Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 907
Filtrar
1.
Bone Joint J ; 102-B(1): 42-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888361

RESUMO

AIMS: Patient engagement in adaptive health behaviours and interactions with their healthcare ecosystem can be measured using self-reported instruments, such as the Patient Activation Measure (PAM-13) and the Effective Consumer Scale (ECS-17). Few studies have investigated the influence of patient engagement on limitations (patient-reported outcome measures (PROMs)) and patient-reported experience measures (PREMs). First, we assessed whether patient engagement (PAM-13, ECS-17) within two to four weeks of an upper limb fracture was associated with limitations (the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and Patient-Reported Outcome Measurement Information System Upper Extremity Physical Function computer adaptive test (PROMIS UE PF) scores) measured six to nine months after fracture, accounting for demographic, clinical, and psychosocial factors. Secondly, we assessed the association between patient engagement and experience (numerical rating scale for satisfaction with care (NRS-C) and satisfaction with services (NRS-S) six to nine months after fracture. METHODS: A total of 744 adults with an isolated fracture of the proximal humerus, elbow, or distal radius completed PROMs. Due to multicollinearity of patient engagement and psychosocial variables, we generated a single variable combining measures of engagement and psychosocial factors using factor analysis. We then performed multivariable analysis with p < 0.10 on bivariate analysis. RESULTS: Patient engagement and psychosocial factors combined to form a single factor (factor 1) accounting for 20% (QuickDASH, semi-partial R2 = 0.20) and 14% (PROMIS UE PF, semi-partial R2 = 0.14) of the variation in limitations six to nine months after fracture. Factor 1 also accounted for 17% (NRS-C, semi-partial R2 = 0.17) of variation in satisfaction with care, and 21% (NRS-S, semi-partial R2 = 0.21) of variation in satisfaction with services. Demographic factors (age, sex, work status) and measures of greater pathophysiology (type of fracture, high-energy injury, post-surgical complications), accounted for much less variation. CONCLUSION: Patients who actively manage their health and demonstrate effective emotional and social functioning share a common underlying trait. They have fewer limitations and greater satisfaction with care during recovery from upper limb fractures. Future efforts should focus on evaluating initiatives that optimize patient engagement, such as patient education, coaching, and a communication strategy for healthcare professionals. Cite this article: Bone Joint J 2020;102-B(1):42-47.


Assuntos
Articulação do Cotovelo/lesões , Comportamentos Relacionados com a Saúde , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Participação do Paciente , Fraturas do Rádio/cirurgia , Atividades Cotidianas , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Cotovelo/cirurgia , Feminino , Fraturas Ósseas , Promoção da Saúde , Humanos , Fraturas do Úmero/psicologia , Fraturas Intra-Articulares/psicologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Estudos Prospectivos , Fraturas do Rádio/psicologia , Autoeficácia , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
2.
Orthop Clin North Am ; 51(1): 27-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739877

RESUMO

Distal femoral replacement (DFR) is a reasonable treatment option when used for select indications. In the setting of comminuted intra-articular distal femoral fractures, distal femoral arthroplasty should be considered in low-demand patients with poor bone quality. This article summarizes the existing literature plus the authors' personal experience with DFR use for distal femoral fractures of the native knee.


Assuntos
Fraturas do Fêmur/cirurgia , Fêmur/cirurgia , Fraturas Cominutivas/cirurgia , Articulação do Joelho/cirurgia , Idoso , Humanos , Fraturas Intra-Articulares/cirurgia , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Implantação de Prótese/métodos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Reimplante/métodos , Reimplante/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
3.
Eklem Hastalik Cerrahisi ; 30(3): 224-32, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650918

RESUMO

OBJECTIVES: The aim of this study was to evaluate both clinical and radiological results of intraarticular comminuted distal radius fractures treated with volar locking plate (VLP), non-bridging external fixator (NbEF), and bridging external fixator (BEF). PATIENTS AND METHODS: 95 patients (44 males, 51 females; median age 49 years; interquartile range (IQR), 37 to 60 years) who were treated with VLP, NbEF, or BEF due to intraarticular comminuted distal radius fractures between January 2010 and April 2014 were evaluated retrospectively. 34 of these patients were treated with a VLP (VLP group), 30 with a NbEF (NbEF group) and 31 with a BEF (BEF group). In the final follow-up, all patients were evaluated according to clinical and radiological parameters. RESULTS: The median follow-up was 5 (IQR, 4 to 6) years. The VLP and NbEF groups had better results than the BEF group in terms of wrist range of motion, loss of grip strength, Green O'Brien, Mayo Modified Wrist, The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and VAS scores. The VLP group had the most significant radiological improvement. CONCLUSION: Although clinical and radiological results for intraarticular comminuted distal radius fractures are more significantly improved in patients treated with VLP, favorable results close to VLP can be also obtained with NbEF. The BEF seems to be the least effective treatment option among the three surgical methods.


Assuntos
Placas Ósseas , Fixadores Externos , Fixação de Fratura/métodos , Fraturas Cominutivas/cirurgia , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/cirurgia , Adulto , Avaliação da Deficiência , Feminino , Fraturas Cominutivas/diagnóstico por imagem , Força da Mão , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular , Estudos Retrospectivos
4.
J Shoulder Elbow Surg ; 28(10): 1998-2006, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31540725

RESUMO

HYPOTHESIS: We hypothesized that arthroscopic osteocapsular arthroplasty has a comparable outcome to that of the corresponding open procedure. METHODS: Patients treated with osteocapsular arthroplasty for post-traumatic stiffness were assigned to open procedure (OPEN) and arthroscopic procedure (ARTHRO) groups. The clinical outcomes were measured based on range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) score. Based on the initial trauma, the patients were grouped into either intra-articular fracture (I) or extra-articular fracture (E) groups, followed by comparison of the 2 groups. RESULTS: The overall, ROM, VAS, and MEPS scores showed improvement in both groups. Preoperative VAS scores improved from 6.6 ± 1.4 to 2.2 ± 0.9 following OPEN and from 6.5 ± 1.2 to 2.1 ± 1.0 following ARTHRO. Preoperative flexion improved from 88° ± 14° to 113° ± 17° following OPEN and from 102° ± 15° to 122° ± 8° following ARTHRO. Preoperative extension improved from 36° ± 14° to 17° ± 12° following OPEN and from 30° ± 8° to 15° ± 7.4° following ARTHRO. Preoperative MEPS improved from 48.9 ± 11.5 to 80.0 ± 14.8 following OPEN and from 52.3 ± 12.2 to 80.8 ± 7.9 following ARTHRO. All values for the clinical outcomes were worse in group I than in group E. CONCLUSIONS: Arthroscopic osteocapsular arthroplasty is comparable to the corresponding open procedure with regard to the use of our indications. The clinical outcomes in the intra-articular fracture group as a previous trauma were worse than those in the extra-articular fracture group.


Assuntos
Artroplastia/métodos , Artroscopia , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Fraturas Intra-Articulares/cirurgia , Adulto , Articulação do Cotovelo/lesões , Feminino , Humanos , Fraturas Intra-Articulares/complicações , Fraturas Intra-Articulares/fisiopatologia , Cápsula Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
J Bone Joint Surg Am ; 101(15): e75, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393432

RESUMO

BACKGROUND: Coronal shear fractures of the distal aspect of the humerus that involve the capitellum and the trochlea are rare; nevertheless, they are difficult to treat because of the complex fracture patterns and osteochondral nature of the fragments, limiting optimal screw placement. The use of anterior-to-posterior screw fixation by a lag technique (without countersinking) could potentially improve the strength of the construct. Our primary research question was to anatomically determine if there is a non-articulating zone for screw placement along the anterior aspect of the lateral trochlear ridge (aLTR) throughout normal elbow range of motion. METHODS: Eight fresh-frozen cadaveric elbows were used. The region of interest was defined with 3 polymeric pins inserted in the inferior, middle, and superior-most aspects of the aLTR of each elbow, with use of an extensor digitorum communis (EDC) split approach. The elbows were then mounted on a magnetic resonance imaging (MRI)-compatible compression frame and subjected to high-resolution 7-T MRI at 90°, 120°, and 145° of flexion (positions of potential impingement), and at neutral and maximal pronation and maximal supination for each position of flexion. Portions of the aLTR that had free adjacent space were identified using the sagittal and coronal scans. This non-articulating region was identified as the "non-articulating zone" (NAZ). RESULTS: The NAZ was found to encompass the proximal 38.2% (range, 30.2% to 48.9%) of the aLTR, measuring, on average, 5.2 mm in width. It was consistently located either directly adjacent to the apex of the ridge or just medial to it. The distal 61.8% of the aLTR articulated with either the ulna or the radial head in some of the elbows. CONCLUSIONS: Our results suggest that there is a portion of the aLTR that, despite being covered with articular cartilage, is non-articulating throughout normal elbow range of motion. CLINICAL RELEVANCE: In situations in which headless anterior-to-posterior and posterior-to-anterior screw insertion results in inadequate fixation of capitellar-trochlear fractures, anterior-to-posterior lag screw instrumentation along the non-articulating portion of the aLTR may provide a location for additional fixation in some patients. However, because of variation between patients, each case must be individualized.


Assuntos
Parafusos Ósseos , Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas/instrumentação , Fraturas do Úmero/cirurgia , Fenômenos Biomecânicos , Cadáver , Articulação do Cotovelo/lesões , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Fraturas Intra-Articulares/cirurgia , Masculino , Variações Dependentes do Observador , Pronação/fisiologia , Amplitude de Movimento Articular/fisiologia , Sensibilidade e Especificidade , Supinação/fisiologia
6.
Orthop Clin North Am ; 50(4): 445-459, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466661

RESUMO

Posttraumatic arthritis (PTA) is a form of joint degeneration that occurs after physical trauma to a synovial joint. Development of PTA is multifactorial and results from mechanical damage at the time of trauma, a cell-mediated inflammatory response, and abnormal articulation due to persistent malalignment or joint instability. Although some risk factors may be unavoidable, preventing the development of PTA of the knee after intra-articular fracture (IAF) requires restoring anatomic articulation and alignment. Reconstruction with total knee arthroplasty is the treatment of choice for PTA and may be a useful primary treatment for IAF in some.


Assuntos
Fraturas do Fêmur/cirurgia , Fraturas Intra-Articulares/cirurgia , Osteoartrite do Joelho/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Artroplastia do Joelho , Criança , Feminino , Fraturas do Fêmur/complicações , Fixação Interna de Fraturas , Humanos , Fraturas Intra-Articulares/complicações , Masculino , Osteoartrite do Joelho/etiologia , Fraturas da Tíbia/complicações , Resultado do Tratamento
7.
J Hand Surg Asian Pac Vol ; 24(3): 342-346, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438800

RESUMO

Background: Multi-fragmental intra-articular middle phalanx base fractures mostly occur in young adults during sports or work-related activities. If left untreated properly proximal interphalangeal joint (PIPJ) instability and pain persists, thus impairing the hand's function and the patient's quality of life. Joint surface reconstruction with hamate osteochondral graft can be used for multi-fragmental middle phalanx base reconstruction. Methods: A retrospective study was conducted. The technique was used for 17 patients. Follow-up was performed at least 6 months after the surgery. Patients were asked to fulfil multiple surveys: Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE) and Modern Activity Subjective Survey 2007 (MASS07). Objective measurements included strength of the power and pinch grip, range of motions (ROM) in both proximal interphalangeal and distal interphalangeal (DIPJ) joints. All measurements were taken on both hands, on operated and contralateral fingers. Results: Out of 17 patients 5 were females and 12 males, mean age 40 (ranged 22-65 years) Eleven patients agreed to participate in the follow-up. All patients were right-handed, 8 patients had injured their right hand. The injuries' aetiologies were sports (n = 3), fighting (n = 2) and work-related (n = 4). Six patients were treated with immobilisation before the surgery, which was performed on average 45 days after the injury (ranged 1-184 days). Two patients developed arthrosis post-operatively and received synthetic joints. Mean DASH score was 6.9, PRWE score was 5.2 and mean MASS07 score was 6.8. Patients achieved on average 90% of power grip and 100% of pinch grip with their injured hand compared to their healthy hand. Average ROM in PIPJ was 82.2° and in DIPJ 68.9°. No patients experienced joint instability or chronic pain. Conclusions: Hemi-hamate arthroplasty provides satisfactory results in patients with both acute and chronic dislocated intra-articular middle phalanx base fractures.


Assuntos
Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Hemiartroplastia , Fraturas Intra-Articulares/cirurgia , Luxações Articulares/cirurgia , Adulto , Idoso , Feminino , Hamato/transplante , Força da Mão , Humanos , Luxações Articulares/etiologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
J Pediatr Orthop ; 39(8): e572-e577, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393291

RESUMO

BACKGROUND: Tibial spine fractures are rare, complex injuries. Management remains varied given a lack of consensus about the optimal approach. Thus, the purpose of this study is to determine prevailing strategies among pediatric orthopaedists and establish areas of agreement and ongoing controversy in the management of tibial spine fractures. METHODS: An electronic survey was distributed to the Pediatric Orthopaedic Society of North America (POSNA) membership. Surgeon demographics, experience, and responses to clinical vignettes were collected. Surgeons were grouped according to how frequently they treat tibial spine fractures and responses were compared. RESULTS: Of the 180 POSNA members who completed the survey, all were attending surgeons and nearly all (90.4%) had academic affiliations, treated mostly skeletally immature patients (88.5%), and 3 or fewer fractures per year (62.4%). In younger patients, respondents were more likely to treat type II fractures closed and less likely to cross the physis. Arthrofibrosis was the most commonly reported complication and postoperative duration of immobilization was identified as a risk factor by most. However, high-frequency surgeons identified this risk factor more often (P=0.015) and recommended immobilization for <2 weeks more frequently (P=0.018). There was, however, considerable discrepancy regarding the duration of immobilization. Although there were areas of agreement on general principles, there continues to be disagreement regarding specific treatment strategies. CONCLUSIONS: Surgeons within POSNA agree on general principles of treatment for tibial spine fractures. Members, regardless of high-volume or low-volume caseload, are all less likely to pursue surgical options when treating younger patients and treating arthrofibrosis during the first 2 postoperative months. The most commonly reported adverse outcome after treatment was arthrofibrosis, for which high-frequency surgeons identified length of immobilization as a significant risk factor more often and thus, recommended shorter periods of immobilization. Although surgeons may agree on general principles in some cases, there continues to be disagreement regarding specific strategies suggesting that a prospective multicenter study of this topic is warranted. LEVEL OF EVIDENCE: Level V.


Assuntos
Fraturas Intra-Articulares/cirurgia , Articulação do Joelho/patologia , Ortopedia/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Fraturas da Tíbia/cirurgia , Adolescente , Criança , Fibrose , Humanos , Fraturas Intra-Articulares/complicações , Ortopedia/métodos , Pediatria/métodos , Estudos Prospectivos , Inquéritos e Questionários , Fraturas da Tíbia/complicações
9.
J Shoulder Elbow Surg ; 28(11): 2198-2204, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31445787

RESUMO

BACKGROUND: Total elbow arthroplasty (TEA) is a reliable treatment for elderly patients with comminuted intra-articular distal humeral fractures. However, the longevity and long-term complications associated with this procedure are unknown. The objectives of this study were to examine long-term outcomes and implant survival in elderly patients undergoing TEA for fracture. METHODS: Patients from a previously published randomized controlled trial of 42 patients in which TEA was compared with open reduction-internal fixation (ORIF) were followed up long term. Patients were aged 65 years or older with comminuted intra-articular distal humeral fractures. Outcomes included patient-reported grading of function and pain, revision surgical procedures, and implant survival. RESULTS: Data were obtained for 40 patients, 15 treated with ORIF and 25 treated with TEA, with a mean follow-up period of 12.5 years for surviving patients and 7.7 years for deceased patients. The reoperation rate was 3 of 25 in the TEA group and 4 of 15 in the ORIF group (P = .39). Of the 25 patients with TEAs, only 1 required (early) revision arthroplasty; 7 were living with their original arthroplasty, and 15 died with a well-functioning implant in situ. Three were lost to follow-up. CONCLUSIONS: TEA is an effective and reliable procedure for the treatment of comminuted distal humeral fractures in the elderly patient. Our study reveals reliable implant long-term survival, with no patient requiring a late revision. For the majority of these patients, a well-performed TEA will give them a well-functioning elbow for life and will be the last elbow procedure required.


Assuntos
Artroplastia de Substituição do Cotovelo , Fraturas Cominutivas/cirurgia , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Reoperação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artralgia/etiologia , Articulação do Cotovelo/cirurgia , Prótese de Cotovelo , Feminino , Seguimentos , Fixação Interna de Fraturas , Humanos , Masculino , Estudos Multicêntricos como Assunto , Redução Aberta , Falha de Prótese , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
Eklem Hastalik Cerrahisi ; 30(2): 168-74, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291867

RESUMO

OBJECTIVES: This study aims to review the results of surgically treated displaced intra-articular calcaneal fractures with a fast, less complicated, and modified percutaneous technique. PATIENTS AND METHODS: This retrospective study included 114 patients (86 males, 28 females; mean age 39 years; range, 16 to 66 years) admitted to our clinic for calcaneal fractures between May 2012 and June 2016 and operated using closed reduction and percutaneous fixation with two crossed Schanz pins. Trauma type, additional injuries, medical comorbidities, pre- and postoperative period, duration of operation, time to bone healing, complications, postoperative functional and radiological results were evaluated. RESULTS: The increase in the postoperative Bohler's angle measurements was statistically significant compared to preoperative values (p=0.001; p<0.01). According to Sanders classification, seven feet (5.3%) were type II, 76 feet (57.57%) were type III, and 49 feet (37.12%) were type IV. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 80.4 (range, 47 to 92). According to Sanders classification, the mean AOFAS scores were 81.25 for type II, 81.88 for type III, and 80.19 for type IV. Mean duration of operation was 8±1.5 minutes. CONCLUSION: Modified percutaneous fixation can give good results, even when open reduction is contraindicated. Maintaining the alignment and elevating the depressed intra-articular fragment may be sufficient for good mid-term results without anatomic reduction.


Assuntos
Calcâneo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Adolescente , Adulto , Idoso , Pinos Ortopédicos , Calcâneo/diagnóstico por imagem , Calcâneo/lesões , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
Tech Hand Up Extrem Surg ; 23(4): 160-164, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31157734

RESUMO

This article describes a novel technique for flexor digitorum profundus (FDP) avulsion injuries, useful for Leddy Packer type 3, 4, and 5 injuries. Multidirectional stability is achieved with combination pull-out suture, which neutralizes the deforming force of FDP, and cerclage wire, which holds the bone fragment in an anatomic position and provides interfragmentary compression. Traditional techniques such as interosseous wires, Kirschner wires, or plating risk fragment comminution and loss of reduction due to proximal pull of FDP as demonstrated in this case report of failed Kirschner-wire fixation. The technique presented here eliminates the risk of avulsion fragment comminution and provides stable fixation that allows for early mobilization.


Assuntos
Falanges dos Dedos da Mão/cirurgia , Fixação Interna de Fraturas/métodos , Fratura Avulsão/cirurgia , Fraturas Intra-Articulares/cirurgia , Idoso , Fios Ortopédicos , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/lesões , Fratura Avulsão/diagnóstico por imagem , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Radiografia , Suturas
12.
Medicine (Baltimore) ; 98(25): e15915, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232924

RESUMO

RATIONALE: Osteochondral flap fractures of the elbow are rare in children. To the best of our knowledge, only 12 cases are reported in the literature. Only 1 case was accompanied with lateral condyle fracture classified as Milch I, which was nondisplaced. The mechanism of these injuries is not explained in detail, and the treatment methods are not discussed. Here, we present 3 cases of osteochondral flap fracture of the ulnar coronoid process with accompanying obvious displacement of the lateral condyle fracture. PATIENT CONCERNS: All patients fell into one of their outstretched arms, which caused elbow pain and functional limitation. DIAGNOSIS: All 3 patients were diagnosed with lateral condyle fracture of the humerus and osteochondral flap fracture of the ulnar coronoid process. INTERVENTIONS: All patients underwent open reduction and internal fixation. OUTCOMES: At 3 months after the operation, they regained full range of motion of the limb and had no elbow instability. LESSONS: Osteochondral flap fracture should be considered when there is a bone mass in the elbow space with accompanying displacement of the humeral lateral condyle fracture.


Assuntos
Articulação do Cotovelo/lesões , Fraturas do Úmero/diagnóstico , Fraturas Intra-Articulares/diagnóstico , Luxações Articulares/diagnóstico , Ulna/lesões , Acidentes por Quedas , Pré-Escolar , Diagnóstico Diferencial , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Imagem por Ressonância Magnética , Masculino , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X
13.
Orthop Surg ; 11(3): 524-529, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31207078

RESUMO

OBJECTIVE: To determine the visible size of the distal humeral articular surface by using a novel combined medial-lateral approach as an alternative method of surgical treatment for intra-articular distal humeral fractures. METHODS: In this anatomical study, 12 adult fresh-frozen cadaveric elbows were randomly divided into a medial-lateral group and an olecranon osteotomy group, with 6 in each group. In the medial-lateral group, a medial approach was first used, and then a lateral approach. The sizes of the distal humeral articular surface exposed by each incision and the joined size were measured and calculated. In the olecranon osteotomy group, a posterior olecranon osteotomy approach was applied, and the maximal visible sizes of the articular surface were marked and calculated. Ratios of the maximal sizes of the distal humeral articular surface of the two approaches were compared. RESULTS: In the medial-lateral group, the medial approach could expose 2/5 of the medial trochlea and 1/3 of the capitellum, while the mean visible size of the distal humeral articular surface was 6.8 cm2 , 34.8% of the entire surface; the lateral approach can expose 3/7 of the capitellum and 1/4 of the medial trochlea, while the mean visible size of the distal humeral articular surface was 6.7 cm2 , 33.9% of the whole surface; for the combined medial-lateral approach, the mean scope exposed of the medial and lateral visible articular surface was 38.2% and 43.1%, respectively. Meanwhile, in the olecranon osteotomy group, the posterior olecranon osteotomy was found to expose most of the posterior distal humeral articular surface, except for 1/3 of the anterior trochlea and 1/4 of the anterior capitellum, and the visible range of articular surface was 65.3%. The combined medial-lateral approach exposed 9.2 cm2 in total, 46.9% of the whole distal humeral articular surface, which averaged 19.6 cm2 . However, the visible size of the distal humeral articular surface for the olecranon osteotomy approach was 13.7 cm2 , 63.1% of the entire distal humeral articular surface, which averaged 21.3 cm2 . There was a significant difference observed between the medial-lateral group (46.9%) and the olecranon osteotomy group (63.1%) for the maximal visible size of the distal humeral articular surface (t = 7.201, P = 0.001). CONCLUSIONS: The combined medial-lateral approach can expose 46.9% of the distal humeral articular surface, concentrating on the anterior part, so it can be recommended to treat intra-articular fractures with a simple pattern in the posterior with the anterior side of the distal humerus less comminuted.


Assuntos
Articulação do Cotovelo/lesões , Fixação de Fratura/métodos , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Articulação do Cotovelo/anatomia & histologia , Articulação do Cotovelo/cirurgia , Humanos , Olécrano/cirurgia , Osteotomia
14.
Eur J Orthop Surg Traumatol ; 29(6): 1331-1336, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31037405

RESUMO

INTRODUCTION: This study is to report the prevalence of osteochondral lesions in subtalar joint following intra-articular calcaneal fracture, including the relationship between fracture severity and lesion characteristics, using modified computed tomography (CT) mapping analysis. METHODS: Thirty patients with intra-articular calcaneal fracture who were preoperatively imaged with modified CT mapping analysis were recruited. The presence of talar-sided osteochondral lesions (OLTS) of subtalar joint was noted with lesion area defined by Akiyama's mapping classification. Lesion severity was assessed via Ferkel's classification, and fracture severity via Sanders' classification. RESULTS: Lesions were found in 28 patients (93.3%), mostly at anterior [16 (57.1%) lesions] or central [13 (46.4%) lesions] areas of posterior talar facet. Most common grade of lesion severity was grade I (mild) seen in 24 (80%) patients. Most fractures were classified as Sanders' grade III and IV with 12 (40%) and 12 (40%) patients noted, respectively. High severity of fracture denoted by Sanders' grade IV showed a trend of higher prevalence of OLTS at anterior and central sites of posterior talar facet (P = 0.181). Lesion severity was significantly higher in patients with double lesions than patients with single lesions (P = 0.005). However, OLTS were not significantly related with osteoarthritic changes in follow-up radiographs (P > 0.05). CONCLUSIONS: The prevalence of OLTS is very high following intra-articular calcaneal fractures. Most lesions occur at anterior or central area of posterior talar facet and are more likely to occur in patients with higher fracture severity. Lesion severity was significantly higher in patients with double lesions than patients with single lesions.


Assuntos
Calcâneo , Fraturas Ósseas , Fraturas Intra-Articulares , Osteocondroma , Complicações Pós-Operatórias , Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/cirurgia , Calcâneo/diagnóstico por imagem , Calcâneo/patologia , Calcâneo/cirurgia , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Fraturas Intra-Articulares/diagnóstico , Fraturas Intra-Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteocondroma/diagnóstico , Osteocondroma/epidemiologia , Osteocondroma/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Prevalência , Índice de Gravidade de Doença , Articulação Talocalcânea/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
16.
J Orthop Surg Res ; 14(1): 132, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088497

RESUMO

PURPOSE: The traditional strategy for fixing intra-articular distal humerus fractures is double plating placed in an orthogonal or parallel configuration, based on posterior approach. With a combined medial and lateral approach, a novel configuration of plating (combined anteromedial and anterolateral plating) has been used. In this study, we investigated the biomechanical properties of the novel plating by comparing it with orthogonal plating. METHODS: Based on the 3D morphology of a healthy subject's humerus, the models of simple intra-articular distal humerus fractures were simulated. Two configurations of plating were applied to fix the models: the novel plating (with one plate anteromedially and the other anterolaterally on distal humerus), and orthogonal plating. Stresses, displacement, and stiffness were simulated and calculated under the conditions of axial compression, rotation torsion, bending torsion, and valgus torsion by using finite element analysis. RESULTS: In all the conditions, the maximal von Mises stresses of the novel plating are similar to those of orthogonal plating, and the patterns of stress distribution are similar between these two configurations. However, the impact of high stresses was weaker on the novel plating. The maximal displacement of the novel plating is smaller than that of orthogonal plating. The stiffness of the novel plating is superior to that of orthogonal plating, with the improvements of 19.4%, 122.7%, 25.0%, and 54.2% in axial compression, rotation torsion, bending torsion, and valgus torsion, respectively. CONCLUSIONS: The novel plating is stronger than orthogonal plating without increasing stress magnitude when fixing simple intra-articular distal humerus fractures, which makes it a feasible alternative. Further biomechanical and clinical studies are needed for a decisive conclusion.


Assuntos
Placas Ósseas , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Modelos Biológicos , Desenho de Prótese/métodos , Adulto , Fenômenos Biomecânicos/fisiologia , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X/métodos
17.
J Plast Surg Hand Surg ; 53(5): 255-259, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31032685

RESUMO

Volar locking plate (VLP) fixation for distal radius fractures (DRF) is a technically demanding procedure, where accurate placement of the distal screws for subchondral articular support is essential. The purpose of this retrospective, case-control study was to compare a computed tomography (CT) navigation system for VLP fixation of intra-articular DRF with conventional freehand fluoroscopy guided surgery. Twelve consecutive patients with DRF, AO type C3.1, underwent VLP fixation using intraoperative CT navigation (navigated group) and 16 consecutive patients had conventional freehand fluoroscopy guided surgery (non-navigated group). Follow-up was done mean 12 (range, 4-18) months after surgery. Radiological outcomes included evaluation of placement for the distal fixation screws and radiological parameters such as; radial inclination, palmar tilt, ulnar variance, fracture-gap, and step-off. Clinical outcomes included grip strength, wrist range of motion, Mayo wrist score, and the Disabilities of the arm, shoulder and hand (DASH) questionnaire. Dorsal cortical and articular screw penetrations were significantly more common in the non-navigated group compared with the navigated group. At the final follow-up, a significantly larger intra-articular fracture gap was observed in the non-navigated group compared to the navigated group. There were no significant differences in clinical outcomes between the two treatment groups. Our results suggest that CT navigation guided surgery for VLP fixation of type C3 DRF, compared with conventional freehand fluoroscopy guided surgery, provides a more accurate placement of the distal screws which minimize the risk for intra-articular and dorsal cortical screw penetration.


Assuntos
Fixação Interna de Fraturas , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Cirurgia Assistida por Computador/métodos , Adulto , Idoso , Placas Ósseas , Parafusos Ósseos , Estudos de Casos e Controles , Feminino , Fluoroscopia , Seguimentos , Humanos , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
18.
Acta Orthop Belg ; 85(1): 130-136, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31023210

RESUMO

To report the clinical efficacy of open reduction and internal fixation (ORIF) assisted by medial distraction for intra-articular calcaneus fractures. From September 2010 to November 2013, 151 patients with intra-articular calcaneus fractures were treated at our department by ORIF. They were 95 men and 56 women, 18 to 69 years of age. According to the Sanders classification, there were 24 cases of type II, 76 ones of type III and 51 ones of type IV. Medial distraction was used in 27 cases but not in 124 ones. The 2 groups were compatible, without significant differences in preoperative general data (p > 0.05). The two groups were compared in intraoperative indexes and follow-up radiological data. The mean duration of surgery in the distraction group (71.6 ±18.3 minutes) was significantly shorter than that in the non-distraction group (80.4±20.7 minutes), and the varus angle in the distraction group (5.3° ± 4.4°) was significantly smaller than that in the non-distraction group (10.6° ± 6.5°) (p < 0.05). There were no significant differences between the 2 groups in intraoperative bleeding, postoperative drainage, hospital stay, bone union time, follow-up duration, American Orthopaedic Foot & Ankle Society score, Böhler angle, Gissane angle, calcaneal axis, calcaneal horizontal length, tuberosity height, hillock calcaneal height, calcaneal width, or talar inclination angle (p > 0.05). ORIF assisted by medial distraction technique is effective for intra-articular calcaneal fractures, especially in correcting the calcaneal axis.


Assuntos
Calcâneo/lesões , Calcâneo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Intra-Articulares/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
19.
Eklem Hastalik Cerrahisi ; 30(1): 61-4, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30885110

RESUMO

In this article, we report a 41-year-old right-handed male patient with Ideberg-type Vb fracture who was treated with arthroscopic reduction and fixation. The patient was a laborer who suffered from a high-energy trauma (fall from height). X-ray revealed an intra-articular fracture of the left scapula. Computed tomography with three-dimension reconstruction confirmed the fracture type to be an Ideberg-type Vb glenoid fracture. The patient was operated, discharged on postoperative day two, and was able to continue his daily activities even at two months postoperatively. At six months, the University of California at Los Angeles shoulder score was 33 of 35 and the Disabilities of the Arm, Shoulder, and Hand questionnaire score was 2 of 100. Arthroscopic reduction and fixation of Ideberg-type Vb fracture appears to be safe with good radiological and clinical outcomes.


Assuntos
Artroscopia , Fixação Interna de Fraturas/métodos , Cavidade Glenoide/lesões , Fraturas Intra-Articulares/cirurgia , Adulto , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/fisiopatologia , Masculino , Articulação do Ombro/fisiopatologia , Tomografia Computadorizada por Raios X
20.
J Shoulder Elbow Surg ; 28(4): 742-750, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30885311

RESUMO

BACKGROUND: The paratricipital approach is a relatively new approach in a complex intra-articular fracture of distal humerus (AO13-C). The aim of this study was to ascertain this approach compared with the olecranon osteotomy approach. Also, we aimed to investigate whether advancing age and surgical delay yield a poor outcome. MATERIALS AND METHODS: Between 2011 and 2015, 51 adult patients with closed AO 13-C-type fractures were included in the study and divided into 2 groups, that is, paratricipital approach (PT) group and olecranon osteotomy (OO) group. Patients were treated by 2 senior trauma surgeons. They were prospectively analyzed for outcome and complications. Mayo elbow performance score (MEPS) was used to evaluate the outcome. RESULTS: Of the total 51 patients (mean age, 41.6 years), 27 patients were in the PT group and 24 in the OO group. There was no difference in arc of motion (P = .513) and MEPS (P = .127) as well as complication rate (χ2 statistic = 0.36, P = .54). However, specifically in the type C3 fracture, the PT group had a poor outcome for arc of motion (P = .002) and MEPS (P = .019) compared with the OO group. Also, age and surgical delay had a weak, negative correlation with arc of motion and MEPS. The association between age and surgical delay against arc of motion was statistically significant (P = .005 and .01, respectively). CONCLUSIONS: The PT approach and the OO approach can be used alternatively for AO 13-C1 and -C2 fractures with similar outcomes. However, in type C3, the PT approach yields a poor outcome in comparison with the OO approach.


Assuntos
Fraturas Fechadas/cirurgia , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Olécrano/cirurgia , Osteotomia , Adulto , Idoso , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA