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1.
Medicine (Baltimore) ; 100(14): e25253, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832086

RESUMO

RATIONALE: Hoffa fracture is a rare fracture confined to the coronal-plane involving femoral condyles. This occurs simultaneously with rotational dislocation of the knee joint is extremely rare. Up to now, there is no valid recommendation for the treatment of the Hoffa fracture. PATIENT CONCERNS: A 50-year-old female patient broke her knee joint while skiing, experiencing severe pain in the right knee, which was swollen. She presented limited function of the knee and movement upon arrival in the emergency room. DIAGNOSIS: Comminuted Hoffa fracture in the right knee associated with rotational dislocation in the knee joint. INTERVENTIONS: We treated the dislocated knee joint through manual reduction initially. During the operation, we used posterolateral approach to expose the fracture fragments, thereafter using headless compression screws and a buttress plate to provide sufficient stability for the fracture. Early postoperative rehabilitation was encouraged. OUTCOMES: The patient finally achieved fracture healing three months after operation. In addition, she achieved 0-130° range of function of the knee after four months post-operation, and the patient obtained a satisfactory prognosis after our treatment. LESSONS: By using appropriate surgical approach to obtain enough exposure, headless compression screws and the buttress plate provided adequate stability during early active rehabilitation, which resulted in satisfactory results in the treatment of the injury. We reviewed literatures regarding the treatment of Hoffa fracture to demonstrate that our treatment was effective.


Assuntos
Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/instrumentação , Luxações Articulares/terapia , Articulação do Joelho/cirurgia , Placas Ósseas , Parafusos Ósseos , Feminino , Fraturas do Fêmur/complicações , Fraturas do Fêmur/diagnóstico por imagem , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Esqui/lesões
2.
Int J Periodontics Restorative Dent ; 41(5146): 217-224, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33819326

RESUMO

One of the chronic problems with traditional cement or screw retention of crowns to implants is the development of biologic and technical complications, including soft tissue complications, bone loss, screw loosening, loss of retention, and veneering material fractures. The purpose of this case series report is to document preliminary results, specifically crown retention, using a friction-fit connection of crown to abutment. A sample composed of patients who had one or more implants restored between July 1, 2019, and October 30, 2019, were enrolled in this retrospective case-control series. Each patient had their crown connected to the implant abutment using a friction-fit system. Patients were seen for routine follow-up for documentation of crown retention, and 24 crowns were followed. After 6 months of follow-up, 100% of the crowns retained retention and did not become loose under normal masticatory function. The use of a friction-fit connection provided excellent retention of the crown to the abutment over the 6-month follow-up period.


Assuntos
Coroas , Cimentos Dentários , Parafusos Ósseos , Dente Suporte , Prótese Dentária Fixada por Implante , Fricção , Humanos , Estudos Retrospectivos
3.
Artigo em Inglês | MEDLINE | ID: mdl-33819331

RESUMO

This study aimed to assess how frequently the maxilla anatomy allows for lingualized immediate implants in the central incisor region with a screw channel that has an ideal distance of 1.5 mm from the incisal margin. The effect of abutments with angle correction on case selection will also be verified. A retrospective cross-sectional study of 181 CBCT scans was carried out. Using an implant-planning software, implant placement was simulated in the lingual aspect of the socket. The location of the prospective screw channel was registered as incisal, lingual, or facial. The angle between the actual screw channel and the position of the ideal one was calculated. The effect of angle correction on allowing an ideal screw channel configuration was computed. Out of 161 eligible cases, 144 presented favorable anatomy for an immediate implant. The screw channel had an incisal position in 40 cases (28%), a lingual position in 60 cases (42%), and a facial position in 44 cases (30%). The screw channel could be placed at the planned distance from the incisal edge in 35 cases (24%). The position was unfavorable in the remaining 109 cases. In 103 of these cases, an abutment with an angled screw channel could make the conditions feasible. Within the simulated conditions, a majority of maxillary central incisors present favorable ridge anatomy for lingualized immediate implant placement. Achieving a proper location of the screw channel requires abutments with angle correction in a majority of cases.


Assuntos
Implantes Dentários , Tomografia Computadorizada de Feixe Cônico Espiral , Parafusos Ósseos , Estudos Transversais , Estudos de Viabilidade , Humanos , Incisivo/diagnóstico por imagem , Maxila/diagnóstico por imagem , Maxila/cirurgia , Estudos Prospectivos , Estudos Retrospectivos
4.
Sensors (Basel) ; 21(6)2021 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-33799632

RESUMO

High orthodontic forces and various directions of applied forces can be associated with loosening of the screw anchorage in the bone. Screw designs have been modified to increase the stability of the miniscrews. This research evaluates the influence of three-designs on the stability of orthodontic miniscrews. A conventionally cylinder-type miniscrew design (Bio-Action screw, Jin-Biomed co., Bucheon, Korea) was set as a control, and three conditions were studied based on modifications of this control design. Condition-1 has narrowed threads in the upper part of the screw; Condition-2 has a notch at the middle part; and Condition-3 has the combination of Condition-1 and Condition-2. The moment required to unwind the miniscrew to five degrees is tested, and the moment generated at the cortical bone and the trabecular bone were calculated with finite element analysis. Compared to the control, all three conditions showed a higher moment required to unwind the miniscrew and a higher moment generated at the cortical bone. At the trabecular bone, condition-2 and -3 showed higher moment than the control, and condition-1 showed similar moment to the control. Condition-3 required a higher overall moment to unwind the miniscrew. These findings validate the design modifications used to increase the rotational resistance.


Assuntos
Procedimentos de Ancoragem Ortodôntica , Parafusos Ósseos , Análise de Elementos Finitos , República da Coreia , Titânio
5.
Ann R Coll Surg Engl ; 103(5): 345-353, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33852340

RESUMO

AIMS: Persistent wound leakage following joint arthroplasty is a known risk for periprosthetic joint infection. Little is known of the predictors of wound leakage, particularly in patients with a fractured neck of femur. We aimed to determine patient and surgical risk factors for wound leakage in this cohort. MATERIALS AND METHODS: All patients undergoing surgery for a fractured neck of femur at Leicester Royal Infirmary between May and August 2017 were included. Patients were identified from a prospective database and placed into two groups: those with wound leakage later than three days postoperatively and those without leakage. All previously reported potential risk factors for wound leakage were compared between groups using a chi-square test and logistic regression. A Kattan-style nomogram was also created to allow probabilities output for the regression predictive models in a visual representation. RESULTS: Two hundred patients underwent surgery for a fractured neck of femur. Overall, 17% of patients (33/200) developed a persistent leaky wound. A multivariable model highlighted increased age (p = 0.01), raised body mass index (BMI; > 25 kg/m2; p = 0.047), diabetes (p = 0.03) and intramedullary hip screw fixation (p = 0.03) as significant risk factors for wound leakage. Patients with persistent wound leakage had significantly longer hospital admission than those without (p = 0.001). DISCUSSION: Our analysis identified four perioperative risk factors for wound leakage following fractured neck of femur surgery. We also developed a novel tool to identify those patients at highest risk of leakage. Once identified, the aggressive management of certain medical comorbidities in these patients may help to reduce their incidence of wound issues and the prolonged admissions that result.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Ferida Cirúrgica/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/estatística & dados numéricos , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/estatística & dados numéricos , Hemiartroplastia/efeitos adversos , Hemiartroplastia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Fatores de Risco , Ferida Cirúrgica/epidemiologia
6.
J Surg Orthop Adv ; 30(1): 20-23, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33851909

RESUMO

The objective of this study is to report operative time and associated complications of six types of implants and to determine if surgeons are adequately compensated. Hardware removals were analyzed from 2014-2019. Implants were flexible nails, intramedullary rigid nails, long plates, screw(s), single guided-growth plates, and multiple guided-growth plates. Patient demographics, operative time, blood loss, complications, and relative value units (RVU)/min were collected. RVU/min was used to maximize rate. In total, 392 patients were analyzed. Long plate removals took significantly longer than screw removal, therefore RVU/min was significantly lower (p < 0.001). Long plate removals also took significantly longer, and RVU/min was significantly lower compared to guided-growth plate removal (p < 0.001). Intramedullary nails took significantly longer compared to flexible nails, nearly double the RVU/min (p = 0.02). The results from this study indicate that the RVU/ minute for these six different types of implant removals are not equal. Surgeons can use this data to set up their schedule to ensure maximum utilization. (Journal of Surgical Orthopaedic Advances 30(1):020-023, 2021).


Assuntos
Fixação Interna de Fraturas , Fixação Intramedular de Fraturas , Pinos Ortopédicos , Placas Ósseas , Parafusos Ósseos , Humanos , Reoperação
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(4): 403-408, 2021 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-33855821

RESUMO

Objective: To review the research progress on intra-articular screw penetration in proximal humeral fracture treated with locking plate. Methods: The domestic and foreign literature about the proximal humeral fracture treated with locking plate was extensively reviewed. The incidence of screw penetration and risk factors were summarized from both primary and secondary screw penetrations, and the reasons of the intra-articular screw penetration and the technical solutions to avoid the penetration were analyzed. Results: The incidence of intra-articular screw penetration is about 11%-30%, which includes primary and secondary screw penetrations. The primary screw penetration is related to improper operation, inaccurate measurement, and "Steinmetz solid" effect, which results in inadequate fluoroscopy and blind zone. The secondary screw penetration is related to the loss of reduction and varus, collapse, and necrosis of the humeral head. The risk factors for intra-articular screw penetration include the bone mass density, the fracture type, the quality of fracture reduction, the applied location, number, and length of the plate and screws, and whether medial column buttress is restored. Improved fracture reduction, understanding the geometric distribution of screws, good intraoperative fluoroscopy, and reconstruction of medial column buttress stability are the key points for success. Conclusion: The risk of the intra-articular screw penetration in the proximal humeral fractures treated with locking plates is still high. Follow-up studies need to further clarify the cause and mechanism of screw penetration, and the risk factors that lead to screw penetration, in order to effectively prevent the occurrence of this complication.


Assuntos
Fixação Interna de Fraturas , Fraturas do Ombro , Placas Ósseas , Parafusos Ósseos , Humanos , Cabeça do Úmero , Fraturas do Ombro/cirurgia
8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(4): 431-438, 2021 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-33855826

RESUMO

Objective: To compare the effectiveness of posterior malleolus fractures treated by plate and screw internal fixation through posterolateral approach. Methods: The clinical data of 95 patients with posterior malleolus fractures who were admitted between January 2016 and December 2019 and met the selection criteria were retrospectively analysed. They were divided into plate group (44 cases, treated with posterolateral plate internal fixation) and screw group (51 cases, treated with posterolateral screw internal fixation) according to different treatment methods. There was no significant difference in general data between the two groups of patients such as age, gender, cause of injury, side of injury, ankle fracture or injury classification, time from injury to operation, and percentage of posterior ankle fracture area to the distal tibia articular surface ( P>0.05). The operation time, hospital stay, fracture healing time, and surgical complications were compared between the two groups. Imaging examinations (X-ray film, CT scan and reconstruction) were used to assess the reduction quality of ankle fracture, articular congruity, and re-displacement in ankle fracture. At last follow-up, the pain visual analogue scale (VAS) score was used to evaluate the patients' pain, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate ankle joint function. Results: Patients in both groups were followed up 6-30 months, with an average of 18.2 months. The operation time of the plate group was significantly longer than that of the screw group ( U=-2.040, P=0.041); there was no significant difference in hospital stay between the two groups ( U=-1.068, P=0.285). Incision swelling occurred in 2 cases in the plate group, sural nerve injury in 3 cases, and traumatic arthritis in 2 cases during follow-up. In the screw group, there were 1, 2, and 2 cases, respectively. The incidence of complications in the two groups (15.9% vs. 9.8%) was not significantly different ( P=0.372). All patients who underwent tibiofibular screw fixation underwent the removal of the tibiofibular screw before taking full weight bearing at 12 weeks after operation, and there was no screw fracture and retention. During the follow-up, there was no infection, re-displacement of fracture, delayed bone union or nonunion, and there was no significant difference in fracture healing time between the two groups ( t=0.345, P=0.731). There was no significant difference between the two groups of reduction quality of ankle fracture and articular congruity evaluation results ( P>0.05). At last follow-up, there was no significant difference in VAS score, AOFAS ankle-hindfoot score and evaluation grade between the two groups ( P>0.05). Conclusion: Both the plate and screw internal fixation through posterolateral approach can achieve satisfied effectiveness in the treatment of posterior ankle fractures with maintenance of fracture reduction, and recovery of ankle joint function. The screw internal fixation has the advantages of minimal invasion and shorter operation time.


Assuntos
Fraturas do Tornozelo , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Parafusos Ósseos , Fixação Interna de Fraturas , Humanos , Estudos Retrospectivos , Tíbia , Resultado do Tratamento
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(4): 439-444, 2021 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-33855827

RESUMO

Objective: To investigate the effectiveness of the extended Carlson approach in the treatment of lateral femoral condylar Hoffa fractures. Methods: The clinical data of 17 patients with lateral femoral condyle Hoffa fractures between September 2012 and January 2019 were retrospectively analyzed. There were 10 males and 7 females, with a mean age of 43 years (range, 32-68 years). Fractures were caused by traffic accident in 9 cases, by falling from height in 6 cases, and by the other mechanism in 2 cases. According to the Letenneur's classification, there were 8 cases of typeⅠ, 6 cases of type Ⅱ, and 3 cases of type Ⅲ. The mean time from injury to operation was 7 days (range, 3-32 days). All patients were treated with extended Carlson approach. Patients with Letenneur types Ⅰ and Ⅲ were fixed by a posterior antigliding plate combined with headless compression screws from anteroposterior direction, and patients with Letenneur typeⅡ were fixed by headless compression screws from anteroposterior direction. The anteroposterior and lateral X-ray films, CT and three-dimensional reconstruction of the knee joint were taken after operation to assess fracture healing and position of the internal fixators. The knee function was evaluated according to Letenneur's functional assessment system. Results: All patients were followed up 13-28 months (mean, 15 months). All the incisions healed by first intention, and no complication such as fracture redisplacement, fracture nonunion, internal fixator fracture, and common peroneal nerve injury occurred. The mean time of fracture healing was 18 weeks (range, 16-32 weeks). At last follow-up, according to Letenneur's functional assessment system, the knee function was excellent in 12 cases and good in 5 cases, with an excellent and good rate of 100%. Conclusion: The extended Carlson approach for the treatment of lateral femoral condylar Hoffa fractures has the advantages of clear exposure, easy reduction and fixation, high fracture healing rate, few complications, and good recovery of knee joint function.


Assuntos
Fraturas do Fêmur , Adulto , Idoso , Parafusos Ósseos , Feminino , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(4): 445-452, 2021 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-33855828

RESUMO

Objective: To investigate the effect of modified lateral mass screws implantation strategy on axial symptoms in cervical expansive open-door laminoplasty. Methods: A clinical data of 166 patients, who underwent cervical expansive open-door laminoplasty between August 2011 and July 2016 and met the selection criteria, was retrospective analyzed. Among them, 81 patients were admitted before August 2014 using the traditional mini-plate placement and lateral mass screws implantation strategy (control group), and 85 patients were admitted after August 2014 using modified lateral mass screws implantation strategy (modified group). There was no significant difference in the gender composition, age, clinical diagnosis, disease duration, diseased segment, and preoperative Japanese Orthopaedic Association (JOA) score, pain visual analogue scale (VAS) score, Neck Disability Index (NDI), cervical curvature and range of motion, spinal canal diameter and cross-sectional areas, and Pavlov's value between the two groups ( P>0.05). The operation time, intraoperative blood loss, the number of facet joints penetrated by lateral mass screws, effectiveness evaluation indexes (JOA score and improvement rate, VAS score, NDI), imaging evaluation indexes (cervical curvature and range of motion, spinal canal diameter and cross-sectional areas, Pavlov's value, and lamina open angle), and complications were recorded and compared between the two groups. Results: The modified group had shorter operation time and lower intraoperative blood loss than the control group ( P<0.05). There were 121 (29.9%, 121/405) and 10 (2.4%, 10/417) facet joints penetrated by lateral mass screws in control and modified groups, respectively; and the difference in incidence was significant ( χ 2=115.797, P=0.000). Eighteen patients in control group had 3 or more facet joints penetrated while no patients in modified group suffered 3 or more facet joint penetrated. The difference between the two groups was significant ( P=0.000). All patients were followed up, the follow-up time was (28.7±4.9) months in modified group and (42.4±10.7) months in control group, showing significant difference ( t=10.718, P=0.000). The JOA score, VAS score, and NDI at last follow-up of the two groups were significantly improved compared with preoperative ( P<0.05); there was no significant difference in JOA score and improvement rate and VAS score between the two groups ( P>0.05), but the NDI was significantly lower in modified group than in control group ( P<0.05). There were significant differences in cervical curvature and range of motion, spinal canal diameter, Pavlov's value, and cross-sectional areas at last follow-up when compared with those before operation in both groups ( P<0.05). There was no significant difference in the above indicators and lamina open angle between the two groups ( P>0.05). The modified group has a relative lower axial symptom rate (23/85, 27.1%) than the control group (27/81, 33.3%), but the difference was not significant ( Z=-1.446, P=0.148). There was no significant differences between the two groups in the incidences of C 5 nerve root palsy, cerebrospinal fluid leakage, wound infection, and lung or urinary tract infection ( P>0.05). Conclusion: In the cervical expansive open-door laminoplasty, the modified lateral mass screws implantation strategy can effectively reduce the risk of lateral mass screw penetrated to the cervical facet joints, and thus has a positive significance in avoiding the axial symptoms caused by facet joint destruction.


Assuntos
Laminoplastia , Parafusos Ósseos , Vértebras Cervicais/cirurgia , Humanos , Laminectomia , Estudos Retrospectivos , Resultado do Tratamento
11.
BMC Surg ; 21(1): 181, 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33823821

RESUMO

BACKGROUND: The imaging characteristics of sacral sacralalar-iliac (S2AI) screw trajectory in adult degenerative scoliosis (ADS) patients will be determined. METHODS: S2AI screw trajectories were mapped on three-dimensional computed tomography (3DCT) reconstructions of 40 ADS patients. The starting point, placement plane, screw template, and a circle centered at the lowest point of the ilium inner cortex were set on these images. A tangent line from the starting point to the outer diameter of the circle was selected as the axis of the screw trajectory. The related parameters in different populations were analyzed and compared. RESULTS: The trajectory length of S2AI screws in ADS patients was 12.00 ± 0.99 cm, the lateral angle was 41.24 ± 3.92°, the caudal angle was 27.73 ± 6.45°, the distance from the axis of the screw trajectory to the iliosciatic notch was 1.05 ± 0.81 cm, the distance from the axis of the screw trajectory to the upper edge of the acetabulum was 1.85 ± 0.33 cm, and the iliac width was 2.12 ± 1.65 cm. Compared with females, the lateral angle of male ADS patients was decreased, but the trajectory length was increased (P < 0.05). Compared to patients without ADS in previous studies, the lateral angle of male patients was larger, the lateral angle of female patients was increased, and the caudal angle was decreased (P < 0.05). CONCLUSIONS: There is an ideal trajectory of S2AI screws in ADS patients. A different direction should be noticed in the placement of S2AI screws, especially in female patients.


Assuntos
Ílio , Sacro , Escoliose , Adulto , Parafusos Ósseos , Feminino , Humanos , Ílio/diagnóstico por imagem , Ílio/cirurgia , Imageamento Tridimensional , Masculino , Sacro/diagnóstico por imagem , Sacro/cirurgia , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X
12.
Orthop Clin North Am ; 52(2): 137-147, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33752835

RESUMO

Anterior vertebral body tether (AVBT) is a nonfusion surgical procedure for correction of scoliosis in skeletally immature individuals. With US Food and Drug Administration approval in 2019, AVBT technology is spreading and early to midterm reports are being published. Early clinical reports are promising while precise indications, outcomes, complication profiles, and best practices are being established. Patients who are skeletally immature and wish to avoid a fusion surgery may benefit from this procedure. This article highlights the translational science foundation, early to midterm clinical reports, and future directions for this growing technique in pediatric spinal deformity surgery.


Assuntos
Parafusos Ósseos , Escoliose/cirurgia , /cirurgia , Adolescente , Humanos , Resultado do Tratamento , Estados Unidos
13.
Cochrane Database Syst Rev ; 3: CD013409, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33687067

RESUMO

BACKGROUND: Hip fractures are a major healthcare problem, presenting a huge challenge and burden to patients, healthcare systems and society. The increased proportion of older adults in the world population means that the absolute number of hip fractures is rising rapidly across the globe. The majority of hip fractures are treated surgically. This review evaluates evidence for types of internal fixation implants used in joint-preserving surgery for intracapsular hip fractures. OBJECTIVES: To determine the relative effects (benefits and harms) of different implants for the internal fixation of intracapsular hip fractures in older adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Web of Science, Cochrane Database of Systematic Reviews, Epistemonikos, Proquest Dissertations and Theses, and National Technical Information Service in July 2020. We also searched clinical trials databases, conference proceedings, reference lists of retrieved articles and conducted backward-citation searches. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs comparing implants used for internal fixation of fragility intracapsular proximal femoral fractures in older adults. Types of implants were smooth pins (these include pins with fold-out hooks), screws, or fixed angle plates. We excluded studies in which all or most fractures were caused by specific pathologies other than osteoporosis or were the result of a high energy trauma. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion. One review author extracted data and assessed risk of bias which was checked by a second review author. We collected data for seven outcomes: activities of daily living (ADL), delirium, functional status, health-related quality of life (HRQoL), mobility, mortality (reported within four months of surgery as early mortality, and at 12 months since surgery), and unplanned return to theatre for treating a complication resulting directly or indirectly from the primary procedure (such as deep infection or non-union). We assessed the certainty of the evidence for these outcomes using GRADE. MAIN RESULTS: We included 38 studies (32 RCTs, six quasi-RCTs) with 8585 participants with 8590 intracapsular fractures. The mean ages of participants in the studies ranged from 60 to 84 years; 73% were women, and 38% of fractures were undisplaced. We report here the findings of the four main comparisons, which were between different categories of implants. We downgraded the certainty of the outcomes for imprecision (when data were available from insufficient numbers of participants or the confidence interval (CI) was wide), study limitations (e.g. high or unclear risks of bias), and inconsistency (when we noted substantial levels of statistical heterogeneity). Smooth pins versus fixed angle plate (four studies, 1313 participants) We found very low-certainty evidence of little or no difference between the two implant types in independent mobility with no more than one walking stick (1 study, 112 participants), early mortality (1 study, 383 participants), mortality at 12 months (2 studies, 661 participants), and unplanned return to theatre (3 studies, 736 participants). No studies reported on ADL, delirium, functional status, or HRQoL. Screws versus fixed angle plates (11 studies, 2471 participants) We found low-certainty evidence of no clinically important differences between the two implant types in functional status using WOMAC (MD -3.18, 95% CI -6.35 to -0.01; 2 studies, 498 participants; range of scores from 0 to 96, lower values indicate better function), and HRQoL using EQ-5D (MD 0.03, 95% CI 0.00 to 0.06; 2 studies, 521 participants; range -0.654 (worst), 0 (dead), 1 (best)). We also found low-certainty evidence showing little or no difference between the two implant types in mortality at 12 months (RR 1.04, 95% CI 0.83 to 1.31; 7 studies, 1690 participants), and unplanned return to theatre (RR 1.10, 95% CI 0.95 to 1.26; 11 studies, 2321 participants). We found very low-certainty evidence of little or no difference between the two implant types in independent mobility (1 study, 70 participants), and early mortality (3 studies, 467 participants). No studies reported on ADL or delirium. Screws versus smooth pins (seven studies, 1119 participants) We found low-certainty evidence of no or little difference between the two implant types in mortality at 12 months (RR 1.07, 95% CI 0.85 to 1.35; 6 studies, 1005 participants; low-certainty evidence). We found very low-certainty evidence of little or no difference between the two implant types in early mortality (3 studies, 584 participants) and unplanned return to theatre (5 studies, 862 participants). No studies reported on ADL, delirium, functional status, HRQoL, or mobility. Screws or smooth pins versus fixed angle plates (15 studies, 3784 participants) In this comparison, we combined data from the first two comparison groups. We found low-certainty evidence of no or little difference between the two groups of implants in mortality at 12 months (RR 1.04, 95% CI.083 to 1.31; 7 studies, 1690 participants) and unplanned return to theatre (RR 1.02, 95% CI 0.88 to 1.18; 14 studies, 3057 participants). We found very low-certainty evidence of little or no difference between the two groups of implants in independent mobility (2 studies, 182 participants), and early mortality (4 studies, 850 participants). We found no additional evidence to support the findings for functional status or HRQoL as reported in 'Screws versus fixed angle plates'. No studies reported ADL or delirium. AUTHORS' CONCLUSIONS: There is low-certainty evidence that there may be little or no difference between screws and fixed angle plates in functional status, HRQoL, mortality at 12 months, or unplanned return to theatre; and between screws and pins in mortality at 12 months. The limited and very low-certainty evidence for the outcomes for which data were available for the smooth pins versus fixed angle plates comparison, as well as the other outcomes for which data were available for the screws and fixed angle plates, and screws and pins comparisons means we have very little confidence in the estimates of effect for these outcomes. Additional RCTs would increase the certainty of the evidence. We encourage such studies to report outcomes consistent with the core outcome set for hip fracture, including long-term quality of life indicators such as ADL and mobility.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Parafusos Ósseos , Cabeça do Fêmur/lesões , Fixação Interna de Fraturas/instrumentação , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Viés , Intervalos de Confiança , Feminino , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/mortalidade , Fraturas do Quadril/mortalidade , Articulação do Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
14.
Orthod Fr ; 92(1): 129-140, 2021 Mar 01.
Artigo em Francês | MEDLINE | ID: mdl-33787498

RESUMO

The objective of this case series was to show how only one miniscrew can be used to treat simultaneously or successively canine impaction and different malocclusions. Three patients aged of 13 years old who had malocclusions, such as Class II, overbite and canine impaction, were each one treated with the same miniscrew throughout the treatment period. Palatal miniscrews were placed mesially to the first molar and used as a direct or indirect anchorage depending on the moment of the treatment. In each case, satisfactory treatment was obtained with correction of overbite, class II malocclusion and canine impaction. The first steps of treatment were aesthetic for the patient and did not require patient cooperation.


Assuntos
Má Oclusão de Angle Classe II , Procedimentos de Ancoragem Ortodôntica , Adolescente , Idoso , Parafusos Ósseos , Cefalometria , Estética Dentária , Humanos , Má Oclusão de Angle Classe II/terapia , Técnicas de Movimentação Dentária
15.
Ann R Coll Surg Engl ; 103(5): 337-344, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33715420

RESUMO

INTRODUCTION: The COVID-19 pandemic presented extraordinary challenges to the UK healthcare system. This study aimed to assess the impact of the COVID-19 lockdown on the epidemiology, treatment pathways and 30-day mortality rates of hip fractures. Outcomes of COVID-19 positive patients were compared against those who tested negative. METHODS: An observational, retrospective, multicentre study was conducted across six hospitals in the South East of England. Data were retrieved from the National Hip Fracture Database and electronic medical records. Data was collected for the strictest UK lockdown period (period B=23 March 2020-11 May 2020), and the corresponding period in 2019 (period A). RESULTS: A total of 386 patients were admitted during period A, whereas 381 were admitted during period B. Despite the suspension of the 'Best Practice Tariff' during period B, time to surgery, time to orthogeriatric assessment, and 30-day mortality were similar between period A and B. The length of inpatient stay was significantly shorter during period B (11.5 days vs 17.0 days, p<0.001). Comparison of COVID-19 positive and negative patients during period B demonstrated that a positive test was associated with a significantly higher rate of 30-day mortality (53.6% vs 6.7%), surgical delay >36h (46.4% vs 30.8%, p=0.049), and increased length of inpatient stay (15.8 vs 11.7 days, p=0.015). CONCLUSIONS: The COVID-19 lockdown did not alter the epidemiology of hip fractures. A substantially higher mortality rate was observed among patients with a COVID-19 positive test. These findings should be taken into consideration by the healthcare policymakers while formulating contingency plans for a potential 'second wave'.


Assuntos
/prevenção & controle , Controle de Doenças Transmissíveis , Fraturas do Quadril/epidemiologia , Tempo de Internação/estatística & dados numéricos , Mortalidade , Política Pública , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Parafusos Ósseos , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Fixação Interna de Fraturas , Fixação Intramedular de Fraturas , Hemiartroplastia , Fraturas do Quadril/complicações , Fraturas do Quadril/cirurgia , Humanos , Masculino , Reoperação
16.
Neurol Neurochir Pol ; 55(2): 227-229, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33687730

RESUMO

BACKGROUND: Type II odontoid fractures are mostly encountered in the elderly. Due to a high risk of non-union fractures in the case of conservative treatment, surgical fixation is widely recommended. Anterior odontoid screw fixation (AOSF) is a method that allows for a wide range of cervical mobility, and it is a relatively safe procedure that is recommended as the method of choice, although rare complications can be fatal when it leads to life-threatening oesophageal perforation. PURPOSE: The aim of this study is to present potential risk factors which lead to these rare complications, and possible methods of treatment. METHODS: This article presents the case of a patient hospitalised in the Neurosurgery Department of St Lukas Hosital in Tarnów in 2016. A literature review was performed using PubMed; search criteria included the phrases 'odontoid fracture perforation' and 'anterior cervical spine perforation'. The search returned 235 articles, of which 55 publications were in line with the subject of this paper, with only 12 deemed appropriate for consideration. RESULT: The authors present the case of an elderly patient with a history of odontoid fracture. Ten weeks after primary AOSF, the patient came to the Neurosurgery Department due to expectorating screws. This implied the need for further examination and even oesophageal reconstructive surgery or another spinal surgery. In laryngological examination and in gastroscopy there were no signs of fistula. In this case conservative treatment was proceeded. Due to odontoid fracture, non-union cervical posterior stabilisation was necessary. CONCLUSION: Patients with oesophageal perforation should be treated with special care.


Assuntos
Perfuração Esofágica , Processo Odontoide , Fraturas da Coluna Vertebral , Idoso , Parafusos Ósseos , Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Fixação Interna de Fraturas , Humanos , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/lesões , Processo Odontoide/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
17.
Medicine (Baltimore) ; 100(11): e24220, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725928

RESUMO

INTRODUCTION: Traditional open discectomy and intervertebral fusion surgery is the common strategy for lumbar disc herniation (LDH). However, it has the disadvantages of long recovery time and severe paravertebral soft tissue injury. Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion (ZELIF), as a novel minimally invasive surgical technique for LDH, has the advantages in quicker recovery, less soft tissue destruction, shorter hospital stays and less pain. We report a novel technique of ZELIF under intraoperative neuromonitoring (INM) for the treatment of LDH. PATIENT CONCERNS: A 51-year-old male presented to our hospital with left lower extremity pain and numbness for 1 year. DIAGNOSIS: Lumbar disc herniation (LDH). INTERVENTIONS: This patient was treated with Zina percutaneous screw fixation combined with endoscopic neural decompression, endplate preparation, and intervertebral fusion through Kambin's triangle. Each step of the operation was performed under INM. OUTCOMES: The follow-up period lasted 12 months; the hospitalization lasted 4 nights; the blood loss volume was 65 ml, and the time of operation was 266 min. INM showed no neurological damage during the surgery. No surgical complications, including neurological deterioration, cage migration, non-union, instrumentation failure or revision operation, were observed during the follow-up period. Visual Analogue Scale (VAS) score reduced from 7 to 1; the Oswestry Disability Index (ODI) decreased from 43 to 14; the EQ-5D score was 10 preoperatively and 15 at the final follow-up visit; the Physical Component Summary of the 36-Item Short Form Health Survey (SF-36) was 48 preoperatively and 49 at the last follow up visit; the SF-36 Mental Component Summary was 47 before surgery and decreased to 41 postoperatively. CONCLUSION: ZELIF under INM may represent a feasible, safe and effective alternative to endoscopic intervertebral fusion and percutaneous screw fixation, for decompressing the lumbar's exiting nerve root directly with minimal invasion in selected patients.


Assuntos
Parafusos Ósseos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/instrumentação
18.
J Equine Vet Sci ; 99: 103384, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33781430

RESUMO

Surgical repair of unicortical fractures of the distal condyles of the third metacarpal/metatarsal bones (MCIII/MTIII) has been described. In the present case, a bioabsorbable screw was used to stabilize a unicortical fracture in the palmar aspect of the medial condyle of MCIII in a National Hunt Thoroughbred racehorse. The clinical, radiographic, and magnetic resonance imaging findings before and after surgery were recorded. Eighteen weeks after surgery, the lameness had resolved and the bone surrounding the fracture had recovered its normal architecture. One year after surgery, the horse was in training, showed no recurrence of the primary lesion and was considered a "racing prospect" by the trainer. The use of a bioabsorbable screw in this case was associated with a successful outcome and is worthy of further investigation.


Assuntos
Fraturas Ósseas , Doenças dos Cavalos , Ossos Metacarpais , Implantes Absorvíveis , Animais , Parafusos Ósseos , Fraturas Ósseas/veterinária , Doenças dos Cavalos/diagnóstico por imagem , Cavalos
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