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1.
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
2.
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
3.
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
4.
Mymensingh Med J ; 29(4): 823-828, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116083

RESUMO

Femoral fractures are frequent in the pediatric population. Treatment options are based on the patient's age, fracture pattern, type of trauma and associated soft tissue injury. The traditional treatment method for pediatric femoral shaft fracture has been traction and spica casting. The immediate spica cast is safe and effective for children up to 6 years of age with isolated femoral fracture and acceptable reduction. Patients between 6 and 10 years of age can also be treated with spica casting with or without traction. This prospective study was done in the department of Orthopaedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh form from July 2015 to June 2019 to evaluate the outcome of closed reduction and internal fixation by titanium elastic nailing for fracture shaft of femur. Twenty patients, all presenting with fresh diaphyseal fractures of femur, treated with closed reduction and internal fixation by titanium elastic nailing. These patients were prospectively evaluated over a period of at least 18 months. Fractures were classified according to Association of Orthopaedics (AO) classification of shaft of femur fractures. According to AO classification, all were A1, A2, A3 fractures. Average age of the patients was 11±2.7 years; range was 6 to 16 years. There were 15 males and 5 females. Out of 20 cases treated with this method, stable fixation and union was achieved in all of them. Radiological union was achieved at an average of 10±2.3 weeks (8-15 weeks). The results were excellent in twelve patients (60%), successful in five (25%) and poor in three patients (15%) as per the scoring criteria for TEN. The effective treatment of diaphyseal fractures of the femur is intramedullary fixation by titanium elastic nailing in patients of the 6-16 years age group.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Adolescente , Bangladesh , Criança , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Humanos , Masculino , Estudos Prospectivos , Titânio , Resultado do Tratamento
5.
J Biol Regul Homeost Agents ; 34(3 Suppl. 2): 47-52, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32856439

RESUMO

Polyostotic fibrous dysplasia (PFD) generally cause deformities and fractures of femur and tibia and surgery is often required. The current surgical treatment for deformities is based on single or multiple osteotomies followed by stabilization with intramedullary nails, which are commonly used also for fractures. One of the most common surgical complications of intramedullary nailing is represented by surgical site infection with possible extension to the whole skeletal segment. In the present study we evaluated the incidence of surgical site infections in 44 patients affected by PFD in which 91 femurs or tibiae underwent intramedullary nailing to treat deformities or fractures. We never observed any infection of the operated femurs or tibiae until the final follow-up. The only post surgical infection was present in a patient with monomelic involvement at the contralateral non affected limb, which was surgically treated for limb length inequality, by femur shortening osteotomy stabilized by an intramedullary nail. The most likely hypothesis to explain the complete absence of infections in these patients may be related to the high local concentration of prophylactic antibiotic in the highly vascularized fibrodysplastic bone.


Assuntos
Fraturas do Fêmur , Displasia Fibrosa Poliostótica , Fixação Intramedular de Fraturas , Pinos Ortopédicos , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Fixação Intramedular de Fraturas/efeitos adversos , Humanos , Extremidade Inferior , Tíbia , Resultado do Tratamento
6.
Bone Joint J ; 102-B(8): 1056-1061, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731819

RESUMO

AIMS: Current American Academy of Orthopaedic Surgeons (AAOS) guidelines for treating femoral fractures in children aged two to six years recommend early spica casting although some individuals have recommended intramedullary stabilization in this age group. The purpose of this study was to compare the treatment and family burden of care of spica casting and flexible intramedullary nailing in this age group. METHODS: Patients aged two to six years old with acute, non-pathological femur fractures were prospectively enrolled at one of three tertiary children's hospitals. Either early closed reduction with spica cast application or flexible intramedullary nailing was accomplished under general anaesthesia. The treatment method was selected after discussion of the options by the surgeon with the family. Data were prospectively collected on patient demographics, fracture characteristics, complications, pain medication, and union. The Impact on Family Scale was obtained at the six-week follow-up visit. In all, 75 patients were included in the study: 39 in the spica group and 36 in the nailing group. The mean age of the spica group was 2.71 (2.0 to 6.9) years and the mean age of the nailing group was 3.16 (2.0 to 6.9) years. RESULTS: All fractures healed without evidence of malunion or more than 2.0 cm of shortening. The mean Impact on Family score was 70.2 for the spica group and 63.2 (55 to 99) for the nailing group, a statistically significant difference (p = 0.024) in a univariate analysis suggesting less impairment of the family in the intramedullary nailing group. There was no significant difference between pain medication requirements in the first 24 hours postoperatively. Two patients in the spica group and one patient in the intramedullary nailing group required additional treatment under anaesthesia. CONCLUSION: Both early spica casting and intramedullary nailing were effective methods for treating femoral fractures in children two to six years of age. Intramedullary stabilization provides an option in this age group that may be advantageous in some social situations that depend on the child's mobility. Fracture treatment should be individualized based on factors that extend beyond anatomical and biological factors. Cite this article: Bone Joint J 2020;102-B(8):1056-1061.


Assuntos
Moldes Cirúrgicos , Fraturas do Fêmur/terapia , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Manejo da Dor/métodos , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Seguimentos , Fixação de Fratura/métodos , Hospitais Pediátricos , Humanos , Masculino , Seleção de Pacientes , Estudos Prospectivos , Medição de Risco , Fatores de Tempo
7.
Bone Joint J ; 102-B(8): 1048-1055, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731828

RESUMO

AIMS: The Fassier Duval (FD) rod is a third-generation telescopic implant for children with osteogenesis imperfecta (OI). Threaded fixation enables proximal insertion without opening the knee or ankle joint. We have reviewed our combined two-centre experience with this implant. METHODS: In total, 34 children with a mean age of five years (1 to 14) with severe OI have undergone rodding of 72 lower limb long bones (27 tibial, 45 femoral) for recurrent fractures with progressive deformity despite optimized bone health and bisphosphonate therapy. Data were collected prospectively, with 1.5 to 11 years follow-up. RESULTS: A total of 24 patients (33%) required exchange of implants (14 femora and ten tibiae) including 11 rods bending with refracture. Four (5%) required reoperation with implant retention. Loss of proximal fixation in the femur and distal fixation in the tibia were common. Four patients developed coxa vara requiring surgical correction. In total, 13 patients experienced further fractures without rod bending; eight required implant revision. There was one deep infection. The five-year survival rate, with rod revision as the endpoint, was 63% (95% confidence interval (CI) 44% to 77%) for femoral rods, with a mean age at implantation of 4.8 years (1.3 to 14.8), and 64% (95% CI 36% to 82%) for tibial rods, with a mean age at implantation of 5.2 years (2.0 to 13.8). CONCLUSION: FD rods are easier to implant but do not improve on the revision rates reported for second generation T-piece rods. Proximal femoral fixation is problematic in younger children with a partially ossified greater trochanter. Distal tibial fixation typically fails after two years. Future generation implants should address proximal femoral and distal tibial fixation to avoid the majority of complications in this series. Cite this article: Bone Joint J 2020;102-B(8):1048-1055.


Assuntos
Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Osteogênese Imperfeita/cirurgia , Reoperação/métodos , Fraturas da Tíbia/cirurgia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/etiologia , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Humanos , Fixadores Internos , Masculino , Osteogênese Imperfeita/complicações , Osteogênese Imperfeita/diagnóstico por imagem , Estudos Prospectivos , Recidiva , Reoperação/estatística & dados numéricos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/etiologia , Fatores de Tempo
8.
Medicine (Baltimore) ; 99(27): e21053, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629731

RESUMO

Internal fixation such as elastic stable intramedullary(ESIN) nail and submuscular plate (SMP) is gaining popularity for femoral shaft fractures in school-aged children. However, external fixation (ExFix) might be a valuable option for the distal third femoral shaft fractures, where the fracture heals rapidly, but it is crucial to avoid angular malunion. This study aims to compare the clinical outcomes, postoperative complications of distal third femoral shaft fractures in school-aged children treated by ESIN versus ExFix.Patients aged 5 to 11 years with distal third femoral shaft fractures treated at our institute from January 2014 to January 2016 were included and categorized into ESIN (n = 33) and ExFix (n = 38) group. The preoperative data, including baseline information of the patients, radiographic parameters, and type of surgical procedure, were collected from the hospital database, and postoperative data, including complications, were collected during the follow-up visit.In all, 33 patients (average, 8.0 ±â€Š2.1 years, male 20, female 13) in the ESIN group and 38 patients (average, 8.3 ±â€Š2.3 years, male 23, female 15) in the ExFix group were included in this study. There was significantly less operative time for the ExFix group (45.4 ±â€Š7.8 min) as compared to the ESIN group (57.8 ±â€Š11.3 min) (P < .01), reduced estimated blood loss (EBL) in the ExFix group (9.9 ±â€Š3.5) as compared to the ESIN group (16.4 ±â€Š6.5) (P < .01). As for the frequency of fluoroscopy, there was a significant difference between the ExFix group (13.9 ±â€Š2.4) and the ESIN group (15.5 ±â€Š3.2) (P = .02). The rate of major complications was not significantly different between the 2 groups (P = .19). The rate of implant irritation was significantly higher in the ExFix group (28/38, 73.7%) than the ESIN group (12/33, 36.4%) (P < .01). The rate of surgical site infection (SSI) is significantly higher in the ExFix group (18/38, 47.4%)) than the ESIN group (1/33, 3%) (P < .01). The rate of scar concern was significantly higher in the ExFix (9/38, 23.7%) than the ESIN (2/33, 6.1%), (P = .04). According to the Flynn scoring system, 30(90.9%) patients in the ESIN group and 24(89.5%) patients in the ExFix group were rated as excellent. None of the patients had poor outcomes.Both ESIN and ExFix produced satisfactory outcomes in distal third femoral shaft fractures. ExFix remains a viable choice for selected cases, especially in resource-challenged and austere settings.


Assuntos
Pinos Ortopédicos/efeitos adversos , Placas Ósseas/efeitos adversos , Fixadores Externos/efeitos adversos , Fraturas do Fêmur/cirurgia , Assistência ao Convalescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pinos Ortopédicos/normas , Placas Ósseas/normas , Criança , Pré-Escolar , China/epidemiologia , Diáfises/diagnóstico por imagem , Diáfises/patologia , Fixadores Externos/normas , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fluoroscopia/estatística & dados numéricos , Fixação de Fratura/métodos , Fixação de Fratura/tendências , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(24): e20569, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541485

RESUMO

RATIONALE: Fat embolism syndrome with cerebral fat embolism, rarely observed at our neurology department, is often associated with long bone fractures. Its diagnosis is based on medical history and supportive imaging data and is usually not difficult. However, its pathogenesis remains poorly understood. PATIENT CONCERNS: A 46-year-old woman was urgently presented to a nearby hospital because of a femur fracture caused by an accident. She rapidly developed somnolence and was suspected to have fat embolism syndrome. DIAGNOSES: Due to patients history of trauma and supportive imaging data, she was diagnosed with fat embolism syndrome obviously. However, severe brain damage confused our understanding of the pathogenesis. The subsequent diagnosis of fat embolism syndrome with patent foramen ovale provided a reasonable explanation. INTERVENTIONS: Initially, we did not consider the fact that the patient had developed fat embolism syndrome and thus designed a comprehensive treatment program for fat embolism syndrome. Then the routine cardiac and vascular ultrasound screening were followed up, but patent foramen ovale was diagnosed unexpectedly, which led to a more aggressive treatment of brain injury. OUTCOMES: After relevant symptomatic treatment continued for nearly 3 months, an overall improvement was observed. Patients consciousness was restored but language disorders were left. LESSONS: Clinicians should consider patent foramen ovale as the embolization pathway, particularly in young and middle-aged patients with cerebral embolism because it is often mistaken for a rare situation.


Assuntos
Embolia Gordurosa/etiologia , Fraturas do Fêmur/complicações , Forame Oval Patente/complicações , Embolia Intracraniana/etiologia , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Forame Oval Patente/diagnóstico por imagem , Humanos , Embolia Intracraniana/diagnóstico por imagem , Pessoa de Meia-Idade
10.
Rev. osteoporos. metab. miner. (Internet) ; 12(2): 62-70, abr.-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193785

RESUMO

OBJETIVO: El diagnóstico de osteoporosis se ha fundamentado en la medición de la densidad mineral ósea, si bien esta variable tiene una capacidad limitada en la discriminación de pacientes con o sin fracturas. La aplicación del análisis de elementos finitos (FE) sobre imágenes volumétricas de tomografía computarizada ha mejorado la clasificación de sujetos hasta 90%, aunque la dosis de radiación, complejidad y coste no aconsejan su práctica regular. Nuestro objetivo es aplicar el análisis FE a modelos tridimensionales con absorciometría radiológica dual (3D-DXA), para clasificar pacientes con fractura osteoporótica de fémur proximal y sin fractura. MATERIAL Y MÉTODOS: Se seleccionó una cohorte de 111 pacientes con osteoporosis densitométrica: 62 con fractura y 49 sin ella. Se utilizaron modelos FE sujeto-específicos para el impacto, como la simulación estática de la caída lateral. Las simulaciones de impacto permiten identificar la región crítica en el 95% de los casos, y la respuesta mecánica a una fuerza lateral máxima. Se realizó un análisis mediante un clasificador discriminativo (Support Vector Machine) por tipo de fractura, tejido y género, utilizando las mediciones DXA y parámetros biomecánicos. RESULTADOS: Los resultados mostraron una sensibilidad de clasificación del 100%, y una tasa de falsos negativos de 0% para los casos de fractura de cuello para el hueso trabecular en las mujeres. Se identifica la variable tensión principal mayor (MPS) como el mejor parámetro para la clasificación. CONCLUSIÓN: Los resultados sugieren que el uso de modelos 3D-DXA podría ayudar a discriminar mejor a los pacientes con elevado riesgo de fracturarse


OBJETIVE: The diagnosis of osteoporosis has been based on the measurement of bone mineral density, although this variable has a limited capacity in discriminating patients with or without fractures. The application of finite element analysis (FE) on computed tomography volumetric images has improved the classification of subjects by up to 90%, although the radiation dose, complexity, and cost do not favor their regular practice. Our objective is to apply FE analysis to three-dimensional models with dual-energy x-ray absorptiometry (3D-DXA), to classify patients who present osteoporotic fracture of the proximal femur and those without fracture. MATERIAL AND METHODS: A cohort of 111 patients with densitometric osteoporosis was selected: 62 with fracture and 49 without it. Subject-specific FE models for impact were used, such as static simulation of lateral fall. Impact simulations allow identifying the critical region in 95% of cases, and the mechanical response to maximum lateral force. An analysis was performed using a discriminative classifier (Support Vector Machine) by fracture type, tissue and gender, using DXA measurements and biomechanical parameters. RESULTS: The results showed a classification sensitivity of 100%, and a false negative rate of 0% for cases of neck fracture for trabecular bone in women. The variable major main stress (MPS) is identified as the best parameter for the classification. CONCLUSION: The results suggest that using 3D-DXA models help in order to better discriminate patients with raised fracture risk


Assuntos
Humanos , Masculino , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/etiologia , Fraturas por Osteoporose/diagnóstico por imagem , Densidade Óssea , Absorciometria de Fóton , Estudos de Coortes
11.
Radiologe ; 60(6): 523-531, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32405746

RESUMO

BACKGROUND: A confident diagnosis and classification of proximal femoral and tibia fractures are crucial to determine further therapeutic procedures. MATERIALS AND METHODS: In this article the current standards regarding diagnostic imaging of proximal femoral and tibia fractures are presented and the different classification systems are discussed. CONCLUSIONS: Plain radiography in two planes remains the initial investigation of choice for suspected osseous injury. While this is usually sufficient to determine further procedures for injuries of the proximal femur, cross-sectional imaging is normally necessary in the diagnosis of proximal tibia fractures.


Assuntos
Fraturas do Fêmur , Fraturas da Tíbia , Adulto , Osso e Ossos , Fraturas do Fêmur/diagnóstico por imagem , Fêmur , Humanos , Radiografia , Tíbia , Fraturas da Tíbia/diagnóstico por imagem
13.
Bone Joint J ; 102-B(5): 638-645, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32349590

RESUMO

AIMS: Accurate estimations of the risk of fracture due to metastatic bone disease in the femur is essential in order to avoid both under-treatment and over-treatment of patients with an impending pathological fracture. The purpose of the current retrospective in vivo study was to use CT-based finite element analyses (CTFEA) to identify a clear quantitative differentiating factor between patients who are at imminent risk of fracturing their femur and those who are not, and to identify the exact location of maximal weakness where the fracture is most likely to occur. METHODS: Data were collected on 82 patients with femoral metastatic bone disease, 41 of whom did not undergo prophylactic fixation. A total of 15 had a pathological fracture within six months following the CT scan, and 26 were fracture-free during the five months following the scan. The Mirels score and strain fold ratio (SFR) based on CTFEA was computed for all patients. A SFR value of 1.48 was used as the threshold for a pathological fracture. The sensitivity, specificity, positive, and negative predicted values for Mirels score and SFR predictions were computed for nine patients who fractured and 24 who did not, as well as a comparison of areas under the receiver operating characteristic curves (AUC of the ROC curves). RESULTS: The sensitivity of SFR was 100% compared with 88% for the Mirels score, and the specificity of SFR was 67% compared with 38% for the Mirels score. The AUC was 0.905 for SFR compared with 0.578 for the Mirels score (p = 0.008). CONCLUSION: All the patients who sustained a pathological fracture of the femur had an SFR of > 1.48. CTFEA was far better at predicting the risk of fracture and its location accurately compared with the Mirels score. CTFEA is quick and automated and can be incorporated into the protocol of CT scanners. Cite this article: Bone Joint J 2020;102-B(5):638-645.


Assuntos
Fraturas do Fêmur/diagnóstico por imagem , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/secundário , Fraturas Espontâneas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Feminino , Análise de Elementos Finitos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
J Orthop Trauma ; 34(8): 389-394, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32427809

RESUMO

Mounting evidence suggests that the pathogenesis of coronavirus disease 2019 (COVID-19) involves a hyperinflammatory response predisposing patients to thromboembolic disease and acute respiratory distress. In the setting of severe blunt trauma, damaged tissues induce a local and systemic inflammatory response through similar pathways to COVID-19. As such, patients with COVID-19 sustaining orthopaedic trauma injuries may have an amplified response to the traumatic insult because of their baseline hyperinflammatory and hypercoagulable states. These patients may have compromised physiological reserve to withstand the insult of surgical intervention before reaching clinical instability. In this article, we review the current evidence regarding pathogenesis of COVID-19 and its implications on the management of orthopaedic trauma patients by discussing a case and the most recent literature. LEVEL OF EVIDENCE:: Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Infecções por Coronavirus/complicações , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Controle de Infecções/métodos , Pneumonia Viral/complicações , Trombose Venosa/cirurgia , Idoso de 80 Anos ou mais , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Fraturas do Fêmur/complicações , Fraturas do Fêmur/diagnóstico por imagem , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Humanos , Procedimentos Ortopédicos/métodos , Pandemias , Segurança do Paciente , Pneumonia Viral/diagnóstico , Medição de Risco , Trombectomia/métodos , Resultado do Tratamento , Trombose Venosa/diagnóstico
15.
Int J Comput Assist Radiol Surg ; 15(5): 847-857, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32335786

RESUMO

PURPOSE: Demonstrate the feasibility of a fully automatic computer-aided diagnosis (CAD) tool, based on deep learning, that localizes and classifies proximal femur fractures on X-ray images according to the AO classification. The proposed framework aims to improve patient treatment planning and provide support for the training of trauma surgeon residents. MATERIAL AND METHODS: A database of 1347 clinical radiographic studies was collected. Radiologists and trauma surgeons annotated all fractures with bounding boxes and provided a classification according to the AO standard. In all experiments, the dataset was split patient-wise in three with the ratio 70%:10%:20% to build the training, validation and test sets, respectively. ResNet-50 and AlexNet architectures were implemented as deep learning classification and localization models, respectively. Accuracy, precision, recall and [Formula: see text]-score were reported as classification metrics. Retrieval of similar cases was evaluated in terms of precision and recall. RESULTS: The proposed CAD tool for the classification of radiographs into types "A," "B" and "not-fractured" reaches a [Formula: see text]-score of 87% and AUC of 0.95. When classifying fractures versus not-fractured cases it improves up to 94% and 0.98. Prior localization of the fracture results in an improvement with respect to full-image classification. In total, 100% of the predicted centers of the region of interest are contained in the manually provided bounding boxes. The system retrieves on average 9 relevant images (from the same class) out of 10 cases. CONCLUSION: Our CAD scheme localizes, detects and further classifies proximal femur fractures achieving results comparable to expert-level and state-of-the-art performance. Our auxiliary localization model was highly accurate predicting the region of interest in the radiograph. We further investigated several strategies of verification for its adoption into the daily clinical routine. A sensitivity analysis of the size of the ROI and image retrieval as a clinical use case were presented.


Assuntos
Diagnóstico por Computador , Fraturas do Fêmur/diagnóstico por imagem , Bases de Dados Factuais , Aprendizado Profundo , Fraturas do Fêmur/classificação , Fraturas do Fêmur/cirurgia , Humanos , Radiografia
16.
Bone Joint J ; 102-B(4): 530-538, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228080

RESUMO

AIMS: Dual plating of distal femoral fractures with medial and lateral implants has been performed to improve construct mechanics and alignment, in cases where isolated lateral plating would be insufficient. This may potentially compromise vascularity, paradoxically impairing healing. This study investigates effects of single versus dual plating on distal femoral vascularity. METHODS: A total of eight cadaveric lower limb pairs were arbitrarily assigned to either 1) isolated lateral plating, or 2) lateral and medial plating of the distal femur, with four specimens per group. Contralateral limbs served as matched controls. Pre- and post-contrast MRI was performed to quantify signal intensity enhancement in the distal femur. Further evaluation of intraosseous vascularity was done with barium sulphate infusion with CT scan imaging. Specimens were then injected with latex medium and dissection was completed to assess extraosseous vasculature. RESULTS: Quantitative MRI revealed a mean reduction of 21.2% (SD 1.3%) of arterial contribution in the lateral plating group and 25.4% (SD 3.2%) in the dual plating group (p = 0.051); representing a mean decrease in arterial contribution of 4.2%. The only significant difference found between both experimental groups was regionally, at the lateral aspect of the distal femur with a mean drop in arterial contribution in the lateral plating group of 18.9% (SD 2.6%) versus 24.0% (SD 3.2%) in the dual plating group (p = 0.048), representing a mean decrease in arterial contribution of 5.1%. Gross dissection revealed complete destruction of periosteal vessels underneath either medial or lateral plates in both groups. The network of genicular branches contributing to the posterior and distal femoral condyles was preserved in all specimens. A medial vascular pedicle was found dividing from the superficial femoral artery at a mean 12.7 cm (SD 1.7) proximal to the medial epicondyle and was undisrupted in the dual plating group. CONCLUSION: Lateral locking-plate application resulted in mean 21.2% reduction in distal femur vascularity. Addition of medial plates did not further markedly decrease vascularity. As such, the majority of the vascular insult occurred with lateral plating alone. Supplemental medially based fixation did not lead to marked devascularization of the distal femur, and should therefore be considered in the setting of comminution and poor bone stock in distal femoral fractures. Further clinical research is required to confirm the results of this study. Cite this article: Bone Joint J 2020;102-B(4):530-538.


Assuntos
Placas Ósseas/efeitos adversos , Fraturas do Fêmur/cirurgia , Fêmur/irrigação sanguínea , Traumatismos do Joelho/cirurgia , Adulto , Cadáver , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Tomografia Computadorizada por Raios X/métodos
17.
J Pediatr Orthop ; 40(2): 86-92, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923168

RESUMO

BACKGROUND: Traumatic posterior hip dislocations in children and adolescents requires emergent closed reduction. Postreduction imaging is necessary to assess the concentricity of reduction and structural injuries to the hip. There is no a consensus for which imaging is a modality of choice in such condition. The purposes of this study are to describe magnetic resonance imaging (MRI) findings of traumatic posterior hip dislocations and to compare the effectiveness of MRI with computerized tomography (CT) in detecting structural abnormalities of the hip that impact patient management. METHODS: This study is a retrospective review of imaging in traumatically dislocated hips in patients who were treated at our institution. All CT and MRI imaging were reviewed and specific osseous and soft tissue injuries documented by consensus among 2 musculoskeletal pediatric radiologists who interpreted the MRI and CT scans of each patient in a blinded manner. RESULTS: In total, 27 patients (23 males, 4 females) with mean age of 12.5 years (range, 2 to 19 y) with postreduction MRI were evaluated. MRI findings revealed femoral head injuries in 17 (62.9%), posterior labral entrapments in 6 (22.2%), posterior labral tears in 17 (62.9%), posterior wall fractures in 15 (55.5%), fracture of the posterior unossified part of acetabulum in 4 (14.8%), and ligamentum teres injuries in 8 (29.6%). Of 16 patients who had postreduction CT scans, 6 (37.5%) had femoral head fractures, 9 (56.3%) had posterior wall fractures, and 8 (50%) had intra-articular osseous entrapments. All bony fractures and intra-articular entrapment could be seen on MRI imaging. In 16 patients with both CT and MRI, posterior acetabular injury was detected in 10/16 (62.5%) on MRI and 9/16 (56.3%) on CT. Three patients with entrapment of labrums identified on MRI could not be seen on CT scan. One patient with persistently unstable hip after reduction had an entrapped unossified portion of acetabular fracture which was seen on MRI but not on CT. CONCLUSIONS: MRI is superior to CT scan for detection of structural injuries in children and adolescents with traumatic hip dislocation. The unique structural injuries included entrapment of posterior labrum and posterior unossified acetabular fractures could be seen only at MRI. These findings will impact surgical decision making of these injuries. LEVEL OF EVIDENCE: Level IV.


Assuntos
Acetábulo/diagnóstico por imagem , Fraturas do Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Acetábulo/lesões , Adolescente , Criança , Pré-Escolar , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/lesões , Luxação do Quadril/terapia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Ligamentos Redondos/lesões , Lesões dos Tecidos Moles/diagnóstico por imagem , Adulto Jovem
20.
Am J Perinatol ; 37(3): 313-321, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30731480

RESUMO

OBJECTIVE: To assess the effect of range-of-motion exercise program on bone mineralization and somatic growth of very low birth weight (VLBW) infants. STUDY DESIGN: A total of 36 VLBW infants were randomized into 18 VLBW infants receiving range-of-motion exercise and 18 VLBW control infants receiving tactile stimulation for 4 weeks. Laboratory investigations were performed at baseline and postexercise and included serum calcium, serum phosphorus (s.PO4), magnesium, alkaline phosphatase (ALP), urinary calcium/phosphate ratio, and serum carboxy-terminal cross-linked telopeptide of type 1 collagen (CTX). Dual-energy X-ray absorptiometry was performed at the end of the exercise protocol to measure bone mineral content, bone mineral density (BMD), bone area, lean mass, and fat mass. RESULTS: The weight and the rate of weight gain were significantly higher (p < 0.001) in the exercise group compared with controls postexercise. Also, higher s.PO4, lower ALP, and lower urinary calcium/phosphate ratio were observed postexercise in the exercise group (p = 0.001, p = 0.005, and p = 0.04, respectively), whereas serum CTX showed no difference between the two groups (p = 0.254). Postexercise BMD significantly improved in the exercise group (p < 0.001) compared with controls. CONCLUSION: Although the sample size was small, we may be able to suggest favorable effects of range-of-motion exercise versus tactile stimulation on bone metabolism, BMD, and short-term growth in VLBW infants.


Assuntos
Calcificação Fisiológica , Recém-Nascido Prematuro/fisiologia , Recém-Nascido de muito Baixo Peso/fisiologia , Modalidades de Fisioterapia , Densidade Óssea , Método Duplo-Cego , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Fêmur/lesões , Humanos , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Masculino , Radiografia , Amplitude de Movimento Articular , Ganho de Peso
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