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1.
Bone Joint J ; 102-B(2): 227-231, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009431

RESUMO

AIMS: The purpose of this study was to evaluate the relationships between the degree of injury to the medial and lateral collateral ligaments (MCL and LCL) and associated fractures in patients with a posterolateral dislocation of the elbow, using CT and MRI. METHODS: We retrospectively reviewed 64 patients who presented between March 2009 and March 2018 with a posterolateral dislocation of the elbow and who underwent CT and MRI. CT revealed fractures of the radial head, coronoid process, and medial and lateral humeral epicondyles. MRI was used to identify contusion of the bone and collateral ligament injuries by tear, partial or complete tear. RESULTS: A total of 54 patients had a fracture; some had more than one. Radial head fractures were found in 25 patients and coronoid fractures in 42. Lateral and medial humeral epicondylar fractures were found in eight and six patients, respectively. Contusion of the capitellum was found in 43 patients and rupture of the LCL was seen in all patients (partial in eight and complete in 56), there was complete rupture of the MCL in 37 patients, partial rupture in 19 and eight had no evidence of rupture. The LCL tear did not significantly correlate with the presence of fracture, but the MCL rupture was complete in patients with a radial head fracture (p = 0.047) and there was significantly increased association in those without a coronoid fracture (p = 0.015). CONCLUSION: In posterolateral dislocation of the elbow, LCL ruptures are mostly complete, while the MCL exhibits various degrees of injury, which are significantly associated with the associated fractures. Cite this article: Bone Joint J 2020;102-B(2):227-231.


Assuntos
Ligamentos Colaterais/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Fraturas do Úmero/diagnóstico por imagem , Luxações Articulares/diagnóstico por imagem , Fraturas do Rádio/diagnóstico por imagem , Fraturas da Ulna/diagnóstico por imagem , Adulto , Idoso , Ligamentos Colaterais/lesões , Articulação do Cotovelo/lesões , Feminino , Humanos , Fraturas do Úmero/complicações , Luxações Articulares/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/complicações , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Ulna/diagnóstico por imagem , Ulna/lesões , Fraturas da Ulna/complicações , Adulto Jovem
2.
Medicine (Baltimore) ; 99(7): e17763, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049775

RESUMO

Unstable distal metaphyseal and dia-metaphyseal fractures of the radius may have treated with a variety of operative techniques, Kirschner wires (K-wires), dorsally inserted titanium elastic stable intramedullary nailing (DESIN), and short titanium elastic stable intramedullary nailing (SESIN) in children.The aim of this study was to evaluate the differences in clinical and radiographic outcomes between these methods.Between January 2009 and December 2017 196 children were treated for forearm fractures in the distal third of the distal radius. Gender of the patients, different types of surgical techniques, number of postoperative X-rays, date of metal removal and degree of axis deviation after the metal removal were studied. Distance of the fracture line from the radiocarpal surface, the width of the distal epiphysis of the radius, and the cumulative width of the distal epiphysis of the ulna and radius were analyzed.Out of the 196 children, stabilization of the fracture was achieved by K-wire in 139, by DESIN in 44, and by SESIN in 13 patients. The average time of metal removal was significantly shorter (3.8 months), following stabilization with K-wire. In children treated with K-wire, axial deviation of <5° was seen in 118 patients, 5° to 10° deviation in 15 patients, while deviation was above 10° in 6 children. In the DESIN group, <5° axial deviation was found in 37 patients and 5° to 10° in seven patients. In all 13 children treated with SESIN, axial deviation was measured to be <5°. The fracture distance from the radiocarpal surface was on average 23.7 and 45.6 mm in the children treated with K-wire and DESIN, respectively.Fracture distance from the radiocarpal surface might determine the type of surgical technique required. If the distance of the fracture line is less than the width of the distal radius, osteosynthesis with a K-wire is recommended, while if the distance of the fracture is more than the cumulative width of the radius and the ulna, then DESIN may provide better results. The use of SESIN may be indicated when the area of the growth plate is injured.


Assuntos
Fixação de Fratura/instrumentação , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Fios Ortopédicos , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Masculino , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Fraturas da Ulna/diagnóstico por imagem
3.
Medicine (Baltimore) ; 99(8): e19259, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080133

RESUMO

BACKGROUND: The aim of this study was to evaluate the effectiveness and safety of surgical treatment of intra-articular distal radius fractures (DRFs) with the assistance of three-dimensional (3D) printing technique. METHODS: Patients with intra-articular DRFs in our hospital from February 2017 to November 2018 were enrolled in this study, and were randomly assigned to 2 parallel groups to receive surgical treatment with the assistance of 3D printing technique or not. For patients in the 3D printing group, the surgical procedure was simulated with 3D physical model before surgery. Volar plate and K-wire fixation were performed in all patients. Patients in the 2 groups were compared in terms of intraoperative indexes and postoperative function. RESULTS: A total of 32 patients were included in our study. During surgery, mean operation time in the 3D model group was significantly lower than that in the routine group (P < .001). Besides, significantly less blood was lost in the 3D model group than that in the routine group (P < .001). Furthermore, the 3D model group had a significantly less times of intraoperative fluoroscopy than that in the routine group (P = .002). However, the 3D model group showed no significant difference in visual analog scale (VAS) score, the disabilities of the arm, shoulder, and hand (DASH) score, or active wrist range of motion (ROM) in comparison with the routine group (P > .05). CONCLUSION: With the assistance of 3D printing technique, the operation time, amount of intraoperative bleeding, and times of intraoperative fluoroscopy can be reduced during the surgical treatment of intra-articular DRFs with volar plating and K-wire fixation. This technique is safe and effective, and is worth spreading in other orthopedic surgeries.


Assuntos
Simulação por Computador , Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Impressão Tridimensional , Fraturas do Rádio/cirurgia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Placas Ósseas , Fios Ortopédicos , Avaliação da Deficiência , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Duração da Cirurgia , Cuidados Pré-Operatórios , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X , Escala Visual Analógica
4.
Medicine (Baltimore) ; 99(2): e18508, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914022

RESUMO

This is a retrospective evaluated. The objective of this study was to test the interobserver reliability and intraobserver reproducibility of fracture classification with Arbeitsgemeinschaftfür Osteosynthesefragen (AO) system and Fernandez system used by 5 senior orthopedic surgeons.Anteroposterior and lateral radiographs of 160 patients hospitalized for displaced distal radius fracture were examined. Independently, 5 orthopedic surgeons evaluated the radiographs according to 2 different distal radius classification systems (3 types of results). Three statistical tools were used to measure interobserver reliability and intraobserver reproducibility. The intraclass correlation coefficient and kappa coefficient (k) were used to assess both interobserver and intraobserver agreement of AO and Fernandez. Kappa value indicated poor agreement (<0), slight (0-0.20), fair (0.21-0.40), moderate (0.41-0.60), good (0.61-0.80), and perfect (0.81-1.00).The intraobserver reproducibility of AO system (9 types) and Fernandez system were moderate with a value of 0.577 and 0.438. The intraobserver reproducibility of AO system (27 subtypes) was 0.286. The interobserver reliability of AO system (9 types) was moderate with a value of 0.469 and that of Fernandez was moderate with a value of 0.435. The interobserver reliability of AO system (27 subtypes) was 0.299.Neither of the 2 systems can give us a satisfactory agreement between interobserver reliability and intraobserver reproducibility. In AO system, the interobserver reliability and intraobserver reproducibility of the 9 types decreased with the increase of subgroups.


Assuntos
Fraturas do Rádio/classificação , Fraturas do Rádio/diagnóstico por imagem , Reprodutibilidade dos Testes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Cirurgiões Ortopédicos , Radiografia/métodos , Estudos Retrospectivos , Adulto Jovem
5.
Bone Joint J ; 102-B(1): 137-143, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888368

RESUMO

AIMS: Carpal malalignment after a distal radial fracture occurs due to loss of volar tilt. Several studies have shown that this has an adverse influence on function. We aimed to investigate the magnitude of dorsal tilt that leads to carpal malalignment, whether reduction of dorsal tilt will correct carpal malalignment, and which measure of carpal malalignment is the most useful. METHODS: Radiographs of patients with a distal radial fracture were prospectively collected and reviewed. Measurements of carpal malalignment were recorded on the initial radiograph, the radiograph following reduction of the fracture, and after a further interval. Linear regression modelling was used to assess the relationship between dorsal tilt and carpal malalignment. Receiver operating characteristic (ROC) analysis was used to identify which values of dorsal tilt led to carpal malalignment. RESULTS: A total of 250 consecutive patients with 252 distal radial fractures were identified. All measures of carpal alignment were significantly associated with dorsal tilt at each timepoint. This relationship persisted after adjustment for age, sex, and the position of the wrist. Capitate shift consistently had the strongest relationship with dorsal tilt and was the only parameter that was not influenced by age or the position of the wrist. ROC curve analysis identified that abnormal capitate shift was seen with > 9° of dorsal tilt. CONCLUSION: Carpal malalignment is related to dorsal tilt following a distal radial fracture. Reducing the fracture and improving dorsal tilt will reduce carpal malalignment. Capitate shift is easy to assess visually, unrelated to age and sex, and appears to be the most useful measure of carpal malalignment. The aim during reduction of a distal radial fracture should be to realign the capitate with the axis of the radius and prevent carpal malalignment. Cite this article: Bone Joint J 2020;102-B(1):137-143.


Assuntos
Mau Alinhamento Ósseo/etiologia , Ossos do Carpo , Fraturas do Rádio/complicações , Mau Alinhamento Ósseo/diagnóstico por imagem , Feminino , Humanos , Fraturas Intra-Articulares/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Fraturas do Rádio/diagnóstico por imagem
6.
Arch Orthop Trauma Surg ; 140(1): 51-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31515620

RESUMO

INTRODUCTION: The purpose of this study is to analyze the mid-term outcomes of a modular monopolar type of radial head arthroplasty in the treatment of complex fractures associated with acute elbow joint instability. We postulated that radiographic changes are related to the development of clinical complications. MATERIALS AND METHODS: We evaluated at last follow-up 26 radial head arthroplasties in 26 consecutive patients who were followed for at least one and a half year. All patients had suffered radial head fractures (Mason III) in the context of unstable elbow injuries. Definitive treatment of the radial fracture was performed with modular and monopolar prosthesis which was inserted as a press fit. All patients were evaluated preoperatively and postoperatively. The evaluation included a clinical examination and a protocolized imaging study (standard X-Rays and CT) of the elbow. We analyzed the incidence of: heterotopic ossifications, secondary radiocapitellar joint osteoarthritis, hardware loosening, hardware disengagement, and joint infection. Diagnosis of clinical failure of the implant was defined as the time to the second surgery due to major complications related to the prosthesis, such as persistent lateral side pain or elbow stiffness and any kind of implant instability or dislocation. RESULTS: The implant-specific reoperation rate was 15% (four reoperations). The need for the second surgery was statistically associated with heterotopic ossifications, radiocapitellar osteoarthritis and cortical resorption around radial neck (p = 0.054, p = 0.033, and p = 0.019, respectively), being periprosthetic osteolysis the most likely factor related to failure, and radial pain the main symptom leading to surgical revision. CONCLUSIONS: Our study shows a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty. Failed radial head replacements may lead to reoperation mainly due to pain, and this can be distinguished from other causes of pain in elbow region based on its radial location. Radiological loosening was prevalent in this group of failed replacement.


Assuntos
Artroplastia , Fraturas do Rádio , Rádio (Anatomia) , Artroplastia/efeitos adversos , Artroplastia/estatística & dados numéricos , Seguimentos , Humanos , Prótese Articular , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/fisiopatologia , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/cirurgia , Tomografia Computadorizada por Raios X , Falha de Tratamento
7.
Br J Radiol ; 93(1106): 20190620, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573325

RESUMO

CT is a readily available imaging modality for cross-sectional characterization of acute musculoskeletal injuries in trauma. Dual-energy CT provides several additional benefits over conventional CT, namely assessment for bone marrow edema, metal artifact reduction, and enhanced assessment of ligamentous injuries. Winter sports such as skiing, snowboarding, and skating can result in high speed and high energy injury mechanisms; dual-energy CT is well suited for the characterization of those injuries.


Assuntos
Esportes na Neve/lesões , Tomografia Computadorizada por Raios X/métodos , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Lesões do Quadril/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/diagnóstico por imagem , Fraturas da Tíbia/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Adulto Jovem
8.
J Pediatr Orthop ; 40(1): e6-e13, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30969197

RESUMO

BACKGROUND: Most distal radius fractures can be treated with closed reduction and casting in pediatric patients. These skills are traditionally developed treating real patients, however, there is growing interest in the use of simulation training to supplement traditional learning strategies. METHODS: Seventy-eight children with distal radius fractures that underwent closed reduction and casting by novice orthopaedic surgery residents were retrospectively reviewed. Radiographic measures of patients treated by simulation-trained residents were compared with patients treated by residents without simulation training. RESULTS: Patients treated by simulation-trained residents had less residual angulation in the anteroposterior radiograph (3.7 vs. 6.3 degrees, P=0.006) and translation on the lateral (14% vs. 21%, P=0.040) and anteroposterior radiograph (10% vs. 16%, P=0.029). Patients treated by simulation-trained residents also had lower rates of redisplacement (50% vs. 79%, P=0.016). CONCLUSIONS: Loss of reduction is common, particularly when novice trainees perform their first independent reductions. Residents who underwent simulation training had lower rates of loss of reduction, thus simulation training has potential as a supplement to the traditional apprentice model of medical education. LEVEL OF EVIDENCE: Level III.


Assuntos
Redução Fechada/educação , Internato e Residência/métodos , Ortopedia/educação , Fraturas do Rádio/cirurgia , Treinamento por Simulação , Moldes Cirúrgicos , Criança , Feminino , Humanos , Masculino , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
9.
J Pediatr Orthop ; 40(1): e14-e18, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30973474

RESUMO

BACKGROUND: Recent studies indicate that formal postreduction radiographs may be unnecessary for closed, isolated pediatric wrist, and forearm when mini C-arm fluoroscopy is used for reduction. Our institution changed the Emergency Department (ED) management protocol to reflect this by allowing orthopaedic providers to determine if fluoroscopy was acceptable to assess fracture reduction. We hypothesized that using fluoroscopy as definitive postreduction imaging would decrease total encounter time, without an increase in the rate of rereduction or surgery. METHODS: Patients with closed, isolated distal radius/distal ulna (DR/DU) or both bone forearm (BBFA) fractures that required sedation and reduction under mini C-arm fluoroscopy at our Level 1 pediatric ED were reviewed for 6 months both before and after this policy change. Before, all patients had formal postreduction radiographs; after, the decision was left to the orthopaedic physician. Timestamp data were collected, as was the need for rereduction or surgery. In addition to descriptive statistics, between-group differences were analyzed with the Student t test, χ test, and multivariable regression as appropriate. RESULTS: A total of 243 patients (119 before, 124 after) had 165 DR/DU and 78 BBFA fractures. Demographic data were similar before and after. After protocol implementation, univariable analysis (Student t test) showed that sedation times were longer, while total ED time and the time from sedation beginning to discharge were similar. The proportion of patients requiring rereduction or surgery were similar.After multivariable regression, "fluoroscopy as definitive imaging" was the only independent determinant of the time intervals compared with using conventional radiography. Sedation was an average of 13.8 minutes longer (P<0.001), while the interval from sedation beginning to discharge was 15.8 minutes shorter (P=0.007), and total ED time was 33.0 minutes shorter (P=0.018). Fluoroscopy as definitive imaging was not a predictor of surgery (odds ratio=0.63, P=0.520), although having a BBFA increased the likelihood (odds ratio=4.50, P=0.008). CONCLUSIONS: Implementing a protocol in which the provider could use mini C-arm fluoroscopy for definitive postreduction imaging did not result in increased rates remanipulation or need for surgery. Regression analysis further demonstrated time savings associated with foregoing conventional radiographs. LEVEL OF EVIDENCE: Level III-therapeutic.


Assuntos
Redução Fechada , Sedação Consciente , Fluoroscopia , Tempo de Internação , Fraturas do Rádio/diagnóstico por imagem , Fraturas da Ulna/diagnóstico por imagem , Criança , Serviço Hospitalar de Emergência , Feminino , Antebraço , Humanos , Masculino , Radiografia , Fraturas do Rádio/cirurgia , Fatores de Tempo , Fraturas da Ulna/cirurgia , Punho
10.
J Shoulder Elbow Surg ; 29(1): 132-138, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31521526

RESUMO

BACKGROUND: The aim of this study was to determine the lateral ulnar collateral ligament (LUCL) injury associated with isolated radial head fracture (RHF) and the relationship of the ligament injury with the displacement of the fragment-loss of contact-in unstable displaced partial articular RHF in individuals without any history of ulnohumeral dislocation. METHODS: We retrospectively identified 131 consecutive patients who underwent open reduction and internal fixation of isolated closed Mason type II RHF performed at our institution. We identified 3 subsets by the pattern of RHF and the position of the unstable fragment (anterior or posterior) relative to the capitulum humeri: displaced stable (group I), displaced anterior unstable (group II), and displaced posterior unstable (group III). Standard radiographs were obtained preoperatively and postoperatively. The pattern of lateral collateral ligament avulsion and its distribution were inferred from intraoperative records. RESULTS: Preoperative radiographs of the 131 patients showed 101 nonseparated fractures (77%, group I) and 30 unstable fractures (23%). Anterior displacement of the fragment was found in 18 elbows (14%, group II) and posterior displacement in 12 (9%, group III). LUCL avulsion was found in 18 of 30 unstable RHFs (60%) and in 1 of 60 stable RHFs (1.6%). CONCLUSION: RHF is a complex fracture often associated with soft tissue lesions. It is important to determine which structures need to be repaired to avoid complications that could lead to elbow instability. The RHF pattern and classification as stable or unstable can help the surgeon in the identification and treatment of LUCL lesions.


Assuntos
Ligamento Colateral Ulnar/diagnóstico por imagem , Ligamento Colateral Ulnar/lesões , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Adulto , Idoso , Ligamento Colateral Ulnar/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Epífises/lesões , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas Intra-Articulares/complicações , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Masculino , Pessoa de Meia-Idade , Redução Aberta , Período Pré-Operatório , Radiografia , Fraturas do Rádio/complicações , Estudos Retrospectivos , Ruptura/complicações , Ruptura/cirurgia , Adulto Jovem
11.
Bull Hosp Jt Dis (2013) ; 77(4): 279-284, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31785143

RESUMO

Appendicular metastasis from multiple myeloma (MM) frequently presents with a pathologic fracture. In this case report, a patient with a long history of MM and an associated pathologic fracture was treated using a specialized brace. This orthosis uses a deforming element to asymmetrically increase the soft tissue pressure around the pathologic fracture. The patient experienced rapid pain relief and bony healing without surgical intervention.


Assuntos
Neoplasias Ósseas/terapia , Fixação de Fratura/instrumentação , Fraturas Espontâneas/terapia , Mieloma Múltiplo/terapia , Aparelhos Ortopédicos , Fraturas do Rádio/terapia , Idoso , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Desenho de Equipamento , Consolidação da Fratura , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/fisiopatologia , Humanos , Masculino , Mieloma Múltiplo/complicações , Mieloma Múltiplo/secundário , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/etiologia , Fraturas do Rádio/fisiopatologia , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(52): e18429, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876721

RESUMO

RATIONALE: Galeazzi fractures are uncommon, and are less common in children than in adults. Galeazzi-equivalent fractures, a variant of the classic Galeazzi fractures, mostly occur in children or adolescents. Galeazzi equivalent fractures may commonly accompany distal radial fractures or injury of the epiphyseal plate of the distal ulna. PATIENT CONCERNS: A 13-year-old man visited our emergency department after stumbling over a rock. Manual reduction and splinting was already done in a nearby medical center. Plain radiographs revealed fractures in the distal radius and fracture of the ulnar epiphyseal plate. DIAGNOSIS: Plain radiographs showed Galeazzi-equivalent fracture. The result of primary closed reduction was not enough and there was still displacement of fracture. INTERVENTIONS: Anatomical reduction of distal radius was fixed with a plate and screws, and K-wires were inserted percutaneously for reduction and fixation of ulnar fracture. OUTCOMES: Complete bone union was achieved and normal range of motion is shown 2 years postoperatively. The patient is able to perform daily activities and sport activities without any signs of ulnar growth arrest. LESSONS: Open reduction is required in patients with malalignment, failure to reduce the DRUJ or maintain its reduction, or older ages which are hard to expect sufficient bone remodeling.


Assuntos
Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Traumatismos do Punho/cirurgia , Acidentes por Quedas , Adolescente , Humanos , Masculino , Redução Aberta/métodos , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/patologia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/patologia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/patologia
13.
BMC Musculoskelet Disord ; 20(1): 567, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775704

RESUMO

BACKGROUND: Severely displaced radial neck fractures in skeletally immature children are rare and can be difficult to reduce. The purpose of this study is to evaluate the results using our reduction maneuver. METHODS: From October 2011 to December 2015, 26 children with radial neck fractures(O'Brien type II, III and Judet type III, IV) were treated at our institute. All patients underwent percutaneous K-wire leverage and radial intramedullary pinning in an average surgery time of 35 mins (15-80 min). The injured arm was immobilized at the functional position with plaster for 4-6 weeks, evaluated clinically and radiologically. The Metaizeau classification and Mayo elbow performance score were used to evaluate the radiological and clinical results, respectively. Percutaneous K-wire leverage and radial intramedullary pinning were performed for 26 patients. No patients were treated with open reduction. Twenty four patients were followed up for a mean of 33 (range 12-53 months) months. RESULTS: There were 15 girls and 9 boys with ages ranging from 1.5 to 12 years and an average age of 7.2 years. Percutaneous K-wire leverage reduction and intramedullary pinning were successfully used in an average total surgery time of 35 mins (range 15-80 min). In total, 2 cases (O'Brien type III and Judet type IVb, angulation = 90°) needed the additional maneuver. Bone union was achieved in all patients within a mean time of 4.2 weeks. The clinical results were evaluated basing on the Mayo elbow performance score, and there were 23 excellent results and one good result. There were no refractures and no incidences of nonunion, suture infection, iatrogenic radial nerve injury, asymptomatic enlargements of the radial head or growth arrest in the proximal radial epiphysis. CONCLUSION: Our modified percutaneous leverage technique with radial intramedullary fixation may be successfully used to avoid open reduction.


Assuntos
Fixação Intramedular de Fraturas/métodos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Índice de Gravidade de Doença , Criança , Pré-Escolar , Feminino , Seguimentos , Fixação Intramedular de Fraturas/instrumentação , Humanos , Lactente , Masculino
14.
BMC Musculoskelet Disord ; 20(1): 538, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31722689

RESUMO

BACKGROUND: Volar locked plate for distal radius fracture is one of the common procedures performed in trauma surgery. There are already some factors which can be used to predict the functional outcome after volar locked plating for distal radius fracture. However their limitations caused that the outcomes couldn't be satisfactorily predicted. Better factors for predicting the prognosis more precisely are of great interest. The aim of this study is to introduce such a new factor. METHODS: A total of 56 patients suffered from unilateral distal radius fracture were managed operatively with the volar locked plate. Before operation, all CT scans of the distal radius were obtained. The ratios of soft tissue circumference to bone circumference at the watershed line in the distal radius were calculated based on the preoperative CT scans. Outcomes were evaluated after operation. The correlations between the ratio and the outcomes were analyzed using single factor linear regression analysis. RESULTS: Statistically significant linear relationships between the ratio and flexion degrees, extension degrees also patient-rated wrist evaluation (PRWE) scores were discovered. With the increase of the ratios, the flexion and extension range increased and the PRWE scores declined. CONCLUSIONS: There are obvious linear relationships between the ratio and postoperative wrist flexion-extension degrees also PRWE scores when using volar locked plating for distal radius fracture. So the ratio can be used as a predictor aiding surgeons to predict the outcome.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura , Fraturas do Rádio/cirurgia , Traumatismos do Punho/cirurgia , Adulto , Idoso , Pontos de Referência Anatômicos , Fenômenos Biomecânicos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Desenho de Prótese , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/fisiopatologia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/fisiopatologia
15.
J Orthop Surg Res ; 14(1): 342, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694677

RESUMO

BACKGROUND: Recently, computerized virtual surgery planning has been increasingly applied in various orthopedic procedures. In this study, we developed an image fusion system for 3D preoperative planning and fluoroscopy for the osteosynthesis. To assess the utility of image fusion system, we evaluated the reproducibility of preoperative planning in the osteosynthesis of distal radius fractures with using the image fusion system, and compared with the reproducibility of the patients without using the image fusion system. METHODS: Forty-two wrists of 42 distal radius fracture patients who underwent osteosynthesis using volar locking plates were evaluated. The patients were divided into two groups. Image fusion group utilized three-dimensional (3D) preoperative planning and image fusion system. Control group utilized only 3D preoperative planning. In both groups, 3D preoperative planning was performed in order to determine reduction, placement, and choice of implants. In the image fusion group, the outline of planned image was displayed on a monitor overlapping with fluoroscopy images during surgery. Reductions were evaluated by volar tilt and radial inclination of 3D images. Plate positions were evaluated with distance to joint surface, plate center axis position, and inclination relative to the radius axis. Screw choices were recorded for the plan and actual choices for each screw hole. Differences in the parameters between pre- and postoperative images were evaluated. Differences in reduction shape, plate positions, and screw choices were compared between groups. RESULTS: The differences in the distance from plate to joint surface were significantly smaller in the image fusion group compared to the control group (P < 0.01). The differences in the distal screw choices were significantly smaller in the image fusion group compared to the control group (P < 0.01). CONCLUSIONS: The image fusion system was useful to reproduce the planned plate position and distal screw choices in the osteosynthesis of distal radius fractures. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03764501.


Assuntos
Fluoroscopia/métodos , Fixação Interna de Fraturas/métodos , Imageamento Tridimensional/métodos , Cuidados Pré-Operatórios/métodos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/instrumentação , Adulto Jovem
16.
BMJ Case Rep ; 12(11)2019 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-31712239

RESUMO

We present the case of an 11-year-old girl who was presented to the Emergency Department with right elbow pain and swelling following a fall. Radiography demonstrated intra-articular displacement of an avulsed medial epicondyle ossification centre, which was not readily identified at presentation. She proceeded to an uncomplicated open reduction and internal fixation.


Assuntos
Fraturas do Úmero/diagnóstico por imagem , Fraturas do Rádio/diagnóstico por imagem , Acidentes por Quedas , Criança , Articulação do Cotovelo/lesões , Feminino , Humanos , Fraturas do Úmero/cirurgia , Redução Aberta/métodos , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/etiologia , Radiografia , Fraturas do Rádio/cirurgia
17.
Tohoku J Exp Med ; 249(3): 147-154, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31708524

RESUMO

Osteoporosis is characterized by bone loss and skeletal fragility and is likely to occur in postmenopausal women. Distal radius fracture is a type of fragility fractures associated with osteoporosis. Bone mineral density (BMD) refers to the amount of mineral in bone tissue and is an indicator of osteoporosis. This study aimed to investigate the relationship between the severity of distal radius comminution and the BMD of the healthy contralateral forearm and femur in postmenopausal women. Of 165 women who sustained low-energy trauma from falls on flat ground, forearm and femoral neck BMDs were measured in 155 and 163 participants, respectively. Evaluation of distal radius comminution was performed by computed tomography, and the severity is classified based on the degree of articular surface comminution and on the presence of metaphyseal comminution. We thus evaluated 165 cases of articular surface comminution (extra-articular, 43 cases; intra-articular simple, 91 cases; and intra-articular multifragment, 31 cases) and metaphysis comminution (metaphyseal simple, 58 cases; metaphyseal monocortical comminution on either the palmar or dorsal side, 82 cases; and metaphyseal bicortical comminution on the palmar and dorsal sides, 25 cases). There was no significant association between intra-articular comminution and BMD of the forearm and femur. By contrast, the participants with metaphyseal bicortical comminution showed lower BMD of the forearm and femur compared with other types of metaphysis comminution (p < 0.05). In conclusion, postmenopausal women who developed bicortical comminuted fractures of the distal radius tend to have lower femoral BMD, which may predispose them to future hip fractures.


Assuntos
Densidade Óssea , Fêmur/fisiopatologia , Antebraço/fisiopatologia , Fraturas Cominutivas/fisiopatologia , Pós-Menopausa/fisiologia , Fraturas do Rádio/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estatura , Índice de Massa Corporal , Peso Corporal , Feminino , Colo do Fêmur/fisiopatologia , Fraturas Cominutivas/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Fraturas do Rádio/diagnóstico por imagem , Tomografia Computadorizada por Raios X
18.
J Orthop Surg Res ; 14(1): 347, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703693

RESUMO

BACKGROUND: The objective of the study was to depict the pathoanatomy of traumatic valgus instability of the elbow and to report clinical outcomes of primary operation. METHODS: Thirty-one patients presented with traumatic valgus instability of the elbow without dislocation. Thirty-one patients underwent surgical intervention of radial head fractures (28 open reduction and internal fixation and 3 radial head resection) and anatomical repair of the anterior bundle of medial collateral ligament (AMCL) with suture anchors. Twenty patients with disruption of the flexor-pronator tendon (FPT) and 14 patients with tears of the anterior capsule had primary repair of the FPT and anterior capsule simultaneously. Clinical outcomes were evaluated with the Mayo Elbow Performance Score (MEPS), modified hospital for special surgery assessment scale (HSS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS: The median follow-up was 37.3 months (range, 15-53 months). Radial head fractures and complete avulsion of the medial collateral ligament (MCL) from its humeral footprint were confirmed in all patients intraoperatively. Intraoperative findings indicated disruption of the FPT in 20 patients and tears of the anterior capsule in 14 patients. Twenty-nine of 31 patients returned to previous activity and work levels within 6 months after surgery. The MEPS, modified HSS, and DASH score were 94 ± 4, 91 ± 5, and 8 ± 2 at the latest follow-up. CONCLUSIONS: Radial head fractures with avulsion of the MCL can lead to severe valgus instability of the elbow. Primary operation to repair these disrupted structures, especially repair of the AMCL, can effectively restore valgus stability.


Assuntos
Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Articulação do Cotovelo/lesões , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
19.
Acta Orthop Belg ; 85(3): 305-316, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31677626

RESUMO

The purpose of this study was to evaluate and compare the results of plate osteosynthesis, intramedullary nailing (IMN), and hybrid fixation for the treatment of both-forearm-bone shaft fractures in adults. One-hundred-one cases of both-forearm-bone shaft fractures were retrospectively reviewed. All fractures were divided into the following three groups, according to the method used for internal fixation : open reduction and internal fixation ORIF group (plate osteosynthesis), IMN group, and HYBRID group (plate osteosynthesis for the radius and intramedullary nail for the ulna). The results were assessed based on the time to union, functional recovery, restoration of the ulna and radial bow, operating time, complications, and patient satisfaction. In the ORIF, IMN, and HYBRID groups, the average union time was 10.8, 14.9, and 11.5 weeks, respectively. No intergroup differences were observed in the functional outcomes. The ORIF and HYBRID groups had a significantly better radial bow ratio compared to the IMN group. All patients in the three groups achieved union, with the exception of a single case of nonunion in the IMN group. ORIF and HYBRID fixation resulted in a more anatomical restoration of radial bow ratio, compared to the contralateral side. Such significant differences in the restoration of the radial bow had no effect on the final functional outcomes and minimal effect on forearm range of motion. Although there are statistically significant effects on the final forearm range of motion, the difference was only 5°. Thus, if the indication is properly selected, our results suggest that hybrid fixation would be acceptable and effective treatment options for both-forearm-bone fractures in adults.


Assuntos
Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Adulto , Placas Ósseas , Feminino , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Redução Aberta/métodos , Duração da Cirurgia , Satisfação do Paciente , Radiografia , Fraturas do Rádio/complicações , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Fraturas da Ulna/complicações , Fraturas da Ulna/diagnóstico por imagem
20.
Pediatr Emerg Care ; 35(11): e220-e222, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31688805

RESUMO

This case report presents entrapment with subsequent complete disruption of the median nerve in the distal ulna in a both-bone fracture of the forearm in a 9-year-old girl. Closed fractures of the radius and ulna commonly occur in pediatric populations. Postinjury nerve dysfunction is often seen. Severe nerve injury is rare. There are only 3 reports of the median nerve becoming entrapped in an ulnar fracture in a child, with no reports of entrapment in the distal forearm. Features seen on examination and the radiographs supported possible nerve entrapment. Although uncommon, nerve entrapment or transection should be considered in all forearm fractures with sensory or motor nerve dysfunction. If suspicions are high, an early diagnosis of nerve entrapment may be obtained with magnetic resonance imaging evaluation.


Assuntos
Neuropatia Mediana/etiologia , Fraturas do Rádio/complicações , Fraturas da Ulna/complicações , Basquetebol/lesões , Criança , Redução Fechada/efeitos adversos , Diagnóstico Tardio , Feminino , Humanos , Neuropatia Mediana/diagnóstico , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/terapia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/terapia
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