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1.
Orthop Clin North Am ; 52(4): 481-489, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538355
2.
Orthop Clin North Am ; 52(4): 451-479, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538354

RESUMO

Craniocervical injuries (CCJs) account for 10% to 30% of all cervical spine trauma. An increasing number of patients are surviving these injuries due to advancements in automobile technology, resuscitation techniques, and diagnostic modalities. The leading injury mechanisms are motor vehicle crashes, falls from height, and sports-related events. Current treatment with urgent rigid posterior fixation of the occiput to the cervical spine has resulted in a substantial reduction in management delays expedites treatment of CCJ injuries. Within CCJ injuries, there is a spectrum of instability, ranging from isolated nondisplaced occipital condyle fractures treated nonoperatively to highly unstable injuries with severely distracted craniocervical dissociation. Despite the evolution of understanding and improvement in the management of cases regarding catastrophic failure to diagnose, subsequent neurologic deterioration still occurs even in experienced trauma centers. The purpose of this article is to review the injuries that occur at the CCJ with the accompanying anatomy, presentation, imaging, classification, management, and outcomes.


Assuntos
Articulação Atlantoaxial/lesões , Articulação Atlantoccipital/lesões , Vértebras Cervicais/lesões , Luxações Articulares , Osso Occipital/lesões , Traumatismos da Coluna Vertebral , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Articulação Atlantoccipital/diagnóstico por imagem , Articulação Atlantoccipital/cirurgia , Vértebra Cervical Áxis/diagnóstico por imagem , Vértebra Cervical Áxis/lesões , Vértebra Cervical Áxis/cirurgia , Atlas Cervical/diagnóstico por imagem , Atlas Cervical/lesões , Atlas Cervical/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico , Luxações Articulares/cirurgia , Luxações Articulares/terapia , Osso Occipital/diagnóstico por imagem , Osso Occipital/cirurgia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/terapia , Traumatismos do Sistema Nervoso/etiologia , Traumatismos do Sistema Nervoso/cirurgia , Traumatismos do Sistema Nervoso/terapia
3.
BMC Musculoskelet Disord ; 22(1): 651, 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34332559

RESUMO

BACKGROUND: Osteoporotic fractures impose significant costs on society. The objective of this study was to estimate the direct costs of the hip, vertebral, and forearm fractures in the first year after fracture incidence in Iran. METHODS: We surveyed a sample of 300 patients aged over 50 years with osteoporotic fractures (hip, vertebral, and forearm) admitted to four hospitals affiliated to Tehran University of Medical Sciences, Iran, during 2017 and were alive six months after the fracture. Inpatient cost data were obtained from the hospital patient records. Using a questionnaire, the data regarding outpatient costs were collected through a phone interview with patients at least six months after the fracture incidence. Direct medical and non-medical costs were estimated from a societal perspective. All costs were converted to the US dollar using the average exchange rate in 2017 (1USD = IRR 34,214) RESULTS: The mean ± standard deviation (SD) age of the patient was 69.83 ± 11.25 years, and 68% were female. One hundred and seventeen (39%) patients had hip fractures, 56 (18.67%) patients had vertebral fractures, and 127 (42.33%) ones had forearm fractures. The mean direct cost (medical and non-medical) during the year after hip, vertebral and forearm fractures were estimated at USD5,381, USD2,981, and USD1,209, respectively. CONCLUSION: The direct cost of osteoporotic fracture in Iran is high. Our findings might be useful for the economic evaluation of preventive and treatment interventions for osteoporotic fractures as well as estimating the economic burden of osteoporotic fractures in Iran.


Assuntos
Fraturas do Quadril , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Feminino , Antebraço , Custos de Cuidados de Saúde , Humanos , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/terapia
4.
Biomed Res Int ; 2021: 4650057, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34327227

RESUMO

Background: Postoperative pain, dysfunction, and significant bone loss may occur after vertebral fractures, which will lead to the occurrence of refractures and shorten the survival time, so postoperative rehabilitation is very important. Pulsed electromagnetic field therapy is noninvasive, pain-relieving, and beneficial to reduce bone loss and is an important treatment for patients to recover after surgery. Therefore, this study analyzed the effect of postmenopausal women's vertebral fracture rehabilitation after pulsed electromagnetic field treatment. Method: This study uses a randomized controlled study, respectively, in the pulsed electromagnetic field treatment group (40 cases) and the control group (42 cases), respectively. We studied the results of health-related quality of life scores (HRQOL), back pain, body function, hip bone density, bone microstructure of tibia, and radius after 1 month and 3 months after surgery. Results: Compared with the control group, the pulsed electromagnetic field treatment group (PEMF) can improve significantly the psychological score, 6-minute walk test, and Chair Sit-and-Reach one month after the operation. And at 3 months after surgery, the pulsed electromagnetic field treatment group can improve significantly in health-related quality of life scores (HRQOL), back pain, and body function. Regarding the effect of changes in bone mass, compared with the control group, pulsed electromagnetic field treatment had no significant effect on changes in hip bone density. As a result of changes in bone microstructure, pulsed electromagnetic field treatment can significantly improve the bone microstructure of the radius and tibia three months after vertebral fractures. Conclusion: Pulsed electromagnetic field therapy has positive significance for improving pain, body functional changes, and bone loss after vertebral fracture surgery.


Assuntos
Campos Eletromagnéticos , Fraturas por Osteoporose/terapia , Pós-Menopausa/fisiologia , Fraturas da Coluna Vertebral/terapia , Densidade Óssea , Osso e Ossos/patologia , Osso e Ossos/fisiopatologia , Humanos , Pessoa de Meia-Idade , Tamanho do Órgão , Fraturas por Osteoporose/fisiopatologia , Qualidade de Vida , Fraturas da Coluna Vertebral/fisiopatologia
5.
Ugeskr Laeger ; 183(27)2021 07 05.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34219645

RESUMO

Acute onset back pain is a common reason for referral to primary health care or emergency departments. In this review, the different spine fracture types are highlighted, and a treatment algorithm is proposed. CT is the modality of choice when a spine fracture is suspected. MRI should be performed when disc or ligamentous lesions are suspected or in patients with known ankylosis or diffuse idiopathic skeletal hyperostosis. Treatment is mainly conservative with bracing, but unstable fractures and patients with neurological deficits should be treated surgically.


Assuntos
Hiperostose Esquelética Difusa Idiopática , Fraturas da Coluna Vertebral , Braquetes , Humanos , Imageamento por Ressonância Magnética , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X
6.
Medicina (Kaunas) ; 57(6)2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34070410

RESUMO

Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson-Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson-Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson-Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5-14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3-11 points) and SF-36 score (median: 91 points; range: 64-96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest.


Assuntos
Fraturas Ósseas , Fraturas da Coluna Vertebral , Adolescente , Vértebras Cervicais/lesões , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X
7.
Spine (Phila Pa 1976) ; 46(13): E743-E749, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34100842

RESUMO

STUDY DESIGN: Case report and literature review. OBJECTIVE: We present a case of a pathologic unstable fracture of the odontoid process due to vertebral osseous sarcoidosis. The surgical management of this unreported pathology is described and a review of the literature is given. SUMMARY OF BACKGROUND DATA: Sarcoidosis is a chronic inflammatory systemic disease of unknown etiology, characterized by multiorgan noncaseating granulomatous infiltrations. It affects primarily the lungs, lymphatic system, eyes, skin, heart, and nervous system. Osseous sarcoidosis is usually clinically asymptomatic and therefore frequently under-diagnosed. When it does affect the skull or vertebral column, specific surgical therapy is only necessary in cases with nonmanageable pain or where structural integrity is threatened. METHODS: Our patient underwent a so-called semiconservative approach, consisting of a minimally invasive transoral-transpharyngeal approach, surgical debridement of the lytic bony lesion, transplantation of cancellous homologous bone, and carbon chest halo-immobilization. Halo-immobilization was left for 8 weeks, followed by a further 6 weeks with a hard cervical collar. RESULTS: Routine computed tomography scans 3 days, 6, 12, 18 weeks, and 1 year after surgery showed good filling of the original defect with cancellous bone, correct alignment of the upper cervical spine, and progressive fracture consolidation and stability. Surgical site infection (SSI) was not observed. The patient had no neurological postoperative deficits. After initial dysphagia, swallowing was not permanently impaired. CONCLUSION: Sarcoidosis-induced odontoid fractures can be managed successfully using a semiconservative approach, consisting of transoral-transmucosal, minimally invasive surgical procedure for debridement of the lesion and transplantation of cancellous bone with additional halo-immobilization. Permanent fusion of C1-2 with loss of the cervical range of motion is avoided. Despite performing bone surgery in a potentially markedly contaminated site, bacterial infection was not an issue, possibly supported by the temporary discontinuation of immunosuppressive agents and the prudent use of antibiotics.Level of Evidence: 4.


Assuntos
Processo Odontoide , Sarcoidose , Fraturas da Coluna Vertebral , Humanos , Pescoço/diagnóstico por imagem , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/lesões , Amplitude de Movimento Articular/fisiologia , Sarcoidose/complicações , Sarcoidose/diagnóstico por imagem , Sarcoidose/fisiopatologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X
8.
World Neurosurg ; 151: e747-e752, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33957284

RESUMO

BACKGROUND: Sports-related injuries are the third commonest cause of spine fractures. Spinal fractures incurred as a result of partaking in sport by their nature are different from those associated with frailty and road traffic accidents. The patient demographics and nature of fractures associated with sports activities are not well documented. We aim to describe the management and outcome of patients with a sports-related spine fracture in a single U.K. major trauma center in a 6-year time period. METHODS: Patients with sports-related spinal fractures were identified from the Trauma Audit and Research Network database at a U.K. major trauma center between January 2011 and December 2016. Patient notes were retrospectively reviewed for demographics, injury severity score, treatment, complications, and outcomes. RESULTS: In the study period, 122 patients were admitted with a sports-related spinal fracture, sustaining a total of 230 fractures. Of these, 48 (20.9%) were in the cervical, 79 (34.3%) in the thoracic, and 103 (44.8%) in the lumbar regions. The sports most commonly associated with spinal fractures were horse riding (n = 55), cycling (n = 36), and boating (n = 10). Of the 230 fractures, 32 (13.9%) were associated with neurologic injury. Forty-five of the 230 fractures (19.6%) were managed surgically, and the remainder were managed conservatively. CONCLUSIONS: Within our population, sports most commonly associated with spinal fractures were horse riding, cycling, and boating. The majority of cases were managed nonoperatively. Further research is required to establish evidence-based guidelines on the management of sports-related spinal fractures.


Assuntos
Traumatismos em Atletas/complicações , Traumatismos em Atletas/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/patologia , Adulto , Idoso , Traumatismos em Atletas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/terapia , Reino Unido
9.
Medicine (Baltimore) ; 100(20): e25705, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011028

RESUMO

RATIONALE: One repetition maximum (1-RM) testing is a standard strength assessment procedure in clinical exercise intervention trials. Because no adverse events (AEs) are published, expert panels usually consider it safe for patient populations. However, we here report a vertebral fracture during 1-RM testing. PATIENT CONCERNS: A 69-year-old breast cancer survivor (body-mass-index 31.6 kg/m2), 3 months after primary therapy, underwent 1-RM testing within an exercise intervention trial. At the leg press, she experienced pain accompanied by a soft crackling. DIAGNOSIS: Imaging revealed a partially unstable cover plate compression fracture of the fourth lumbar vertebra (L4) with a vertical fracture line to the base plate, an extended bone marrow edema and a relative stenosis of the spinal canal. INTERVENTIONS: It was treated with an orthosis and vitamin D supplementation. Another imaging to exclude bone metastases revealed previously unknown osteoporosis. OUTCOMES: The patient was symptom-free 6.5 weeks after the event but did not return to exercise. CONCLUSION: This case challenges safety of 1-RM testing in elderly clinical populations. LESSONS: Pre-exercise osteoporosis risk assessment might help reducing fracture risk. However, changing the standard procedure from 1-RM to multiple repetition maximum (x-RM) testing in studies with elderly or clinical populations would be the safest solution.


Assuntos
Neoplasias da Mama/complicações , Teste de Esforço/efeitos adversos , Fraturas por Osteoporose/etiologia , Treinamento de Força/efeitos adversos , Fraturas da Coluna Vertebral/etiologia , Idoso , Sobreviventes de Câncer , Ensaios Clínicos como Assunto , Teste de Esforço/métodos , Feminino , Humanos , Vértebras Lombares/lesões , Aparelhos Ortopédicos , Fraturas por Osteoporose/terapia , Treinamento de Força/métodos , Fraturas da Coluna Vertebral/terapia , Vitamina D/administração & dosagem
10.
Age Ageing ; 50(3): 985-989, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33951150

RESUMO

INTRODUCTION: Acute vertebral fragility fracture requiring hospital admission is common, painful and disabling. No comprehensive clinical guideline for their care exists. To support the development of such a guideline, we sought the views of experts in the field. METHODS: A modified Delphi study was used. A total of 70 statements were presented, using an online platform, over three consensus-seeking rounds, to participants with experience in the hospital care of patients with acute vertebral fragility fractures from UK-based specialist societies. Participants rated the level of their agreement with each statement on a 5-point Likert scale. Consensus was defined at 70% of respondents choosing either agree/strongly agree or disagree/strong disagree. Over the first two rounds, statements not reaching consensus were modified in subsequent rounds, and new statements proposed by participants and agreed by the research team could be added. RESULTS: There were 71 participants in the first round, 37 in the second round and 28 (most of whom were geriatricians) in the third round. Consensus was reached in 52 statements covering fracture diagnosis, second-line imaging, organisation of hospital care, pain management and falls and bone health assessment. Consensus was not achieved for whether vertebral fragility fractures should be managed in a specific clinical area. DISCUSSION: These findings provide the basis for the development of clinical guidelines and quality improvement initiatives. They also help to justify research into the merits of managing acute vertebral fragility fracture patients in a specific clinical area.


Assuntos
Fraturas Ósseas , Fraturas da Coluna Vertebral , Consenso , Técnica Delfos , Hospitais , Humanos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/terapia
11.
J Am Acad Orthop Surg ; 29(17): 741-747, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33826546

RESUMO

INTRODUCTION: Despite guidelines recommending postfracture bone health workup, multiple studies have shown that evaluation and treatment of osteoporosis has not been consistently implemented after fragility fractures. The primary aim of this study was to evaluate rates of osteoporosis evaluation and treatment in adult patients after low-energy thoracolumbar vertebral compression fractures (VCFs). METHODS: We retrospectively reviewed all patients ≥60 years old presenting to a single academic trauma center with acute thoracolumbar VCFs after a ground-level fall from 2016 to 2020 . Rates of osteoporosis screening with dual-energy x-ray absorptiometry and initiation of pharmaceutical treatment were recorded at four time points: before the date of injury, during index hospitalization, at first primary care provider follow-up, and at final primary care provider follow-up. Rates of subsequent falls and secondary fragility fractures were recorded. One-year mortality and overall mortality were also calculated. RESULTS: Fifty-two patients with a mean age of 83 years presenting with thoracic and/or lumbar fractures after a ground-level fall were included. At a mean final follow-up of 502 days, only 10 patients (19.2%) received pharmacologic therapy for osteoporosis and only 6 (11.5%) underwent postinjury dual-energy x-ray absorptiometry evaluation. Twenty-five patients (48%) had at least one subsequent fall at a mean of 164 days from the initial date of injury. Eleven patients with subsequent falls sustained an additional fragility fracture because of the fall, including six operative injuries. One-year mortality among the 52 patients was 26.9%, and the overall mortality rate was 44.2% at the final follow-up. DISCUSSION: Osteoporosis remains a major public health issue that markedly affects quality of life and healthcare costs. Our study demonstrates the additional need for improved osteoporosis workup and intervention among patients who have sustained VCFs. We hope that our study helps raise awareness for improved osteoporosis evaluation and treatment among spine surgeons and all medical professionals treating patients with fragility fractures. LEVEL OF EVIDENCE: Retrospective Case Series, Level IV Evidence.


Assuntos
Fraturas por Compressão , Osteoporose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Adulto , Idoso de 80 Anos ou mais , Fraturas por Compressão/etiologia , Fraturas por Compressão/terapia , Humanos , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/epidemiologia , Fraturas por Osteoporose/terapia , Qualidade de Vida , Estudos Retrospectivos , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia
12.
Biomed Res Int ; 2021: 6650358, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33928158

RESUMO

Objective: We conducted this meta-analysis to provide better evidence of the efficacy and safety of zoledronic acid (ZA) combined with percutaneous vertebroplasty/kyphoplasty (PVP/PKP) on osteoporotic vertebral compression fracture (OVCF) and proposed a protocol for its application in clinical practice. Methods: All randomized controlled trials (RCTs) of ZA combined with PVP or PKP compared to individual PVP/PKP for the management of patients with OVCFs were included in this study. Electronic database searches were conducted from database inception to November 2020, including the Cochrane Library, PubMed, Web of Science, and Embase. The pooled data were analyzed using RevMan 5.3 software. Results: Seven RCTs with 929 subjects were finally included. All included studies reported visual analog scores (VAS), and no statistically significant differences were identified at follow-ups of 3 d and 1 w (P > 0.05). In contrast, significant differences were observed at the 1 mo, 3 mo, 6 mo, and 12 mo follow-ups (P < 0.05). Two trials reported the Cobb angle and vertebral body height (VBH), including 182 subjects without significant differences at the 12 mo follow-up (P > 0.05). In addition, significant differences in the bone mineral density (BMD), ß-isomerized C-terminal telopeptide of type I collagen (ß-CTX), N-terminal propeptide of type I collagen (PINP), and N-terminal molecular fragment (N-MID) levels were observed between the two groups (P < 0.05). All trials reported side effects. Significant differences in recurrent fractures, fever, flu-like symptoms, and arthralgia or myalgia were identified (P < 0.05); however, no significant difference in postoperative leakage was detected (P > 0.05). Conclusion: Compared to PVP/PKP alone, an additional ZA injection had advantages of long-term analgesic effects with improved bone metabolism indexes. Moreover, combination therapy significantly prevented complications and drug reactions were well tolerated. Overall, this systematic review revealed that ZA combined with PVP/PKP was an effective, safe, and comprehensive therapy for patients with OVCFs.


Assuntos
Fraturas por Compressão/terapia , Cifoplastia , Fraturas por Osteoporose/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fraturas da Coluna Vertebral/terapia , Vertebroplastia , Ácido Zoledrônico/efeitos adversos , Ácido Zoledrônico/uso terapêutico , Fraturas por Compressão/tratamento farmacológico , Fraturas por Compressão/cirurgia , Humanos , Fraturas por Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/tratamento farmacológico , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
13.
Medicine (Baltimore) ; 100(13): e25334, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787631

RESUMO

ABSTRACT: Cervical spine (C-spine) fractures in young children are very rare, and little information on treatment modalities and functional, radiographic, and patient-reported outcome exists. In this 2-center, retrospective case series, we assessed subjective and functional mid-term outcomes in children aged ≤5 years whose C-spine fractures were treated nonoperatively.Between 2000 and 2018, 6 children (median age at injury: 23.5 months; range: 16-31 months) with C1 or C2 injuries were treated with Minerva cast/brace or soft collar brace at 1 of the 2 study centers. Two patients suffered C1 fractures, and 4 patients had lysis of the odontoid synchondrosis. Overall, 3 children had sustained polytrauma. One child died due to the consequences of massive head injury.For the primary outcome parameter, we recorded subjective symptoms such as pain and functional restrictions due to the sequelae of C-spine injuries at follow-up.Based on medical records, we also assessed the causes of injury, diagnostic procedures, treatments and complications, and time to fracture consolidation.Median follow-up of the 5 surviving children was 51 months (range: 36-160 months). At the latest follow-up, 4 of 5 children did not complain of any pain. One child who sustained an open head injury in combination with a subluxation of the odontoid and undisplaced fracture of the massa lateralis reported occasional headache. All patients experienced complete fracture healing and normal range of motion of the cervical spine.Median duration of cast/brace treatment was 8.5 weeks. Fracture healing was confirmed by computed tomography in all patients.All C-spine injuries were managed with either Minerva cast/Halo brace or soft collar brace without complications.In our retrospective case series, nonoperative treatment of atlas fractures and dislocations or subluxations of the odontoid in young children using Minerva casts or prefabricated Halo braces resulted in good subjective and functional outcomes at mid-term. We observed no complications of conservative treatment of C1 and C2 injuries in young children.


Assuntos
Braquetes/efeitos adversos , Atlas Cervical/lesões , Tratamento Conservador/métodos , Processo Odontoide/lesões , Fraturas da Coluna Vertebral/terapia , Atlas Cervical/diagnóstico por imagem , Pré-Escolar , Tratamento Conservador/efeitos adversos , Tratamento Conservador/instrumentação , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Incidência , Lactente , Masculino , Processo Odontoide/diagnóstico por imagem , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/epidemiologia , Tomografia Computadorizada por Raios X , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento
15.
Eur Spine J ; 30(6): 1551-1555, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33616789

RESUMO

OBJECTIVE: Compare short-term mortality rates following operative and nonoperative management of geriatric patients following an acute type II odontoid process fracture. METHODS: One hundred forty-one patients with a type II odontoid fracture were identified from a single centre between 2002 and 2018. Patient demographics, details of injury and management, plus mortality data were collected. The incidence of mortality at 3 and 12 months was calculated, and a multivariate model built which included the treatment modality variable and allowed adjustment for six individual confounders. RESULTS: Of the 141 patients with a type II odontoid process fracture, 39 were managed operatively, while 102 were managed nonoperatively. Relative to the nonoperative group, the operative group was younger (79.0 ± 7.0 vs. 83.7 ± 7.6), more likely to have odontoid angulation > 15° (74.4% vs. 43.1%, p < 0.01), and a greater proportion having fracture displacement > 2 mm (74.4% vs. 31.4%, p < 0.01). Both groups were comparable for gender, comorbidities, and associated injuries. On univariate analysis of treatment modality, the odds ratio of 3-month mortality with nonoperative management was 2.55 (95% CI: 0.82-7.92; p = 0.08), whilst at 12-months it was 3.12 (95% CI: 1.11-8.69; p = 0.02). On multivariate analysis of 12-month mortality, however, treatment modality was not found to be significant. This multivariate analysis suggested that increasing age, male gender, and injury severity were significant predictors of 12-month mortality. CONCLUSION: In contrast to the findings of a number of previous studies, operative management may not influence survival at 3- and 12-months.


Assuntos
Fraturas Ósseas , Processo Odontoide , Fraturas da Coluna Vertebral , Idoso , Humanos , Incidência , Masculino , Processo Odontoide/lesões , Estudos Retrospectivos , Fraturas da Coluna Vertebral/terapia , Resultado do Tratamento
16.
Spine J ; 21(7): 1149-1158, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33577924

RESUMO

BACKGROUND CONTEXT: The recommended primary treatment for type III odontoid fractures (OFx) is external immobilization, except for patients having major displacement of the odontoid fragment. The bony fusion rate of type III OFx has been reported to be >85%. High compliance to treatment recommendations is favorable only if the treatment leads to a good outcome. PURPOSE: The primary aim of this study was to determine the long-term outcome after conservative and surgical treatment of type III OFx and to reaffirm that primary external immobilization is the best treatment for most type III fractures. STUDY DESIGN/SETTING: Retrospective study based on a prospective database. PATIENT SAMPLE: Two hundred twelve consecutive patients with type III OFx treated at Oslo University Hospital over an 8-year period (2009-2017). OUTCOME MEASURES: Long-term rates of bony fusion, crossover from primary conservative treatment to surgical fixation, new onset spinal cord injury (SCI), severe persistent neck pain (visual analogue scale - VAS), and persistent disability measured with Neck Disability index (NDI). METHODS: The present study was based on data extracted from our quality control database for acute cervical spine fractures from a general population. During the years 2018 to 2019 long-term follow-up of alive patients was performed (median follow-up time was 38.0 months; range 3.0-108.0 months). The follow-up included neurological examination, radiological examination and scoring of bony fusion status, crossover from primary conservative treatment to surgical fixation, new onset SCI, neck pain, and Neck Disability Index (NDI score). RESULTS: In this consecutive series of 212 patients with type III acute OFx, median patient age was 72 years, 56% had severe preinjury comorbidities (ASA score ≥3) and 22% lived dependently. Severe comorbidities and dependent living were significantly associated with increasing age (p<.001). The trauma mechanism was fall injury in 82%. The median age of patients injured by falls was significantly higher than in patients with a nonfall injury (p<.001). At the time of diagnosis, 4% had an OFx related SCI. Primary treatment was external immobilization alone in 95.3% and open surgical fixation in 4.7%. Patients treated with primary external immobilization alone presented with significantly less translation of the odontoid fragment (p<.001) and less angulation of the odontoid fragment (p=.025) than patients treated with primary surgery. Subsequent crossover to surgical fixation was performed in 5.4%. At long-term follow-up, 95.7% of patients had bony fusion of the OFx, 80.5% had minimal/no neck pain, and none developed new onset SCI. There was no significant difference in long-term follow-up VAS (p=.444) or NDI (p=.562) between the primary external immobilization group and the primary surgical group. CONCLUSION: This study reaffirms that nonsurgical treatment remains the preferable option in the majority of patients with type III OFx.


Assuntos
Processo Odontoide , Fraturas da Coluna Vertebral , Idoso , Vértebras Cervicais/lesões , Humanos , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/lesões , Prognóstico , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/terapia , Resultado do Tratamento
17.
J Clin Neurosci ; 85: 49-56, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33581789

RESUMO

Management of patients with thoracolumbar burst fractures who do not have a neurologic injury has historically been controversial. Whilst management with an orthosis has gained popularity over surgical management, more recent evidence has suggested that even an orthosis may be unnecessary. A systematic review of the literature comparing orthosis with no orthosis in the management of thoracolumbar burst fractures in patients without neurological deficit was conducted. A risk of bias assessment was performed according to the Cochrane Collaboration Back Review Group. The quality of evidence was assessed according to the GRADE system. Two trials met the eligibility criteria. The functional outcomes, radiologic measures of kyphosis, pain scores, and quality of life scores were equivalent between the orthosis and the no orthosis groups. The level of evidence ranged from very low to moderate for the outcomes evaluated. The rate of complications and the rate of failure of treatment requiring surgery was low. Evidence from two small randomised controlled trials suggests that there are equivalent outcomes between treatment with and without an orthosis. Larger trials are needed to assess the treatment effect with greater confidence.


Assuntos
Braquetes , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento
18.
Ann R Coll Surg Engl ; 103(2): e74-e75, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559547

RESUMO

We present a case of bilateral anterior superior iliac spine avulsion fractures in an adult patient who was involved in a road traffic collision. Her injuries were managed conservatively and she has had an uncomplicated recovery with a good outcome. This is, to our knowledge, the only reported case of bilateral simultaneous anterior superior iliac spine apophyseal avulsion fractures in an adult.


Assuntos
Acidentes de Trânsito , Tratamento Conservador , Fratura Avulsão/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico , Feminino , Fratura Avulsão/etiologia , Fratura Avulsão/terapia , Humanos , Ílio/diagnóstico por imagem , Ílio/lesões , Ílio/cirurgia , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Spine (Phila Pa 1976) ; 46(15): 1039-1047, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-33625117

RESUMO

STUDY DESIGN: Nationwide Readmissions Database Study. OBJECTIVE: The aim of this study was to investigate readmission rates and factors related to readmission after surgical and nonsurgical management of odontoid fractures. SUMMARY OF BACKGROUND DATA: Management of odontoid fractures, which are the most common isolated spine fracture in the elderly, continues to be debated. The choice between surgical or nonsurgical treatment has been reported to impact mortality and might influence readmission rates. Hospital readmissions represent a large financial burden upon our healthcare system. Factors surrounding hospital readmissions would benefit from a better understanding of their associated causes to lower health care costs. METHODS: A retrospective study was performed using the 2016 Healthcare Utilization Project (HCUP) Nationwide Readmission Database (NRD). Demographic information and factors associated with readmission were collected. Readmission rates, complications, length of hospital stay were collected. Patients treated operatively, nonoperatively, and patients who were readmitted or not readmitted were compared. Statistical analysis was performed using open source software SciPy (Python v1.3.0) for all analyses. RESULTS: We identified 2921 patients who presented with Type II dens fractures from January 1, 2016 to September 30, 2016, 555 of which underwent surgical intervention. The readmission rate in patients who underwent surgery was 16.4% (91/555) and 29.4% (696/2366) in the nonoperative group. Hospital costs for readmitted and nonreadmitted patients were $353,704 and $174,922, and $197,099 and $80,715 for nonoperatively managed patients, respectively. Medicaid and Medicare patients had the highest readmission rate in both groups. Charlson and Elixhauser comorbidity indices were significantly higher in patients who were readmitted (P < 0.0001). CONCLUSION: We report an overall 90-day readmission rate of 16.4% and 29.4%, in operative and nonoperative management of type II odontoid fractures, respectively. In the face of a rising incidence of this fracture in the elderly population, an understanding of the comorbidities and age-related demographics associated with 90-day readmissions following both surgical and nonsurgical treatment are critical.Level of Evidence: 3.


Assuntos
Processo Odontoide/lesões , Readmissão do Paciente/estatística & dados numéricos , Fraturas da Coluna Vertebral , Humanos , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/terapia
20.
World Neurosurg ; 145: 462-470.e1, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32891841

RESUMO

BACKGROUND: Vertebroplasty (VP), kyphoplasty (KP), SpineJack system (SJ), radiofrequency kyphoplasty (RFK), Kiva system (Kiva), Sky kyphoplasty system (SK), and conservative treatment are widely used in the treatment of osteoporotic vertebral compression fractures (OVCFs). However, it is still unknown which is the best intervention. The aim of the current study was to evaluate the effectiveness and safety of VP, KP, SJ, RFK, Kiva, SK, and CT in the treatment of OVCFs. METHODS: Randomized controlled trials and cohort studies comparing VP, KP, SJ, RFK, Kiva, SK, or CT for the treatment of OVCFs were identified on the basis of databases including PubMed, the Cochrane Library, Web of Science, and Springer Link. A network meta-analysis was performed using STATA 15.1. RESULTS: A total of 56 studies with 6974 patients and 7 interventions were included in this study. The results of the surface under the cumulative probability demonstrated that SK was the best intervention in decreasing VAS scores and recovering middle vertebral height, RFK was the best intervention in improving ODI scores and decreasing incidence of new fractures, SJ was the best intervention to restore kyphosis angle, and Kiva was the best intervention to reduce incidence of bone cement leakage. Cluster analysis showed that SK was the preferable intervention on the basis of the outcomes of VAS, ODI, middle vertebral height, and kyphotic angle, and RFK was the preferable treatment in decreasing the incidence of adverse events. In our network meta-analysis, node-splitting analysis and loop inconsistency analysis showed no significant inconsistencies. CONCLUSIONS: SK may be the most effective treatment in relieving pain, improving the quality of life, and recovering vertebral body height and kyphotic angle, while RFK may be the safest intervention for OVCFs. However, considering the limitations of this study, more high-quality trials are needed in the future to confirm the current conclusion.


Assuntos
Fraturas por Compressão/terapia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Tratamento Conservador/métodos , Humanos , Metanálise em Rede , Procedimentos Ortopédicos/métodos
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