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1.
Bone Joint J ; 103-B(2): 309-320, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517729

RESUMO

AIMS: The aim of this study was to determine whether fixation, as opposed to revision arthroplasty, can be safely used to treat reducible Vancouver B type fractures in association with a cemented collarless polished tapered femoral stem (the Exeter). METHODS: This retrospective cohort study assessed 152 operatively managed consecutive unilateral Vancouver B fractures involving Exeter stems; 130 were managed with open reduction and internal fixation (ORIF) and 22 with revision arthroplasty. Mean follow-up was 6.5 years (SD 2.6; 3.2 to 12.1). The primary outcome measure was revision of at least one component. Kaplan-Meier survival analysis was performed. Regression analysis was used to identify risk factors for revision following ORIF. Secondary outcomes included any reoperation, complications, blood transfusion, length of hospital stay, and mortality. RESULTS: Fractures (B1 n = 74 (49%); B2 n = 50 (33%); and B3 n = 28 (18%)) occurred at median of 4.2 years (interquartile range (IQR) 1.2 to 9.2) after primary total hip arthroplasty (THA) (n = 138) or hemiarthroplasty (n = 14). Rates of revision and reoperation were significantly higher following revision arthroplasty compared to ORIF for B2 (p = 0.001) and B3 fractures (p = 0.050). Five-year survival was significantly better following ORIF: 92% (95% confidence interval (CI) 86.4% to 97.4%) versus 63% (95% CI 41.7% to 83.3%), p < 0.001. ORIF was associated with reduced blood transfusion requirement and reoperations, but there were no differences in medical complications, hospital stay, or mortality between surgical groups. No independent predictors of revision following ORIF were identified: where the bone-cement interface was intact, fixation of B2 or B3 fractures was not associated with an increased risk of revision. CONCLUSION: When the bone-cement interface was intact and the fracture was anatomically reducible, all Vancouver B fractures around Exeter stems could be managed with fixation as opposed to revision arthroplasty. Fixation was associated with reduced need for blood transfusion and lower risk of revision surgery compared with revision arthroplasty. Cite this article: Bone Joint J 2021;103-B(2):309-320.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Redução Aberta , Fraturas Periprotéticas/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Cimentos para Ossos , Feminino , Fraturas do Fêmur/etiologia , Seguimentos , Prótese de Quadril , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Reoperação/instrumentação , Estudos Retrospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(4): e23616, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530163

RESUMO

RATIONALE: Pediatric femoral shaft combined with ipsilateral femoral neck fractures are very rare but challenging injuries fraught with the development of avascular necrosis, coxa vara, and leg length discrepancy. Majority of the previous reports indicated the neck femur fracture was fixed with cannulated screws or/and pins, femoral shaft fracture was stabilized with a plate and screws. However, we used cannulated screws combined with elastic stable intramedullary nails to minimally invasive procedures treat this type of injury and achieved good follow-up results. PATIENT CONCERNS: A 7-year-old boy (Case 1) was hospitalized due to a traffic accident resulting in swelling and deformity of the right thigh accompanied by limited mobility of hip and knee. A 5-year-old male child (Case 2) presented with pain and swelling in the bilateral lower limb after fall from approximately 12 feet. DIAGNOSES: Physical examination, X-ray film, and computed tomography were performed. Both patients were diagnosed with ipsilateral femoral neck and shaft fracture. INTERVENTIONS: The fractures were reduced closed by image-intensifier imaging. Two partially threaded cancellous screws were used to fix femoral neck fracture, and elastic intramedullary nails were performed to stable the femoral shaft fracture. Postoperatively, the patients were immobilized in a one-and-a-half hip spica cast for six weeks. The internal fixations were removed after one year. OUTCOMES: Case one was follow-up at 14 months and the other one was followed up for 3 years. And at the last follow-up showed a normal and painless hip function. No clinical complications were found during follow-up visit, including head penetration, implant failure, fracture nonunion, avascular necrosis and hip varus deformity. LESSONS: Clinician should carefully check and read relevant imaging data to avoid missed diagnosis. And the internal fixation method described in this paper may be more minimally invasive.


Assuntos
Fraturas do Fêmur/cirurgia , Fraturas do Colo Femoral/cirurgia , Colo do Fêmur/lesões , Fixação Intramedular de Fraturas/métodos , Pinos Ortopédicos , Placas Ósseas , Parafusos Ósseos , Criança , Pré-Escolar , Colo do Fêmur/cirurgia , Humanos , Masculino
3.
BMJ Case Rep ; 14(2)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33558382

RESUMO

Fracture healing has four phases: haematoma formation, soft callus, hard callus and remodelling. Often, non-healing fractures have an arrest of one of these phases, which need resurgery. We have repurposed denosumab for impaired fracture healing cases to avoid surgical intervention. Here, we report a series of three cases of impaired fracture healing where denosumab was given 120 mg subcutaneous dosages for 3 months to enhance healing. All the three cases have shown complete bone union at a mean follow-up of 6.7 months (5-9 months) as assessed clinically and radiologically, and have observed no adverse effect of the therapy. Denosumab given in this dose aids fracture healing by increasing callus volume, density and bridges the fracture gap in recalcitrant fracture healing cases where the callus fails to consolidate.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Denosumab/uso terapêutico , Consolidação da Fratura/efeitos dos fármacos , Fraturas não Consolidadas/fisiopatologia , Fraturas não Consolidadas/terapia , Adulto , Calo Ósseo/efeitos dos fármacos , Calo Ósseo/fisiologia , Fraturas do Fêmur/fisiopatologia , Fraturas do Fêmur/terapia , Fixação Interna de Fraturas , Fraturas Fechadas/fisiopatologia , Fraturas Fechadas/terapia , Humanos , Fraturas do Úmero/fisiopatologia , Fraturas do Úmero/terapia , Masculino , Pessoa de Meia-Idade , Reoperação , Adulto Jovem
4.
Instr Course Lect ; 70: 101-120, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438907

RESUMO

Femur fractures range from simple oblique or transverse fractures to complex, comminuted types. The reduction and fixation of these fractures can be challenging, with difficulty in attaining fracture alignment, length, and rotation. Added to this complexity can be associated bone loss in open fractures. Various methods and techniques have been described to achieve an acceptable reduction for fracture healing without detriment to the patient's functional outcome. This chapter describes femur fractures from the subtrochanteric to supracondylar regions with fracture reduction aids, patient position, reduction tools, and implant use including plates and nails, either individually or in conjunction. Reduction starts with closed or percutaneous techniques because these are the most biologically friendly and minimize additional iatrogenic soft-tissue injury. However, obtaining an acceptable reduction may require escalation to open techniques. This chapter is divided into sections: the first details femoral nailing and the second details femoral plating.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Pinos Ortopédicos , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fêmur , Fixação Interna de Fraturas , Humanos , Resultado do Tratamento
5.
Oper Orthop Traumatol ; 33(1): 46-54, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33501513

RESUMO

OBJECTIVE: Minimally invasive, sufficiently stable for movement and partial weight bearing, osteosythesis of pertrochanteric femoral fractures in children < 6-8 years using elastic, stable intramedullary nailing (ESIN). INDICATIONS: Proximal, pertrochanteric femoral fractures Delbet type IV in children < 6 years. CONTRAINDICATIONS: Comminuted fractures, femoral neck fractures. SURGICAL TECHNIQUE: By inserting three elastic titanium nails (TEN), prebent in the proximal third, retrograde into the femur, a stable 3­point support stabilizes the proximal fragment. For further improvement of stability, EndCaps can be used. POSTOPERATIVE MANAGEMENT: Partial weight bearing (sole-contact) for 4-5 weeks. X­ray controls immediately after surgery and after 4-5 weeks. No sports for 3 months. RESULTS: In our patient population we have good experience with this technique for very rare pertrochanteric fractures in children younger than 6-8 years. With minimally invasive access, exercise-stable administration can be achieved without a pelvic leg cast.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Pinos Ortopédicos , Criança , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Consolidação da Fratura , Humanos , Resultado do Tratamento
6.
Ann Intern Med ; 174(1): JC9, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395342

RESUMO

SOURCE CITATION: Black DM, Geiger EJ, Eastell R, et al. Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med. 2020;383:743-53. 32813950.


Assuntos
Fraturas do Fêmur , Fraturas por Osteoporose , Difosfonatos/efeitos adversos , Feminino , Fraturas do Fêmur/induzido quimicamente , Fraturas do Fêmur/epidemiologia , Fêmur , Humanos , Fraturas por Osteoporose/induzido quimicamente , Fraturas por Osteoporose/epidemiologia
7.
BMJ Case Rep ; 14(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419755

RESUMO

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease with an estimated annual incidence of 0.5-6.8 per million. It is characterised by necrotising vasculitis with multiorgan eosinophilic infiltration. Pulmonary manifestations are the most common presentation of EGPA, and cardiac complications are the most common cause of death. Anaesthetic management of EGPA is challenging due to perioperative pulmonary complications, multiorgan involvement and greater risk of cholinesterase enzyme deficiency. We are reporting the anaesthetic management of a 58-year-old woman, diagnosed with EGPA 3 years ago, who underwent urgent intramedullary nail insertion for a femur fracture. The anaesthetic technique comprised femoral nerve block and spinal anaesthesia, thereby avoiding (1) the need for upper airway manipulation, (2) potential adverse effects of anticholinesterase drugs (for reversal of neuromuscular blockade) and (3) histamine release associated with morphine administration perioperatively. Surgery and anaesthesia were uneventful.


Assuntos
Raquianestesia , Eosinofilia/complicações , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas , Granulomatose com Poliangiite/complicações , Bloqueio Nervoso , Feminino , Fraturas do Fêmur/complicações , Humanos , Pessoa de Meia-Idade
8.
Arch Osteoporos ; 16(1): 8, 2021 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-33409668

RESUMO

Treatment rates for osteoporosis after a major osteoporotic fracture are unacceptably low. We evaluate the effectiveness of an ortho-geriatric team (OGT) in initiating pharmacologic therapy for osteoporosis post-hip fracture. The OGT was able to achieve a higher treatment rate for patients post-hip fracture in comparison to usual care provided by the primary care hospitalist. Potential reasons for delaying or not proceeding with drug therapy include patient concern regarding potential rare side effects of antiresorptive therapy including osteonecrosis of the jaw and atypical femoral fracture. These events however are rare, and in this study, only 3% of hip fractures were atypical femoral fractures. INTRODUCTION: Currently, a significant care gap for osteoporosis therapy exists post-hip fracture despite advances in pharmacologic therapy. We evaluate the effectiveness of the OGT at the Oakville Trafalgar Memorial Hospital (OTMH), Ontario, Canada, in reducing the care gap and initiating pharmacologic therapy in hip fracture patients prior to hospital discharge. We also evaluated the incidence of atypical femoral fracture (AFF) separately. METHODS: A retrospective chart review of patients 59 years and older with a hip fracture admitted to OTMH from January 1, 2016, to February 1, 2017, was conducted. The primary outcome was the proportion of hip fracture patients discharged from the hospital with appropriate treatment for their underlying osteoporosis. A sub-analysis was completed reporting the incidence of AFF among older adults. RESULTS: A total of 197 patients with a hip fracture were identified, 134/197 (68%) patients were seen by the OGT, 98/134 (73%) of these patients were started on pharmacologic therapy prior to discharge, and 120/134 (89%) of patients seen by the OGT were on treatment within 3 months of discharge following assessment in the complex osteoporosis clinic. Sixty-three patients of the 197 (63/197) (32%) of the hip fracture patients were seen by a hospitalist, and treatment rates prior to discharge were 5%. Only 6/197 patients had experienced an AFF during the study period, and all patients with an atypical femoral fracture had been on long-term bisphosphonate therapy. All of the patients with an AFF had thigh or groin pain for several weeks to months prior to the development of the atypical femoral fracture, providing an opportunity to stop therapy and possibly prevent the development of a complete AFF. CONCLUSION: The OGT was able to initiate anti-osteoporosis therapy in significantly more patients in comparison to usual care, and higher treatment rates are possible with an OGT.


Assuntos
Conservadores da Densidade Óssea , Fraturas do Fêmur , Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Idoso , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos , Fraturas do Quadril/epidemiologia , Hospitais Comunitários , Humanos , Ontário , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Estudos Retrospectivos
9.
Bone Joint J ; 103-B(1): 71-78, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380191

RESUMO

AIMS: Periprosthetic fractures (PPFs) around cemented taper-slip femoral prostheses often result in a femoral component that is loose at the prosthesis-cement interface, but where the cement-bone interface remains well-fixed and bone stock is good. We aim to understand how best to classify and manage these fractures by using a modification of the Vancouver classification. METHODS: We reviewed 87 PPFs. Each was a first episode of fracture around a cemented femoral component, where surgical management consisted of revision surgery. Data regarding initial injury, intraoperative findings, and management were prospectively collected. Patient records and serial radiographs were reviewed to determine fracture classification, whether the bone cement was well fixed (B2W) or loose (B2L), and time to fracture union following treatment. RESULTS: In total, 47 B2W fractures (54.0%) and one B3 fracture (1.1%) had cement that remained well-fixed at the cement-bone interface. These cases were treated with cement-in-cement (CinC) revision arthroplasty. Overall, 43 fractures with follow-up united, and two patients sustained further fractures secondary to nonunion and required further revision surgery. A total of 19 B2L fractures (21.8%) and 19 B3 fractures (21.8%) had cement that was loose at the cement-bone interface. These cases were managed by revision arthroplasty with either cemented or uncemented femoral components, or proximal femoral arthroplasty. One case could not be classified. CONCLUSION: We endorse a modification of the original Vancouver system to include a subclassification of B2 fractures around cemented femoral prostheses to include B2W (where cement is well-fixed to bone) and B2L (where the cement is loose). Fractures around taper-slip design stems are more likely to fracture in a B2W pattern compared to fractures around composite beam design stems which are more likely to fracture in a B2L pattern. B2W fractures can reliably be managed with CinC revision. Cite this article: Bone Joint J 2021;103-B(1):71-78.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur/classificação , Fraturas Periprotéticas/classificação , Adulto , Idoso , Cimentos para Ossos , Feminino , Fraturas do Fêmur/cirurgia , Fixação de Fratura/métodos , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/cirurgia , Falha de Prótese , Reoperação , Propriedades de Superfície
10.
J Formos Med Assoc ; 120(1 Pt 2): 395-403, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32586721

RESUMO

BACKGROUND/PURPOSE: Orthopaedic Trauma Association (OTA) C-type distal femoral fractures can be very challenging to treat effectively. While locked plating is widely used in the complex distal femoral fracture, failure of locked plate fixation is not uncommon. First, we tried to determine the risk factor related to early failure of multiplanar OTA C-type fracture in the distal femur after fixation with lateral locked plate. Second, we tried to provide a strategy for surgeons to prevent pitfalls of early failure in the complex distal femoral fractures treated with lateral locked plating. METHODS: We retrospectively reviewed 44 adults with OTA C-type fractures of the distal femur treated with locked plate fixation between 2010 and 2016 at Tri-Service General Hospital. Average length of follow-up was 27.6 months (range, 12-54 months). Univariate and multivariate logistic regression were used to determine the association of variables on early failure of fixation. A p-value < 0.05 in univariate and multivariate analyses were considered significant. RESULTS: There were six patients experiencing early failure, and the early failure rate was 13.6%. The risk factors associated with early failure of complex distal femoral fracture identified by univariate analysis included sagittal oblique fracture pattern, longer working length and post-operative sagittal malalignment (odds ratio [OR] and 95% confidence intervals [CI]: 90.00 (6.85-1183.33), 0.55 (0.31-0.98) and 8.63 (1.077-69.075) respectively). The multivariate analysis showed only sagittal oblique fracture pattern was associated with early failure [OR: 52.348 (3.06-895.23)]. CONCLUSION: Sagittal oblique fracture was more likely to result in early postoperative failure. Early recognition of the fracture pattern should be considered to avoid catastrophic results.


Assuntos
Fraturas do Fêmur , Consolidação da Fratura , Placas Ósseas , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Humanos , Estudos Retrospectivos , Resultado do Tratamento
11.
Rev Assoc Med Bras (1992) ; 66(12): 1702-1706, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33331580

RESUMO

OBJECTIVES: To describe the incidence by gender and region, lethality, and costs associated with the treatment of femoral fractures in the elderly (≥ 60 years) hospitalized in the Unified Health System (SUS) of Brasil between 2008 and 2018. METHODS: This is a cross-sectional, descriptive, retrospective study of hospitalizations of elderly people due to femoral fractures by analyzing secondary data obtained from the SUS Hospital Information System (SIH/SUS) between 2008 and 2018; for calculation of epidemiological coefficients, we used information from demographic censuses (2000 and 2010) of the Brazilian Geography and Statistics Institute (IBGE). RESULTS: A total of 478,274 hospitalizations were recorded in the period; the incidence was 1.7 times higher in females (overall average of 274.91/100,000 for women and 161/100,000 for men). The Southeast region had the highest absolute number of hospitalizations and the South region presented the highest annual overall average incidence (224.02/100,000). The average annual cost for SUS for the treatment of femoral fractures in the elderly was R$ 99,718,574.30. CONCLUSIONS: In the evaluated period (2008-2018), femoral fractures in the elderly had a high incidence (478,274 hospitalizations; 224.02 cases/100,000 elderly), a predominance of females (1.7F/1.0M), a higher absolute number of hospitalizations in the Southeast region and a higher incidence in the South region; the lethality was high (an increase of 17.46%; overall mean coefficient of 4.99%/year); and the costs for the SUS were huge (an increase of 126.24%; average annual expenditure of R$ 99,718,574.30).


Assuntos
Fraturas do Fêmur , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Fraturas do Fêmur/epidemiologia , Hospitalização , Humanos , Incidência , Masculino , Estudos Retrospectivos
12.
Medicine (Baltimore) ; 99(50): e23206, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327237

RESUMO

INTRODUCTION: Human Immunodeficiency Virus (HIV) infection remains prevalent co-morbidity, and among fracture patients. Few studies have investigated the role of exercise interventions in preventing bone demineralization in people who have fractures and HIV. If exercise exposed, HIV-infected individuals may experience improved bone health outcomes (BMD), function, quality of life (QoL). The study will aim to assess the impact of home based exercises on bone mineral density, functional capacity, QoL, and some serological markers of health in HIV infection among Nigerians and South Africans. METHODS AND DESIGN: The study is an assessor-blinded randomized controlled trial. Patients managed with internal and external fixation for femoral shaft fracture at the study sites will be recruited to participate in the study. The participants will be recruited 2 weeks post-discharge at the follow-up clinic with the orthopaedic surgeon. The study population will consist of all persons with femoral fracture and HIV-positive and negative (HIV-positive medically confirmed) aged 18 to 60 years attending the above-named health facilities. For the HIV-positive participants, a documented positive HIV result, as well as a history of being followed-up at the HIV treatment and care center. A developed home based exercise programme will be implemented in the experimental group while the control group continues with the usual rehabilitation programme. The primary outcome measures will be function, gait, bone mineral density, physical activity, and QoL. DISCUSSION: The proposed trial will compare the effect of a home-based physical exercise-training programme in the management of femoral fracture to the usual physiotherapy management programmes with specific outcomes of bone mineral density, function, and inflammatory markers. TRIAL REGISTRATION: The study was prospectively registered with the Pan African Clinical Trials Registry (Reference number - PACTR201910562118957) on October 21, 2019. (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9425).


Assuntos
Exercício Físico/fisiologia , Fraturas do Fêmur/reabilitação , Fraturas Ósseas/etiologia , Fraturas Ósseas/reabilitação , Infecções por HIV/complicações , Adulto , Densidade Óssea/fisiologia , Terapia por Exercício/métodos , Feminino , Fraturas do Fêmur/cirurgia , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Marcha/fisiologia , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Prevalência , Qualidade de Vida , África do Sul/epidemiologia
13.
Acta Ortop Mex ; 34(1): 47-52, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33231000

RESUMO

INTRODUCTION: Anterior dislocation is a rare complication of total hip arthroplasty (THA). There exist only three cases in the literature. None of them report disassembly of the prosthesis components. We present a morbidly obese woman who suffered an irreducible obturator dislocation of an infected total hip arthroplasty (THA), due to uncontrolled adduction during an early debridement surgery. Following unsuccessful closed reduction attempts, a Vancouver B2 periprosthetic fracture and disassembly of the prosthetic components were observed. Two-stage revision THA was necessary to resolve the infection and restore hip functionality. In obturator dislocation, the femoral head prosthetic can be trapped in the obturator foramen, and this may disassemble the prosthesis components during reduction maneuvers; theres also risk of periprosthetic fracture. This mandate an open reduction of the joint. Patient obesity could be a determining factor for this rare type of hip arthroplasty dislocation. Obturator dislocation is an extremely rare complication of the total hip arthroplasty, whose reductions should be handled with caution given the risks of periprosthetic fractures. In most cases, an open reduction of the joint is required. CLINICAL IMPORTANCE: Our work is likely to be of great interest because it offers tips for the management of this rare complication based on our experience.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur , Luxação do Quadril , Prótese de Quadril , Obesidade Mórbida , Fraturas Periprotéticas , Artroplastia de Quadril/efeitos adversos , Feminino , Fraturas do Fêmur/cirurgia , Luxação do Quadril/etiologia , Luxação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/cirurgia , Reoperação
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1359-1363, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191690

RESUMO

Objective: To compare the predictive value of the two concepts for complications by comparing the incidences of surgical complications associated with different tip-apex distance (TAD) and calcar referenced tip-apex distance (Cal-TAD) in the treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail (APFN) fixation. Methods: A total of 188 cases of femoral intertrochanteric fractures treated with APFN fixation between January 2014 and December 2018 were collected according to inclusion criteria. TAD and Cal-TAD were measured on the X-ray film at immediate after operation; the patients were divided into two groups according to the measurement results: <25 mm and ≥25 mm. Gender, age, and fracture side and AO type were recorded. The patients in each group were reviewed whether there was delayed fracture union or nonunion, whether the screw blade moved axially, whether the femoral neck collapsed or even screw blade cut out, whether the internal fixator became loose or broken within 12 months after operation. Then statistical analysis was performed. Results: There were 119 patients with TAD<25 mm and 69 patients with TAD≥25 mm, and 142 patients with Cal-TAD<25 mm and 46 patients with Cal-TAD≥25 mm. There was no significant difference in gender, age, or fracture side and AO type between groups ( P>0.05). During the follow-up, 6 patients (5.04%) with TAD<25 mm, 10 patients (14.49%) with TAD≥25 mm had complications, and 1 patient (0.70%) with Cal-TAD<25 mm and 15 patients (32.61%) with Cal-TAD≥25 mm had complications. There were significant differences in the incidence of complication between the patients with different TAD, between the patients with different Cal-TAD, and between patients with TAD<25 mm and Cal-TAD<25 mm ( P<0.05). Conclusion: In the operation of femoral intertrochanteric fracture with APFN fixation, surgical complications can be significantly reduced when TAD or Cal-TAD was controlled within 25 mm, Cal-TAD is more significant in the prediction of postoperative complications.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas do Quadril , Pinos Ortopédicos , Fraturas do Quadril/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1454-1457, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191705

RESUMO

Objective: To summarize the research progress of medial buttress plate assisted fixation for femoral neck fractures in young adults. Methods: The literature about buttress plate assisted fixation for femoral neck fractures in young adults was widely reviewed and analyzed. The design principle, background, biomechanical characteristics, and clinical results of buttress plate were summarized. Results: Medial buttress plate assisted fixation is the latest treatment of femoral neck fractures in young adults, which can convert the shear force at the fracture sides into compression force and promote fracture healing. Medial buttress plate can improve the biomechanical stability of femoral neck fractures and reduce the maximum stress of fixation implants. In clinical, the medial buttress plate can maintain fracture reduction, reduce the incidences of nonunion and surgical failure, and improve hip joint function. Conclusion: Medial buttress plate assisted fixation can achieve good effectiveness for femoral neck fractures in young adults. However, due to the preliminary application, its indications, fixation implants, and long-term effectiveness need to be further studied and improved.


Assuntos
Fraturas do Fêmur , Fraturas do Colo Femoral , Placas Ósseas , Fraturas do Colo Femoral/cirurgia , Fixação de Fratura , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Adulto Jovem
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1458-1461, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191706

RESUMO

Objective: To summarize the research progress of osteonecrosis of femoral head (ONFH) following femoral intertrochanteric fractures in adults. Methods: Relevant literature at home and abroad was extensively reviewed to summarize the pathogenesis, high-risk factors, and treatment of ONFH after femoral intertrochanteric fracture in adults. Results: ONFH after femoral intertrochanteric fracture mostly occurs within 2 years after operation, with a lower incidence. At present, it is believed that comminuted and large displacement fractures caused by high-energy injuries, fracture line close to the base of neck, excessive external rotation deformity, improper intramedullary nail entry points, and rough intraoperative manipulating may injury the deep branch of the medial circumflex femoral artery, causing ONFH. Hip replacement is the main treatment for necrosis, which can achieve good results. Conclusion: Addressing the above risks, excessive external rotation, overstretching, and rough manipulating should be avoided. Anatomical reduction should be performed during the operation, the nail entry point should be accurate and avoid repeated drilling and thermally bone necrosis.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas do Quadril , Pinos Ortopédicos , Cabeça do Fêmur/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
17.
Medicine (Baltimore) ; 99(45): e22881, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157931

RESUMO

The number of femoral fractures is expected to continue to increase as the size of the older population rapidly grows. However, old age is accompanied by various comorbidities and is an important postoperative risk factor in itself, meaning that patients who undergo surgery for a femur fracture may require admission to an ICU. We investigated pulmonary complications in patients over the age of 65 admitted to the ICU after femur fracture surgery.In this single-center retrospective observational study, 289 patients over 65 years who admitted to the ICU after femur fracture surgery between June 2008 and December 2016 were investigated.Pulmonary complications occurred in 97 of these patients (33.6%) after surgery. Mean hospitalization days (34.1 ±â€Š25.7 vs 23.1 ±â€Š15.7, P < .001) and mean ICU length of stay (8.4 ±â€Š16.1 vs 2.5 ±â€Š1.1, P = .001) were significantly longer for patients with pulmonary complications than for patients without pulmonary complications after femur fracture surgery. Patients with pulmonary complications were significantly more likely to have pulmonary disease (19.6% vs 8.9%, P = .009) and exhibit sequelae on preoperative chest X-rays (9.3% vs 3.6%, P = .048) than were patients without pulmonary complications. In addition, significant differences were observed in the right ventricular systolic pressure (RVSP) measured during preoperative echocardiography (37.4 ±â€Š10.9 mm Hg vs 40.7 ±â€Š9.3 mm Hg for patients without and with pulmonary complications, P = .010) and in the proportion of each group that had an RVSP of >35 mm Hg, which is a marker for pulmonary hypertension (55.2% vs 76.3% for patients without and with pulmonary complications, P < .001). In multivariate analysis, an RVSP of >35 mm Hg during preoperative echocardiography was associated with pulmonary complications after femur fracture surgery (OR, 2.6; 95% CI, 1.45-4.53).In conclusion, Pulmonary complications in older patients admitted to the ICU after femur fracture surgery was associated with longer hospitalization and ICU stays. Preoperative RVSP measurement could identify those older patients with a high risk of pulmonary complications following transferal to the ICU after femur fracture surgery.


Assuntos
Pressão Sanguínea/fisiologia , Fraturas do Fêmur/cirurgia , Unidades de Terapia Intensiva , Doenças Respiratórias/epidemiologia , Sístole/fisiologia , Função Ventricular Direita/fisiologia , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Humanos , Tempo de Internação , Masculino , Admissão do Paciente , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , República da Coreia/epidemiologia , Estudos Retrospectivos
18.
Acta Chir Orthop Traumatol Cech ; 87(5): 309-317, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-33146597

RESUMO

Periprosthetic femoral fractures around the femoral stem of a hip prosthesis constitute a serious challenge. The number of these fractures, associated with a high failure rate and a high number of overall complications, including higher mortality, has been on an increase worldwide. Stable femoral stems are indicated for osteosynthesis, while in case of loosening the method of choice is the replacement by a revision implant. The aim of osteosynthesis of periprosthetic femoral fractures is a stable fixation with soft tissue preservation which results in faster union allowing the patient to return to pre-injury activities. Biomechanical studies on cadavers or on synthetic models and computer simulations make it possible to evaluate the fixation strength in various types of implants in dependence on fracture characteristics and bone quality, but cannot be substituted for clinical trials since there is no direct proportion between fixation rigidity and fracture union. Fundamental principles that shall be followed in osteosynthesis of periprosthetic fractures can be deduced from the available studies. Proximal fixation by screws or a combination of screws and cables are biomechanically more advantageous than the Ogden fixation by cerclage wires or cables. Bicortical fixation enabled by state-of-the-art implants of LAP-LCP or NCB type represents a significantly more stable construction compared to monocortical fixation and led to reduced use of structural allografts. Better stability can be achieved by "double plating" technique which is applied especially in revision surgeries, but also in osteoporotic periprosthetic fractures with a defect zone. In these cases, osteosynthesis with long plates is recommended, bridging the entire femur, i.e. distally with femoral condyles fixation since this prevents the risk of a fracture below the plate. In shorter plates, this risk created by stress concentration at the end screw is amplified when a distal bicortical locking screw is used. That is why it is beneficial to reduce this stress by a monocortical screw or with the use of a conventional screw. Adherence to the principles regarding the position, type and number of screws constitutes the key parameter of successful osteosynthesis of periprosthetic fractures. Key words: hip joint, arthroplasty, periprosthetic fractures, biomechanics of osteosynthesis.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur , Fraturas Periprotéticas , Artroplastia de Quadril/efeitos adversos , Placas Ósseas , Parafusos Ósseos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Humanos , Fraturas Periprotéticas/cirurgia
19.
Georgian Med News ; (306): 99-106, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33130655

RESUMO

The goal of our research was to study the to identify key aspects of the management of emotional disorders in the practice of operative treatment of proximal femoral fractures in elderly patients. The study was conducted with 24 patients who needed surgical treatment of proximal femoral fracture and were at risk for the development of psycho-emotional disorders due to the presence of emotional disorders of an anxiety-depressive nature were examined. The presence of such disorders was recorded at the time of admission, before and after surgical treatment using specialized psychodiagnostic techniques. Mini Mental State Examination, modified Hachinski ischemic scale, Frontal assessment battery, Spielberg-Khanin Scale of Reactive and Trait Anxiety, The Zung Self-Rating Depression Scale were used. Results of the clinical study of the Most patients at risk had a high level of reactive anxiety - 14 (58.33%) patients (equally in subgroups I and II - 7 (29.17%) patients in each) compared with moderate levels (10 (41.67%) patients) - equally I and II subgroups (5 (20.83%) patients in each). In the subgroups I and II with moderate and high levels of reactive anxiety, a predominance of female patients was noted: subgroup I - female patients with a moderate level - 3 (12.50%), and with a high level -5 (20.83%); subgroup II - 3 (12.50%) and 4 (16.67%) female patients respectively. As a result of determining the key aspects of the management of emotional disorders in the practice of operative treatment of proximal femoral fractures in elderly patients:the presence of moderate (41.67%) and high (58.33%) levels of reactive and trait anxiety in elderly patients with proximal femoral fractures and emotional disorders is noted. The presence of a depressive state of varying severity was recorded: a subdepressive state (75.00%) and mild depression (25.00%). The general levels of reactive and trait anxiety and depressive disorders showed the presence of limit levels between moderate, high (reactive and trait anxiety) and mild depression and sub-depressive state (depressive disorders): reactive anxiety (42.52±0.05), trait anxiety (42.23±0.07) and depressive disorders (51.41±0.07). It is proved that the treatment of emotional disturbances of the anxiety-depressive spectrum lead to a significant levelling in existing psychological changes.The deterioration of the existing emotional disorders of the anxiety-depressive spectrum among patients at risk in the absence of drug treatment has been established.


Assuntos
Transtorno Depressivo , Fraturas do Fêmur , Sintomas Afetivos , Idoso , Ansiedade , Transtornos de Ansiedade , Feminino , Fraturas do Fêmur/cirurgia , Humanos
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5167-5170, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019149

RESUMO

Micromotion can accelerate fracture healing, with critical parameters being range of motion, frequency of motion, duration of motion, as well as initial timing of the motion. However, these parameters of micromotion have not been optimized. It is because in previous studies large animals were used. The displacement among fracture fragments caused by animal activity brings a considerable systemic error to experimental data. Also, the sample size is limited by time and cost. Thus, the rat with femur fracture can be a good animal model in investigating this problem as its advantages on high consistency of experimental results, short convalescence, and low maintenance cost. The challenge in using a small animal model in the micromotion study include 1) highly specific stiffness of the fixator; 2) lightweight fixator to bring less interference to animal's activity; 3) high accuracy on measurement method. This study aims to solve this problem by integrating 1) an aluminum fixator with a solid construction; 2) a modularized experimental device with dismountable parts; 3) a non-contact measurement model based on video identification technology. Our preliminary validation results confirmed the reliability and reproducibility of the external fixation device used in the investigation on the effect of applied micromotion on bone healing.


Assuntos
Fraturas do Fêmur , Fraturas da Tíbia , Animais , Fixadores Externos , Fraturas do Fêmur/cirurgia , Consolidação da Fratura , Ratos , Reprodutibilidade dos Testes
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