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1.
Sports Health ; 12(1): 66-73, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31469616

RESUMO

BACKGROUND: The relationship of training load to injury using wearable technology has not been investigated in professional American football players. The primary objective of this study was to determine the correlation between player workload and soft tissue injury over the course of a football season utilizing wearable global positioning system (GPS) technology. HYPOTHESIS: Increased training load is associated with a higher incidence of soft tissue injuries. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 3. METHODS: Player workloads were assessed during preseason and regular-season practice sessions using GPS tracking and triaxial accelerometry from 2014 to 2016. Soft tissue injuries were recorded during each season. Player workload during the week of injury (acute) and average weekly workload during the 4 weeks (chronic) prior to injury were determined for each injury and in uninjured position-matched controls during the same week. A matched-pairs t test was used to determine differences in player workload. Subgroup analysis was also conducted to determine whether observed effects were confounded by training period and type of injury. RESULTS: In total, 136 lower extremity injuries were recorded. Of the recorded injuries, 101 injuries with complete GPS and clinical data were included in the analysis. Injuries were associated with greater increases in workload during the week of injury over the prior month when compared with uninjured controls. Injured players saw a 111% (95% CI, 66%-156%) increase in workload whereas uninjured players saw a 73% (95% CI, 34%-112%) increase in workload during the week of injury (P = 0.032). Individuals who had an acute to chronic workload ratio higher than 1.6 were 1.5 times more likely to sustain an injury relative to time- and position-matched controls (64.6% vs 43.1%; P = 0.004). CONCLUSION: Soft tissue injuries in professional football players were associated with sudden increases in training load over the course of a month. This effect seems to be especially pronounced during the preseason when player workloads are generally higher. These results suggest that a gradual increase of training intensity is a potential method to reduce the risk of soft tissue injury. CLINICAL RELEVANCE: Preseason versus regular-season specific training programs monitored with wearable technology may assist team athletic training and medical staff in developing programs to optimize player performance.


Assuntos
Acelerometria/instrumentação , Comportamento Competitivo/fisiologia , Monitores de Aptidão Física , Futebol Americano/lesões , Condicionamento Físico Humano/efeitos adversos , Condicionamento Físico Humano/métodos , Lesões dos Tecidos Moles/etiologia , Adulto , Estudos de Casos e Controles , Humanos , Estudos Longitudinais , Extremidade Inferior/lesões , Masculino , Estudos Retrospectivos , Fatores de Risco , Lesões dos Tecidos Moles/prevenção & controle , Adulto Jovem
2.
J Sports Med Phys Fitness ; 59(7): 1119-1125, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31332988

RESUMO

BACKGROUND: Hamstring strain injuries (HSI) are among the most common injuries in field-based team sports with a high-speed running component. The implementation of the Nordic hamstring exercise (NHE) is a well-documented method of improving eccentric hamstring strength to mitigate the risk of HSI occurrence. Sprint training is specific to the injury mechanism and is thought to activate the hamstrings through maximal eccentric contractions. The purpose of this study was to compare the effects of sprint training and the NHE on eccentric hamstring strength and sprint performance. METHODS: Twenty-eight participants (mean±SD age=16.21±1.34 years; height=1.75m±0.10m; body mass=68.5kg±12.1kg) completed an eccentric hamstring strength assessment and 40m sprint to assess acceleration and maximum speed. Participants were randomly allocated to either a NHE training or sprint training group. Two sessions per week for four-weeks of training was performed with baseline testing procedures repeated in the week following the intervention. Perceptions of soreness were recorded following the warm-up in each training session. RESULTS: Both the NHE (effect size=0.39, P<0.05) and sprint training (effect size=0.29, P<0.05) groups displayed significant gains in eccentric hamstring strength. The NHE group reported trivial improvements in sprint performance, whilst the sprint training group experienced a moderate improvement, specifically in maximum speed (ES=0.83 Moderate). Sprint training also produced greater perceptions of soreness than the NHE following a four-week training intervention, specifically before the start of the last session (P<0.05). CONCLUSIONS: These findings indicate that sprint training had a beneficial effect for both eccentric hamstring strength and sprint performance, whilst also producing greater soreness than the NHE following the final training session. It was concluded that a four-week block of maximum speed training may have both an injury prevention and performance enhancement benefit.


Assuntos
Músculos Isquiotibiais/fisiologia , Força Muscular/fisiologia , Corrida/fisiologia , Adolescente , Exercício/fisiologia , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Fatores de Risco , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/prevenção & controle
3.
PLoS One ; 14(1): e0211476, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703172

RESUMO

BACKGROUND: With increasing use of nCPAP, the safety and comfort associated with nCPAP have come into the forefront. The reported incidence of nasal injuries associated with the use of nCPAP is 20% to 60%. A recent meta-analysis concluded that the use of nasal masks significantly decreases CPAP failure and the incidence of moderate to severe nasal injury and stress the need for a well powered RCT to confirm their findings. METHODS: In this Open label, 3 arms, sequential, stratified randomized controlled trial, we evaluated the incidence and severity of nasal injury at removal of nCPAP when using two different nasal interfaces and in three groups (i.e. rotation group, mask continue group, prong continue group). Preterm infants with gestation ≤ 30 weeks and respiratory distress within the first 6 hours of birth and in need of CPAP were eligible for the study. RESULTS: Among the 175 newborns included in the study, incidence of nasal injury in mask continue group [n = 19/57 (33.3%)] was significantly less as compared to prong continue group [n = 55/60 (91.6%)] and rotation group [33/ 58 (56.9%), p value <0.0001]. Median maximum nasal injury score was significantly less in Mask continue group as compared to Prong continue group and Rotation group [Injury Score 0 (IQR 0-1) vs. Injury Score 3 (IQR 2-5) vs. Injury Score 1 (IQR 0-2), p value = <0.0001] respectively. The proportion of infants failing nCPAP was similar across the three groups. CONCLUSION: nCPAP with nasal masks significantly reduces nasal injury in comparison with nasal prongs or rotation of nasal prongs and nasal masks. However, the type of interface did not affect the nCPAP failure rates.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Pressão Positiva Contínua nas Vias Aéreas/métodos , Máscaras , Nariz/lesões , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Lesões dos Tecidos Moles/prevenção & controle , Adulto , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Feminino , Humanos , Incidência , Índia/epidemiologia , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Lesões dos Tecidos Moles/epidemiologia
4.
Br J Sports Med ; 53(21): 1362-1370, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30808663

RESUMO

RESEARCH QUESTION: Does the Nordic hamstring exercise (NHE) prevent hamstring injuries when included as part of an injury prevention intervention? DESIGN: Systematic review and meta-analysis. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We considered the population to be any athletes participating in any sporting activity, the intervention to be the NHE, the comparison to be usual training or other prevention programmes, which did not include the NHE, and the outcome to be the incidence or rate of hamstring injuries. ANALYSIS: The effect of including the NHE in injury prevention programmes compared with controls on hamstring injuries was assessed in 15 studies that reported the incidence across different sports and age groups in both women and men. DATA SOURCES: MEDLINE via PubMed, CINAHL via Ebsco, and OpenGrey. RESULTS: There is a reduction in the overall injury risk ratio of 0.49 (95% CI 0.32 to 0.74, p=0.0008) in favour of programmes including the NHE. Secondary analyses when pooling the eight randomised control studies demonstrated a small increase in the overall injury risk ratio 0.52 (95% CI 0.32 to 0.85, p=0.0008), still in favour of the NHE. Additionally, when studies with a high risk of bias were removed (n=8), there is an increase of 0.06 in the risk ratio to 0.55 (95% CI 0.34 to 0.89, p=0.006). CONCLUSIONS: Programmes that include the NHE reduce hamstring injuries by up to 51%. The NHE essentially halves the rate of hamstring injuries across multiple sports in different athletes. TRIAL REGISTRATION NUMBER: PROSPERO CRD42018106150.


Assuntos
Traumatismos em Atletas/prevenção & controle , Músculos Isquiotibiais/lesões , Traumatismos da Perna/prevenção & controle , Lesões dos Tecidos Moles/prevenção & controle , Atletas , Humanos
5.
Int Wound J ; 16(3): 684-695, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30697945

RESUMO

Patients who are immobile endure prolonged bodyweight-related compressive, tensional and shear loads at their body-support contact areas that over time may lead to the onset of pressure ulcers (PUs). Approximately, one-third of the common sacral PUs are severe and classified as category 3 or 4. If a PU has occurred, off-loading is the basic, commonly accepted clinical intervention; however, in many situations, complete off-loading of sacral PUs is not possible. Minimising the exposure of wounds and their surroundings to elevated mechanical loads is crucial for healing. Accordingly, in the present study, we aimed to investigate the biomechanical effects of the structural and mechanical properties of different treatment dressings on stresses in soft tissues surrounding a non-offloaded sacral PU in a supine patient. Using a novel three-dimensional anatomically realistic finite element modelling framework, we have compared performances of three dressing designs: (a) The Mepilex Border Sacrum (MBS) multilayer anisotropic silicone foam dressing (Mölnlycke Health Care), (b) an isotropic stiff dressing, and (c) an isotropic flexible dressing. Using our newly developed protective efficacy index (PEI) and aggravation index (AI) for assessing prophylactic and treatment dressings, we identified the anisotropic stiffness feature of the MBS dressing as a key design element.


Assuntos
Bandagens , Movimentação e Reposicionamento de Pacientes/métodos , Lesão por Pressão/prevenção & controle , Lesão por Pressão/fisiopatologia , Região Sacrococcígea/fisiopatologia , Estresse Mecânico , Cicatrização/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões dos Tecidos Moles/fisiopatologia , Lesões dos Tecidos Moles/prevenção & controle , Decúbito Dorsal
6.
Scand J Med Sci Sports ; 29(4): 515-523, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30536639

RESUMO

BACKGROUND: Although the Nordic Hamstring Exercise (NHE) prevents hamstring injury in soccer players effectively, the annual incidence of these injuries still increases. This may be because of poor long-term compliance with the program. Furthermore, the timing and amplitude of gluteal and core muscle activation seem to play an important role in hamstring injury prevention, the NHE program was not designed to improve activation of these muscles. Therefore, we propose plyometric training as an alternative to reduce hamstring injuries in soccer players. PURPOSE: To determine the preventive effect of the Bounding Exercise Program (BEP) on hamstring injury incidence and severity in adult male amateur soccer players. STUDY DESIGN: A cluster-Randomized Controlled Trial. METHODS: Thirty-two soccer teams competing in the first-class amateur league were cluster-randomized into the intervention or control group. Both groups were instructed to perform their regular training program, and the intervention group additionally performed BEP. Information about player characteristics was gathered at baseline and exposure, hamstring injuries and BEP compliance were weekly registered during one season (2016-2017). RESULTS: The data of 400 players were analyzed. In total, 57 players sustained 65 hamstring injuries. The injury incidence was 1.12/1000 hours in the intervention group and 1.39/1000 hours in the control group. There were no statistically significant differences in hamstring injury incidence (OR = 0.89, 95% CI 0.46-1.75) or severity between the groups (P > 0.48). CONCLUSION: In this large cluster-randomized controlled trial, no evidence was found for plyometric training in its current form to reduce hamstring injuries in amateur soccer players.


Assuntos
Músculos Isquiotibiais/lesões , Traumatismos da Perna/prevenção & controle , Exercício Pliométrico , Lesões dos Tecidos Moles/prevenção & controle , Adolescente , Adulto , Atletas , Humanos , Masculino , Futebol , Adulto Jovem
7.
Acta Chir Orthop Traumatol Cech ; 85(1): 54-56, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30257770

RESUMO

PURPOSE OF THE STUDY With the concept of the lateral compression plate (LLCP) a technique has been available designed to combine the advantages of a fixed-angle fixation with a complete sinking of the implant into the proximal bone. The objective of the present study was to investigate the results of the LLCP compared with classical screw osteosynthesis (SO). MATERIAL AND METHODS 31 patients with pes planovalgus who received calcaneal displacement osteotomy and osteosyntheses with screws (n = 17) or LLCP (n = 14) between 2010 and 2015 were investigated retrospectively.The ankle-hindfoot scale, Kaikkonen score, VAS, and the SF-36 were determined preoperatively as well as at the last clinical follow-up. In addition, a radiological control of osseous integration was performed in all patients 12 weeks after surgery. RESULTS With regard to clinical scores both methods depicted significant improvement. In the overall cohort there were no pseudarthroses. In the SO group 5 cases (29%) showed hardware irritation, in the LLCP group there were none. Results in the LLCP group were significantly superior in the area of the physical section of the SF 36. CONCLUSIONS Based on the results of our study, surgical treatment of stage II pes planovalgus by means of calcaneal displacement osteotomy using the LLCP is equivalent to SO with a lower incidence of hardware irritation. Key words:pes planovalgus, lateral compression plate, osteosynthesis, screw, hardware irritation. LEVEL OF EVIDENCE: Level IV, retrospective case serie.


Assuntos
Pé Chato/cirurgia , Fixação Interna de Fraturas , Osteotomia , Complicações Pós-Operatórias , Lesões dos Tecidos Moles , Placas Ósseas , Parafusos Ósseos , Calo Ósseo/diagnóstico por imagem , Calcâneo/cirurgia , Pesquisa Comparativa da Efetividade , Feminino , Pé Chato/diagnóstico , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Osteotomia/instrumentação , Osteotomia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Lesões dos Tecidos Moles/diagnóstico , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/prevenção & controle
8.
J Am Acad Orthop Surg ; 26(18): 640-651, 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-30134307

RESUMO

Fractures of the distal tibial plafond (ie, pilon) comprise a broad range of injury mechanisms, patient demographics, and soft-tissue and osseous lesions. Patients often present with considerably comminuted fracture patterns and notable soft-tissue compromise. Surgical intervention must be performed with respect for the exceedingly vulnerable soft-tissue envelope and with a properly executed technique. Even with proper timing, favorable host factors, and expert surgical technique, restoration of function and avoidance of complications are not always achievable. Recently validated techniques further diminish the risk of soft-tissue and osseous sepsis. These techniques include early (ie, "immediate") fixation, upgrading, primary arthrodesis, staged sequential posterior and anterior fixation, acute shortening, and transsyndesmotic fibular plating. Proper application of these recently adopted techniques may be instrumental in achieving aseptic union of pilon fractures.


Assuntos
Artrodese/efeitos adversos , Fixação de Fratura/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Lesões dos Tecidos Moles/prevenção & controle , Fraturas da Tíbia/cirurgia , Artrodese/métodos , Placas Ósseas/efeitos adversos , Fixação de Fratura/métodos , Humanos , Complicações Pós-Operatórias/etiologia , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgia , Fraturas da Tíbia/complicações
9.
Foot Ankle Int ; 39(10): 1237-1241, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29860866

RESUMO

BACKGROUND: Fractures of the talar neck and body can be fixed with percutaneously placed screws directed from anterior to posterior or posterior to anterior. The latter has been found to be biomechanically and anatomically superior. Percutaneous guidewire and screw placement poses anatomic risks for posterolateral and posteromedial neurovascular and tendinous structures. The objective of this study was to determine the injury rate to local neurovascular and tendinous structures using this technique in a cadaveric model. In addition, we aimed to determine the number of attempts at passing the guidewires required to achieve acceptable placement of 2 parallel screws. METHODS: Eleven fresh frozen cadaver limbs were used. Two 2.0-mm guidewires were placed under fluoroscopic guidance, posterior to anterior centered within the talus. The number of attempts required was recorded. A layered dissection was then performed to identify injury to any local anatomic structure. The shortest distance between the closest guidewire and the soft tissue structures was measured. RESULTS: The mean total number of guidewires passed to obtain optimal placement of 2 parallel screws was 2.9 ± 0.7. Direct contact between the guidewire and the sural nerve was seen in 100% of the specimens, with the nerve impaled by the guidewire in 3 of 11 (27.2%) cases. The peroneal tendons were impaled in 1 of 11 (9%) specimens and the Achilles tendon was in contact with the guidewire in 8 of the 11 (72.7%) specimens, and impaled at its most lateral border with the guidewire in 2 specimens (18.2%). CONCLUSION: The placement of posterior to anterior percutaneous screws for talar neck fixation is technically demanding, and multiple guidewires are needed. Our cadaveric study showed that important tendinous and neurovascular structures were in proximity with the guidewires and that the sural nerve was injured in 100% of the cases. CLINICAL RELEVANCE: Given the risk of injury to these structures, we recommend a formal posterolateral incision for proper visualization and retraction of the anatomic structures at risk.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Lesões dos Tecidos Moles/prevenção & controle , Tálus/diagnóstico por imagem , Tálus/cirurgia , Fios Ortopédicos , Cadáver , Fluoroscopia , Humanos
10.
World Neurosurg ; 113: e480-e485, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29462734

RESUMO

BACKGROUND: A major drawback to use of cortical bone trajectory pedicle screws (CBTPSs) with traditional posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion grafts is that traditional graft insertion trajectories require wider posterior exposure. This wider exposure, beyond the limits otherwise required for CBTPS placement, negates a primary benefit of CBTPS fixation. The aim of this study was to define an alternative surgical technique for interbody graft placement that, when used in conjunction with CBTPS fixation, permits both minimal soft tissue dissection and optimal graft placement. METHODS: A team of neurosurgeons specializing in treatment of spinal pathologies developed a surgical technique for insertion of bilateral PLIF grafts that complements the principles of CBTPS fixation. This technique is illustrated in a patient undergoing lumbosacral decompression, CBTPS fixation, and 3-column arthrodesis. RESULTS: The described technique uses a divergent trajectory of bilateral PLIF grafts rather than the traditional parallel or convergent trajectories. CONCLUSIONS: By aiming medially to laterally with the interbody graft, one recapitulates many advantages of CBTPSs, including avoidance of wide tissue dissection, greater intergraft volume available for bone grafting, and greater graft coverage of the hypophyseal ring. The prospective collection of outcome data for patients who undergo lumbosacral fusion using the divergent PLIF technique is ongoing.


Assuntos
Transplante Ósseo/métodos , Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Parafusos Pediculares , Fusão Vertebral/métodos , Descompressão Cirúrgica/instrumentação , Discotomia/métodos , Feminino , Humanos , Complicações Intraoperatórias/prevenção & controle , Laminectomia/métodos , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Complicações Pós-Operatórias/prevenção & controle , Lesões dos Tecidos Moles/prevenção & controle , Fusão Vertebral/instrumentação , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Espondilose/complicações , Espondilose/cirurgia , Articulação Zigapofisária/cirurgia
11.
J Orthop Trauma ; 32 Suppl 1: S21-S24, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29461398

RESUMO

Fracture surgeons do a great job of managing bone issues, but they may overlook the associated soft tissue injuries that play a significant role in the final outcome after musculoskeletal injury. The soft tissue reconstruction ladder can help guide reconstructive procedures based on the least complex procedure that allows the best chance of fracture healing. Muscle injury, volume loss, and deconditioning occur with traumatic injury and during the recovery phase. Neuromuscular stimulation, nutrition, and strength training are potential ways to aid in recovery. Complex periarticular knee injuries have a high rate of associated soft tissue injuries that may affect outcome if associated with knee instability. Identifying and addressing these injuries can increase the likelihood of a good outcome. Articular cartilage loss can make articular reconstruction impossible. Large fresh osteoarticular allografts can be a reconstructive option. Addressing all the damaged structures involved with a fracture may be the next step in improving patient outcomes.


Assuntos
Consolidação da Fratura , Fraturas Ósseas/complicações , Fraturas Ósseas/terapia , Lesões dos Tecidos Moles/prevenção & controle , Fixação de Fratura , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles/etiologia
12.
J Strength Cond Res ; 32(5): 1254-1262, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28459795

RESUMO

Ribeiro-Alvares, JB, Marques, VB, Vaz, MA, and Baroni, BM. Four weeks of Nordic hamstring exercise reduce muscle injury risk factors in young adults. J Strength Cond Res 32(5): 1254-1262, 2018-The Nordic hamstring exercise (NHE) is a field-based exercise designed for knee-flexor eccentric strengthening, aimed at prevention of muscle strains. However, possible effects of NHE programs on other hamstring injury risk factors remain unclear. The purpose of this study was to investigate the effects of a NHE training program on multiple hamstring injury risk factors. Twenty physically active young adults were allocated into 2 equal-sized groups: control group (CG) and training group (TG). The TG was engaged in a 4-week NHE program, twice a week, 3 sets of 6-10 repetitions; while CG received no exercise intervention. The knee flexor and extensor strength were assessed through isokinetic dynamometry, the biceps femoris long head muscle architecture through ultrasound images, and the hamstring flexibility through sit-and-reach test. The results showed that CG subjects had no significant change in any outcome. TG presented higher percent changes than CG for hamstring isometric peak torque (9%; effect size [ES] = 0.27), eccentric peak torque (13%; ES = 0.60), eccentric work (18%; ES = 0.86), and functional hamstring-to-quadriceps torque ratio (13%; ES = 0.80). The NHE program led also to increased fascicle length (22%; ES = 2.77) and reduced pennation angle (-17%; ES = 1.27) in biceps femoris long head of the TG, without significant changes on muscle thickness. In conclusion, a short-term NHE training program (4 weeks; 8 training sessions) counteracts multiple hamstring injury risk factors in physically active young adults.


Assuntos
Exercício/fisiologia , Músculos Isquiotibiais/fisiologia , Articulação do Joelho/fisiologia , Traumatismos da Perna/prevenção & controle , Lesões dos Tecidos Moles/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Masculino , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Fatores de Risco , Torque , Adulto Jovem
13.
Expert Rev Med Devices ; 14(12): 925-927, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29025351

RESUMO

Despite the well-established success of total knee arthroplasty (TKA), iatrogenic ligamentous and soft tissue injuries are infrequent, but potential complications that can have devastating impact on clinical outcomes. These injuries are often related to technical errors and excessive soft tissue manipulation, particularly during bony resections. Recently, robotic-arm assisted TKA was introduced and demonstrated promising results with potential technical advantages over manual surgery in implant positioning and mechanical accuracy. Furthermore, soft tissue protection is an additional potential advantage offered by these systems that can reduce inadvertent human technical errors encountered during standard manual resections. Therefore, due to the relative paucity of literature, we attempted to answer the following questions: 1) does robotic-arm assisted TKA offer a technical advantage that allows enhanced soft tissue protection? 2) What is the available evidence about soft tissue protection? Recently introduced models of robotic-arm assisted TKA systems with advanced technology showed promising clinical outcomes and soft tissue protection in the short- and mid-term follow-up with results comparable or superior to manual TKA. In this review, we attempted to explore this dimension of robotics in TKA and investigate the soft tissue related complications currently reported in the literature.


Assuntos
Artroplastia do Joelho/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Lesões dos Tecidos Moles/prevenção & controle , Artroplastia do Joelho/efeitos adversos , Humanos , Doença Iatrogênica/prevenção & controle , Articulação do Joelho/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Lesões dos Tecidos Moles/etiologia
14.
J Craniofac Surg ; 28(7): e667-e668, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28857987

RESUMO

Iatrogenic lip injury is a rather common complication after facial bone surgery, but is usually treated lightly by the surgeon compared with other more severe functional complications. However, these injuries can have permanent sequelae and can therefore be a reason for patient dissatisfaction, especially after cosmetic surgery. Intraoperative lip injuries during facial bone surgery are usually caused by heat-generating surgical instruments or forced traction on the operative fields. The authors have applied a special technical strategy using a hydrocolloid dressing material to avoid these intraoperative lip injuries. This method does not disturb the operative procedure itself, but efficiently prevents lip injuries and decreases surgical morbidities and postoperative swelling.


Assuntos
Ossos Faciais/cirurgia , Doença Iatrogênica/prevenção & controle , Lábio/lesões , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Lesões dos Tecidos Moles/prevenção & controle , Curativos Hidrocoloides , Humanos
15.
J Nippon Med Sch ; 84(3): 144-147, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28724849

RESUMO

Forefoot fractures are frequently accompanied by severe soft tissue damage. Therefore, treatment should focus not only on fractures but also on soft tissue damage, for which external fixation can be used as a surgical option. A 63-year-old woman presented to the emergency clinic of our hospital with forefoot pain after a motorcycle accident. Comminuted fracture of the proximal part of the metatarsal was diagnosed. Because of the swollen foot and fracture comminution, an operation using the Ilizarov mini external fixator was performed to prevent further damage to the soft tissue. Weight-bearing was permitted seven weeks after the operation, and the extraction of the apparatus was performed nine weeks postoperatively. One year later, the patient had no pain and had returned to ballroom dancing, a hobby which she performed five days a week, with no difficulties. Our results suggest that the Ilizarov mini external fixator should be considered not only for temporary treatment, but also for the entire duration of treatment of first metatarsal fractures associated with severe soft tissue damage.


Assuntos
Fixação de Fratura/instrumentação , Fraturas Ósseas/cirurgia , Ossos do Metatarso/lesões , Acidentes de Trânsito , Feminino , Fraturas Ósseas/complicações , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Treinamento de Resistência , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/prevenção & controle , Lesões dos Tecidos Moles/terapia , Fatores de Tempo , Resultado do Tratamento
16.
Eur J Orthop Surg Traumatol ; 27(7): 1011-1017, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28497280

RESUMO

PURPOSE AND HYPOTHESIS: Both spondylolysis and spondylolisthesis come in second place in the causes of pain among athletes. Treatment options include both conservative management and different operative methods. Athletes and adolescents are groups where the priority is to protect tissues from perioperative damage. OBJECTIVE: We present our modification of the Buck's, direct pars repair method, which we believe offers maximum protection of tissues. We used the modified surgical method in young, competitive athletes, in whom non-surgical treatment was not effective. METHOD: Eight pars defects in five patients were treated using suggested method. All of them were young males (aged between 13 and 18 years), who practice soccer professionally. We use modified method of direct repair pars through the cannulated screw fixation, first proposed by Buck. Preoperative preparation consists of proper analysis of computer tomography images in multiplanar reconstruction mode: measuring screw length, measurement of inclination angle of the optimal screw trajectory in the frontal and sagittal plane. During the operation, the wire proper direction is performed by usage of the predetermined angles. Starting point for guide wire was also changed to the lower end of the facet. The fusion takes place with a screw of 3 mm diameter. After the operation patient need to use thoracolumbar spinal orthosis as a primary immobilization for 6 weeks and appropriate rehabilitation for another 6 weeks. We used these methods in eight pars fixations. RESULTS: All of the patients were painless in first week after surgery. All of them underwent total rehabilitation programme and returned to sport. CONCLUSIONS: Direct pars repair using Buck's method with proposed modification, including adequate radiographic preparation, the use of a thin cannulated screw and changing the point of screw entry, allows precise and safe screw placement, regardless of the size of the bone at the defect site.


Assuntos
Atletas , Espondilólise/cirurgia , Adolescente , Parafusos Ósseos , Humanos , Complicações Intraoperatórias/prevenção & controle , Masculino , Cuidados Pré-Operatórios/métodos , Volta ao Esporte , Lesões dos Tecidos Moles/prevenção & controle , Fusão Vertebral/métodos , Fusão Vertebral/reabilitação , Espondilolistese/reabilitação , Espondilolistese/cirurgia , Espondilólise/reabilitação
17.
Accid Anal Prev ; 102: 144-152, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28363171

RESUMO

INTRODUCTION: Partial ejection (PE) of the upper extremity (UE) can occur in a motor vehicle crash (MVC) resulting in complex and severe soft tissue injuries (SSTI). This study evaluated the relationship between partial ejection and UE injuries, notably SSTIs, in MVCs focusing on crash types and characteristics, and further examined the role of side curtain airbags (SCABs) in the prevention of partial ejection and reducing SSTI of the UE. METHODS: Weighted data was analyzed from the National Automotive Sampling System Crashworthiness Data System (NASS-CDS) from 1993 to 2012. Logistic regression models were used to assess the relationship of PE with SSTI of the UE and the effect of SCABs in both nearside impacts and rollover collisions. Crash Injury Research and Engineering Network (CIREN) case studies illustrated PE involving SSTI of the UE, and long term treatment. RESULTS: Rollover and nearside impact collisions had the highest percentages of partial ejection, with over half occurring in rollover collisions. Annually over 800 SSTIs of the UE occurred in all MVCs. For nearside lateral force impacts, a multivariable analysis adjusting for belt use and delta V showed a 15 times (OR 15.35, 95% CI 4.30, 54.79) greater odds of PE for occupants without SCABs compared to those with a SCAB deployment. No occupants (0 of 51,000) sustained a SSTI of the UE when a SCAB deployed in nearside impacts, compared to 0.01% (114 of 430,000) when SCABs were unavailable or did not deploy. In rollover collisions, a multivariable analysis adjusted for number of quarter turns and belt use showed 3 times the odds (OR 3.02, 95% CI 1.22, 7.47) of PE for occupants without SCABs compared to those with a SCAB deployment. Just 0.17% (32 of 19,000) of the occupants sustained a SSTI of the UE in rollovers with a SCAB deployment, compared to 0.53% (2294 of 431,000) of the occupants when SCABs were unavailable or did not deploy. CIREN case studies illustrated the injury causation of SSTI of the UE due to partial ejection, and the long term treatment and medical costs associated with a SSTI to the UE. CONCLUSIONS: The majority of severe soft tissue injuries (SSTI) of the upper extremity (UE) involved partial ejection out the nearside window of outboard seated occupants in nearside impacts and rollover collisions. Real world case studies showed that SSTIs of the upper extremity require extensive treatment, extended hospitalization and are costly. Occupants without a side curtain airbag (SCAB) deployment had an increase in the odds of partial ejection. SCAB deployments provided protection against partial ejection and prevented SSTIs of the UE, with none occurring in nearside impacts, and a small percentage and reduction occurring in rollover collisions compared to those where SCABs were unavailable or did not deploy.


Assuntos
Acidentes de Trânsito , Air Bags , Traumatismos do Braço/prevenção & controle , Veículos Automotores , Lesões dos Tecidos Moles/prevenção & controle , Adolescente , Adulto , Traumatismos do Braço/etiologia , Engenharia , Feminino , Hospitalização , Humanos , Modelos Logísticos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Cintos de Segurança , Lesões dos Tecidos Moles/etiologia , Adulto Jovem
18.
J Safety Res ; 61: 1-7, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28454855

RESUMO

INTRODUCTION: Motorcyclists represent an increasing proportion of road users globally and are increasingly represented in crash statistics. Soft tissue injuries are the most common type of injuries to crashed motorcyclists. These injuries can be prevented through the use of protective clothing designed for motorcycle use. However, the quality of such clothing is not controlled in many countries around the world. A European Standard was developed to assess the performance of clothing but as this is not mandatory, clothing certified to this Standard is difficult to obtain. Given the importance of this Standard, and that it has been validated only once, further validation work is required. METHODS: In-depth crash investigation data were used to investigate the relationship between the abrasion resistance performance of clothing and real-world injury outcome. Clothing was collected from riders who crashed on public roads in Sydney and Newcastle, Australia. This clothing was tested according to the EU Standard and the time to hole was recorded. Hospital medical records were reviewed and the association between a rider suffering a soft tissue injury and the time-to-hole for the garment was examined. RESULTS: The probability of soft tissue injury for Level 1 Standard garments was between 40-60%, but more than 60% of garments tested failed to meet the minimum requirement. CONCLUSIONS: The findings of this study provide qualified support for the Standard, with a marginal association between time-to-hole and injury being found. PRACTICAL IMPLICATIONS: This work supports the need for improved safety performance and an increased number of high performing garments being available to motorcyclists.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Motocicletas/estatística & dados numéricos , Roupa de Proteção/normas , Lesões dos Tecidos Moles/prevenção & controle , Adulto , Austrália , Feminino , Humanos , Masculino , Segurança
19.
Dent Traumatol ; 33(3): 199-204, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28160512

RESUMO

BACKGROUND/AIM: Published data about orofacial injuries and mouthguard use by professional handball players are scarce. The aim of this study was to investigate the prevalence of orofacial trauma and mouthguard use in professional handball players. MATERIALS AND METHODS: Data were collected from 100 professional handball players through a questionnaire, which contained 17 questions about age, experience in playing handball, playing position, orofacial trauma experience during the past 12 months, type of injury and mouthguard use. RESULTS: Almost half (49%) of the interviewed players experienced head and/or facial trauma during the past year. The most common injuries were soft tissue lacerations (39.6%). Dental injuries occurred in 22% of the participants, with socket bleeding being the most frequent injury (14%). Of the affected teeth, 76.9% were upper incisors. Mouthguards had a statistically significant protective role regarding tooth fractures and tooth avulsion (P=.043). Players who wore a mouthguard had a 5.55 times less chance of suffering dental injuries. Almost 76% of dental injuries resulted in complications afterward. Sixty-seven percentage of the players knew that mouthguards could prevent injuries, but only 28% used them regularly. Of the players who wore a mouthguard regularly, 76.9% were advised to do so by their dentists. CONCLUSIONS: The incidence of head and orofacial injuries among professional handball players is high. Mouthguards prevented severe dental injuries such as tooth fracture and avulsion, but their use was still limited.


Assuntos
Traumatismos em Atletas/epidemiologia , Traumatismos Faciais/epidemiologia , Protetores Bucais/estatística & dados numéricos , Lesões dos Tecidos Moles/epidemiologia , Traumatismos Dentários/epidemiologia , Traumatismos em Atletas/prevenção & controle , Croácia/epidemiologia , Estudos Transversais , Traumatismos Faciais/prevenção & controle , Humanos , Incidência , Masculino , Prevalência , Fatores de Risco , Lesões dos Tecidos Moles/prevenção & controle , Inquéritos e Questionários , Traumatismos Dentários/prevenção & controle , Adulto Jovem
20.
IEEE Trans Biomed Eng ; 64(10): 2384-2393, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28237916

RESUMO

OBJECTIVE: This work presents a method to assess and prevent tissue trauma in real-time during surgery. BACKGROUND: Tissue trauma occurs routinely during laparoscopic surgery with potentially severe consequences. As such, it is crucial that a surgeon is able to regulate the pressure exerted by surgical instruments. We propose a novel method to assess the onset of tissue trauma by considering the mechanical response of tissue as it is loaded in real-time. METHODS: We conducted a parametric study using a lab-based grasping model and differing load conditions. Mechanical stress-time data were analyzed to characterize the tissue response to grasps. Qualitative and quantitative histological analyses were performed to inspect damage characteristics of the tissue under different load conditions. These were correlated against the mechanical measures to identify the nature of trauma onset with respect to our predictive metric. RESULTS: Results showed increasing tissue trauma with load and a strong correlation with the mechanical response of the tissue. Load rate and load history also showed a clear effect on tissue response. The proposed method for trauma assessment was effective in identifying damage. The metric can be normalized with respect to loading rate and history, making it feasible in the unconstrained environment of intraoperative surgery. SIGNIFICANCE: This work demonstrates that tissue trauma can be predicted using mechanical measures in real-time. Applying this technique to laparoscopic tools has the potential to reduce unnecessary tissue trauma and its associated complications by indicating through user feedback or actively regulating the mechanical impact of surgical instruments.


Assuntos
Colo/fisiopatologia , Colo/cirurgia , Testes de Dureza/métodos , Laparoscopia/efeitos adversos , Modelos Biológicos , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/fisiopatologia , Animais , Colo/lesões , Força Compressiva , Simulação por Computador , Módulo de Elasticidade , Laparoscopia/métodos , Monitorização Intraoperatória/métodos , Lesões dos Tecidos Moles/prevenção & controle , Suínos
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