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1.
Life Sci ; 241: 117132, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31837327

RESUMO

INTRODUCTION: This study aimed to verify the effects of cigarette smoke exposure in bone mineralization and fibrillar matrix composition as well as in bone healing after tibial fracture induction. METHODS: C57Bl/6 Mice were assigned according to exposure and surgery: C room air; F room air and tibia open osteotomy; CS cigarette smoke; FCS cigarette smoke and tibia open osteotomy. In order to study fracture healing we performed, under anesthesia, a bone injury through a tibial shaft osteotomy. Bone samples were obtained to evaluate bone histomorphometry, trabecular morphology and volume, trabecular collagen types composition and presence of inflammatory cytokines and growth factors. RESULTS: CS exposure significantly reduced the thickness of bone trabeculae associated with decrease in mineralizing surface and mineral deposition rate, leading a lower bone formation rate and longer mineralization time. Resorption surface and osteoclastic surface were greater in the CS group, attesting increased resorptive action. There was a decrease in type I collagen deposition and genes expression in the CS and FCS groups compared to C group and in contrast there was an increase in type V collagen deposition and genes expression in the CS, FC and FSC groups compared to C group. Also, CS exposure induced a decrease in bone forming cytokines and an increase in inflammatory associated cytokines, and these changes were intensified under fracture conditions. CONCLUSION: Cigarette smoke exposure alters bone matrix composition and worsens bone mineralization, leading to bone fragility by increasing collagen V synthesis and deposition and impairing collagen I fibril forming and assembling. And these deleterious effects contributed to the worsening in fracture healing after tibia osteotomy.


Assuntos
Calcificação Fisiológica/efeitos dos fármacos , Fumar Cigarros/efeitos adversos , Osteogênese/efeitos dos fármacos , Fumaça/efeitos adversos , Tíbia/patologia , Fraturas da Tíbia/patologia , Animais , Colágeno Tipo I/metabolismo , Citocinas/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Tíbia/efeitos dos fármacos , Tíbia/lesões , Tíbia/metabolismo , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/metabolismo
2.
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
3.
Medicine (Baltimore) ; 98(42): e17338, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626090

RESUMO

RATIONALE: Unicompartmental knee arthroplasty (UKA) is an effective method to treat single compartment disease of the knee joint. Report about the complications of UKA, especially tibial plateau fractures, is rare. Given its rarity, its pathogenesis is not well described, and a standard of treatment is still not established. Therefore, relevant studies and analysis of this complication have a significant effect on helping physicians avoid risks and guide clinical diagnosis and treatment. PATIENT CONCERNS: The 1st case corresponds to a 70-year-old male patient who complained of knee pain, difficulty walking, nocturnal rest pain, and elevated skin temperature at 3 weeks after the left knee arthroplasty. The second case is a 72-year-old female patient who complained of left knee pain and swelling during movement at 2 weeks after the left knee arthroplasty. DIAGNOSIS: The 1st case showed a fracture of the medial malleolus of the left knee and a secondary depression of the medial tibial plateau in X-rays and the second case showed a fracture of the medial malleolus of the left knee in computed tomography (CT) and X-rays. INTERVENTIONS: The 1st case was treated with plate and screw fixation and the second case was treated conservatively and immobilized using brace and remained nonweight bearing for 6 weeks. OUTCOMES: After 1 year, both patients have good joint activity, and there was no pain or loosening of the prosthesis and fragment displacement. LESSONS: The incidence of tibial plateau fractures (TPF) related to UKA might be low, but fatal and difficult to treat. Its pathogenesis determines procedure-related factors; when fracture develops, treatment should be based on the degree of displacement, stability of implant fixation, etc.


Assuntos
Artroplastia do Joelho/efeitos adversos , Tratamento Conservador/métodos , Fixação Interna de Fraturas/métodos , Complicações Pós-Operatórias/terapia , Fraturas da Tíbia/terapia , Idoso , Idoso de 80 Anos ou mais , Braquetes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(38): e17123, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567950

RESUMO

To investigate the age, gender, time, and etiology differences of traumatic lower limb fractures (TLLFs) in a population of children (≤18 years old), we retrospectively reviewed 936 children who had TLLFs and who came to our university-affiliated hospitals from 2001 to 2010. This study enrolled 657 males (70.2%) and 279 females (29.8%) aged (11.6 ±â€Š4.9) years old. The most common etiologies and fracture sites were motor vehicle collisions (MVCs, 440, 47.0%) and tibias (376, 40.2%). A total of 126 (13.5%) patients suffered neurological deficits (NDs), 127 (13.6%) patients sustained associated injuries (ASOIs), and 78 (8.3%) patients sustained complications. During all periods the occurrence increased with increasing age group and a male preponderance was observed in all age groups. With increasing age, the proportion of injuries due to different etiologies increased and the proportion of femur fracture decreased from 65.2% to 34.5%. With increasing year of admission, the proportion of injuries due to MVCs decreased. The most common fracture sites were tibias in MVCs, femurs in low fall, high fall, and struck by object, feet in sprain. Male patients presented with significantly higher proportions of injuries due to struck by object and sprain, significantly lower proportions of pelvis fracture than the female patients. MVCs and tibias were the most common etiologies and fracture sites. Prevention and treatment should be taken according to the pattern of TLLFs which have specific annual, gender, and age characteristics.


Assuntos
Fraturas do Fêmur/epidemiologia , Fraturas da Tíbia/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Serviços de Saúde da Criança , Pré-Escolar , China/epidemiologia , Feminino , Fraturas do Fêmur/etiologia , Humanos , Lactente , Extremidade Inferior/lesões , Masculino , Fatores Sexuais , Fraturas da Tíbia/etiologia
5.
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
6.
Knee ; 26(5): 1143-1151, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31439367

RESUMO

BACKGROUND: Implant fractures are a very rare complication in primary total knee replacement (TKR) surgery and with modern implant designs and improved metals these events have nearly been eliminated. In this case series we report three cases of tibial metal baseplate fractures in uncemented Regenerex® TKR. METHODS: Cases originated from a prospective case series of 80 patients operated between 2013 and 2016. Five patients were pilot cases and 75 were participants in a prospective randomized double-blinded clinical trial that evaluated different adjuvant bone anti-resorptive medical therapies. All patients were treated with an uncemented press-fit Regenerex® Porous Titanium Construct tibial tray and matching cemented (Refobacin Bone Cement R) patella and femoral components (hybrid implant). RESULTS: We report three cases of medial side metal baseplate fractures of a modular finned tibial stem. All three baseplate fractures were in male patients. Confirmed failure of the implant occurred after 10, 12 and 23 months, in situ, with a mean follow-up of 15 months (range 10-23). CONCLUSIONS: Based on the current case series we cannot make any causal inferences. Failures may represent a multifactorial process with a cascade of events with implant failure as the result. However, like in most other case reports of metal failures in the literature, the implant fractures in this report were located on the medial side of the tibial component in male patients.


Assuntos
Artroplastia do Joelho/efeitos adversos , Prótese do Joelho/efeitos adversos , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Desenho de Prótese , Reoperação , Tíbia/diagnóstico por imagem , Tíbia/lesões , Fraturas da Tíbia/diagnóstico , Fraturas da Tíbia/etiologia , Adulto Jovem
7.
Undersea Hyperb Med ; 46(1): 75-79, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154688

RESUMO

More blast injuries are encountered in the civilian setting in recent years as terrorist attacks have increased globally. A 17-year-old male patient with severe blast injury of the right lower extremity was admitted to our department on the fifth day after a terrorist bombing attack. Initially he had been admitted to an emergency department with segmental tibia fracture and arterial injury (Gustilo IIIC). An amputation had been foreseen due to ischemia that persisted even after orthopedic fixation and revascularization interventions, followed by fasciotomy incisions. After consultation with our department hyperbaric oxygen (HBO2) therapy was administered twice daily for the first week. Ischemia improved prominently after 10 HBO2 sessions. HBO2 therapy was continued together with antibiotherapy and wound care. The patient underwent a total of 40 HBO2 sessions and two reconstructive operations and healed without amputation. Vascular injuries with concomitant orthopedic trauma cause most of the delayed amputations in bombing attacks since ischemia can persist at the microvascular level even though adequate treatments are applied. HBO2 corrects hypoxia at tissue level and so provides oxygen for the critically ischemic cells in the injured area. HBO2 also enhances host defense and decreases the ischemia reperfusion injury. In this case, HBO2 was effective in survival and functional recovery (salvage) of the extremity together with regular wound care, antibiotherapy and surgical repair.


Assuntos
Traumatismos por Explosões/terapia , Oxigenação Hiperbárica , Isquemia/terapia , Traumatismos da Perna/terapia , Perna (Membro)/irrigação sanguínea , Terrorismo , Adolescente , Pé/irrigação sanguínea , Humanos , Isquemia/etiologia , Masculino , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/terapia
8.
Pan Afr Med J ; 32: 46, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31143351

RESUMO

We here report the case of a 16-year old patient with triplane fracture of the proximal end of the tibia due to a sporting accident occurred during a cycling race. CT scan (CT) was performed to assess the fracture with a high level of accuracy. After identification of all fragments requiring osteosynthesis, closed reduction was performed with fixation of fracture fragments using cannulated screws. At the last follow-up visit, radiological and functional results were excellent.


Assuntos
Ciclismo/lesões , Fixação Interna de Fraturas/métodos , Fraturas da Tíbia/etiologia , Adolescente , Traumatismos em Atletas/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Tomografia Computadorizada por Raios X/métodos
9.
Vet J ; 247: 44-49, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30971350

RESUMO

Long bone fractures in racehorses may present as stress fractures which have a good prognosis, or complete fractures, which often result in a fatal outcome. In order to identify differences in modifiable management practices that may contribute to these outcomes, racing histories of horses with humeral or tibial fractures and of matched controls were examined. A retrospective case-control study of Australian Thoroughbred racehorses diagnosed with a fracture of the humerus or tibia by scintigraphy or at post-mortem between 2002 and 2016 was undertaken. Control horses were matched from the same race or trial on age and sex. Statistical analysis was performed using conditional logistic regression, χ2 and Mann-Whitney U tests. More humeral fractures than tibial fractures were fatal (12/47, 26% vs. 3/35, 8.6%, P = 0.049). No differences in pre-injury racing histories were observed between cases and controls for humeral and tibial fractures. Both humeral and tibial fracture case horses were younger than the registered Thoroughbred racing population (P < 0.001), but horses sustaining humeral fractures were older than those with tibial fractures (3.3 ± 0.9 vs. 2.8 ± 0.8 years, P = 0.005) yet raced fewer times prior to the injury (0.5 ± 1.1 vs. 1.3 ± 1.7 races, P = 0.009). Horses with fatal humeral fractures were less likely to have raced than those with non-fatal humeral fractures (16.7% vs. 55.6%, P = 0.02). In conclusion, tibial and humeral fractures occur in young racehorses, and humeral fractures are more likely to be fatal in those with the least exposure to trialling and racing.


Assuntos
Cavalos/lesões , Fraturas do Úmero/veterinária , Esportes , Fraturas da Tíbia/veterinária , Fatores Etários , Animais , Austrália , Estudos de Casos e Controles , Feminino , Fraturas do Úmero/etiologia , Fraturas do Úmero/mortalidade , Masculino , Condicionamento Físico Animal , Cintilografia/veterinária , Estudos Retrospectivos , Fatores de Risco , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/mortalidade
10.
Plast Reconstr Surg ; 143(5): 1522-1529, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033835

RESUMO

BACKGROUND: The Gustilo classification serves as a proxy for injury severity, but recent data suggest rising complications with decreasing arterial runoff. This study aims to compare different microsurgical anastomosis options based on the number of patent vessels in the lower extremity. METHODS: A single-center retrospective review of 806 lower extremity free flaps performed from 1976 to 2016 was performed. Patients with Gustilo type IIIB injuries were grouped based on the number of patent vessels in the leg (three, two, or one). Patients were compared based on the type of anastomosis performed, evaluating for perioperative complications and flap failures. RESULTS: Perioperative complications occurred in 111 flaps (27 percent): 71 take-backs (17 percent), 45 partial losses (11 percent), and 37 complete losses (9 percent). Among patients with three-vessel runoff (61.8 percent), there was no difference in take-backs or flap loss between those with end-to-end versus end-to-side anastomoses. In 68 patients (18.7 percent) with two-vessel runoff, no difference between take-backs or flap loss was noted when comparing any anastomosis (i.e., end-to-end into an injured vessel, end-to-end into an uninjured vessel, or end-to-side into an uninjured vessel), although vein grafts were required more often in the end-to-side groups (p < 0.01). Finally, in 39 patients (10.7 percent) with single-vessel runoff, no difference was seen between end-to-end anastomosis into an injured vessel or end-to-side anastomosis into an uninjured vessel in terms of take-backs or flap loss. CONCLUSION: Higher rates of flap failure correlated with decreasing numbers of patent vessels in the leg, but neither type of microvascular anastomosis nor vessel selection demonstrated any impact on reconstructive outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Artérias/lesões , Fraturas Expostas/cirurgia , Retalhos de Tecido Biológico/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões do Sistema Vascular/cirurgia , Acidentes de Trânsito , Adulto , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Artérias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Feminino , Fíbula/lesões , Fíbula/cirurgia , Fraturas Expostas/complicações , Retalhos de Tecido Biológico/transplante , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Humanos , Masculino , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Resultado do Tratamento , Lesões do Sistema Vascular/etiologia
11.
Eur J Orthop Surg Traumatol ; 29(5): 1073-1079, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30729308

RESUMO

Fractures of the anterior tibial tubercle are infrequent lesions. They often occur in male adolescent athletes, usually in relation with sports involving powerful jumps. We present a retrospective study of 10 patients, with an average age of 15.1 years, all of them males, and a total of 11 acute avulsions of the anterior tibial tubercle. We analyzed the etiology of the lesion, the type of treatment used as well as non-weight bearing period, protected immobilization period, and time until sports reincorporation. We obtained 11 acute avulsions: one case of type I; three cases of type II; four cases of type III; and three cases of type IV. Five cases were treated conservatively, including the three cases of type IV, and surgery was only performed in six cases since an anatomical reduction was not obtained with closed reduction. The results were satisfactory in all cases, with 100% percentage of sport reincorporation in less de 25 weeks. We registered only one complication, intolerance of material, which did not require additional surgeries. These fractures, although rare, have an excellent prognosis. Even if they are often treated surgically, we have obtained good results with the conservative treatment in patterns previously reported as surgical.


Assuntos
Redução Fechada , Redução Aberta , Tíbia/lesões , Fraturas da Tíbia , Adolescente , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Redução Fechada/métodos , Redução Fechada/reabilitação , Fratura Avulsão/etiologia , Fratura Avulsão/terapia , Humanos , Masculino , Redução Aberta/métodos , Redução Aberta/reabilitação , Seleção de Pacientes , Prognóstico , Volta ao Esporte , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/reabilitação , Fraturas da Tíbia/cirurgia , Fraturas da Tíbia/terapia , Resultado do Tratamento
12.
J Arthroplasty ; 34(5): 846-851, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30733072

RESUMO

BACKGROUND: This study compared the rates of plain radiographs and computed tomography (CT) for detecting lateral hinge fractures and to evaluate factors affecting lateral hinge fractures in patients following medial opening-wedge high tibial osteotomy (MOWHTO). METHODS: This prospective study included 59 patients (65 knees) undergoing MOWHTO for primary medial compartment osteoarthritis with a 2-year follow-up between 2013 and 2016. Clinical and radiographic evaluations were performed using Knee Society Score and Western Ontario and McMaster Universities Arthritis Index, and we calculated the hip-knee-ankle angle, weight-bearing line ratio, lateral distal femoral angle, medial proximal tibial angle, posterior tibial slope, osteotomy gap height, and osteotomy gap filling rate. Immediate plain radiographs and CT were used to detect lateral hinge fractures according to Takeuchi's method. RESULTS: Among 65 knees, the incidence of lateral hinge fractures was 13.8% (Type I: 7, Type II: 2). Only 6 knee fractures (9.2%) were detected on postoperative plain radiographs, including 5 Type I fractures and 1 Type II fracture. An additional 3 knees (4.6%) were detected on postoperative CT scans, including 2 Type I fractures and 1 Type II fracture. Furthermore, osteotomy gap height (adjusted odds ratio = 1.831, P = .016) was the only predictor of lateral hinge fractures. CONCLUSION: The incidence of lateral hinge fractures after MOWHTO was 13.8%. CT (13.8%) afforded higher detection rates for lateral hinge fractures than did plain radiographs (9.2%) despite a marginal difference with uncertain significance. Osteotomy gap height was the only predictor of lateral hinge fractures. LEVEL OF EVIDENCE: Prospective cohort study (Level II).


Assuntos
Osteoartrite do Joelho/cirurgia , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Tíbia/cirurgia , Fraturas da Tíbia/diagnóstico por imagem , Adulto , Idoso , Placas Ósseas , Feminino , Fraturas Ósseas , Humanos , Incidência , Joelho , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/instrumentação , Osteotomia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Prospectivos , Radiografia , República da Coreia/epidemiologia , Fraturas da Tíbia/epidemiologia , Fraturas da Tíbia/etiologia , Tomografia Computadorizada por Raios X , Suporte de Carga
13.
Bone Joint J ; 101-B(2): 162-169, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30700126

RESUMO

AIMS: Many authors have reported a shorter treatment time when using trifocal bone transport (TFT) rather than bifocal bone transport (BFT) in the management of long segmental tibial bone defects. However, the difference in the incidence of additional procedures, the true complications, and the final results have not been investigated. PATIENTS AND METHODS: A total of 86 consecutive patients with a long tibial bone defect (≥ 8 cm), who were treated between January 2008 and January 2015, were retrospectively reviewed. A total of 45 were treated by BFT and 41 by TFT. The median age of the 45 patients in the BFT group was 43 years (interquartile range (IQR) 23 to 54). RESULTS: The size of the bone defect was significantly longer (p = 0.005), the number of previous operations was significantly higher (p < 0.001), the operating time was significantly longer (p < 0.001), and the bone transport distance was significantly increased (p = 0.017) in the TFT group. However, the external fixation time (p < 0.001), the healing index (p < 0.001), the number of additional procedures (p = 0.013), and the number of true complications (p < 0.001) were significantly reduced in this group. Both groups achieved highly satisfactory bone and functional results. CONCLUSION: TFT can significantly reduce the treatment time, the number of additional surgical procedures, and true complications compared with BFT in the treatment of long segmental tibial bone defects.


Assuntos
Técnica de Ilizarov , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Adulto , Transplante Ósseo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/lesões , Fraturas da Tíbia/etiologia , Adulto Jovem
14.
J Foot Ankle Surg ; 58(3): 567-572, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30803911

RESUMO

Osteochondral lesions (OCLs) are injuries affecting the articular cartilage surface of a joint. OCLs are well reported in the literature to affect the knee, talus, tibia, navicular, and first metatarsal. This rare case of a bipolar osteochondral lesion of the cuboid and calcaneus presented as lateral heel pain after a traumatic injury. After an unsuccessful course of conservative therapy, the lesion was treated with curettage and application juvenile particulate cartilage allograft. Eight months postoperatively, the patient was ambulating in supportive shoe gear without pain. The mechanism of injury leading to calcaneocuboid joint osteochondral lesions is not clearly understood. It is also questionable whether anatomic variances are contributory. Regardless of causality, OCLs should be included in the differential diagnoses for patients presenting with calcaneocuboid joint or lateral hindfoot pain.


Assuntos
Calcâneo/cirurgia , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Ossos do Tarso/cirurgia , Articulações Tarsianas/lesões , Articulações Tarsianas/cirurgia , Acidentes por Quedas , Aloenxertos , Calcâneo/diagnóstico por imagem , Calcâneo/lesões , Cartilagem/transplante , Cartilagem Articular/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/lesões , Articulações Tarsianas/diagnóstico por imagem , Fraturas da Tíbia/etiologia
15.
Ann Vasc Surg ; 57: 35-40, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30684614

RESUMO

BACKGROUND: Early identification of peripheral vascular injuries is crucial to prevent acute limb ischemia and amputation. We sought to identify predictors of vascular injury in patients with blunt lower extremity fractures. METHODS: A single institutional retrospective analysis of patients with blunt lower extremity fractures at a university-affiliated, county hospital over a 2-year period was performed. Patients with lower extremity vascular injury were compared to patients without lower extremity vascular injury. Multivariate logistic regression analysis was performed to identify independent predictors of vascular injury. RESULTS: Two hundred seventy-four patients were identified. The mean age was 37.2 ± 17.6 years, and 73.7% were male. The most common mechanisms were auto versus pedestrian/bicycle (44.2%) and motor vehicle accidents (27.7%). Twenty-two patients (8.0%) had vascular injuries, of which the most commonly injured arteries were the anterior tibial artery (8, 36.4%) and the posterior tibial artery (8, 36.4%). Patients with vascular injuries were more likely to have a tibia-fibula fracture (90.9% vs 52.4%, P < 0.01), an open fracture (63.6% vs 21.8%, P < 0.01), and a mid-shaft fracture (59.1% vs 19.4%, P < 0.01). Amputation was required in 3 patients (13.6%) with a vascular injury. On multivariate analysis, a tibia-fibula fracture (odds ratio [OR] = 5.48, 95% confidence interval [CI] = 1.15-26.1, P < 0.05), an open fracture (OR = 3.87, 95% CI = 1.37-11.0, P = 0.01), and mid-shaft fracture (OR = 2.91, 95% CI = 1.04-8.1, P < 0.05) were associated with the presence of a vascular injury. CONCLUSIONS: Open tibia-fibula fractures particularly those involving a mid-shaft location are independent predictors of vascular injuries in patients with blunt lower extremity fracture. These findings may help identify patients requiring diagnostic and surgical intervention.


Assuntos
Fíbula/lesões , Traumatismos da Perna/etiologia , Extremidade Inferior/irrigação sanguínea , Fraturas da Tíbia/etiologia , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/etiologia , Adulto , Amputação , Feminino , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Fixação de Fratura , Humanos , Traumatismos da Perna/diagnóstico por imagem , Traumatismos da Perna/cirurgia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia , Adulto Jovem
16.
Osteoporos Int ; 30(2): 519-523, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30171299

RESUMO

Denosumab, a novel agent that inhibits osteoclasts, reduces the risk of fracture in patients with osteoporosis. However, worsening of hypophosphatemia and other symptoms may be induced by denosumab in patients with pre-existing hypophosphatemic osteomalacia. A 58-year-old man with hepatitis B presented with diffuse bone pain and muscle weakness. Denosumab was prescribed by the orthopedist according to documented low bone mass and spine compression fracture. After administering denosumab, the patient's bone pain worsened, and he later developed a right tibia stress fracture. His condition was diagnosed as adult-onset hypophosphatemic osteomalacia complicated by multiple bone fractures, which resulted from Fanconi syndrome with proximal tubulopathy due to tenofovir disoproxil fumarate (TDF) treatment for his hepatitis B. Denosumab use leads to aggressive hypophosphatemic osteomalacia and the complication of stress fractures, because of its effects on bone resorption. Physicians should be aware that in patients with chronic hepatitis B monoinfection who are administered TDF therapy, bone pain or fracture is possible but preventable by timely monitoring of serum phosphate levels. Denosumab should not be used in patients with untreated osteomalacia or vitamin D deficiency, as it may lead not only to hypocalcemia but also to hypophosphatemia in these patients.


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Denosumab/efeitos adversos , Síndrome de Fanconi/induzido quimicamente , Hipofosfatemia/induzido quimicamente , Osteomalacia/tratamento farmacológico , Antivirais/efeitos adversos , Antivirais/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Denosumab/uso terapêutico , Síndrome de Fanconi/complicações , Fraturas de Estresse/diagnóstico por imagem , Fraturas de Estresse/etiologia , Hepatite B Crônica/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Osteomalacia/diagnóstico por imagem , Radiografia , Cintilografia , Tenofovir/efeitos adversos , Tenofovir/uso terapêutico , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/etiologia , Tomografia Computadorizada por Raios X
18.
Knee ; 25(6): 988-996, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30377023

RESUMO

BACKGROUND: Tibial plateau fracture is an important complication of cementless Oxford unicompartmental knee replacement. The press fit between the keel and the bone's keel slot is responsible for primary fixation and also contributes to fracture risk. This study investigates whether the fracture risk could be reduced without compromising primary fixation, by using different instruments to widen the keel slot. METHODS: Keel slots were made in polyurethane blocks (n = 60) using the standard keel cut saw blade or a new blade that was 0.2 mm wider, with adjuvant use of the cemented pick or a prototype rasp. A tibial component was pushed into and pulled out of the slots using a Dartec materials testing machine. It was assumed that the 'push-in' force was related to the risk of fracture and 'pull-out' force was related to fixation. Reproducibility studies with 10 different tibial components were undertaken. RESULTS: The new blade required significantly lower push-in forces than the standard blade (789 N SD 130, 1411 N SD 180; P < 0.001), but the pull-out forces were not different (240 N SD 47, 230 N SD 56; P > 0.999). With the standard blade the pick decreased the push-in (818 N SD 318; P < 0.001) and pull-out (128 N SD 58; P < 0.001) forces, but the rasp had no effect. With the new blade the pick had no effect, but the rasp increased the push-in force (1390 N SD 202; P < 0.001). CONCLUSIONS: This study suggests the fracture risk will be reduced with the new blades, with no compromise in fixation. If the new blades are used routine use of the cemented pick appears to be of no benefit.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho/efeitos adversos , Fraturas da Tíbia/prevenção & controle , Artroplastia do Joelho/efeitos adversos , Cimentos para Ossos , Humanos , Modelos Anatômicos , Poliuretanos , Desenho de Prótese/métodos , Reprodutibilidade dos Testes , Tíbia/cirurgia , Fraturas da Tíbia/etiologia
19.
BMC Musculoskelet Disord ; 19(1): 323, 2018 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-30200931

RESUMO

BACKGROUND: Periprosthetic fractures after total knee arthroplasty (TKA) are an increasing problem and challenging to treat. The tibial side is commonly less affected than the femoral side wherefore few studies and case reports are available. The aim of this study was to analyze the outcome of periprosthetic tibial fractures and compare our data with current literature. METHODS: All periprosthetic tibial TKA fractures that were treated at our Level 1 Trauma Center between 2011 and 2015 were included and analyzed consecutively. The Felix classification was used to assess the fracture type and evaluation included the radiological and clinical outcome (Knee Society Score/KSS, Oxford Knee Score/OKS). RESULTS: From a total of 50 periprosthetic TKA fractures, 9 cases (7 female, 2 male; 2 cruciate retaining, 7 constrained TKAs) involving the tibial side were identified. The mean age in this group was 77 (65-85) years with a follow-up rate of 67% after a mean of 22 (0-36) months. The Felix classification showed type IB (n = 1), type IIB (n = 2), type IIIA (n = 4) and type IIIB (n = 2) and surgical intervention included ORIF (n = 6), revision arthroplasty (n = 1), arthrodesis (n = 1) and amputation (n = 1). The rate of adverse events and revision was 55.6% including impaired wound healing, infection and re-fracture respectively peri-implant fracture. Main revision surgery included soft tissue surgery, arthrodesis, amputation and re-osteosynthesis. The clinical outcome showed a mean OKS of 29 (19-39) points and a functional/knee KSS of 53 (40-70)/41 (17-72) points. Radiological analyses showed 4 cases of malalignment after reduction and plate fixation. CONCLUSIONS: Periprosthetic tibial fractures predominantly affect elderly patients with a reduced bone quality and reveal a high complication rate. Careful operative planning with individual solutions respecting the individual patient condition is crucial. If ORIF with a plate is considered, restoration of the correct alignment and careful soft tissue management including minimal invasive procedures seem important factors for the postoperative outcome.


Assuntos
Artroplastia do Joelho/efeitos adversos , Fraturas Periprotéticas/etiologia , Fraturas da Tíbia/etiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/instrumentação , Feminino , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Prótese do Joelho , Masculino , Fraturas Periprotéticas/diagnóstico por imagem , Fraturas Periprotéticas/cirurgia , Fatores de Risco , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
20.
J Am Acad Orthop Surg ; 26(20): e426-e433, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30113345

RESUMO

With recent design modifications, proper patient selection, and sound surgical technique, medial unicompartmental knee arthroplasty has demonstrated long-term success in the management of degenerative joint disease. Nevertheless, complications do occur, most often aseptic loosening, tibial fracture, polyethylene wear, bearing dislocation, disease progression, infection, and unexplained pain. Some failures can be managed with retention of the implant, whereas others require revision to total knee arthroplasty (TKA), possibly including augments and stems. Although outcomes of unicompartmental knee arthroplasty may not match those of a primary TKA, they tend to exceed results of revision of a previous TKA.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Dor Crônica/etiologia , Progressão da Doença , Humanos , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Seleção de Pacientes , Polietileno , Complicações Pós-Operatórias , Desenho de Prótese , Falha de Prótese , Infecções Relacionadas à Prótese/etiologia , Reoperação , Fraturas da Tíbia/etiologia , Falha de Tratamento
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