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1.
Zhongguo Gu Shang ; 33(1): 20-6, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115920

RESUMO

OBJECTIVE: To analyze and compare the effect of fibular plate fixation on the treatment of tibial and fibular fractures. METHODS: From July 2016 to September 2018, 65 cases of middle and lower 1/3 fractures of tibia and fibula were retrospectively analyzed, including 46 males and 19 females, aged 22 to 61 years old. There were 37 cases in fibular fixation group (27 males and 10 females) , 28 cases in fibular non fixation group (19 males and 9 females) . By comparing the operation time, intraoperative bleeding, fracture healing time, ankle rotation and valgus angle, postoperative complications, last follow-up ankle mobility and Baird Jackson score, the operation effect was evaluated. RESULTS: All patients were followed up for 12 to 16 months with an average of (13.67±1.23) months. There were 3 cases of infection of the fibular incision, all of which healed in the first stage without incision dehiscence, and 4 cases of delayed union without nonunion. In the fibula fixation group, the external rotation of ankle joint increased (7.16±1.36) ° and the valgus angle increased (3.35±1.16) °; while in the non fixation group, the external rotation increased (10.25±1.58) ° and the valgus angle increased (6.46±1.23) ° with statistical significance (P<0.05) . There was no significant difference in ankle joint activity, fracture healing time and complication rate between two groups (P>0.05) ; there was significant difference in operation time, intraoperative hemorrhage and Baird Jackson score at the latest follow-up (P<0.05) . CONCLUSION: The fibular plate fixation can prevent the ankle joint from malrotation and valgus deformity, and can obtain better surgical effect and functional prognosis.


Assuntos
Fixação Intramedular de Fraturas , Fraturas Ósseas , Fraturas da Tíbia , Adulto , Feminino , Fíbula , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tíbia , Fraturas da Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
2.
Niger J Clin Pract ; 23(1): 120-122, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31929218

RESUMO

We present a very rare case of Sevoflurane Induced Diffuse Alveolar Haemorrhage in a young male patient with a closed tibial fracture after direct trauma to the right cruris. The patient was operated for tibial fracture, but diffuse alveolar haemorrhage developed after sevoflurane inhalation in the postoperative period following general anesthesia. Diffuse alveolar haemorrhage (DAH) is associated with inhalation injury from halogenated gases and reported as a unique entity in the literature that practicing clinicians should be aware of and consider in post-operative cases of acute respiratory distress. As DAH usually presents with symptoms the presence of hemoptysis, anemia, dyspnoea and radiological alveolar infiltrates, rapid detection of the aetiology and initiation of cause-directed treatment are of great importance on survival.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Hemoptise/induzido quimicamente , Hemorragia/induzido quimicamente , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Alvéolos Pulmonares/diagnóstico por imagem , Sevoflurano/farmacologia , Fraturas da Tíbia/cirurgia , Adulto , Anestesia Geral , Broncoscopia , Hemoptise/terapia , Humanos , Masculino , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Alvéolos Pulmonares/patologia , Tomógrafos Computadorizados , Resultado do Tratamento
3.
Bone Joint J ; 102-B(1): 17-25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888370

RESUMO

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


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

RESUMO

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


Assuntos
Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fixação de Fratura/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
5.
J Pediatr Orthop ; 40(1): 48-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31815862

RESUMO

BACKGROUND: Evaluation of the union of osteotomies and fractures in patients with osteogenesis imperfecta (OI) is a critical component of patient care. Studies of the OI patient population have so far used varied criteria to evaluate bony union. The radiographic union score for tibial fractures (RUST), which was subsequently revised to the modified RUST, is an objective standardized method of evaluating fracture healing. We sought to evaluate the reliability of the modified RUST in the setting of the tibias of patients with OI. METHODS: Tibial radiographs of 30 patients with OI fractures, or osteotomies were scored by 3 observers on 2 separate occasions. Each of the 4 cortices was given a score (1=no callus, 2=callus present, 3=bridging callus, and 4=remodeled, fracture not visible) and the modified RUST is the sum of these scores (range, 4 to 16). The interobserver and intraobserver reliabilities were evaluated using intraclass coefficients (ICC) with 95% confidence intervals. RESULTS: The ICC representing the interobserver reliability for the first iteration of scores was 0.926 (0.864 to 0.962) and for the second series was 0.915 (0.845 to 0.957). The ICCs representing the intraobserver reliability for each of the 3 reviewers for the measurements in series 1 and 2 were 0.860 (0.707 to 0.934), 0.994 (0.986 to 0.997), and 0.974 (0.946 to 0.988). CONCLUSIONS: The modified RUST has excellent interobserver and intraobserver reliability in the setting of OI despite challenges related to the poor quality of the bone and its dysplastic nature. The application and routine use of the modified RUST in the OI population will help standardize our evaluation of osteotomy and fracture healing. LEVEL OF EVIDENCE: Level III-retrospective study of nonconsecutive patients.


Assuntos
Consolidação da Fratura , Osteogênese Imperfeita/fisiopatologia , Fraturas da Tíbia/diagnóstico por imagem , Adolescente , Pré-Escolar , Feminino , Humanos , Variações Dependentes do Observador , Osteogênese Imperfeita/complicações , Osteogênese Imperfeita/cirurgia , Osteotomia , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Adulto Jovem
6.
Niger J Clin Pract ; 22(12): 1715-1721, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31793479

RESUMO

Aims: The aim of this study is to assess the functional and radiological outcomes of 52 surgically treated tibial plateau fractures and to determine the factors affecting functional outcomes. Subjects and Methods: A total of 52 patients who were operated between 2007 and 2014 due to tibial plateau fractures were retrospectively reviewed. The Knee Society Score (KSS) was used for the functional outcome assessment. The Kellgren-Lawrence radiological evaluation score was used for the relationship between postoperative trauma and osteoarthritis in the last follow-up. Results: Patients' mean age was 47.7 years (range, 14-84 years). The immobilization period was 4.2 weeks (range, 0-8 weeks), the full weightbearing time was 3.3 months (range, 1.5-5 months), and the follow-up time was 47 months (range, 17-102 months). Patients' mean KSS was 84.3 (range, 40-100). According to the Kellgren-Lawrence classification, 26 patients had grade 0, 11 patients had grade 1, 8 patients had grade 2, 5 patients had grade 3, and 2 patients had grade 4 postoperative osteoarthritis. Conclusion: Use of graft if there is collapse on joint surface, early knee motion, and early started full weightbearing after surgical fixation of tibial plateau fracture is essential for successful outcome. Findings of osteoarthritis on X-rays are not related to poor functional outcome at the mid- to long-term follow-up of surgical treated tibial plateau fractured patients.


Assuntos
Fixação Interna de Fraturas , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Tíbia/lesões , Fraturas da Tíbia/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
7.
Zhongguo Gu Shang ; 32(11): 1008-1013, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870048

RESUMO

OBJECTIVE: To compare clinical effects of minimally invasive percutaneous plate osteosynthesis(MIPPO) and open reduction and internal fixation under arthroscopy for the treatment of low energy tibial plateau fracture with ligament injury. METHODS: From March 2016 to March 2017, 60 tibial plateau fracture patients with ligament injury were divided into A and B groups according to random number table. In group A, there were 30 patients including 14 males and 16 females aged from 30 to 63 years old with an average of (47.25±5.36) years old; 8 patients were classified type I, 12 patients were typeII and 10 patients type III; treated by MIPPO under arthroscopy. In group B, there were 30 patients including 16 males and 14 females aged from 32 to 60 years old with an average of (43.39±4.62) years old; 10 patients were classified to type I, 11 patients were type I and 9 patients type III; treated by open reduction and internal fixation. Imaging data, length of incision, postoperative volume of drainage, intraoperative blood loss, complications, postoperative activity time and hospital stays were observed and compared. Postoperative HSS score at 18 months was used to compare recovery of knee joint function. RESULTS: Sixty patients were followed up for 12 to 24 months with average of 18 months. There were no statistical differences in tilt angle of the tibial plateau (TPA), posterior angle of tibial plateau (PA) and femoro tibial angle (FTA) between two groups at 3 days and 12 months after operation. There was no significance in width of internal joint apace before operation, while group B(6.59±0.71) mm was bigger than group A (4.25±0.65) mm after operation at 12 months. Two patients in group A occurred complications and 6 patients in group B occurred complications, and had differences between two groups(P<0.05). Length of incision, hospital stays, postoperative volume of drainage, intraoperative blood loss and postoperative activity time in group A were(5.17±1.89) cm, (2.14±0.65) weeks, (30.02±3.15) ml, (62.63±9.58) ml, (3.16±1.87)d, respectively; while in group B were(16.25±3.47) cm, (4.57±1.09) weeks, (63.75±9.84) ml, (145.89±12.61) ml, (7.86±2.14) d, respectively; and had statistical differences between two groups(P<0.05). HSS score in group A (87.68±7.39) was higher than that of in group B(69.42±5.13) at 18 months after operation (P<0.05). CONCLUSIONS: Both of MIPPO and open reduction and internal fixation under arthroscopy for low energy tibial plateau fracture with ligament injury could provide stable fixation. Open reduction and internal fixation has advantages of simple operation, but had seriously-injured, MIPPO has advantages of less trauma, good recovery of joint function, less complications and could deal with ligament and meniscus injury.


Assuntos
Artroscopia , Fraturas da Tíbia , Adulto , Placas Ósseas , Feminino , Fixação Interna de Fraturas , Humanos , Ligamentos , Masculino , Pessoa de Meia-Idade , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
8.
Bone Joint J ; 101-B(11): 1416-1422, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674252

RESUMO

AIMS: In this randomized study, we aimed to compare quality of regenerate in monolateral versus circular frame fixation in 30 patients with infected nonunion of tibia. PATIENTS AND METHODS: Both groups were comparable in demographic and injury characteristics. A phantom (aluminium step wedge of increasing thickness) was designed to compare the density of regenerate on radiographs. A CT scan was performed at three and six months postoperatively to assess regenerate density. A total of 30 patients (29 male, one female; mean age 32.54 years (18 to 60)) with an infected nonunion of a tibial fracture presenting to our tertiary institute between June 2011 and April 2016 were included in the study. RESULTS: The regenerate mineralization on radiographs was comparable in both groups at two, four, six, and ten months' follow-up but the rail fixator group had statistically significant higher grades of mineralization when compared with the circular frame group at eight and 12 months' follow-up. The regenerate mineralization was also higher in the rail fixator group than in the circular frame group on CT at three and six months, although this difference was not statistically significant. CONCLUSION: Overall, the regenerate mineralization was higher in the monolateral than the circular frame group. A monolateral fixator may be preferred in patients with infected nonunion of the tibia with bone defects up to 7 cm. Cite this article: Bone Joint J 2019;101-B:1416-1422.


Assuntos
Fraturas não Consolidadas/cirurgia , Osteogênese por Distração/métodos , Fraturas da Tíbia/cirurgia , Infecção dos Ferimentos/cirurgia , Adolescente , Adulto , Densidade Óssea/fisiologia , Desenho de Equipamento , Fixadores Externos , Feminino , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese por Distração/instrumentação , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Radiografia , Fraturas da Tíbia/diagnóstico por imagem , Infecção dos Ferimentos/diagnóstico por imagem , Adulto Jovem
10.
J Am Podiatr Med Assoc ; 109(6): 477-481, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755767

RESUMO

Tillaux fracture is known to occur in adolescents once it happens during the transition period when the medial and central physis has finished closure, but the lateral physis is still opened. The trauma mechanism is typically external rotation ankle injury resulting in an avulsion fracture of the anterolateral tibial plafond. This fracture has rarely been reported in adults, especially associated with other injuries. We report a case of Tillaux fracture in an adult, associated with a Volkmann fracture and a Maisonneuve fracture, that were surgically treated with open reduction and internal fixation and had an excellent outcome. Recognizing and appropriately treating these injuries is key in the prevention of further degenerative arthritis and instability.


Assuntos
Traumatismos do Tornozelo/cirurgia , Fixação Interna de Fraturas/métodos , Ligamentos Articulares/lesões , Fraturas da Tíbia/cirurgia , Idoso , Traumatismos do Tornozelo/complicações , Feminino , Humanos , Radiografia , Tíbia/diagnóstico por imagem , Fraturas da Tíbia/complicações , Fraturas da Tíbia/diagnóstico por imagem
11.
J Am Podiatr Med Assoc ; 109(6): 459-462, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755769

RESUMO

We present a case of tibial pilon fracture where only the lateral part of the distal tibia was affected. The transfibular approach to the ankle was used for the surgical treatment of the fracture. After an initial nonweightbearing period of 3 weeks, full weightbearing was allowed 8 weeks after surgery. The second-year follow-up showed no evidence of degenerative signs, with full ankle range of motion.


Assuntos
Fíbula/cirurgia , Fixação Interna de Fraturas/métodos , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Adulto , Feminino , Humanos , Tíbia/lesões , Fraturas da Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
12.
Handchir Mikrochir Plast Chir ; 51(6): 484-491, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698490

RESUMO

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


Assuntos
Fraturas Expostas , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Fraturas da Tíbia , Fixação de Fratura , Fraturas Expostas/cirurgia , Humanos , Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Tíbia , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
13.
J Am Acad Orthop Surg ; 27(21): 816-822, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31658120

RESUMO

BACKGROUND: No consensus exists for the management of closed tibia fractures in the adolescent population. METHODS: The Kids' Inpatient Database was used to extract data on patients aged 10 to 18 years with closed diaphyseal tibia fractures. The frequency of closed reduction and internal fixation (IF) was calculated, and the temporal trends were evaluated. RESULTS: Between 1997 and 2012, the rate of IF for closed tibia fractures in the adolescent population increased by 29.8%. The rate of increase in IF between patients aged 10 to 12 years, 13 to 15 years, and 16 to 18 years was not statistically different (P = 0.092). Analysis of hospital variables demonstrated that large hospitals were more likely to perform IF compared with small- and medium-sized hospitals (P < 0.001). A significant difference exists between the IF and closed reduction groups in the length of hospital stay (3.85 ± 0.07 versus 2.44 ± 0.07; P < 0.001) and cost ($37,400 ± $890 versus $15,300 ± $670; P < 0.001). DISCUSSION: The results of this study show a shift in the management of closed tibia shaft fractures in the adolescent population admitted to the hospital, with an absolute rate increase of 29.8% in patients aged 10 to 18 years over a 15-year period. LEVEL OF EVIDENCE: Level III. A retrospective, comparative study.


Assuntos
Redução Fechada/estatística & dados numéricos , Fixação Interna de Fraturas/estatística & dados numéricos , Padrões de Prática Médica/tendências , Fraturas da Tíbia/epidemiologia , Fraturas da Tíbia/cirurgia , Adolescente , Feminino , Humanos , Cobertura do Seguro , Tempo de Internação , Masculino , Estudos Retrospectivos , Estados Unidos/epidemiologia
14.
J Bone Joint Surg Am ; 101(19): 1761-1767, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577681

RESUMO

BACKGROUND: Isolated femoral and tibial fractures are 2 of the top 5 causes of pediatric orthopaedic hospital admission, yet their simultaneous ipsilateral presentation, the "floating knee" injury, remains rare. Historically, treatment consisted of traction and cast immobilization, which resulted in prolonged periods of immobilization, lengthy hospitalizations, and high rates of malunion. As such, previous authors have recommended fixation of at least 1 bone in the setting of a floating knee injury. This strategy, however, has never been evaluated and the outcomes of modern treatment are unknown. METHODS: We performed a multicenter retrospective review of the records of pediatric patients with ipsilateral femoral and tibial fractures that had been treated at 11 tertiary care level-I pediatric trauma centers from 2004 to 2014. Outcomes and treatment strategies were assessed with standardized means. RESULTS: Over the study period, 130 floating knees in 129 patients met the inclusion criteria for evaluation. The average patient age was 10.2 years, and 63.1% were male. One-third of the patients presented with open injuries, and 83.8% of injuries were related to vehicular trauma. Simple diaphyseal fractures (OTA/AO 32-A and B femoral fractures and OTA/AO 42-A and B tibial fractures) were most common. Intramedullary fixation (rigid or flexible) was the most common treatment strategy for femoral fractures (69.2%). Tibial fractures were treated most commonly with casting (27.7%), followed by flexible intramedullary nailing (24.6%). The mean duration of hospitalization was 9.7 days. Outcomes were excellent in 66.6% of cases and good in 26.4% of cases. CONCLUSIONS: Previous literature on pediatric floating knee injuries consisted of small case series that were published prior to the introduction of flexible intramedullary nailing to North America. This multicenter study of a large cohort demonstrates a change in practice pattern from a largely nonoperative treatment strategy to operative fixation of at least the femoral fracture. In the present study, this approach led to good or excellent results in 93.1% of cases and was associated with a short duration of hospitalization. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Moldes Cirúrgicos , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Traumatismos do Joelho/cirurgia , Fraturas da Tíbia/cirurgia , Acidentes de Trânsito , Criança , Feminino , Fraturas do Fêmur/fisiopatologia , Consolidação da Fratura/fisiologia , Humanos , Traumatismos do Joelho/fisiopatologia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fraturas da Tíbia/fisiopatologia , Resultado do Tratamento
15.
Acta Ortop Mex ; 33(2): 96-101, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31480110

RESUMO

Tibial spine avulsion fractures (also called tibial eminence fractures) are bony avulsions of the anterior cruciate ligament (ACL) from its insertion in the intercondylar eminence. It is most commonly seen in children aged eight to 12 years, because LCA is more resistent than bone and physis. Furthermore, the union between epiphisys and LCA is very strong due to the collagen fibers. Meyers and McKeever classification defines three types: type I: non displaced; type II: partially dislaced; and type III: completely displaced. This classification is very important for the treatment. Arthroscopic treatment is the gold standard for displaced fractures. The association with other intraarticular injuries is frequent, and the anterior horn of the medial meniscus or the transverse meniscal ligament is frequently trapped within the fracture site. A miniarthrotomy may still be necessary in fractures that are irreducible by arthroscopic means. Its difficult to find chronic fractures in children in the literature. The treatment is similar to acute cases, but includes debridement of the scar tissue and reparation of intraarticular injuries. Loss of extension is the main problem we find in this patients, although acceptable results may be achieved. In this article we present a seven years old boy with a chronic tibial spine avulsion, the treatment and the outcome.


Assuntos
Lesões do Ligamento Cruzado Anterior , Artroscopia , Fraturas da Tíbia , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Criança , Humanos , Articulação do Joelho , Masculino , Fraturas da Tíbia/cirurgia
16.
Acta Ortop Mex ; 33(1): 2-7, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31480118

RESUMO

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


Assuntos
Amputação , Fraturas Expostas , Fraturas da Tíbia , Tomada de Decisões , Fraturas Expostas/cirurgia , Humanos , Prognóstico , Estudos Retrospectivos , Tíbia , Fraturas da Tíbia/cirurgia
17.
Bone Joint J ; 101-B(9): 1138-1143, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474148

RESUMO

AIMS: The aim of this study was to compare the incidence of anterior knee pain after antegrade tibial nailing using suprapatellar and infrapatellar surgical approaches. PATIENTS AND METHODS: A total of 95 patients with a tibial fracture requiring an intramedullary nail were randomized to treatment using a supra- or infrapatellar approach. Anterior knee pain was assessed at four and six months, and one year postoperatively, using the Aberdeen Weightbearing Test - Knee (AWT-K) score and a visual analogue scale (VAS) score for pain. The AWT-K is an objective patient-reported outcome measure that uses weight transmitted through the knee when kneeling as a surrogate for anterior knee pain. RESULTS: A total of 53 patients were randomized to a suprapatellar approach and 42 to an infrapatellar approach. AWT-K results showed a greater mean proportion of weight transmitted through the injured leg compared with the uninjured leg when kneeling in the suprapatellar group compared with the infrapatellar group at all timepoints at all follow-up visits. This reached significance at four months for all timepoints except 30 seconds. It also reached significance at six months at 0 seconds, and for one year at 60 seconds. CONCLUSION: The suprapatellar surgical approach for antegrade tibial nailing is associated with less anterior knee pain postoperatively compared with the infrapatellar approach Cite this article: Bone Joint J 2019;101-B:1138-1143.


Assuntos
Artralgia/prevenção & controle , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Dor Pós-Operatória/prevenção & controle , Patela/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Artralgia/etiologia , Pinos Ortopédicos/efeitos adversos , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Medidas de Resultados Relatados pelo Paciente , Tíbia/lesões , Tíbia/cirurgia , Adulto Jovem
18.
Medicine (Baltimore) ; 98(36): e17068, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490405

RESUMO

INTRODUCTION: Current treatment of pediatric distal metaphyseal tibial/fibular fractures is challenging due to poor skin and soft tissue coverage and limited blood supply to the distal tibia area in children. It remains unknown whether the SK combined external fixator (made by Double Medical Technology Inc., China) is effective for the treatment of distal metaphyseal tibia/fibula fractures in children. HYPOTHESIS: We hypothesized that SK combined external fixator could achieve satisfying outcomes for pediatric distal metaphyseal tibia/fibula fractures. PATIENTS AND METHODS: A total of 19 pediatric patients with a median age of 6 years (range: 3.8-12.0 years), who had distal tibia/fibula metaphyseal fractures and attended our hospital between January 2017 and November 2017, were evaluated. All patients with tibia fracture had closed reduction and percutaneously fixed SK combined external fixators. Radiographs were taken at an average of every 4 weeks to evaluate the healing of the fracture. Complications were recorded, and the stability of the pin clamp and rod were also checked. Follow-up was conducted for up to 13 months. All patients provided informed consent for publication of the case. RESULTS: All patients achieved a satisfactory clinical outcome at the final follow-up. Weight-bearing exercises were started at post-operative 2 weeks. Bone union was obtained at 8 weeks post-operation on average. No delayed healing or nonunion was observed, although one case of pin site infection and three cases of pin clamp loosening occurred. DISCUSSION: Three-dimensional SK combined external fixators are light, easy to apply, minimally invasive, and result in low rates of complications. They provide excellent stability for pediatric distal tibia/fibula metaphyseal fractures. LEVEL OF EVIDENCE: IV.


Assuntos
Fixadores Externos , Fixação de Fratura/instrumentação , Fraturas da Tíbia/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Melhoria de Qualidade , Estudos Retrospectivos
19.
Bull Hosp Jt Dis (2013) ; 77(3): 200-205, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487486

RESUMO

BACKGROUND: Workers Compensation claims have been previously associated with inferior clinical outcomes. However, variation in inpatient stays for orthopedic trauma injuries according to insurance type has not been previously examined. METHODS: We investigated the differences according to insurance for tibial shaft fractures in regard to length of stay and disposition. Using the New York SPARCS database, we identified 1,856 adult non-elderly patients with an isolated tibial shaft fracture who underwent surgery. Patients were stratified by insurance type, including private, Medicaid, Workers Compensation, and no-fault, which covers medical expenses related to automobile or pedestrian accidents. RESULTS: Compared to private insurance (mean: 2.7 days), length of stay was longer for no-fault (mean: 3.9 days; adjusted difference +33%, p < 0.001) and Medicaid (mean: 3.5 days; adjusted difference +22%, p < 0.001), but not significantly different for Workers Compensation (mean: 3.5 days; adjusted difference +4%, p = 0.474). Compared to private insurance (rate: 3.5%), disposition to a facility was significantly higher for no-fault (rate: 10.1%; adjusted odds ratio [OR] = 3.3, p < 0.001) and Medicaid (rate: 7.6%; OR = 2.2, p = 0.003), but was not significantly different for Workers Compensation (rate: 6.3%; OR = 1.8, p = 0.129). CONCLUSIONS: Patients with no-fault insurance, but not Workers Compensation, are subject to longer hospital stays and are more likely to be discharged to a facility following operative fixation of an isolated tibial shaft fracture. These findings suggest that financial, social, and legal factors influence medical care for patients involved in automobile accidents with no-fault insurance.


Assuntos
Acidentes de Trânsito/economia , Fixação de Fratura , Seguro de Responsabilidade Civil/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Fraturas da Tíbia , Indenização aos Trabalhadores/estatística & dados numéricos , Adulto , Feminino , Fixação de Fratura/economia , Fixação de Fratura/reabilitação , Fixação de Fratura/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Fraturas da Tíbia/economia , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Estados Unidos
20.
BMC Vet Res ; 15(1): 321, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488151

RESUMO

BACKGROUND: Peak reverse torque (PRT) is a valid method to evaluate implants' secondary stability in the healing bone. The secondary stability is achieved by the implant over time and it has been positively correlated with the implants' osseointegration level. In other words, peak reverse torque is the force required to break the bone-implant interface. The purpose of this study was to compare the peak reverse torque for the self-tapping and non-self-tapping screws used in a dynamic compression plate-screw-bone construct after 60 days of loading when used to stabilize 2.5-cm defects in the tibia of goats. The second objective was to compare the peak removal torque of the screws placed in the different positions to evaluate the impact of construct biomechanics on implants osseointegration. RESULTS: In total, 176 non-self-tapping screws and 66 self-tapping screws were used to fix the 8-holes dynamic compression plates to the bones. The screws were placed in the tibiae from proximal (position sites 1,2, 3) to distal (position sites 4,5,6) and were removed 60 days post-implantation. The animals remained weight-bearing throughout the study period. The screws placed in the proximal diaphysis had significantly less peak reverse torque than screws placed in the distal diaphysis in both groups (p < 0.05). The peak reverse torque resistance was also significantly less for the non-self-tapping screws as compared with the self-tapping screws (p < 0.05). The intracortical fractures in the trans-cortex occurred significantly more frequently during the placement of non-self-tapping screws (p < 0.05) as compared with self-tapping screws (p < 0.05). CONCLUSIONS: Based on these results, we concluded that self-tapping screws may be expected to maintain a more stable bone-implant interface during the first 60 days of loading as compared with non-self-tapping screws. This should be a consideration for orthopedic surgeons and scientists using bone plates to stabilize non-load sharing fractures when a stable plate-screw-bone interface is needed to ensure prolonged stability.


Assuntos
Placas Ósseas/veterinária , Parafusos Ósseos/veterinária , Cabras/cirurgia , Fraturas da Tíbia/veterinária , Animais , Feminino , Tíbia , Fraturas da Tíbia/cirurgia , Torque
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