. Function following injury has been shown to be equivalent to an uninjured population, with arthritis progressing slowly or not at all. Joint space narrowing has also been shown to often be benign. CONCLUSION: Knirk and Jupiter originated the threshold value of 2 mm. The lack of correlation between the radiological and clinical presentations warrants further modern investigation. Measurement often varies between observers, calling a threshold concept into question and showing the need for further development in this area. The principle of treatment remains restoration of normal anatomical position. Cite this article: Bone Joint J 2021;103-B(9):1457-1461.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/cirurgia , Artrite/prevenção & controle , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Complicações Pós-Operatórias/prevenção & controle , Fraturas do Rádio/diagnóstico por imagem
11.
J Am Podiatr Med Assoc ; 111(4)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34478532

RESUMO

BACKGROUND: The aim of the present study was to contribute new and updated information to the literature by comparing the clinical and radiologic results of arthroscopic microfracture, platelet-rich plasma (PRP) after arthroscopic microfracture, and BST-Cargel scaffold application after arthroscopic microfracture in the treatment of talar osteochondral lesions. METHODS: Sixty-two talar osteochondral lesion patients (31 women and 31 men) who underwent ankle arthroscopy in two different centers were randomized into three groups. The first group consisted of patients who underwent only arthroscopic microfracture (MF) (n = 22); the second group consisted of patients who underwent the PRP procedure after arthroscopic MF (PRP; n = 19); and the third group consisted of patients who underwent the BST-Cargel procedure after arthroscopic MF was (BST-Cargel; n = 21). The talar osteochondral lesions in the three groups were classified according to magnetic resonance and arthroscopic images. American Orthopedic Foot and Ankle Society, Foot and Ankle Ability Measurement (overall pain, 15-minute walking, running function), and visual analog scale scores were evaluated preoperatively and postoperatively, and postoperative return time to sports activities was performed. RESULTS: Compared to the preoperative score, postoperative American Orthopedic Foot and Ankle Society score increased 48.80 ± 9.60 in the BST-Cargel group, whereas there was an increase of 46.68 ± 3.65 in the PRP group and 29.63 ± 3.69 in the MF group, which were statistically significant (P < .05).There was a statistically significant postoperative change in the visual analog scale scores of the patients in all three groups compared to the preoperative scores (P < .05). At the end of the follow-up, the Foot and Ankle Ability Measurement overall pain, 15-minute walking, and running function results of all three groups increased significantly postoperatively compared to the preoperative values (P < .005). CONCLUSIONS: BST-Cargel application with microfracture is a method that can be applied easily and safely with arthroscopy to lesions larger than 1.5 cm2 regardless of the size of the cartilage defect, and it has been found to be superior to the other two methods in terms of pain, functional score, radiologic recovery, and return to sports activities.


Assuntos
Cartilagem Articular , Fraturas de Estresse , Fraturas Intra-Articulares , Tálus , Artroscopia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Feminino , Humanos , Masculino , Estudos Prospectivos , Tálus/diagnóstico por imagem , Tálus/cirurgia , Resultado do Tratamento
12.
Biomed Res Int ; 2021: 9920189, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34476260

RESUMO

The purpose of this study was to characterize the patterns of a large series of tibial plateau fractures with the use of fracture mapping, with regard to different fracture types using the OTA/AO and Schatzker classification. Patients with intra-articular fractures of the tibial plateau were evaluated, using the OTA/AO and Schatzker classification on CT scans. For fracture mapping, the axial slice that completely displayed the tibial joint plane was first identified, then matched to a template congruently, and the fracture lines were identified and reproduced. In addition to epidemiological data (age and gender), the trauma mechanism (high-energy, low-energy, and pathological fracture) was recorded. In total, 271 patients with 278 intra-articular fractures of the tibial head were analyzed, including seven patients with both sides affected. The mean age was 49.1 years (men 46.3 years, women 53.5 years). The majority of fractures was caused by high-energy trauma. No significant difference could be shown with respect to trauma mechanism and resulting fracture type in terms of OTA/AO (p = 0.352) or Schatzker classification (p = 0.884). A significant difference could be found with respect to gender and resulting fracture type in terms of OTA/AO (p = 0.031). 170 (61.2%) were OTA/AO type B fractures, and 108 (38.8%) were type C fractures. Using the Schatzker classification, we found 53 type I (19.1%), 60 type II (21.6%), 27 type III (9.7%), 32 type IV (11.5%), 16 type V (5.8%), and 90 type VI (32.4%) fractures. The main affection was found in the lateral and intermedial column of the tibial plateaus, concerning both OTA/AO and Schatzker classification. The variability of intra-articular tibial head fractures is very high. In consequence, an individual analysis of fracture patterns and therapy planning by using CT scans is crucial.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/patologia , Tíbia/anatomia & histologia , Fraturas da Tíbia/patologia , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Fraturas Intra-Articulares/classificação , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Fraturas da Tíbia/classificação , Fraturas da Tíbia/diagnóstico por imagem
13.
Int Orthop ; 45(9): 2411-2421, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34370059

RESUMO

BACKGROUND: Operative treatment has become the current trend for displaced intra-articular calcaneus fracture (DIACF), while using cannulated screw fixation or plate fixation is still controversial for treating DIACF. The purpose of this meta-analysis is to compare the outcome of the two fixation methods. METHODS: We searched literature comparing cannulated screw fixation and plate fixation from PubMed, Embase, Web of Science, and Cochrane Library. Only randomized controlled trials were included. The outcomes of post-operative function, radiological measurement, time efficiency, and wound complications were pooled in the meta-analysis. RESULT: Seven RCTs with 902 cases of DIACF were included. Pooled results showed the two fixation methods that had similar function satisfactory of AOFAS score (RR = 0.95, 95% CI = [0.83, 1.09], P = 0.47, I2 = 0%) and Maryland Foot score (RR = 0.93, 95% CI = [0.68, 1.28], P = 0.66, I2 = 84%). Compared to plate fixation, cannulated screw fixation had better improvement of Bohler's angle (WMD = 0.56, 95% CI = [0.20, 0.91], P = 0.002, I2 = 34%) and Gissane's angle (WMD = 1.36, 95% CI = [0.56, 2.16], P = 0.0008, I2 = 7%), better recovery of calcaneal height (WMD = 0.49, 95% CI = [0.02, 0.95], P = 0.04, I2 = 6%), shorter time to operation (WMD = - 2.91, 95% CI = [- 4.99, - 0.84], P = 0.006, I2 = 97%), less operation time (WMD = - 21.58, 95% CI = [- 37.31, - 5.85], P = 0.007, I2 = 98%), reduced length of hospital stay (WMD = - 2.00, 95% CI = [- 3.69, - 0.31], P = 0.02, I2 = 97%), and less wound complications (RR = 0.16, 95% CI = [0.08, 0.32], P < 0.00001, I2 = 0%). CONCLUSION: Cannulated screw fixation and plate fixation have similar postoperative functional satisfactory. Cannulated screw fixation is superior to plate fixation in reduction quality, time efficiency, and wound complications.


Assuntos
Calcâneo , Fraturas Ósseas , Fraturas Intra-Articulares , Placas Ósseas , Parafusos Ósseos , Calcâneo/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Humanos , Fraturas Intra-Articulares/cirurgia , Resultado do Tratamento
14.
J Hand Surg Asian Pac Vol ; 26(3): 440-444, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34380393

RESUMO

Background: Scapholunate injuries in distal radius fractures may frequently be overlooked. The aims of this study were to measure the scapholunate distance in intraarticular distal radius fractures and to find out which fracture types were associated with an increased scapholunate width. Methods: Measurements of the scapholunate distance were performed on computed tomography scans of 143 intraarticular distal radius fractures in 140 patients. The fractures were classified according to the AO classification. The morphology of AO type B fractures was further analysed according to the Bain classification. Results: In 43 AO type B fractures mean scapholunate distance measured 2.1 mm and in 100 type C fractures 1.6 mm. The difference between partial and complete intraarticular fractures was significant. A trend towards a greater scapholunate distance was found in AO type B1 and radial styloid oblique fractures. Conclusions: In this study, partial intraarticular distal radius fractures, especially with a sagittal split, had a greater scapholunate distance and may be at risk for ligamentous injury.


Assuntos
Fraturas do Rádio , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
PLoS One ; 16(8): e0255616, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34375344

RESUMO

PURPOSE: High resolution flat-panel computed tomography arthrography (FPCT-A) and magnetic resonance arthrography (MR-A) are well suited to evaluate osteochondral lesions. The current study compares the performance of FPCT-A versus MR-A in an experimental setting. METHODS: Fourteen cadaveric ankles were prepared with artificial osteochondral defects of various sizes in four separate talar locations. After intra-articular contrast injection, FPCT-A and 3-T MR-A were acquired. Each defect was then filled with synthetic pallets. The resulting cast was used as reference. Two independent radiologists measured the dimensions of all defects with FPCT-A and MR-A. Intra-class correlation coefficients (ICC) were calculated. Data were compared using t-tests and Bland-Altman plots. RESULTS: The correlation for FPCT-A and cast was higher compared to MR-A and cast (ICC 0.876 vs. 0.799 for surface [length x width]; ICC 0.887 vs. 0.866 for depth, p<0.001). Mean differences between FPCT-A and cast measurements were -1.1 mm for length (p<0.001), -0.7 mm for width (p<0.001) and -0.4 mm for depth (p = 0.023). By MR-A, there were no significant differences for length and width compared to cast (p>0.05). Depth measurements were significantly smaller by MR-A (mean difference -1.1 mm, p<0.001). There was no bias between the different modalities. CONCLUSIONS: Ex vivo FPCT-A and MR-A both deliver high diagnostic accuracy for the evaluation of osteochondral defects. FPCT-A was slightly more accurate than MR-A, which was most significant when measuring lesion depth.


Assuntos
Articulação do Tornozelo/patologia , Artrografia/métodos , Fraturas Intra-Articulares/diagnóstico , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Articulação do Tornozelo/diagnóstico por imagem , Cadáver , Humanos , Processamento de Imagem Assistida por Computador , Reprodutibilidade dos Testes
16.
Int Orthop ; 45(9): 2365-2373, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34333675

RESUMO

PURPOSE: The purpose of this study was to compare the clinical outcomes of intra-articular calcaneal fractures with medial column displacement treated with different surgical techniques, namely extensile lateral approach (ELA) or sinus tarsi approach (STA), combined with percutaneous medial reduction. METHODS: Ninety-six patients with intra-articular calcaneal fractures who were subjected to ELA or STA (45 in STA group and 51 in ELA group) were retrospectively assessed. Reduction of the posterior facet, calcaneal body, Böhler's angle, and Gissane's angle were evaluated. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale (VAS). The complications, time to surgery, operative time, and blood loss were also assessed. RESULTS: Incidence of wound complications, post-operative blood drainage, and time to the operation were significantly different between the two groups. There was no significant difference in the recovery of calcaneal anatomy and articular surface between the two groups. Similarly, no difference was detected in Böhler's and Gissane's angles between ELA and STA groups (P > 0.05). Finally, there was no difference in AOFAS and VAS scores between the two groups at the final follow-up (P > 0.05). CONCLUSION: STA resulted in favourable radiological and clinical results with fewer wound complications and a shorter waiting time when compared to ELA. The percutaneous medial reduction technique is effective in reducing medial column displacement.


Assuntos
Calcâneo , Fraturas Ósseas , Fraturas Intra-Articulares , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Resultado do Tratamento
17.
J Orthop Trauma ; 35(9): 479-484, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34415871

RESUMO

OBJECTIVE: To test the external validity of the fracture to plafond (FTP-length of fracture/distance to plafond) ratio to rule out distal intra-articular fractures (DIA) in distal tibial shaft fractures at an independent tertiary trauma center. DESIGN: Retrospective cohort study. SETTING: Two Level 1 trauma centers. PATIENTS: Two hundred seventeen patients with a distal tibial shaft fracture in the model cohort and 146 patients in the validation cohort. INTERVENTION: Radiographic measurements to calculate FTP ratio. MAIN OUTCOME MEASUREMENTS: Calibration plots, area under receiver operating characteristic curve (AUC), and decision curve analyses to evaluate the external validity of FTP ratio to determine DIA. RESULTS: The AUC for the anteroposterior (AP) FTP ratio was 0.83 [95% confidence interval (CI) 0.78-0.88] in the model data set and 0.86 (95% CI 0.80-0.91) in the validation data set. The AUC for the lateral FTP ratio was 0.82 (95% CI 0.77-0.87) in the model data set and 0.82 (95% CI 0.75-0.88) in the validation data set. The previously established AP FTP cutoff ratio of 0.61 had a 94% negative predictive value in the model cohort and a 100% negative predictive value in the validation cohort. CONCLUSION: The FTP ratio is an effective and externally validated screening tool to rule out DIA in distal tibia shaft fractures. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fraturas Intra-Articulares , Fraturas da Tíbia , Fixação Interna de Fraturas , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia
18.
J Orthop Surg Res ; 16(1): 454, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34261501

RESUMO

BACKGROUND: This study aimed to explore the clinical efficacy of treating a first metacarpal base fracture by closed reduction and percutaneous parallel K-wire interlocking fixation between the first and second metacarpals. METHODS: Twenty patients treated by the abovementioned modified technique (modified technique group) and ten patients treated by the traditional percutaneous K-wire fixation technique (traditional technique group) from October 2015 to November 2019 at our institution were retrospectively reviewed. The patients' average age was 38 years (range, 16-61 years). The mean follow-up period was 13 months (range, 10-18 months). At the final follow-up, the functional recovery of the injured hand was assessed and compared between the modified and traditional technique groups. In addition, the functional recovery of the injured hand was compared with that of the uninjured hand within the modified technique group. RESULTS: All patients recovered well, with no cases of infection or nonunion. Compared with the traditional technique group, the modified technique group had a shorter operative time, lower postoperative visual analogue scale pain score, better effective range of motion score of the first carpometacarpal joint (Kapandji score), and had almost no need for auxiliary plaster fixation, enabling functional exercise to be started earlier. Within the modified technique group, the mean hand grip strength, pinch strength, and Kapandji score on the injured side did not significantly differ to the values on the uninjured side in both the extra-articular and intra-articular fracture subgroups. While the abduction and flexion-extension arcs of the thumb on the injured hand were significantly smaller than those on the uninjured hand in both the extra-articular and intra-articular fracture subgroups, the patients felt clinically well with respect to daily activities and strength. CONCLUSION: The percutaneous parallel K-wire and interlocking fixation technique is simple, effective, and economical for first metacarpal base fractures.


Assuntos
Fios Ortopédicos , Redução Fechada/instrumentação , Fraturas Ósseas/cirurgia , Ossos Metacarpais/lesões , Ossos Metacarpais/cirurgia , Adolescente , Adulto , Articulações Carpometacarpais/fisiopatologia , Articulações Carpometacarpais/cirurgia , Redução Fechada/métodos , Feminino , Fraturas Ósseas/fisiopatologia , Força da Mão , Humanos , Fraturas Intra-Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Polegar/fisiopatologia , Resultado do Tratamento , Adulto Jovem
19.
J Foot Ankle Surg ; 60(6): 1184-1187, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092459

RESUMO

Recent literature suggests the majority of osteochondral lesions occur in the ankle joint. Previous studies have suggested that varying incidences of talar osteochondral lesions (OCLT) are associated with ankle fractures. The primary aim of our study was to investigate the incidence of osteochondral lesions associated with acute ankle fractures as observed on computed tomographic (CT) imaging. We also compared the rates of talar osteochondral lesions in patients who had ankle fractures with dislocation and closed manual reduction (CMR) prior to open reduction with internal fixation, to those who did not suffer from ankle joint dislocation. Additionally, a correlation between the location of talar dome lesions with type of ankle fracture as classified by Lauge-Hansen was investigated. Preoperative CT imaging was retrospectively reviewed in 108 patients with acute ankle fractures. A CT-modified version of Berndt Hardy's classification of osteochondral lesions, as previously described by Loomer et al, was used for diagnosis of lesions in our study. The incidence of lesions was calculated across all subjects, and retrospective comparison was performed in those who did and did not undergo closed manual reduction. Supplementary data on location of lesion and its association with ankle fracture type was also recorded. We found an overall incidence of 50.9% OCLT in patients with acute ankle fractures. This number did not significantly differ from those who underwent closed manual reduction (49%). Although a majority of lesions did occur posteriorly, we saw no statistically significant information was seen between either type of fractures or OCLT locations. Careful consideration and thorough evaluation of preoperative CT imaging should be assessed by the performing surgeon, as this could guide both diagnostic and therapeutic treatments for patients with possible osteochondral lesions of the talus undergoing surgical repair of a fractured ankle.


Assuntos
Fraturas do Tornozelo , Fraturas Intra-Articulares , Tálus , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/epidemiologia , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo , Humanos , Incidência , Estudos Retrospectivos , Tálus/diagnóstico por imagem , Tálus/cirurgia
20.
Bone Joint J ; 103-B(6): 1040-1046, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058883

RESUMO

AIMS: We report the long-term outcomes of the UK Heel Fracture Trial (HeFT), a pragmatic, multicentre, two-arm, assessor-blinded, randomized controlled trial. METHODS: HeFT recruited 151 patients aged over 16 years with closed displaced, intra-articular fractures of the calcaneus. Patients with significant deformity causing fibular impingement, peripheral vascular disease, or other significant limb injuries were excluded. Participants were randomly allocated to open reduction and internal fixation (ORIF) or nonoperative treatment. We report Kerr-Atkins scores, self-reported difficulty walking and fitting shoes, and additional surgical procedures at 36, 48, and 60 months. RESULTS: Overall, 60-month outcome data were available for 118 patients (78%; 52 ORIF, 66 nonoperative). After 60 months, mean Kerr-Atkins scores were 79.2 (SD 21.5) for ORIF and 76.4 (SD 22.5) for nonoperative. Mixed effects regression analysis gave an estimated effect size of -0.14 points (95% confidence interval -8.87 to 8.59; p = 0.975) in favour of ORIF. There were no between group differences in difficulty walking (p = 0.175), or on the type of shoes worn (p = 0.432) at 60 months. Additional surgical procedures were conducted on ten participants allocated ORIF, compared to four in the nonoperative group (p = 0.043). CONCLUSION: ORIF of displaced intra-articular calcaneal fractures, not causing fibular impingement, showed no difference in outcomes at 60 months compared to nonoperative treatment, but with an increased risk of additional surgery. Cite this article: Bone Joint J 2021;103-B(6):1040-1046.


Assuntos
Calcâneo/lesões , Tratamento Conservador , Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Redução Aberta/métodos , Adulto , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Reino Unido
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