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1.
Bone Joint J ; 101-B(10): 1300-1306, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564159

RESUMO

AIMS: The primary aim of this study was to develop a reliable, effective radiological score to assess the healing of humeral shaft fractures, the Radiographic Union Score for HUmeral fractures (RUSHU). The secondary aim was to assess whether the six-week RUSHU was predictive of nonunion at six months after the injury. PATIENTS AND METHODS: Initially, 20 patients with radiographs six weeks following a humeral shaft fracture were selected at random from a trauma database and scored by three observers, based on the Radiographic Union Scale for Tibial fractures system. After refinement of the RUSHU criteria, a second group of 60 patients with radiographs six weeks after injury, 40 with fractures that united and 20 with fractures that developed nonunion, were scored by two blinded observers. RESULTS: After refinement, the interobserver intraclass correlation coefficient (ICC) was 0.79 (95% confidence interval (CI) 0.67 to 0.87), indicating substantial agreement. At six weeks after injury, patients whose fractures united had a significantly higher median score than those who developed nonunion (10 vs 7; p < 0.001). A receiver operating characteristic curve determined that a RUSHU cut-off of < 8 was predictive of nonunion (area under the curve = 0.84, 95% CI 0.74 to 0.94). The sensitivity was 75% and specificity 80% with a positive predictive value (PPV) of 65% and a negative predictive value of 86%. Patients with a RUSHU < 8 (n = 23) were more likely to develop nonunion than those with a RUSHU ≥ 8 (n = 37, odds ratio 12.0, 95% CI 3.4 to 42.9). Based on a PPV of 65%, if all patients with a RUSHU < 8 underwent fixation, the number of procedures needed to avoid one nonunion would be 1.5. CONCLUSION: The RUSHU is reliable and effective in identifying patients at risk of nonunion of a humeral shaft fracture at six weeks after injury. This tool requires external validation but could potentially reduce the morbidity associated with delayed treatment of an established nonunion. Cite this article: Bone Joint J 2019;101-B:1300-1306.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Radiografia/métodos , Adulto , Fatores Etários , Tratamento Conservador/métodos , Bases de Dados Factuais , Feminino , Seguimentos , Fixação de Fratura/métodos , Fraturas não Consolidadas/cirurgia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Curva ROC , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo
2.
Mymensingh Med J ; 28(3): 515-519, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391420

RESUMO

Although nonoperative treatment is indicated & successful for the majority of diaphyseal humeral fractures, nonunion is not rare condition. The prevalence of nonunion as a complication of conservative treatment has been reported to be as high as 15%. Locking compression plate combined with autogenous cancellous bone grafting can result in reliable healing of these humeral nonunion with excellent functional outcome. This prospective observational study was conducted September, 2016 to October, 2018 at National Institute of Traumatulogy & Orthopaedic Rehablitation, Dhaka & Mymensingh Medical College, Mymensingh, Bangladesh. Fifteen (15) patients with non-united humeral shaft fractures were treated by open reduction and internal fixation by LCP with autogenous cancellous bone graft. Detailed clinical conditions of all patients, duration of injury, technical difficulty with the implant, hospital stay period were recorded. Follow up period was 6 months. The patients were evaluated clinically and radiologically for outcomes. The progresses of healing as well as occurrence of complications were recorded. The modified Constant and Murley score of functional assessment was used for shoulder & elbow function. Age of the study patients was ranged 20-50 years. Maximum patients were male 12. Mode of injury were found road traffic accident 8 cases, fall from height 5 cases. Right side was injured in 9 patients. Atrophic nonunion was found in 13 patients and hypertropic in 2 patients. The mean union time was 15 weeks. Only one patient had wound infection and 2 patients had shoulder stiffness. Functional outcome which constituted 90% satisfactory results in 13 cases according to modified Constant & Murley scoring system. Union rate was 100%. Therefore, LCP fixation with autogenous cancellous bone graft is a standard treatment method for nonunion of humeral shaft fracture.


Assuntos
Placas Ósseas , Fraturas Mal-Unidas/cirurgia , Fraturas do Úmero , Úmero , Bangladesh , Humanos , Fraturas do Úmero/cirurgia , Úmero/lesões , Masculino , Estudos Prospectivos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(34): e16862, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441860

RESUMO

This study aimed to investigate the effect of auxiliary Kirschner wire (K-wire) technique in the closed reduction of children with Gartland type III supracondylar humerus fractures by comparing with manual reduction alone.Retrospective analysis was performed on the clinical data of 68 cases of supracondylar humerus fractures. Thirty-six patients received closed reduction and percutaneous fixation with auxiliary K-wire technique (group A). Thirty-two patients received conventional manual reduction and percutaneous pin fixation (Group B).In group A, the average operation time was 20.5 ±â€Š8.5 minutes, the average frequency of intraoperative radiographic observations was 4.3 ±â€Š1.1, the average fracture healing time was 6.2 ±â€Š1.8 weeks, and the complication rate was 3/36, 8.3%. The mean operation time was 36.1 ±â€Š10.2 minutes, the average frequency of intraoperative radiography was 8.9 + 1.7 times, the average fracture healing time was (6.1 ±â€Š1.6) weeks, and the complication rate was 2/32, 6.3%. The operation time in group A was significantly shorter than that in group B. The difference between the 2 groups was statistically significant (P = .012). The frequency of radiography in group A was significantly less than that in group B (P = .001).Compared with manual reduction, auxiliary K-wire technology can significantly shorten the operation time, reduce the radiant quantity of the surgeon, improve the efficiency of closed reduction of children with Gartland type III supracondylar humerus fractures, and reduce the risk of developing postoperative complications. And meanwhile, there is no significant effect on the imaging and functional outcomes of affected extremities, which is worthy of respect.


Assuntos
Fios Ortopédicos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Fraturas do Úmero/classificação , Fraturas do Úmero/diagnóstico por imagem , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
4.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(2): 90-98, jun. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1003016

RESUMO

Objetivo: Comunicar la eficacia del clavo endomedular recubierto con antibiótico (CERA) para erradicar la infección en la seudoartrosis infectada de húmero (SIH). Materiales y Métodos: Once pacientes (edad promedio 48 años). El tiempo entre la fractura y la cirugía fue 25 meses. El CERA se impregnó con vancomicina en 9 pacientes. El seguimiento promedio fue de 54 meses. Resultados: Se aisló S. aureus resistente a meticilina (SARM) en 5 pacientes. Todos recibieron antibióticos sistémicos por 7 semanas. El antibiótico más utilizado fue vancomicina. La mediana entre el primer tiempo quirúrgico y la reconstrucción fue 56 días (RIC 47-98). Luego del desbridamiento quirúrgico del primer tiempo, se midió el defecto óseo remanente y se lo dividió con variables dicotómicas: grupo con defectos <2 cm (7 pacientes) y grupo con defectos ≥2 cm (4 pacientes). No se observaron diferencias significativas entre la mediana de días entre el primero y segundo tiempo quirúrgico comparando el desarrollo de SARM con el de otros gérmenes (48 días [RIC 45-75] vs. 73,5 días [RIC 56-149], p = 0,2002 Mann-Whitney), ni en la proporción del tamaño del defecto óseo según el desarrollo de SARM o de otro germen (60% vs. 17%, p = 0,242 Fisher). Todos los cultivos fueron negativos y se logró la consolidación del foco fracturario, sin recurrencia de la infección. Conclusiones: El CERA es una buena opción terapéutica en el primer tiempo quirúrgico para un paciente con SIH. Se pudo controlar la infección, lo que permitió la reconstrucción secundaria de la seudoartrosis. Nivel de Evidencia: IV


Objective: To evaluate the efficiency of the antibiotic cement-coated rods (ACCR) to erradicate infections in infected nonunion of the humerus (INH). Methods: We included 11 patients with INH with a mean age of 48 years. The time from fracture to surgery was 25 months. The ACCR was impregnated with vancomycin in 9 of 11 cases. Follow-up was 54 months. Results: Methicillinresistant Staphylococcus aureus (MRSA) was isolated in 5 cases. All patients received systemic antibiotic treatment for 7 weeks. Vancomycin was the most commonly used antibiotic. Time from ACCR placement to reconstructive surgery averaged 56 days [confidence interval range (CIR) 47-98]. After debridement and implant removal, the residual deformity of the nonunion was measured with dichotomous variables and classified into two groups: group 1, <2 cm (7 patients) and group 2, ≥2 cm (4 patients). No significant differences were observed between the number of days from placement of the ACCR to the development of the MRSA infection, compared to other pathogens [48 days (CIR 45-75) vs. 73 days (CIR 56-149) p=0.2002, Mann-Whitney U test], nor were differences observed in the size of the defect in those who developed MRSA or by any other pathogen (p=0.242, Fisher exact test). Reconstruction was performed with different techniques. Laboratory parameters were normal and cultures were negative. Fractures achieved consolidation without recurrence of the infection. Conclusions: ACCRs are an adequate treatment option for patients with an INH. The infection was controlled in all cases, which allowed for the secondary reconstruction of the nonunion. Level of Evidence: IV


Assuntos
Adulto , Pessoa de Meia-Idade , Pseudoartrose , Fixação Intramedular de Fraturas/métodos , Fraturas do Úmero/cirurgia , Infecção , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(25): e15915, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232924

RESUMO

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


Assuntos
Articulação do Cotovelo/lesões , Fraturas do Úmero/diagnóstico , Fraturas Intra-Articulares/diagnóstico , Luxações Articulares/diagnóstico , Ulna/lesões , Acidentes por Quedas , Pré-Escolar , Diagnóstico Diferencial , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Imagem por Ressonância Magnética , Masculino , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X
6.
Orthop Clin North Am ; 50(3): 297-304, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31084831

RESUMO

The reamer-irrigator-aspirator (RIA) autograft provides large volumes of autogenous graft that exhibit excellent osteogenic, osteoinductive, and osteoconductive properties. These features, combined with the relative ease of graft harvest and low donor site morbidity when compared with the gold standard iliac crest bone graft (ICBG), have made RIA autograft a viable alternative to ICBG. Some suggest RIA autograft is superior to ICBG, particularly in the setting of large segmental bone defects managed with the induced membrane technique. Although significant complications such as fracture and cortical perforation have been reported, they are preventable if proper surgical strategy and tactics are used.


Assuntos
Transplante Ósseo/instrumentação , Fixação Intramedular de Fraturas/instrumentação , Fraturas não Consolidadas/cirurgia , Coleta de Tecidos e Órgãos/instrumentação , Adulto , Transplante Ósseo/métodos , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Fraturas Múltiplas/diagnóstico por imagem , Fraturas Múltiplas/cirurgia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Coleta de Tecidos e Órgãos/métodos , Transplante Autólogo
7.
Mymensingh Med J ; 28(2): 291-297, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086140

RESUMO

Distal third comminuted humerus shaft fractures are challenging injuries to treat because of complex anatomy and fracture patterns. Functional bracing, operative treatment with intramedullary nails or conventional plates also has limitation of inadequate fixation in the distal third comminuted humerus shaft fractures. Locking compression plate (LCP) has been introduced to overcome this problem. Our aim of this study was to assess the effectiveness of osteosynthesis of distal third comminuted humerus shaft fractures by LCP using posterior approach. This prospective observational study was conducted from July 2015 to June 2018 at Mymensingh Medical College Hospital (MMCH) and National Institute of Traumatulogy & Orthopaedic Rehablitation (NITOR), Dhaka, Bangladesh. Thirty three patients were operated on for comminuted fractures of distal third humerus. Two cases were excluded from the evaluation of final out come due to their discontinued follow up. Treatment included open reduction and LCP fixation by posterior mid line approach. The range of motion of the shoulder and elbow were evaluated according to the criteria by modified Constant and Murley scoring system. Union was achieved in all the patients after a mean of 17 weeks (range 12-24 weeks). Deep infection, nonunion, malunion, implant failure or permanent nerve injury did not occur in any of the patients. Three patients had transient radial nerve palsy. Four patients developed superficial infections. All patients were relieved pain postoperatively. Shoulder range of motion was excellent in 20 patients & elbow range of motion was excellent in 21 patients. Functional out come were excellent in 11 & good in 16 patients which constituted 87% satisfactory results. Treatment with open reduction and LCP fixation by posterior approach is a safe and effective option in distal third comminuted humeral fractures.


Assuntos
Fixação Intramedular de Fraturas/instrumentação , Fraturas Cominutivas/cirurgia , Fraturas do Úmero/cirurgia , Redução Aberta/métodos , Bangladesh , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Humanos , Úmero , Estudos Prospectivos , Recuperação de Função Fisiológica , Resultado do Tratamento
9.
J Hand Surg Asian Pac Vol ; 24(2): 247-250, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31035886

RESUMO

We encountered a case of capitellum fracture with radial head dislocation in which it was challenging to diagnose whether the dislocation was coincident with the fracture or this was chronic dislocation that presented before the fracture. Chronic radial head dislocation may be congenital or could occur in patients with untreated post-traumatic dislocation, although diagnosis is particularly challenging if the radial head dislocation is unilateral. Classical capitellum fracture involves anterosuperior bone fragment dislocation. However, in the present case, the bone fragment was present beneath the radial head, which suggests chronic radial head dislocation. When the bone fragment appears in a different position than usual, every effort should be made to understand the pathophysiology by reviewing the mechanism of onset, disease history, and imaging.


Assuntos
Articulação do Cotovelo/cirurgia , Fraturas do Úmero/cirurgia , Luxações Articulares/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/diagnóstico por imagem , Imagem Tridimensional , Luxações Articulares/diagnóstico por imagem , Masculino , Redução Aberta , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Acta Chir Orthop Traumatol Cech ; 86(2): 147-152, 2019.
Artigo em Eslovaco | MEDLINE | ID: mdl-31070575

RESUMO

PURPOSE OF THE STUDY The standard procedure in treating distal humerus fractures is the open reduction internal fixation (ORIF). The surgical approach is still a matter of discussion. The submitted study focuses on comparing the conventional approach with olecranon osteotomy and the paratricipital approach. MATERIAL AND METHODS Since January 2015 a total of 18 patients have been operated on, who met the inclusion criteria of the study on type C distal humerus fracture without the use of olecranon osteotomy. This group of patients was subsequently compared with a control group of patients in whom the olecranon osteotomy was performed in the period 2010-2015. The patients were assessed using the Mayo Elbow Performance Score (MEPS), the range of motion and complications, including the need for removal of osteosynthesis material. RESULTS The control group (Group 1), in which 22 patients operated directly by olecranon osteotomy were assessed, was compared with the group of operated patients (Group 2) consisting of 18 patients. When comparing the range of motion and MEPS, no significant difference was found between the groups (flexion: p = 0.519, extension: p = 0.382, MEPS: p = 0.110). Unlike Group 2, in Group 1 the osteosynthesis material of cerclage was removed in 13 cases. DISCUSSION Apart from the complexity of fracture and choice of fixation technique, it is the choice of surgical approach which constitutes another factor having effect on the final elbow function. Basically, the approaches to distal humerus can be divided into 4 groups, namely splitting, reflecting and sparing approaches and olecranon osteotomy which offers the best access to the fracture during fixation and which is recommended by many experts in treating these complex fractures which, however, has its disadvantages such as longer duration of surgery, longer healing time, non-union or malunion, protruding osteosynthesis material and secondary procedures necessary to remove the material. CONCLUSIONS In our study no significant difference in functional outcomes was found between the examined approaches. A difference was identified with respect to protruding material of the cerclage and soft tissue irritation with subsequent removal of osteosynthesis material after the olecranon osteotomy. Key words:distal humerus fracture, internal fixation, surgical approach, olecranon osteotomy, paratricipital approach, tricepssparing approach, triceps reflecting anconeus pedicle approach.


Assuntos
Fixação Interna de Fraturas , Fraturas do Úmero , Olécrano , Algoritmos , Humanos , Fraturas do Úmero/cirurgia , Úmero , Amplitude de Movimento Articular , Resultado do Tratamento
12.
J Am Acad Orthop Surg ; 27(8): e395-e400, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30958425

RESUMO

INTRODUCTION: Pediatric supracondylar humerus fractures are associated with a high incidence of nerve injury. Therefore, it is imperative that documentation be complete and accurate. This investigation compares orthopaedic resident history and physical (H&P) documentation of pediatric supracondylar fractures for completeness and accuracy with and without the use of an electronic medical record template. METHODS: The electronic medical record H&P documentation of 119 supracondylar humerus fractures surgically treated at a single pediatric institution was retrospectively reviewed. Templated and nontemplated groups were compared for documentation completeness and accuracy. Definitive diagnosis of a nerve palsy was made by a supervising orthopaedic attending surgeon. RESULTS: Forty-two cases had a templated H&P and 77 did not. The H&P documentation in the templated group was markedly more complete than that in the nontemplated group. However, the accuracy of the H&P documentation to identify nerve palsy was not statistically different between the two groups. Overall, the voluntary use of the orthopaedic template declined over time. CONCLUSION: Resident use of an orthopaedic template for documenting the H&P of pediatric supracondylar humerus fractures compared with nontemplated notes resulted in more complete documentation but only comparable accuracy. LEVEL OF EVIDENCE: III.


Assuntos
Confiabilidade dos Dados , Documentação , Registros Eletrônicos de Saúde , Fraturas do Úmero/cirurgia , Internato e Residência , Ortopedia/educação , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Fraturas do Úmero/complicações , Lactente , Masculino , Procedimentos Ortopédicos , Estudos Retrospectivos
13.
Zhongguo Gu Shang ; 32(4): 321-326, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31027407

RESUMO

OBJECTIVE: To investigate clinical effect of open reduction and internal fixation in treating proximal humeral fracture by using long head of biceps tendon cutted-off and re-fixation. METHODS: From January 2014 to January 2017, 50 patients with proximal humeral fractures were treated by open reduction and internal fixation. According to whether long head of biceps tendon cutted-off and re-fixation, patients were divided into control group and treatment group, 25 patients in each group. There were 13 males and 12 females with an average of (73.8±4.5) years old in control group, treated with conventional open reduction and internal fixation. There were 15 males and 10 females, with an average of (74.1±5.4) years old in treatment group, treated by using long head of biceps tendon cutted-off and re-fixation on the basis of control group. Fracture healing time and complications after operation were compared between two groups, VAS score was used to evaluate relieve degree of pain, and Neer functional score at 1, 3, 6, 12 months after operation was applied to access clinical efficacy. RESULTS: All patients were followed up for 12 to 24 months with an average of (14.5±3.6) months. There was no statistical difference in following-up between tow groups. Postoperative VAS score at 1 week between treatment group and control group were 2.92±1.10 and 5.88±0.90 respectively, and had significant difference(P<0.05). Postoperative Neer functional scores at 1 month between treatment group and control group were 77.88±5.70 and 73.68±4.90 respectively, while 85.88±5.30 and 79.88±3.90 respectively at 3 months after operation, and there were significant difference between two groups at 1 and 3 months after operation(P<0.05). There were no statistical differences in Neer functional score between two groups at 6 and 12 months after operation(P>0.05). According to postoperative Neer score at 12 months, 9 patients got excellent results, 14 moderate and 2 poor in treatment group; while 4 patients got excellent results, 18 moderate and 3 poor in control group; but there was no difference between two groups. Fracture were healed without postoperative complications between two groups. CONCLUSIONS: Open reduction internal fixation with in treating proximal humeral fracture by using long head of biceps tendon cutted-off and re-fixation could reduce pain, speed up early recovery of joint function, is worthy of further promotion.


Assuntos
Fraturas do Úmero , Fraturas do Ombro , Idoso , Placas Ósseas , Estudos de Casos e Controles , Feminino , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Fraturas do Úmero/cirurgia , Masculino , Tendões , Resultado do Tratamento
14.
Zhongguo Gu Shang ; 32(4): 350-354, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31027412

RESUMO

OBJECTIVE: To analysis clinical effects of open reduction and internal fixation in treating Gustilo type I and II patients with open distal humeral fracture. METHODS: From 2013 May to 2017 June, 24 patient with Gustilo grade I and II open distal humeral fractures were treated with open reduction and internal fixation, including 20 males and 4 females, aged from 14 to 65 years old with an average of (41.3±13.1) years old. According to Gustilo classification, 16 patients were type I, 8 patients were typeII. Range of motion, complications and secondary surgery were recorded; elbow function were evaluated with VAS (visual analogue scale), MEPS (Mayo elbow performance score) and QuickDASH (quick disabilities of the arm, shoulder, and hand) at 12 months after operation. RESULTS: All patients were followed up from 15 to 60 years with an average of (34.1±11.9) months. VAS score was 0(0, 2); flexion and extension ranged from 50 °to 145° with an average of (115.2±26.1)°; the range of rotation ranged from 100° to 160° with an average of (147.7±17.0)°. MEPS score was for 75 to 90 (90.0±9.1), and 14 patients got excellent result, 10 patients moderate. Quick DASH score was 4.6(0, 14.8). There were 22 patients occurred complications, such as ulnar nerve symptom and internal fixation irritation, and 10 patients accepted the second operation. CONCLUSIONS: Open reduction and internal fixation is a safe and efficient method in treating Gustilo type I and II patients with open distal humeral fractures, which has an advantages of good range of movement and function score.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Adolescente , Adulto , Idoso , Placas Ósseas , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Resultado do Tratamento , Adulto Jovem
15.
J Pediatr Orthop ; 39(5): 232-236, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30969252

RESUMO

BACKGROUND: The purpose of the study was to investigate whether a safety checklist could be used consistently in an academic center, and, whether its presence correlates with a decreased rate of complications, and therefore, improved overall patient safety. METHODS: Data from 3 years before and after the implementation of the checklist were compared. Prechecklist data from August 2008 through August of 2011, including all operative supracondylar humerus fractures treated at our institution, were retrospectively reviewed. Postchecklist data, from August 2011 to August 2014 were prospectively collected. Patients' charts and their imaging were all reviewed for: fracture type, nerve injury, placement of a medial pin, infection, loss of alignment, loss of fixation, and return to the operating room (OR). Patients who were within the checklist group were reviewed for checklist compliance and concordance of resident and attending-attested checklists. RESULTS: Nine hundred thirty-one operative supracondylar humerus fractures were reviewed-394 in the prechecklist group and 537 in the postchecklist group. There was no significant difference in fracture type between the prechecklist and postchecklist groups. No significant differences were found between prechecklist and postchecklist patients in regards to loss of fixation, loss of alignment, infection, or nerve injury. In the postchecklist group, the number of medial pins placed was significantly less than in the prechecklist group (P=0.0001), but this was not found to have clinical significance. In the prechecklist group, 11 patients returned to the OR for a second procedure, whereas 4 in the postchecklist group had a return to the OR. This finding was significant (P=0.015), but the returns to the OR were not related to checklist parameters. The checklist compliance of the attending physicians was 85.85% and the residents were compliant 83.11% of the time. There were documented discrepancies between resident and attending checklists in 7.38% of all total checklists. CONCLUSIONS: Our patient safety checklists are not necessarily affecting patient care in a clinically significant manner. It is important that we validate and refine these specialty-specific checklists before becoming reliant on them. LEVEL OF EVIDENCE: Level III.


Assuntos
Lista de Checagem , Assistência à Saúde/normas , Fraturas do Úmero , Segurança do Paciente , Criança , Feminino , Humanos , Fraturas do Úmero/cirurgia , Masculino , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
16.
Medicine (Baltimore) ; 98(16): e15294, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008978

RESUMO

RATIONALE: Damage control is a staged surgical approach to manage polytraumatized patients. The damage control approach comprises three steps. First, bleeding is controlled and fractures are stabilized temporarily; second, vital parameters are stabilized and the child is rewarmed in the intensive care unit; and third, the child is reoperated for definitive repair of injuries. We aimed to describe the feasibility of the damage control orthopedic approach in a child. PATIENT CONCERNS: An 8-year-old girl fell from the balcony of the 5th floor onto concrete pavement and was admitted to our accident and emergency ward in a stable cardiorespiratory state, but with gross deformity of the lower limbs, left thigh, and forearm. DIAGNOSES: The child had sustained multiple injuries with severe bilateral lung contusion, pneumothorax, fracture of first rib, liver laceration, stable spine fractures, transforaminal fracture of sacrum, pelvic ring fracture, displaced baso-cervical femoral neck fracture, displaced bilateral multifragmental growth plate fractures of both tibiae, fractures of both fibulae, displaced fracture of left forearm, and displaced supracondylar fracture of the humerus. INTERVENTION: In the initial operation, we performed closed reduction and K-wire fixation of the right tibia, closed reduction and external fixation of the left tibia, open reduction and screw osteosynthesis of the femoral neck fracture, closed reduction and K-wire fixation of the radius, and closed reduction of the supracondylar fracture. Subsequently, we transferred the girl to the pediatric intensive care unit for hemodynamic stabilization, respiratory therapy, rewarming, and treatment of crush syndrome. In a third step, 10 days after the injury, we managed the supracondylar fracture of the humerus by closed reduction and K-wire fixation. OUTCOMES: Growth arrest of the left distal tibial growth plate and osteonecrosis of the femoral head and neck, slipped capital femoris epiphysis (SCFE), and coxa vara of the right femur led to balanced leg length inequality 2 years after the injury. The lesion of the left sciatic nerve improved over time and the girl walked without walking aids and took part in school sports but avoided jumping exercises. LESSONS: We emphasize the importance of damage control principles when managing polytraumatized children.


Assuntos
Traumatismo Múltiplo/cirurgia , Acidentes por Quedas , Criança , Contusões/cirurgia , Feminino , Fraturas do Colo Femoral/cirurgia , Fíbula/lesões , Fraturas Ósseas/cirurgia , Humanos , Fraturas do Úmero/cirurgia , Lacerações/cirurgia , Fígado/lesões , Lesão Pulmonar/cirurgia , Ossos Pélvicos/lesões , Pneumotórax/cirurgia , Costelas/lesões , Sacro/lesões , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Tíbia/cirurgia
17.
BMC Infect Dis ; 19(1): 333, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014284

RESUMO

BACKGROUND: Historically Mycobacterium houstonense belongs to the unnamed third biovariant complex of the Mycobacterium fortuitum group, which are sorbitol positive. To date, there have been few reports of human infection induced by M. houstonense worldwide. CASE PRESENTATION: We describe the case of a 68-year-old man with surgical wound infection, following an open humeral fracture, caused by M. houstonense and Escherichia coli. An implant bone plate had been embedded for internal fixation during surgery on the humeral fracture previously. A week later E. coli was isolated from the skin wound secretions. Cefoperazone-sulbactam was used for treatment for two weeks but the infection was not controlled, with a subsequent risk of deep wound infection. External fixation of the fracture was then performed instead of internal fixation. Ten days later, M. houstonense was isolated from new wound secretions. M. houstonense was identified by the molecular sequencing method. The TREK Diagnostic System was used to test the susceptibility to antibiotics by the microbroth dilution method. Levofloxacin and amikacin were used for treatment according to the results of the susceptibility test and the patient's condition obviously improved. CONCLUSION: To the best of our knowledge, this is the first case in China of human surgical wound infection caused by M. houstonense following open humeral fracture. The combination of levofloxacin and amikacin was effective in the treatment of M. houstonense infection.


Assuntos
Fraturas do Úmero/cirurgia , Micobactérias não Tuberculosas/isolamento & purificação , Infecção da Ferida Cirúrgica/diagnóstico , Idoso , Amicacina/farmacologia , Amicacina/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Fixação Interna de Fraturas , Humanos , Levofloxacino/farmacologia , Levofloxacino/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Micobactérias não Tuberculosas/efeitos dos fármacos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/microbiologia
18.
Rev Assoc Med Bras (1992) ; 65(3): 355-360, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30994833

RESUMO

OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.


Assuntos
Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Úmero/lesões , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Feminino , Seguimentos , Humanos , Fraturas do Úmero/fisiopatologia , Úmero/fisiopatologia , Ilustração Médica , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(4): 436-439, 2019 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-30983190

RESUMO

Objective: To observe the effectiveness of locking compression hook plate in treatment of humeral greater tuberosity fractures. Methods: Between March 2014 and September 2017, 16 patients with isolated humeral greater tuberosity fractures were terated with open reduction and internal fixation with locking compression hook plates. There were 11 males and 5 females, with an average age of 38.4 years (range, 22-67 years). The cause of injury was falling injury in 13 cases and sport injury in 3 cases. All patients were closed fractures. Of all patients, 14 patients accompanied with shoulder joint dislocations. CT scan showed the average displacement of fragment was 12.6 mm (range, 8-21 mm) after reduction. All patients began passive functional exercise at 3 days after operation. Results: Primary healing of the incisons achieved in all patients, without complications such as infection and nerve injury. All patients were followed up 12-20 months (mean, 15.3 months). At 3 months after operation, X-ray film showed that all fractures achieved bone union, all of which met the imaging anatomical reduction standard. According to the Neer scoring criteria, 11 cases were excellent and 5 cases were good at last follow-up. One patint presented slight pain of shoulder joint and mild activity limitation, which relieved after 1 year. Conclusion: The method of open reduction and locking compression hook plate internal fixation for isolated humeral greater tuberosity fractures has advantages, such as less intraoperative hemorrhage, mild postoperative pain, firm fixation, and allowing patients to perform functional exercise earlier, which is conducive to shoulder functional recovery and obtain satisfactory effectiveness.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Fraturas Fechadas , Fraturas do Úmero , Fraturas do Ombro , Adulto , Idoso , Feminino , Humanos , Fraturas do Úmero/cirurgia , Úmero , Masculino , Pessoa de Meia-Idade , Fraturas do Ombro/cirurgia , Resultado do Tratamento , Adulto Jovem
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(4): 440-444, 2019 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-30983191

RESUMO

Objective: To investigate the feasibility and effectiveness of unexposed ulnar nerve medial elbow incision, open reduction and internal fixation of anatomical locking compression plate (LCP) for distal humerus fractures. Methods: Fourteen patients with distal humerus fracture were treated between January 2014 and June 2017. There were 5 males and 9 females, aged 18-85 years (mean, 65.5 years). The causes of injury included falling from height in 12 cases and traffic accident in 2 cases, all were closed fractures. Fractures were classified according to the AO/Association for the Study of Internal Fixation (AO/ASIF): 3 cases of type A2, 2 cases of type A3, 4 cases of type B2, 2 cases of type C1, 2 cases of type C2, and 1 case of type C3; without ulnar nerve damage. The time from injury to operation was 4-15 days, with an average of 7 days. The type B2 fractures were treated with unexposed ulnar nerve elbow medial incision and anatomic LCP internal fixation, the rest patients were all treated with unexposed ulnar nerve medial plus conventional lateral approach and bilateral LCP internal fixation. Results: The operation time was 50-140 minutes (mean, 80 minutes), and the intraoperative blood loss was 20-200 mL (mean, 70 mL). There was no blood vessels or nerve damage during operation. All incisions healed by first intension, and no incision infection occurred. All the 14 cases were followed up 9-24 months (mean, 13 months). X-ray films showed that all fractures healed within 4 months without complications such as nonunion and osteomyelitis. No ulnar nerve injury, cubitus varus deformity, and ossifying myositis occurred during follow-up. At last follow-up, the elbow function was assessed by Mayo Elbow Performance score (MEPS), the results were excellent in 8 cases, good in 4 cases, fair in 1 case, and poor in 1 case (type C3 fracture), with the excellent and good rate of 85.7%. Conclusion: The unexposed ulnar nerve medial elbow incision can be used effectively to reduct the fracture, and it is not prone to ulnar nerve injury. Combined with the lateral approach to treat the distal humerus fracture, which has the advantages of short operation time, few trauma, little bleeding, and reliable effectiveness.


Assuntos
Placas Ósseas , Cotovelo , Fixação Interna de Fraturas , Fraturas do Úmero , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Fraturas do Úmero/cirurgia , Úmero , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Nervo Ulnar , Adulto Jovem
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