Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.235
Filtrar
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) ; 99(39): e22364, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991454

RESUMO

Pathological fracture of the proximal femur represents a challenging situation for orthopedic surgeons because of the high risk of non-union, varus union, and avascular necrosis (AVN) of the femoral head. This study aims to investigate the efficacy of ESINs for the treatment of proximal femoral fractures caused by simple bone cysts (SBCs).All the patients with a diagnosis of proximal femoral fracture secondary to SBC treated with ESINs combined with bone grafting between January 2008 and January 2018, were analyzed retrospectively.In all, 11 patients were included in the Double ESINs group (5.1 ±â€Š0.8 years, 5 male, 6 female) and 27 patients were included in the Triple ESINs group (9.1 ±â€Š2.1 years, 11 male, 16 female). There was no significant difference between the 2 groups concerning the patients demographic parameters, including sex and affected side. However, the age in the Double group was significantly younger than those in the Triple group (P < .001). All patients in both groups displayed excellent outcomes according to the Musculoskeletal Tumor Society Score (MSTS), and there was no significant difference between the 2 groups at a 12-month follow-up evaluation (P = .10). As for the Capanna classification (1 + 2), there was no significant difference between these 2 groups (P = .24). In the Triple ESINs group, 24 (88.9%) patients were categorized in Capanna 1 and 2, whereas all patients in Double ESINs were Capanna 1 and 2. Overall, the success rate was 92%.ESINs combined with bone grafting is a successful strategy for proximal femoral fractures caused by SBCs in the pediatric population.


Assuntos
Cistos Ósseos/complicações , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas , Criança , Pré-Escolar , Feminino , Fraturas do Fêmur/etiologia , Humanos , Masculino , Estudos Retrospectivos
3.
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
4.
Chirurg ; 91(10): 804-812, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32504105

RESUMO

The incidence of periprosthetic fractures of the proximal femur is increasing due to the growing numbers of hip replacements in old age. The treatment of these fractures is a challenge for the treating physician and standardized procedures are necessary. The unified classification system (UCS) is a suitable tool to establish treatment strategies: On the basis of the fracture localization and extent, bone quality, stability of the prosthesis and the presence of further implants, the fractures can be classified according to the UCS and a treatment algorithm can be derived. This article gives an overview of the diagnostics, classification and characteristics of the various periprosthetic fracture types as well as the treatment.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Prótese de Quadril/efeitos adversos , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/cirurgia , Fêmur/cirurgia , Humanos , Incidência , Reoperação , Estudos Retrospectivos
5.
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
6.
J Orthop Traumatol ; 21(1): 8, 2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32451636

RESUMO

BACKGROUND: Considering the excellent results already achieved in total hip arthroplasty (THA), new implants must be at least as safe as currently used implants and lead to longer survival. A new cementless femoral stem, SP-CL®, has been introduced. The aim of this study is to evaluate intraoperative complications and assess the risk factors of THA with the SP-CL® implant. MATERIALS AND METHODS: All THA patients who were operated on using the SP-CL® (LINK, Hamburg, Germany) implant between 2015 and 2018 were included in the analysis. Data were collected from medical records from national and hospital electronic databases. Radiological measurements were made from standard pre- and postoperative radiographs. RESULTS: A total of 222 THA were performed using the SP-CL® implant. The average age of the patients was 56 years (14-77 years). There were 1 transient sciatic nerve injury, 1 acetabular fracture, and 11 (5.0%) intraoperative femoral fractures (IFF), of which 7 were treated with cerclage wire or titanium band during the operation while the other fractures were treated conservatively. None of the IFF patients were revised due to fracture during the follow-up period (one revision due to infection). The radiographic morphology of proximal femur was associated with increased risk of IFF (p = 0.02). CONCLUSIONS: The results of the current study demonstrate a 5% incidence of IFF when using the LINK SP-CL® femoral stem in THA. The radiographic morphology of the proximal femur was an important predictor of IFF and should be assessed when using SP-CL®. LEVEL OF EVIDENCE: Level 4.


Assuntos
Artroplastia de Quadril/efeitos adversos , Fraturas do Fêmur/cirurgia , Prótese de Quadril/efeitos adversos , Adolescente , Adulto , Idoso , Artroplastia de Quadril/métodos , Cimentação , Feminino , Fraturas do Fêmur/etiologia , Fêmur/lesões , Fêmur/cirurgia , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Humanos , Complicações Intraoperatórias , Masculino , Metilmetacrilato , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
7.
Clin Orthop Relat Res ; 478(4): 770-776, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32229749

RESUMO

BACKGROUND: Case reports suggest that there is an increased risk of subtrochanteric femur fracture after femoral neck fixation with cannulated screws when the distal-most screw is placed distal to the lesser trochanter. However, to our knowledge, there are no biomechanical data supporting this observation. QUESTIONS/PURPOSES: (1) Is there an increased risk of subtrochanteric femur fracture after femoral neck fixation with cannulated screws in normal density and osteoporotic Sawbones when the distal-most screw is started distal to the lesser trochanter? (2) Does the screw starting point position after femoral neck fixation with cannulated screws affect load to failure when normal density and osteoporotic Sawbones are loaded through their mechanical axis? METHODS: Normal density and osteoporotic Sawbones femora were instrumented with three cannulated screws in a triangular apex distal configuration with the distal-most screw starting either proximal to, at, or distal to the level of the lesser trochanter. Specimens were loaded along the mechanical axis to failure. The fracture location and ultimate load to failure were compared between groups. RESULTS: The screw start point distal to the lesser trochanter resulted in a greater proportion of subtrochanteric femur fractures compared with screw start points at or proximal to the lesser trochanter in the subset of osteoporotic specimens (three of 10 specimens versus 0 of 20 specimens; p = 0.030). No subtrochanteric femur fractures were observed in the normal density specimens. Load to failure was lower when the distal-most screw was started distal to the lesser trochanter than when it was started at or proximal to the lesser trochanter (normal density subset 13,502 ± 1980 N versus 14,675 ±1528 N; osteoporotic subset 8946 ± 1509 N versus 10,026 ± 1256 N; linear regression coefficient 1127 N [95% CI 298 to 1956 N]; adjusted r = 0.71; p = 0.009). CONCLUSIONS: A screw start point distal to the lesser trochanter was associated with subtrochanteric femur fractures in the osteoporotic subset. Additionally, there was decreased load to failure when the distal-most screw was started distal to the lesser trochanter. CLINICAL RELEVANCE: These data suggest that avoiding a screw start point distal to the level of the lesser trochanter in femoral neck fracture fixation may decrease the risk of catastrophic subtrochanteric femur fractures, especially in patients with osteoporosis. However, it should be noted that a more overall varus screw alignment could theoretically compromise the ability to achieve compression across the fracture, with attendant implications with regard to fracture union in the acute setting.


Assuntos
Parafusos Ósseos , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/cirurgia , Fenômenos Biomecânicos , Fixação Interna de Fraturas , Modelos Anatômicos , Osteoporose/complicações , Fatores de Risco
8.
Bone Joint J ; 102-B(3): 293-300, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114805

RESUMO

AIMS: Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF. METHODS: A total of 97 consecutive PPFs (49 males and 48 females) were included with a mean age of 66 years (standard deviation (SD) 14.9). Of these, 86 patients were treated with surgery and 11 were treated conservatively. All living patients had a minimum two-year follow-up. Patient demographics details, fracture healing, functional scores, and complications were assessed. Clinical outcomes between internal fixation and revisions in patients with or without a stable femoral component were compared. Conservatively treated PPFs were evaluated in terms of mortality and healing status. A logistic regression analysis was performed to identify risk factors for complications. RESULTS: In surgically treated patients, all fractures united and nine complications were identified. The mean postoperative Visual Analogue Scale (VAS) for pain was 1.5 (SD 1.3), mean Parker Mobility Score (PMS) was 6.5 (SD 2.4), and mean Harris Hip Score (HHS) was 79.4 (SD 16.2). Among type B2 and type B3 fractures, patients treated with internal fixation had significantly lower PMS (p = 0.032) and required a longer time to heal (p = 0.012). In conservatively treated patients, one-year mortality rate was 36.4% (4/11), and two patients ultimately progressed to surgery. Young age (p = 0.039) was found to be the only risk factor for complications. CONCLUSION: The overall clinical outcome among Vancouver type B PFF was satisfactory. However, treatment with internal fixation in type B2 and B3 fractures had a significantly longer time to heal and lower mobility than revision cases. Conservative treatment was associated with high rates of early mortality and, in survivors, nonunion. This probably reflects our selection bias in undertaking surgical intervention. In our whole cohort, younger patient age was a risk factor for postoperative complications in Vancouver type B PFF. Cite this article: Bone Joint J 2020;102-B(3):293-300.


Assuntos
Tratamento Conservador/métodos , Fraturas do Fêmur/terapia , Fixação Interna de Fraturas/métodos , Fraturas Periprotéticas/terapia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , China/epidemiologia , Feminino , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/etiologia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/diagnóstico , Fraturas Periprotéticas/etiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências
9.
Bone Joint J ; 102-B(2): 162-169, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009427

RESUMO

AIMS: Osseointegrated prosthetic limbs allow better mobility than socket-mounted prosthetics for lower limb amputees. Fractures, however, can occur in the residual limb, but they have rarely been reported. Approximately 2% to 3% of amputees with socket-mounted prostheses may fracture within five years. This is the first study which directly addresses the risks and management of periprosthetic osseointegration fractures in amputees. METHODS: A retrospective review identified 518 osseointegration procedures which were undertaken in 458 patients between 2010 and 2018 for whom complete medical records were available. Potential risk factors including time since amputation, age at osseointegration, bone density, weight, uni/bilateral implantation and sex were evaluated with multiple logistic regression. The mechanism of injury, technique and implant that was used for fixation of the fracture, pre-osseointegration and post fracture mobility (assessed using the K-level) and the time that the prosthesis was worn for in hours/day were also assessed. RESULTS: There were 22 periprosthetic fractures; they occurred exclusively in the femur: two in the femoral neck, 14 intertrochanteric and six subtrochanteric, representing 4.2% of 518 osseointegration operations and 6.3% of 347 femoral implants. The vast majority (19/22, 86.4%) occurred within 2 cm of the proximal tip of the implant and after a fall. No fractures occurred spontaneously. Fixation most commonly involved dynamic hip screws (10) and reconstruction plates (9). No osseointegration implants required removal, the K-level was not reduced after fixation of the fracture in any patient, and all retained a K-level of ≥ 2. All fractures united, 21 out of 22 patients (95.5%) wear their osseointegration-mounted prosthetic limb longer daily than when using a socket, with 18 out of 22 (81.8%) reporting using it for ≥ 16 hours daily. Regression analysis identified a 3.89-fold increased risk of fracture for females (p = 0.007) and a 1.02-fold increased risk of fracture per kg above a mean of 80.4 kg (p = 0.046). No increased risk was identified for bilateral implants (p = 0.083), time from amputation to osseointegration (p = 0.974), age at osseointegration (p = 0.331), or bone density (g/cm2, p = 0.560; T-score, p = 0.247; Z-score, p = 0.312). CONCLUSION: The risks and sequelae of periprosthetic fracture after press-fit osseointegration for amputation should not deter patients or clinicians from considering this procedure. Females and heavier patients are likely to have an increased risk of fracture. Age, years since amputation, and bone density do not appear influential. Cite this article: Bone Joint J 2020;102-B(2):162-169.


Assuntos
Amputação , Fraturas do Fêmur/cirurgia , Osseointegração , Fraturas Periprotéticas/cirurgia , Implantação de Prótese/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Amputação/reabilitação , Feminino , Fraturas do Fêmur/etiologia , Fêmur/lesões , Fêmur/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/etiologia , Falha de Prótese , Estudos Retrospectivos , Fatores de Risco
10.
Int Orthop ; 44(1): 173-177, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31081515

RESUMO

PURPOSE: What are the overall, 30-day, 6-month, and 1-year mortality rates following distal femur fractures? METHODS: Epidemiological cohort study. Retrospective reviews of charts and X-rays based on a search in the National Danish Health Registry. RESULTS: A total of 293 patients were treated for 302 distal femur fractures between 2005 and 2010. The mean age at the time of fracture was 44.0 years for males and 71.6 years for females. The overall mortality rates after a non-periprosthetic distal femur fracture at 30 days, six months, and one year were 5%, 15%, and 21%, respectively. The mortality rates for patients at > 60 years at 30 days, six months, and one year were 8%, 26%, and 35%, respectively. The mortality rates for patients at ≤ 60 years at 30 days, six months, and one year were 1%, 2%, and 3%, respectively. The overall mortality rates after a periprosthetic distal femur fracture at 30 days, six months, and one year were 10%, 15%, and 15%. Males were 2.6 (95% CI 1.01-6.86, P = 0.04) times more likely to die within the first year compared to women. Patients treated by conservative means shows a 2.8 (95% CI 1.41-5.54, P = 0.03) times increased likelihood of death within the first year compared to patients treated with surgery. CONCLUSIONS: The overall one year mortality rate was 21% for non-periprosthetic distal femur fractures and was elevated to 35% in patients older than 60 years. Patients presenting with a periprosthetic fracture showed a one year mortality rate of 15%.


Assuntos
Fraturas do Fêmur/mortalidade , Fraturas Periprotéticas/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Criança , Pré-Escolar , Comorbidade , Tratamento Conservador/mortalidade , Dinamarca/epidemiologia , Feminino , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/terapia , Fêmur/lesões , Fixação de Fratura/efeitos adversos , Fixação de Fratura/mortalidade , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/terapia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
11.
Int Orthop ; 44(1): 53-59, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31098685

RESUMO

BACKGROUND: The number of total hip arthroplasties (THA) is expected to increase worldwide; thus, complications are likely to increase at the same ratio. In this scenario, periprosthetic femoral fractures (PFFs) are an increasing concern. Identifying the predisposing factors is important in order to prevent as much as possible the risk of PFF in the future. PATIENTS AND METHODS: The purpose of this study was to correlate the risk of periprosthetic femoral fractures to the most common patients' comorbidities and stem geometry. We reviewed all THA for non-oncologic indications between 2004 and 2014 with a mean follow-up of six years (range, 2-12). Three thousand two hundred forty-eight patients (3593 implants) were enrolled in the study, and 45 PFF were registered during this time period. Two thousand five hundred seventy-seven implants (71%) were straight stems, and 1015 (28.3%) were anatomic stems. All X-rays were then analyzed and classified according to the modified Vancouver classification. RESULTS: Periprosthetic femoral fractures incidence was associated with anatomic stem geometry (p < 0.001, OR = 2.2), BMI (p < 0.001), and diabetes (p < 0.001, OR = 5.18). PFFs were not significantly associated with age, gender, and all the other variables. Fracture pattern was different between straight and anatomic stems. Clamshell fractures were more likely to occur in anatomic stems compared to straight stems (p < 0.005). CONCLUSIONS: Periprosthetic femoral fractures are highly associated with obesity and osteoporosis. Anatomic stems reported a higher incidence of PPF than straight stems. The typical fracture type for anatomical stems is the clamshell pattern, while straight stems are more likely affected by type B fractures.


Assuntos
Artroplastia de Quadril/efeitos adversos , Fraturas do Quadril/etiologia , Prótese de Quadril/efeitos adversos , Fraturas Periprotéticas/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Complicações do Diabetes/complicações , Feminino , Fraturas do Fêmur/classificação , Fraturas do Fêmur/etiologia , Fêmur/cirurgia , Fraturas do Quadril/classificação , Prótese de Quadril/classificação , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Osteoporose/complicações , Fraturas Periprotéticas/classificação , Desenho de Prótese/efeitos adversos , Desenho de Prótese/classificação , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
12.
J Pediatr Orthop ; 40(2): e149-e154, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31181027

RESUMO

BACKGROUND: Nonossifying fibroma (NOF) is the most common benign osseous lesion in children; however, our understanding of which lesions progress to a fracture remains unclear. In this study, we seek to formulate a classification system for NOFs to assess for fracture risk and determine what this classification system tells us regarding fracture risk of the distal tibia and distal femur NOFs. METHODS: Charts were retrospectively reviewed for patients with NOFs. A 4-point criteria was created and used to calculate fracture risk for distal tibia and distal femur NOFs. The analysis included incidence, specificity, and sensitivity. RESULTS: One point was given for each of the following findings on computed tomography (CT) scan: (1) >50% width on coronal view; (2) >50% width on sagittal view; (3) any cortical breach; (4) lack of a neocortex. In total, 34 patients with NOFs of the distal tibia had CT scans, of which 14 fractured. Zero with a 0- or 1-point score fractured, 2 with a 2-point score fractured (20%), 4 with a 3-point score fractured (44%), and 8 with a 4-point score fractured (100%). Sensitivities of 1-, 2-, 3-, and 4-point scores were 100%, 100%, 85.7%, and 57.1%, respectively, and specificities were 71.4%, 71.4%, 80%, and 100%, respectively. A total of 41 patients with NOFs of the distal femur had CT scans, of which 5 fractured. Zero with a 0-point score fractured, 1 with a 1-point score fractured (4%), 0 with a 2-point score fractured, 1 with a 3-point score fractured (20%), and 3 with a 4-point score fractured (100%). Sensitivities of 1-, 2-, 3-, and 4-point scores were 100%, 80%, 80%, and 60%, respectively; and specificities were 60%, 87.8%, 90%, and 100%, respectively. CONCLUSIONS: Our 4-point CT criteria is easy to apply and identifies patients at high risk of fracture, helping surgeons make decisions regarding treatment. LEVEL OF EVIDENCE: Level IV-prognostic study.


Assuntos
Neoplasias Ósseas/classificação , Fraturas do Fêmur/etiologia , Fibroma/classificação , Fraturas Espontâneas/etiologia , Fraturas da Tíbia/etiologia , Adolescente , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Criança , Feminino , Fibroma/complicações , Fibroma/diagnóstico por imagem , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco/métodos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
13.
BMJ Case Rep ; 12(12)2019 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-31818893

RESUMO

After a high-energy trauma, a 37-year-old motorcyclist presented to the emergency ward with a Hoffa fracture of the lateral femoral condyle of the right knee. Following admission, the patient developed a pale, cold and pulseless right foot. CT angiography scan showed a 5 cm dissection of the popliteal artery. Emergency arterial reconstruction was performed and the Hoffa fracture was repaired in a second stage. To our knowledge, this is the first report of a patient with a Hoffa fracture accompanied by a popliteal artery dissection.


Assuntos
Acidentes de Trânsito , Fraturas do Fêmur/diagnóstico , Fraturas Cominutivas/diagnóstico , Artéria Poplítea/lesões , Adulto , Parafusos Ósseos , Angiografia por Tomografia Computadorizada , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Fraturas Cominutivas/etiologia , Fraturas Cominutivas/cirurgia , Humanos , Masculino , Motocicletas , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Fraturas da Tíbia/diagnóstico , Resultado do Tratamento
14.
JAMA Netw Open ; 2(12): e1917141, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31825502

RESUMO

Importance: Androgen deficiency is common among male opioid users, and opioid use has emerged as a common antecedent of testosterone treatment. The long-term health outcomes associated with testosterone therapy remain unknown, however. Objective: To compare health outcomes between long-term opioid users with testosterone deficiency who filled testosterone prescriptions and those with the same condition but who did not receive testosterone treatment. Design, Setting, and Participants: This cohort study focused on men in the care of the Veterans Health Administration (VHA) facilities throughout the United States from October 1, 2008, to September 30, 2014. It included male veterans who were long-term opioid users, had low testosterone levels (<300 ng/dL), and received either a testosterone prescription or any other prescription. It excluded male patients with HIV infection, gender dysphoria, or prostate cancer and those who received testosterone in fiscal year 2008. Data were analyzed from April 1, 2017, to April 30, 2019. Exposure: Prescription for testosterone. Main Outcomes and Measures: All-cause mortality and incidence of major adverse cardiovascular events (MACE), vertebral or femoral fractures, and anemia during the 6-year follow-up through September 30, 2015. Results: After exclusions, 21 272 long-term opioid users (mean [SD] age, 53 [10] years; n = 16 689 [78.5%] white) with low total or free testosterone levels were included for analysis, of whom 14 121 (66.4%) received testosterone and 7151 (33.6%) did not. At baseline, compared with opioid users who did not receive testosterone, long-term opioid users who received testosterone treatment were more likely to have obesity (43.7% vs 49.0%; P < .001), hyperlipidemia (43.0% vs 48.8%; P < .001), and hypertension (53.9% vs 55.2%; P = .07) but had lower prevalence of coronary artery disease (15.9% vs 12.9%; P < .001) and stroke (2.4% vs 1.3%; P < .001). After adjusting for covariates, opioid users who received testosterone had significantly lower all-cause mortality (hazard ratio [HR] = 0.51; 95% CI, 0.42-0.61) and lower incidence of MACE (HR = 0.58; 95% CI, 0.51-0.67), femoral or hip fractures (HR = 0.68; 95% CI, 0.48-0.96), and anemia (HR = 0.73; 95% CI, 0.68-0.79) during the follow-up period of up to 6 years, compared with their counterparts without a testosterone prescription. In covariate-adjusted models, men who received opioids plus testosterone were more likely to have resolved anemia compared with those who received opioids only during the 6-year follow-up (HR = 1.16; 95% CI, 1.02-1.31). Similar results were obtained in propensity score-matched models and when analyses were restricted to opioid users with noncancer pain or those who did not receive glucocorticoids. Conclusions and Relevance: This study found that, in the VHA system, male long-term opioid users with testosterone deficiency who were treated with opioid and testosterone medications had significantly lower all-cause mortality and significantly lower incidence of MACE, femoral or hip fractures, and anemia after a multiyear follow-up. These results warrant confirmation through a randomized clinical trial to ascertain the efficacy of testosterone in improving health outcomes for opioid users with androgen deficiency.


Assuntos
Androgênios/deficiência , Androgênios/uso terapêutico , Doenças do Sistema Endócrino/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/complicações , Testosterona/deficiência , Testosterona/uso terapêutico , Saúde dos Veteranos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Causas de Morte , Doenças do Sistema Endócrino/etiologia , Doenças do Sistema Endócrino/mortalidade , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/etiologia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/mortalidade , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Resultado do Tratamento , Estados Unidos
15.
JBJS Case Connect ; 9(4): e0179, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31688057

RESUMO

CASE: We describe a nonambulatory 39-year-old man who presented with a diagnosis of osteopetrosis and ankyloses, having experienced bilateral fractures of his proximal femora, undergone unsuccessful conventional surgical interventions, and having developed chronic osteomyelitis of his right proximal femur. Bilateral Girdlestone procedures were performed. Postoperative range of hip motion and Harris hip scores improved, and he became ambulatory, achieving optimal function considering the circumstances at 12 months postoperatively. CONCLUSIONS: Although the indications of the bilateral Girdlestone procedure remain undefined, these procedures may constitute acceptable treatment in patients with osteopetrosis with ankylosis and chronic osteomyelitis of the proximal femur.


Assuntos
Anquilose/cirurgia , Fraturas do Fêmur/cirurgia , Fêmur/cirurgia , Procedimentos Ortopédicos/métodos , Osteomielite/cirurgia , Osteopetrose/cirurgia , Adulto , Anquilose/complicações , Doença Crônica , Fraturas do Fêmur/etiologia , Humanos , Masculino , Osteomielite/etiologia , Osteopetrose/complicações
16.
Acta Chir Orthop Traumatol Cech ; 86(5): 330-333, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748107

RESUMO

PURPOSE OF THE STUDY The pilot study deals with the current situation in proximal femoral fractures in culturally diverse regions, namely in Afghanistan (AFG) and in the Czech Republic (CZ). The study aimed to find out whether there are any differences in proximal femoral fractures in dependence on the selected criteria between the two culturally diverse areas. The study used the data of patients who underwent surgery for proximal femoral fracture at the Department of Orthopaedics of the 1 s t Medical Faculty of the Charles University and the Military University Hospital and at the Military Base Hospital Kabul. MATERIAL AND METHODS The study included patients aged 21 years or older who sustained a proximal femoral fracture in the period from October 2013 to February 2014. For the period concerned, the evaluation comprised 44 patients with a proximal femoral fracture from the Military Base Hospital Kabul, of whom 25 women and 19 men, and a total of 71 patients with a proximal femoral fracture from the Department of Orthopaedics of the 1st Medical Faculty of the Charles University and the Military University Hospital, of whom 43 women and 28 men. Based on the medical documentation, the following evaluation parameters were selected: age, sex, type of fracture. The data was processed using descriptive statistics, one-way and multifactorial analysis (ANOVA) and the POST-HOC test (Fisher LSD test, confidence interval = 95%) RESULTS The mean age of all the patients who suffered a fracture of proximal femur in AFG (58 years) was considerably lower (p < 0.001) than in patients in CZ (81 years). Similarly, a significant difference (p <0.001) was identified in the age of men and women treated for a proximal femoral fracture in both the countries. In AFG there was a statistically significant difference (p = 0.002) between the age of men and women, where women sustaining fractures were younger (54 years) compared to men (63 years). In CZ no significant age difference was reported (83 years vs 78 years). In AFG, the observed fractures occurred generally in their 6th and 7th decade, whereas in CZ only in their 9th decade. The incidence of proximal femoral fractures in Afghan women is the highest in their 5th and 6th decade. Pertrochanteric fractures and intracapsular fractures prevailed in both countries. The lowest age in both types of the fracture was reported in Afghan women (52 years in femoral neck fracture, p <0.001, 54 years in trochanteric fracture, p = 0.039). DISCUSSION Significant differences between the patients in AFG and CZ concern several factors. Afghanistan is a country with the lowest average life expectancy. In the Afghan population a major Vitamin D deficiency was confirmed. This is related to the conservative dress code, especially in women, when the Vitamin D synthesis is suppressed. That can cause the occurrence of osteoporosis in women at a considerably younger age than in the population in the Czech Republic, which is subsequently accompanied by an increased incidence of proximal femoral fractures. Similar results, however, were also obtained in men. One of the risk factors of osteoporosis development is also low physical activity throughout the lifetime. This risk factor is significant primarily in female population in the Muslim world. Afghanistan also faces serious malnutrition. All of that is reflected in low life expectancy in the given country, incidence of osteoporosis and injuries in this region. There is reasonable evidence that the mortality in a causal relationship with proximal femoral fracture is substantially higher in this region than in Western Europe. CONCLUSIONS The results of the pilot study showed that there are significant differences in age and frequency of fractures in dependence on sex and country. The obtained results can be considered valuable since there are virtually no scientific or professional studies on osteoporosis and fractures in the given area that would help physicians get ready for significant differences. These results may become a source of valuable information not only for medical practitioners coming to Afghanistan to help as volunteers in the framework of developmental assistance from all over the world, but also for physicians from Europe, with respect to the wave of migrants coming from this area. Key words: proximal femur, fracture, gender, age, Afghanistan, Czech Republic.


Assuntos
Fraturas do Fêmur/epidemiologia , Fraturas por Osteoporose/epidemiologia , Afeganistão/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , República Tcheca/epidemiologia , Feminino , Fraturas do Fêmur/etiologia , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/etiologia , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/etiologia , Projetos Piloto , Fatores Sexuais
17.
Hawaii J Health Soc Welf ; 78(11 Suppl 2): 47-51, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31773111

RESUMO

Bisphosphonate use has been associated with atypical pathologic fracture and slowed bone turnover. We present a case of a bisphosphonate-associated peri-implant atypical femur fracture following use of a recon nail for treatment of a prior bisphosphonate-associated atypical femur fracture.


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Denosumab , Difosfonatos , Fraturas Periprotéticas/terapia , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/uso terapêutico , Remodelação Óssea , Denosumab/administração & dosagem , Denosumab/efeitos adversos , Difosfonatos/efeitos adversos , Difosfonatos/uso terapêutico , Feminino , Fraturas do Fêmur/etiologia , Humanos
18.
Curr Opin Endocrinol Diabetes Obes ; 26(6): 283-290, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31592780

RESUMO

PURPOSE OF REVIEW: This article summarizes the risk factors for atypical femur fractures (AFF), discusses current and emerging imaging modalities for early identification of AFF, and offers recommendations for prevention and management of AFFs based on the current concepts. RECENT FINDINGS: Antiresorptive therapies are widely recommended for prevention and treatment of osteoporosis. Despite their well established effectiveness to reduce fracture risk, emerging concerns related to potential adverse effects have led to a substantial decline in the use of bisphosphonates. Although, the pathogenesis of AFF has not yet been elucidated, the bulk of evidence supports that the well known therapeutic benefits of bisphosphonate far outweigh the relatively low risk of AFFs. Recommendations for early identification of patients at risk for AFF using radiographic imaging have been established. Consensus on the management of AFF and osteoporosis in patients with AFF needs to be formulated. SUMMARY: AFF is a rare event associated with long-term bisphosphonate therapy, which represents an apparent paradox in the management of osteoporosis. Improved understanding of pathogenetic mechanisms will be helpful in further refining of screening guidelines and standardization of management and treatment strategies.


Assuntos
Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/terapia , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/tendências , Difosfonatos/efeitos adversos , Difosfonatos/uso terapêutico , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/prevenção & controle , Humanos , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/terapia , Guias de Prática Clínica como Assunto , Medicina Preventiva/métodos , Medicina Preventiva/normas , Medição de Risco , Fatores de Risco
19.
Unfallchirurg ; 122(11): 885-900, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31650191

RESUMO

The incidence of periprosthetic hip fractures is increasing due to the increase in endoprosthetic hip replacements. These fractures require a staged and individual treatment concept with the aim of mobilization of the patient as early as possible. The special challenge in the diagnostics is to identify pre-existing signs of loosening of the prosthesis. When the prosthesis is still firmly fixed femoral fractures can be treated with angular stable osteosynthesis. Loosened stems usually have to be revised, mostly in combination with osteosynthesis. Fractures around the acetabulum with a fixed cup can be treated nonoperatively or with osteosynthesis, while loosened cups have to be revised. In revision surgery the stabilization of the dorsal column is crucial for a successful outcome.


Assuntos
Artroplastia de Quadril/efeitos adversos , Fraturas do Fêmur , Fraturas do Quadril , Fraturas Periprotéticas/etiologia , Acetábulo/lesões , Artroplastia de Quadril/métodos , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/terapia , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/etiologia , Fraturas do Quadril/terapia , Humanos , Fraturas Periprotéticas/diagnóstico , Fraturas Periprotéticas/terapia , Falha de Prótese , Reoperação
20.
Medicine (Baltimore) ; 98(38): e17123, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567950

RESUMO

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


Assuntos
Fraturas do Fêmur/epidemiologia , Fraturas da Tíbia/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Serviços de Saúde da Criança , Pré-Escolar , China/epidemiologia , Feminino , Fraturas do Fêmur/etiologia , Humanos , Lactente , Extremidade Inferior/lesões , Masculino , Fatores Sexuais , Fraturas da Tíbia/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...