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1.
Medicine (Baltimore) ; 99(35): e22001, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871954

RESUMO

In adolescent patients, cannulated lag screw (CLS) is a widely accepted choice for fixation of the medial epicondylar fracture of the humerus (MEFH). Absorbable implants, including rod, screw, and mini-plate, have been reported in children. However, to the best of our understanding, this study is the first head-to-head comparative study of CLS versus bioabsorbable screw (BS) in the treatment of MEFH.Patients of MEFH operated at our institute, from January 2010 to January 2016, were reviewed retrospectively. The patients were divided into 2 groups, the CLS group and the BS group, as per the type of implant the patient received. The CLS group consisted of 35 patients, whereas the BS group consisted of 30 patients. Demographic data, including sex, age at the time of surgery, operated side, and implant material, were collected from the hospital database. Elbow range of motion (ROM), radiographic manifestation was recorded during the out-patient visit. The elbow joint function was evaluated according to the Broberg and Morrey elbow scale and Mayo elbow performance index score.Thirty patients, including 18 males and 12 females, were included in the CLS group, whereas 35 patients, including 21 males and 14 females, were included in the BS group. At 6-month follow-up, elbow range of motion, Broberg and Morrey elbow scale and Mayo elbow performance index scale showed no significant difference between the 2 groups. The carrying angle was within the normal range in both groups. There was no nonunion or malunion in either group. The rate of hypoplasia or hyperplasia was low in both groups, 3.3% in CLS and 2.9% in BS. The rate of implant prominence was significantly higher in the CLS group (33.3%) than BS (0%).Both CLS and BS are safe and effective choices for displaced MEFH in adolescents. The BS can produce a satisfactory clinical outcome and is comparable to the CLS. Besides, the BS has the advantage of not needing second surgery for implant removal.


Assuntos
Implantes Absorvíveis , Parafusos Ósseos , Articulação do Cotovelo/lesões , Fixação de Fratura/instrumentação , Fraturas do Úmero/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 99(33): e21696, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872043

RESUMO

INTRODUCTION: Lateral condylar fracture (LCF) of the humerus in children is one of the commonest elbow injuries in children. Early recognition of the problem and appropriate management usually yields satisfactory outcomes. Closed or open reduction with Kirschner-wire (KW) is a cost-effective choice of fixation method for displaced fracture. However, various other methods, including partially threaded cannulated cancellous screw and biodegradable pin (BP), have also been used. This study aimed to investigate the efficacy of BP and compare its clinical outcomes with KW. MATERIAL AND METHODS: Patients with LCF admitted from January 2008 to January 2016 at our institute were reviewed retrospectively. Baseline information and clinical data were collected from Hospital Database. Patients were divided into the KW group and BP group. RESULTS: In all, 85 patients (male 50, female 35) in the KW group and 76 patients (male 47, female 29) in the BP group were included in this study. The average age of patients in the KW group was 5.2 years, and that of BP was 5.9 years. No nonunion or malunion was observed in either group. At the last follow-up visit, there was no statistically significant difference between the 2 groups with regard to elbow function and appearance. The incidence of long-term complications, including avascular necrosis, fishtail deformity, and lateral prominence, showed no significant difference between both the groups. The incidence of hardware prominence was higher in the KW (13/85, 15.6%) than BP (2/76, 2.6%) group (P < .001). CONCLUSIONS: Both KW and BP are safe and effective choices for LCF of the humerus in children. Both the implant designs produce satisfactory and comparable clinical outcomes. However, BP has the advantage of less hardware prominence, no need for hardware removal, and fewer long-term complications.


Assuntos
Implantes Absorvíveis , Fios Ortopédicos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Criança , Pré-Escolar , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Fraturas do Úmero/diagnóstico por imagem , Masculino , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 99(31): e21481, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756174

RESUMO

RATIONALE: Severe bone defect could often occur after removing the fractured fixation plates of comminuted fracture in the distal humerus. The reoperation of internal fixation or conventional total elbow arthroplasty could hardly restore the anatomy structure and function of the elbow. However, a novel exploration of 3-dimensional (3D) printed personalized elbow prosthesis was presented in this work. This is a rare and successful treatment for the severe bone defect after removing the fractured fixation plates of comminuted distal humerus fracture. PATIENT CONCERNS: A 60-year-old male patient was admitted to the hospital with the chief complaint of right elbow joint pain and limitation of motion for 10 years. He suffered from an open reduction with internal fixation surgery 10 years ago due to a fall injury-induced right distal humerus fracture. DIAGNOSES: Plain radiographs and computed tomography scan revealed fracture lines, fracture displacement, and fixator breakage in the right distal humerus. Pain, swelling, and limitation of motion could be found in the physical examination. Fixation failure and nonunion after internal fixation of comminuted distal humerus fracture were considered. INTERVENTIONS: The patient was treated with 3D printed personalized TEA and functional rehabilitation exercises. OUTCOMES: No severe complications were observed during the 36 months follow-up. The patient could complete the daily activities without pain. The hospital for special surgery score increased from 15 points before surgery to 90 points 36 months after surgery. LESSONS: The 3D printed personalized prosthesis could successfully reconstruct the anatomical structures and function of the elbow joint with a severe bone defect. The 3D printed personalized total elbow arthroplasty might provide a feasible method for treating the complex elbow joint diseases in the elderly.


Assuntos
Artroplastia de Substituição do Cotovelo/instrumentação , Prótese de Cotovelo , Fraturas Cominutivas/cirurgia , Fraturas do Úmero/cirurgia , Impressão Tridimensional , Reoperação/instrumentação , Artroplastia de Substituição do Cotovelo/métodos , Placas Ósseas/efeitos adversos , Cotovelo/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta/efeitos adversos , Reoperação/métodos , Resultado do Tratamento
4.
J Pediatr Orthop ; 40(8): e690-e696, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32776771

RESUMO

PURPOSE: The debate on the treatment of type IIa supracondylar humerus fractures has yet to be resolved. The purpose of this study was to assess the factors associated with successful closed reduction and immobilization and to assess the efficacy of a novel radiographic "hourglass" angle measurement in the management of type IIa supracondylar humerus fractures within the pediatric population. METHODS: An institutional review board-approved retrospective review of all children who underwent closed reduction and casting or splinting of an isolated type IIa supracondylar humerus fractures treated at 2 pediatric hospitals from January 1, 2009 to August 31, 2016. Analyzed radiographic parameters included Baumann angle (BA), humerocondylar angle (HCA), perpendicular distance (PD) from the anterior humeral line to the capitellum, and the hourglass angle (HGA). These parameters were measured on injury radiographs (XR), postreduction XR, and at the first and final follow-up XR. The success of closed reduction was defined as maintenance of an acceptable reduction without a secondary procedure. The interobserver reliability was calculated. RESULTS: There were 77 elbows treated with closed reduction and long-arm cast or splint immobilization. Of those closed reductions, 76.62% of elbows (59/77) maintained their reduction alignment and did not require surgical treatment for percutaneous pinning. In this series, the BA was not significantly different following closed reduction ([INCREMENT]1.04 degrees; P=0.081); however, the PD ([INCREMENT]1.89 mm), HGA ([INCREMENT]7.38 degrees), and HCA ([INCREMENT]5.07 degrees) had significant improvement following closed reduction (P<0.001 for all). The use of procedural sedation during reduction was strongly associated with success, 83.05% (49/59) with sedation compared with 55.56% (10/18) success without sedation (P=0.025). Furthermore, fractures that underwent a secondary procedure had 6.20 degrees less HGA following a closed reduction (P=0.016) and required additional follow-up visits (P=0.0037). The success of type IIa supracondylar humerus fractures did not significantly differ based on sex (P=0.5684), laterality (P=0.6975), mechanism of injury (P>0.9999), location of care-emergency department versus clinic (P=0.1160), or type of fracture immobilization (P=0.7411). The mean HGA in normal elbows was 177.8 degrees. The interobserver reliability for HCA was poor [intraclass correlation coefficient (ICC)=0.342]; fair for BA (ICC=0.458); and excellent for both PD and HGA (ICC=0.769 and 0.805, respectively) (P<0.001 for all). CONCLUSIONS: Improved and acceptable radiographic parameters were achieved by a closed reduction in the majority of minimally displaced type IIa fractures treated by closed reduction and immobilization in this series. HCA upon presentation was significantly greater in successful cases, and failure to improve and maintain HGA and PD following closed reduction was associated with loss of reduction. Procedural sedation during reduction was strongly associated with success. The HGA and PD were consistent parameters used to determine effective management of type IIa fractures. This study adds support for a nonoperative closed reduction under sedation with immobilization of selected type IIa supracondylar humerus fractures.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Úmero , Úmero , Criança , Cotovelo/cirurgia , Feminino , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Humanos , Fraturas do Úmero/diagnóstico , Fraturas do Úmero/cirurgia , Úmero/diagnóstico por imagem , Úmero/cirurgia , Masculino , Radiografia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
5.
J Bone Joint Surg Am ; 102(13): e66, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618914

RESUMO

BACKGROUND: Closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures is one of the most common procedures performed in pediatric orthopaedics. The use of full, standard preparation and draping with standard personal protective equipment (PPE) may not be necessary during this procedure. This is of particular interest in the current climate as we face unprecedented PPE shortages due to the current COVID-19 pandemic. METHODS: This is a retrospective chart review of 1,270 patients treated with CRPP of a supracondylar humeral fracture at 2 metropolitan pediatric centers by 10 fellowship-trained pediatric orthopaedic surgeons. One surgeon in the group did not wear a mask when performing CRPP of supracondylar humeral fractures, and multiple surgeons in the group utilized a semisterile preparation technique (no sterile gown or drapes). Infectious outcomes were compared between 2 groups: full sterile preparation and semisterile preparation. We additionally analyzed a subgroup of patients who had semisterile preparation without surgeon mask use. Hospital cost data were used to estimate annual cost savings with the adoption of the semisterile technique. RESULTS: In this study, 1,270 patients who underwent CRPP of a supracondylar humeral fracture and met inclusion criteria were identified. There were 3 deep infections (0.24%). These infections all occurred in the group using full sterile preparation and surgical masks. No clinically relevant pin-track infections were noted. There were no known surgeon occupational exposures to bodily fluid. It is estimated that national adoption of this technique in the United States could save between 18,612 and 22,162 gowns and masks with costs savings of $3.7 million to $4.4 million annually. CONCLUSIONS: We currently face critical shortages of PPE due to the COVID-19 pandemic. Data from this large series suggest that a semisterile technique during CRPP of supracondylar humeral fractures is a safe practice. We anticipate that this could preserve approximately 20,000 gowns and masks in the United States over the next year. Physicians are encouraged to reevaluate their daily practice to identify safe opportunities for resource preservation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Infecções por Coronavirus , Fixação de Fratura/normas , Alocação de Recursos para a Atenção à Saúde/organização & administração , Fraturas do Úmero/cirurgia , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral , Infecção da Ferida Cirúrgica/prevenção & controle , Betacoronavirus , Pinos Ortopédicos , Criança , Pré-Escolar , Redução Fechada/efeitos adversos , Redução Fechada/normas , Feminino , Fixação de Fratura/efeitos adversos , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/métodos , Humanos , Controle de Infecções/economia , Controle de Infecções/normas , Masculino , Equipamento de Proteção Individual/economia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Estados Unidos/epidemiologia
6.
Medicine (Baltimore) ; 99(21): e20015, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481269

RESUMO

The purpose of this study is to define the rate of implant failure and risk factors for failure in patients treated operatively for displaced medial epicondyle fractures.Patients <18 years of age with medial epicondyle humerus fractures that were treated with screw or k-wire fixation between 2005 and 2015 were eligible. Inclusion criteria included follow-up until radiographic union and no known medical conditions that could impair healing.Thirty four patients with 35 fractures were identified with an average age of 12 years old. 11.4% (n = 4/35) of fractures were treated using K-wires, 25.7% (n = 9/35) were treated using a screw and washer construction, and 62.9% (n = 22/35) were treated using screw alone. There were 16 reported complications (46%) including implant prominence requiring reoperation (6), implant failure (1), and fracture displacement (1). Other complications included non-union/delayed union (4), new ulnar nerve palsy (2), and decreased range of motion (2). Rates of complications were not different between the types of fixation (P = 1.0). Those who developed complications were younger than those who did not (P = 0.05). 91.4% of patients returned to full activity including weight bearing and throwing sports.Although 25% of patients experienced implant complications and the overall complication rate approached 50%, nearly all reported return to full activity.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas do Úmero/cirurgia , Complicações Pós-Operatórias/etiologia , Adolescente , Parafusos Ósseos/efeitos adversos , Fios Ortopédicos/efeitos adversos , Criança , Falha de Equipamento , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 99(23): e19602, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501964

RESUMO

OBJECTIVE: To compare the clinical outcomes of perpendicular and parallel plating for the treatment of distal humerus fractures. METHODS: Two investigators independently searched PubMed, OVID, and ScienceDirect databases prior to April 2019, without any limitations on language or publication status. The outcomes were union time, range of motion of elbow, Mayo Elbow Performance Score, and postoperative complications. Two authors independently performed a methodological quality and risk of bias assessment using Cochrane collaboration's tool. Data analysis was performed with STATA version 13.0. RESULTS: Six randomized controlled trials with 305 participants were included. The present meta-analysis indicated that orthogonal plating was associated with a longer union time compared with parallel plating. There were no significant differences between the 2 groups regarding Elbow function, Mayo Elbow Performance Score, operation time, reduction quality, or postoperative complications. CONCLUSION: Both parallel plating and orthogonal plating are considered to be effective methods when treating distal humerus fractures. The results of this study found that parallel plating is superior to orthogonal plating in humerus fracture healing.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Placas Ósseas , Consolidação da Fratura , Humanos , Duração da Cirurgia , Complicações Pós-Operatórias , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica
8.
Bone Joint J ; 102-B(6): 755-765, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475234

RESUMO

AIMS: We aimed to evaluate the health-related quality of life (HRQoL) in children with supracondylar humeral fractures (SCHFs), who were treated following the recommendations of the Paediatric Comprehensive AO Classification, and to assess if HRQoL was associated with AO fracture classification, or fixation with a lateral external fixator compared with closed reduction and percutaneous pinning (CRPP). METHODS: We were able to follow-up on 775 patients (395 girls, 380 boys) who sustained a SCHF from 2004 to 2017. Patients completed questionnaires including the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH; primary outcome), and the Pediatric Quality of Life Inventory (PedsQL). RESULTS: An AO type I SCHF was most frequent (327 children; type II: 143; type III: 150; type IV: 155 children). All children with type I fractures were treated nonoperatively. Two children with a type II fracture, 136 with a type III fracture, and 141 children with a type IV fracture underwent CRPP. In the remaining 27 children with type III or IV fractures, a lateral external fixator was necessary for closed reduction. There were no open reductions. After a mean follow-up of 6.3 years (SD 3.7), patients with a type I fracture had a mean QuickDASH of 2.0 (SD 5.2), at a scale of 0 to 100, with lower values representing better HRQoL (type II: 2.8 (SD 10.7); type III: 3.3 (SD 8.0); type IV: 1.8 (SD 4.6)). The mean function score of the PedsQL ranged from 97.4 (SD 8.0) for type I to 96.1 (SD 9.1) for type III fractures, at a scale of 0 to 100, with higher values representing better HRQoL. CONCLUSION: In this cohort of 775 patients in whom nonoperative treatment was chosen for AO type I and II fractures and CRPP or a lateral external fixator was used in AO type III and IV fractures, there was equally excellent mid- and long-term HRQoL when assessed by the QuickDASH and PedsQL. These results indicate that the treatment protocol followed in this study is unambiguous, avoids open reductions, and is associated with excellent treatment outcomes. Cite this article: Bone Joint J 2020;102-B(6):755-765.


Assuntos
Fraturas do Úmero/classificação , Fraturas do Úmero/cirurgia , Qualidade de Vida , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Procedimentos Ortopédicos , Autorrelato
9.
J Pediatr Orthop ; 40(6): e424-e429, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501903

RESUMO

PURPOSE: Transphyseal humeral separations (TPHS) are rare injuries with only case reports and small series reported in the literature. This multicenter study aimed to assess the various patient characteristics, injury patterns, treatments, outcomes, and complications in a large series of these injuries. METHODS: A retrospective review was conducted at 5 pediatric institutions to identify TPHS that were treated surgically in patients 0 to 3 years of age over a 25-year period. Patient demographics, mechanisms of injury, Child Protective Services involvement, diagnostic modalities, time to surgery, pin size and configuration, time to fracture union, and complications were recorded. RESULTS: A total of 79 patients aged 0 to 46 months, with a mean of 17.6 months, were identified and followed for a median of 57 days postoperatively. The most common mechanism of injury was accidental trauma (n=49), followed by nonaccidental trauma (n=21), cesarean section (n=6), and vaginal delivery (n=3). Child Protective Services were involved in 30 cases (38%). Additional injuries were reported in 19 of the patients; most commonly additional fractures including the humerus, rib, and skull fractures. All patients had elbow radiographs, whereas 4 patients had an elbow ultrasound and/or a magnetic resonance imaging. Time to surgery was greater than 24 hours in 62% of patients (n=49). Intraoperatively, 87% of patients underwent an arthrogram (n=69), 78% of patients had lateral pins only (n=62), averaging utilization of 2.2 pins, and 2 patients underwent an open reduction. In total, 11 complications (14%) were noted, including decreased range of motion (n=4), cubitus varus/valgus (n=6), and need for additional surgery (n=1). No cases of avascular necrosis or physeal arrest were found. No losses of reduction were noted. CONCLUSIONS: This multicenter review provides the largest known demographic and outcomes data on TPHS. TPHS have excellent outcomes in the vast majority of patients when treated surgically. Nonaccidental trauma accounted for 27% of these injuries so it needs to remain high on the differential diagnosis. LEVEL OF EVIDENCE: Level III-retrospective cohort study.


Assuntos
Fraturas do Úmero/cirurgia , Pré-Escolar , Cotovelo/diagnóstico por imagem , Feminino , Humanos , Úmero/diagnóstico por imagem , Lactente , Recém-Nascido , Masculino , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
10.
J Pediatr Orthop ; 40(6): e430-e434, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501904

RESUMO

BACKGROUND: Recently published studies call into question the clinical utility of postoperative radiographs in the management of pediatric supracondylar humerus (SCH) fractures. This topic has been addressed as part of the American Academy of Orthopaedic Surgeons Appropriate Use Criteria, although recommendations regarding serial radiographs were not included as part of the discussion. The purpose of this systematic review is to summarize the recent literature regarding the utility of postoperative radiographs as part of the management of SCH fractures. METHODS: A systematic review of the literature published between January 1, 2000 and December 31, 2017 was conducted using PubMed/MEDLINE and SCOPUS databases to identify studies relevant to postoperative management of SCH. Eight studies met the inclusion criteria, from which data pooled estimates and an analysis of heterogeneity were calculated. RESULTS: The pooled estimate of changes in fracture management on the basis of postoperative radiographs was 1% (0.98±0.33). Significant interstudy heterogeneity was observed with an I test statistic of 76%. Changes in fracture management included prolonged immobilization following pin removal and return to the operating room. CONCLUSIONS: There is a paucity of articles focusing on the utility or appropriate use of postoperative radiographs in changing management of SCH fractures, one of the most common upper extremity fractures in children. There is a very low rate of change in management on the basis of imaging, and frequently authors commented that the management change could have been prompted without routine serial radiographs. The cumulate findings of these studies suggest routine postoperative radiographs after SCH fractures are infrequently associated with changes in management. Practitioners should consider postoperative protocols with the intention of identifying early postoperative alignment loss or when the complication is suspected to prevent excessive routine radiography in the management of pediatric SCH fractures. LEVEL OF EVIDENCE: Level III-systematic review of level III studies.


Assuntos
Fraturas do Úmero/diagnóstico por imagem , Adolescente , Pinos Ortopédicos , Criança , Pré-Escolar , Feminino , Humanos , Fraturas do Úmero/cirurgia , Úmero/diagnóstico por imagem , Lactente , Recém-Nascido , Masculino , Período Pós-Operatório , Radiografia , Estudos Retrospectivos
11.
Zhongguo Gu Shang ; 33(4): 379-82, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32351096

RESUMO

OBJECTIVE: To explore the operative method and clinical effect of lateral mini plate and Kirschner wire in the treatment of distal humeral metaphysis junction fracture in children. METHODS: From January 2015 to December 2018, 21 cases of distal humeral diaphyseal metaphyseal junction fracture were analyzed retrospectively, including 12 males and 9 females, aged 2 to 10 years with an average age of 4.5 years, and the time from injury to operation was 6 hours to 7 days. The imaging data showed that the fracture line was located at the junction of the distal humerus and metaphysis. There were 10 oblique fractures, 8 transverse fractures and 3 comminuted fractures. The operation methods were open reduction, lateral mini plate and Kirschner wire assisted internal fixation, and the improved Flynn elbow joint scoring standard was used to evaluate the clinical effect. RESULTS: All the 21 children were followed up for 8 to 24 months, with an average of 13 months. The healing time was 6 to 8 weeks, with an average of 7.2 weeks. There were no complications such as fracture displacement, cubitus varus and ulnar nerve injury. According to the improved Flynn elbow joint scoring standard, 19 cases were excellent and 2 cases were good. CONCLUSION: The treatment of distal humeral metaphyseal junction fracture in children is different from that of supracondylar fracture of humerus.


Assuntos
Fios Ortopédicos , Fraturas do Úmero , Placas Ósseas , Criança , Pré-Escolar , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/cirurgia , Úmero , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
Niger J Clin Pract ; 23(5): 647-653, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32367871

RESUMO

Background: Supracondylar humerus (SCH) fractures are serious injuries due to the neighborhood of critical neural and vascular structures. One of the most devastating complications of SCH fractures is neurological damage, since it may cause permanent disability. The aim of this study is to categorize neurological complications, to report long-term functional outcomes, and to determine risk factors associated with childhood SCH fractures. Methods: The records of 375 children were reviewed retrospectively. Data about amount and direction of displacement, the shape of the fracture, age at the time of fracture, gender, time from impaction to surgery, time of surgery, type of neurological injury, and recovery time were recorded. Results: Neurological complications were seen in 37 (9.85%) children. Thirteen (35.1%) of the children had an iatrogenic nerve injury. All iatrogenic injuries were fully recovered in this study. However, 2 children who had combined neurological injury of radial, ulnar, and median nerves did not recover. Nearly 95% of all children who had neurological injury recovered fully. An anterior long and sharp bone fragment (spike) was observed in most of the children with neurological injury, and this spike was seen in 14 (58.3%) patients who had a trauma-related injury (n = 24). Conclusion: The prognosis of these nerve injuries is excellent, especially the iatrogenic ones. A long and sharp bone fragment (spike) may be responsible for nerve injuries in some children. Surgical exploration is not necessary after an iatrogenic nerve injury when there is no neurotmesis. Patience and care are utmost needed to handle neurological complications.


Assuntos
Fraturas do Úmero/complicações , Luxações Articulares/cirurgia , Traumatismos dos Nervos Periféricos/diagnóstico , Neuropatias Ulnares/etiologia , Criança , Pré-Escolar , Feminino , Fixação de Fratura/métodos , Humanos , Fraturas do Úmero/cirurgia , Úmero/lesões , Úmero/cirurgia , Doença Iatrogênica , Luxações Articulares/diagnóstico por imagem , Masculino , Nervo Mediano/lesões , Prognóstico , Nervo Radial/lesões , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Nervo Ulnar/lesões
13.
JAMA ; 323(18): 1792-1801, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32396179

RESUMO

Importance: Humeral shaft fractures traditionally have been treated nonsurgically, but there has been a steady increase in the rate of surgery over the past 2 decades without high-quality evidence to justify the trend. Objective: To compare the effectiveness of surgical treatment with open reduction and internal plate fixation to nonsurgical treatment with functional bracing in the treatment of closed humeral shaft fractures. Design, Setting, and Participants: Randomized clinical trial conducted at 2 university hospital trauma centers in Finland, enrollment between November 2012 and January 2018 with a final follow-up of January 2019. A total of 82 adult patients with closed, unilateral, displaced humeral shaft fracture met criteria for inclusion. Patients were excluded if they had cognitive disabilities preventing them from following the protocol or had multimorbidity or multiple trauma. Interventions: Patients were randomly assigned to surgical treatment with open reduction and internal plate fixation (n = 38) or to nonsurgical treatment with functional bracing (n = 44). Main Outcome and Measure: The primary outcome was Disabilities of Arm, Shoulder and Hand (DASH) score at 12 months (range, 0 to 100 points, 0 denotes no disability and 100 extreme disability; minimal clinically important difference, 10 points). Results: Among 82 patients who were randomized (mean age, 48.9 years; 38 women [46%]; 44 men [54%]), 78 (95%) completed the trial. Thirteen (30%) of the patients assigned to functional bracing underwent surgery during the 12-month follow-up period to promote healing of the fracture. At 12 months, the mean DASH score was 8.9 (95% CI, 4.2 to 13.6) in the surgery group and 12.0 (95% CI, 7.7 to 16.4) in the bracing group (between-group difference, -3.1 points; 95% CI, -9.6 to 3.3; P = .34). Eleven patients (25%) allocated to functional bracing developed fracture nonunion. Three patients (8%) allocated to surgery developed a temporary radial nerve palsy. Conclusions and Relevance: Among patients with closed humeral shaft fracture, internal fixation surgery, compared with nonoperative functional bracing, did not significantly improve functional outcomes at 12 months. However, the substantial amount of treatment crossover from nonoperative to surgical treatment should be considered when interpreting the trial results. Trial Registration: ClinicalTrials.gov Identifier: NCT01719887.


Assuntos
Braquetes , Redução Fechada , Fixação Interna de Fraturas , Fraturas do Úmero/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Redução Fechada/efeitos adversos , Redução Fechada/métodos , Avaliação da Deficiência , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/etiologia , Humanos , Fraturas do Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Redução Aberta/métodos , Recuperação de Função Fisiológica
14.
Clin Sports Med ; 39(3): 623-636, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446579

RESUMO

The elbow joint consists of the humeroulnar, humeroradial, and proximal radioulnar joints. Elbow stability is maintained by a combination of static and dynamic constraints. Elbow fractures are challenging to treat because the articular surfaces must be restored perfectly and associated soft tissue injuries must be recognized and appropriately managed. Most elbow fractures are best treated operatively with restoration of normal bony anatomy and rigid internal fixation and repair and/or reconstruction of the collateral ligaments. Advanced imaging, improved understanding of the complex anatomy of the elbow joint, and improved fixation techniques have contributed to improved elbow fracture outcomes.


Assuntos
Articulação do Cotovelo/lesões , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Redução Aberta , Placas Ósseas , Ligamentos Colaterais/lesões , Ligamentos Colaterais/cirurgia , Articulação do Cotovelo/anatomia & histologia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Olécrano/lesões , Olécrano/cirurgia , Redução Aberta/instrumentação , Redução Aberta/métodos , Osteotomia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/cirurgia
15.
Am J Med Sci ; 360(2): 206-207, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32387118

Assuntos
Fraturas por Compressão/etiologia , Fraturas Espontâneas/etiologia , Plasmocitoma/complicações , Fraturas da Coluna Vertebral/etiologia , Neoplasias da Coluna Vertebral/complicações , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bortezomib/administração & dosagem , Descompressão Cirúrgica , Dexametasona/administração & dosagem , Progressão da Doença , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Fraturas do Úmero/etiologia , Fraturas do Úmero/cirurgia , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Laminectomia , Lenalidomida/administração & dosagem , Mieloma Múltiplo/sangue , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/tratamento farmacológico , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/patologia , Plasmocitoma/cirurgia , Tomografia por Emissão de Pósitrons , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X
16.
Medicine (Baltimore) ; 99(17): e19858, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332644

RESUMO

This study aims to evaluate the timing of surgery in surgically treated humeral shaft fractures, to investigate the effects of surgical time on fracture recovery and complications.This was a retrospective and observational study, based on patient data who underwent surgical treatment of humeral shaft fractures from January 2012 to January 2019. There were 52 patients (19 were women and 33 men) with traumatic humeral shaft fractures who were treated consecutively at our hospital.There was a statistically significant difference in time to start physical therapy, time between surgery and bone union, and time between bone fracture and bone union. The mean time to start physical therapy in group 1 was 6.5 weeks (range, 5-12 weeks), it was 10 weeks (range, 6-14 weeks) in group 2 (P < .001). The mean time between surgery and bone union in group 1 was 14.58 weeks (range, 12-20 weeks), it was 17.4 weeks (range, 8-30 weeks) in group 2 (P: .009). The mean time between bone fracture and bone union in group 1 was 113.2 days (range, 86-114 days), it was 179.2 days (range, 89-355 days) in group 2 (P < .001).Classically the first treatment option for humerus shaft fractures is conservative if there is no absolute surgical indication. Surgical treatment may be the first option if patients want to return to early everyday life. Delayed surgery means delayed physical therapy and this means delayed recovery and return to everyday life. In today's technology world, it should be discussed that the initial treatment of uncomplicated humerus shaft fractures is a conservative treatment.


Assuntos
Fraturas do Úmero/cirurgia , Tempo para o Tratamento , Adulto , Idoso , Redução Fechada/métodos , Tratamento Conservador , Feminino , Consolidação da Fratura , Humanos , Fraturas do Úmero/terapia , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Cuidados Pós-Operatórios , Recuperação de Função Fisiológica , Estudos Retrospectivos , Contenções , Adulto Jovem
17.
Medicine (Baltimore) ; 99(17): e19861, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332646

RESUMO

The best treatment for medial humeral epicondyle fractures in children has been debated. In case of incarceration of the epicondylar fragment, particularly after elbow dislocation, several materials are used for fixation, including Kirschner wires (K-wires), metallic compression screws, tension band wire, and suture anchors. Herein, we introduce a new fixation material: the absorbable self-reinforced polylactide (SR-PLA) pin.The aim of the study was to prove the feasibility of a new fixation material (absorbable SR-PLA pins) for the treatment of medial epicondyle fracture in children.Thirty-two patients who underwent surgery in our hospital from August 2007 to January 2012 were retrospectively analyzed. The patients were divided into group A (K-wires) and group B (absorbable SR-PLA pin). Group A comprised 11 males and 4 females, aged 8 to 14 years (average, 12.6 years), with 12 patients with elbow dislocation. Group B comprised 13 males and 4 females, aged 7 to 15 years (average, 11.8 years), with 13 patients with elbow dislocation. The same approach was used for all patients by the same team of surgeons, and all the patients were followed up for over 12 months. In all patients, rehabilitation training was started after 3 weeks. The Broberg and Morrey elbow scale was used to evaluate elbow function at follow-up.Four patients from group A developed pin-track infections that gradually resolved after removal of the K-wires, whereas no infections occurred in group B. One patient refractured her humerus after K-wire removal. Using the Broberg and Morrey elbow scale, outcomes in group A were classified as excellent in 5 patients (33.33%), good in 7 patients (46.67%), fair in 2 patients (13.33%), and poor in 1 (0.07%). Group B outcomes were scored as excellent in 12 patients (70.58%), good in 4 (23.53%), and fair in 1 (0.06%) and no patient (0.00%) had a poor outcome. The average Broberg and Morrey score for group A was significantly lower than that for group B (83.27 ±â€Š7.02 vs 95.21 ±â€Š5.04; P = .0238).Absorbable SR-PLA pins can be safely used for medial epicondyle fractures in children. Our results indicate that SR-PLA pins are associated with better short-term functional outcome than K-wires.Level of evidence: III.


Assuntos
Implantes Absorvíveis , Pinos Ortopédicos , Fixação Interna de Fraturas/instrumentação , Fraturas do Úmero/cirurgia , Poliésteres , Adolescente , Criança , Estudos de Viabilidade , Feminino , Seguimentos , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Recuperação de Função Fisiológica , Estudos Retrospectivos
18.
Vet Surg ; 49(4): 639-647, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32311154

RESUMO

OBJECTIVE: To report the prevalence, configuration, risk factors, fixation methods and outcomes after repair of humeral condylar fractures (HCF) in dogs. STUDY DESIGN: Retrospective nested cohort study. SAMPLE POPULATION: One hundred twelve dogs. METHODS: Medical records of dogs referred between January 2010 and August 2018 were searched for HCF. Demographics, fracture configuration, repair, and complications were obtained from medical records. Radiographs were assessed for fracture reduction, implant positioning, and bone healing. Short-term radiographic and clinical outcomes, and long-term owner-assessed outcome was determined. Associations between these variables were statistically analyzed. RESULTS: Dogs with HCF represented 112 of 43 325 (0.26%, 95% CI 0.22-0.31) referrals. French bulldogs and spaniel breeds were predisposed to HCF (P < .02). French bulldogs were 6.58 times (95% CI 1.62-26.7) more likely than other breeds to have a medial HCF (P = .008). Epicondylar plate fixation was associated with reduced complications compared with lag screws and Kirschner wires (P = .009). Lameness was scored as 1 of 5 (median) in the 85 dogs with initial follow-up (median 6 weeks) after HCF repair. Outcome was considered excellent in 26 of 31 dogs with long-term follow-up (median 36 months). CONCLUSION: French bulldogs and spaniels were predisposed to HCF, and medial HCF were more common in French bulldogs. Epicondylar plate fixation was associated with reduced complications. CLINICAL SIGNIFICANCE: French bulldogs are predisposed to HCF, including medial HCF. Epicondylar plate fixation is recommended over other epicondylar fixation methods to reduce complications.


Assuntos
Cães/cirurgia , Fixação Interna de Fraturas/veterinária , Fraturas do Úmero/veterinária , Animais , Estudos de Coortes , Cães/genética , Cães/lesões , Feminino , Fixação Interna de Fraturas/estatística & dados numéricos , Fraturas do Úmero/etiologia , Fraturas do Úmero/cirurgia , Masculino , Radiografia/veterinária , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
19.
J Hand Surg Asian Pac Vol ; 25(2): 226-231, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32312197

RESUMO

Background: Pediatric supracondylar humerus fracture (PSHF) is one of the most common fractures of the elbow seen among boys aged between 5 and 7 years. The timing of surgical treatment for this type of fracture is still controversial. Thus, we aimed to investigate whether the timing of surgery for PSHFs affects the incidence of early postoperative complications and reduction of PSHFs. Methods: We retrospectively reviewed the medical records of PSHF patients who underwent surgery at our hospital between January 2007 and March 2019. We classified patients who underwent surgery within 12 h and more than 12 h after the fracture as the early and delayed groups, respectively. The outcome measures compared between the two groups were the incidence of postoperative early complications such as neurological deficits, including iatrogenic ulnar nerve injury, vascular compromise, compartment syndrome, K-wire migration, and unplanned returns to the operating room. We also examined surgical time, reduction procedure, and perioperative radiographic parameters. Results: There was no significant difference in the incidence of early complications between the early and delayed groups for either modified Gartland type II or type III fractures. There was also no significant difference in surgical time, reduction procedure, or perioperative radiographic parameters between the two groups. Conclusions: Delayed surgery was not associated with an increased rate of postoperative early complications in either type II or type III fractures. The timing of surgery does not affect the difficulty or quality of reduction.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas do Úmero/cirurgia , Complicações Pós-Operatórias/epidemiologia , Tempo para o Tratamento , Fatores Etários , Fios Ortopédicos , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Tempo
20.
Ann R Coll Surg Engl ; 102(8): e183-e184, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32347737

RESUMO

Following open reduction and internal fixation for a proximal humerus fracture a 71-year-old man re-presented with wound changes consistent with infection and elevated inflammatory markers. No significant improvement was seen with concomitant intravenous antibiotics and multiple debridement procedures. This case was further complicated by soft tissue breakdown at the site of a left thigh haematoma also requiring debridement. Surgical site infections represent the most common cause of morbidity postoperatively. This case highlights the importance of considering a number of differential diagnoses. A diagnosis of pyoderma gangrenosum prompted systemic corticosteroid therapy giving rapid clinical improvement.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas do Úmero/cirurgia , Redução Aberta/efeitos adversos , Pioderma Gangrenoso , Idoso , Desbridamento , Diagnóstico Diferencial , Humanos , Masculino , Coxa da Perna/patologia , Coxa da Perna/cirurgia
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