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1.
Bone Joint J ; 102-B(3): 394-399, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114812

RESUMO

AIMS: A lack of supporting clinical studies have been published to determine the ideal length of intramedullary nail in fixation of trochanteric fractures of the hip. Nevertheless, there has been a trend to use shorter intramedullary nails for the internal fixation of trochanteric hip fractures. Our aim was to determine if the length of nail affected the outcome. METHODS: We randomized 229 patients with a trochanteric hip fracture between two implants: a 'standard' nail of 220 mm and a shorter nail of 175 mm, which had decreased proximal angulation (4° vs 7°) and a reduced diameter at the level of the lesser trochanter. Patients were followed up for one year by a nurse blinded to the type of implant used to determine if there were differences in mobility and pain with two nail designs. Pain was assessed on a scale of 1 (none) to 8 (severe and constant) and mobility on a scale of 1 (full mobility) to 9 (immobile). RESULTS: The shorter nail did not require any reaming of the femur and was quicker to insert (mean difference 5.1 minutes; p < 0.001, 95% confidence interval (CI) of the difference 3.16 to 7.04). Those treated by the shorter nail were less mobile (mean difference in reduction in mobility score at one year 0.80; p = 0.007, 95% CI 1.38 to 0.22). In addition, there was a trend toward greater residual pain for those treated with the shorter nail, although this was not statistically significant (mean difference in pain score at one year 0.24; p = 0.064, 95% CI -0.01 to 0.49). CONCLUSION: These results suggest that the increasing use of this very short intramedullary nail with its design modification may not be appropriate. Cite this article: Bone Joint J 2020;102-B(3):394-399.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/cirurgia , Articulação do Quadril/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/fisiopatologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Radiografia , Amplitude de Movimento Articular , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(10): e19449, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150100

RESUMO

Radial external fixator has been proposed to treat delayed irreducible Gartland type III supracondylar humeral fracture, and this study aims to compare its effects with crossed pinning in a retrospective fashion. Delayed supracondylar humeral fracture is defined as more than 72 hours after injury, 2 or more than 2 times failed attempts of closed reduction can be deemed as irreducible fracture.Between January 2010 and January 2017, patients of Gartland type III supracondylar fractures of the humerus receiving surgery were all selected and reviewed. Overall, 39 patients fitting the inclusion criteria were chosen for the External Fixator Group and patients for control group of crossed pinning with matched age, sex, and clinical parameters (fracture location, injured side, and fracture type) were selected from the database. Surgery duration, number of intraoperative X-ray images, incidence of ulnar nerve injury, postoperative redisplacement, and function of the elbow joint were recorded and analyzed.In this study, 39 patients treated with radial external fixator had significantly shorter surgery duration, fewer intraoperative X-ray images, and lower incidence of ulnar nerve injury, and postoperative redisplacement than those receiving crossed pinning. Patients in 2 groups displayed similar range of motion for elbow joint at follow-up.Radial external fixator is an effective and safe method to treat Gartland type III supracondylar fractures that were diagnosed late.


Assuntos
Pinos Ortopédicos , Fixadores Externos , Fixação de Fratura/instrumentação , Fraturas do Úmero/cirurgia , Criança , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
3.
Instr Course Lect ; 69: 433-448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017744

RESUMO

Lower extremity fractures, ranging from the proximal femur to the distal tibia, come in a variety of patterns and complexity. Treatment modalities typically consist of using plates and intramedullary nails; however, each has its advantages and disadvantages in each anatomic region. In this instructional course, salient points and nuances in setup and implant choice are reviewed. Furthermore, the essential tips and tricks to avoid pitfalls and achieve a desired clinical result are discussed.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Fixação Intramedular de Fraturas , Fraturas Ósseas , Extremidade Inferior , Humanos , Tíbia
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 32-36, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939231

RESUMO

Objective: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) in the treatment of intertrochanteric fracture of femur in traction bed supine position and non-traction bed lateral position. Methods: A retrospective analysis of 102 elderly patients with intertrochanteric fracture of femur who met the selection criteria between January 2013 and April 2018 was made. According to the different operative positions, the patients were divided into two groups: group A (50 cases, PFNA internal fixation in traction bed supine position) and group B (52 cases, PFNA internal fixation in non-traction bed lateral position). There was no significant difference in age, gender, fracture side, cause of injury, AO classification, complications, and time from injury to operation between the two groups ( P>0.05). The preoperative preparation time, incision length, operation time, intraoperative blood loss, intraoperative X-ray fluoroscopy times, fracture healing time, and complications were recorded and compared between the two groups, and the effectiveness was evaluated by Harris hip score at 1 year after operation. Results: There was no significant difference in incision length between groups A and B ( t=1.116, P=0.268). In addition, the preoperative preparation time, operation time, intraoperative blood loss, and intraoperative X-ray fluoroscopy times in group A were significantly greater than those in group B ( P<0.05). Both groups were followed up 12-14 months, with an average of 13 months. There were 3 postoperative complications in group A and group B respectively. In group A, there were 2 cases of hip joint pain and 1 case of local fat liquefaction (healed after dressing change); in group B, there were 2 cases of hip joint pain and 1 case of deep vein thrombosis in lower extremity; there was no significant difference in the incidence of postoperative complications between the two groups ( P=0.642). The patients of the two groups had a good result of fracture reduction and the internal fixation quality, and there was no main nail loosening, screw fracture, spiral blade cutting, withdrawal, and the nail breakage occurred, and no nonunion of bone, coxa vara, and other complications occurred. X-ray showed that the fracture healed in both groups, and there was no significant difference in fracture healing time between the two groups ( t=1.515, P=0.133). There was no significant difference in Harris hip score between the two groups at 1 year after operation ( t=0.778, P=0.438). Conclusion: Compared with the traction bed supine position, PFNA internal fixation for intertrochanteric fracture of femur in the non-traction bed lateral position has the advantages of short preparation time, short operation time, less intraoperative blood loss, less X-ray fluoroscopy times, and satisfactory postoperative recovery effect.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Pinos Ortopédicos , Humanos , Estudos Retrospectivos , Decúbito Dorsal , Tração , Resultado do Tratamento
5.
World Neurosurg ; 133: e653-e657, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568918

RESUMO

BACKGROUND: The C1 lateral mass and C2 pedicle screw with rod fixation system has been used commonly in recent years. Despite the numerous reports on this technique in the literature, there are no studies regarding the effect of the angle of the rod used. We investigated the effect of rod angle on subaxial lordosis, cervical sagittal balance, and pain scores. METHODS: Clinical records and radiologic images of 58 patients who underwent procedures between 2011 and 2016 at our clinic were assessed retrospectively. We recorded clinical findings, visual analog scale (VAS) scores, angles of cervical and segmental lordosis, and the distance between the C2 sagittal vertical axis (SVA) and the C7 posterior-superior corner. RESULTS: A total of 36 male and 22 female patients were enrolled. A negative correlation was found between the C1-C2 lordosis angle and the C2-C7 lordosis angle irrespective of surgical technique. In patients who were operated on using 30°-angled rods, there was a postoperative increase in C1-C2 lordosis degree and an improvement in C2 cervical SVA values. Postoperative month 6 VAS scores were significantly better in the patients who were operated on with angled rods compared with those who received straight rods. CONCLUSIONS: We believe this is because of the positive effect of the angled rod on sagittal balance. Nevertheless, prospective case-control studies should be conducted with larger groups of subjects. Furthermore, every patient should be evaluated considering the whole spinal sagittal balance.


Assuntos
Articulação Atlantoaxial/cirurgia , Pinos Ortopédicos , Lordose , Fusão Vertebral/instrumentação , Adulto , Vértebra Cervical Áxis/cirurgia , Atlas Cervical/cirurgia , Feminino , Humanos , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Estudos Retrospectivos , Resultado do Tratamento
6.
Vet Clin North Am Small Anim Pract ; 50(1): 101-121, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31653537

RESUMO

This article describes the technique of percutaneous pinning in dogs and cats. Only acute fractures evaluated within the first 48 hours after trauma are selected for percutaneous pinning. Reduction is performed with careful manipulation of the fracture to minimize the trauma to the growth plate. After ensuring the fracture is reduced anatomically, smooth pins of appropriate size are inserted through stab incisions or through large-gauge needles. Depending on the anatomic location, the pins are cut flush with the bone or bent over. The main advantages of this technique are the minimal surgical trauma and lower perioperative morbidity.


Assuntos
Pinos Ortopédicos/veterinária , Gatos/cirurgia , Cães/cirurgia , Fraturas Ósseas/veterinária , Animais , Gatos/lesões , Cães/lesões , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos
7.
Vet Clin North Am Small Anim Pract ; 50(1): 67-100, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31668598

RESUMO

Reviews of clinical outcomes led to the foundation of a new approach in fracture management known as biological osteosynthesis. As intramedullary rods featuring cannulations and locking devices at both extremities, interlocking nails are well suited for bridging osteosynthesis. Unique biological and mechanical benefits make them ideal for minimally invasive nail osteosynthesis and an attractive, effective alternative to plating, particularly in revisions of failed plate osteosynthesis. Thanks to a new angle-stable locking design, interlocking nailing indications have been expanded to osteosynthesis of epi-metaphyseal fractures, including those with articular involvement and angular deformities such as distal femoral varus and associated patellar luxations.


Assuntos
Pinos Ortopédicos/veterinária , Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Fenômenos Biomecânicos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
8.
Orthop Clin North Am ; 51(1): 37-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739878

RESUMO

In situ pinning of slipped capital femoral epiphysis (SCFE) is a safe and effective treatment modality, but often results in residual deformity leading to femoroacetabular impingement, which may limit patient activities and predispose to early onset arthritis. Enhanced understanding of the implications of femoroacetabular impingement and new surgical techniques have prompted interest in treating post-slipped capital femoral epiphysis deformity to both improve current symptoms and delay or prevent hip arthrosis.


Assuntos
Coxa Magna/cirurgia , Quadril/diagnóstico por imagem , Osteoartrite do Quadril/prevenção & controle , Escorregamento das Epífises Proximais do Fêmur/cirurgia , Artroscopia/métodos , Pinos Ortopédicos/efeitos adversos , Pinos Ortopédicos/normas , Impacto Femoroacetabular/etiologia , Impacto Femoroacetabular/cirurgia , Fêmur/cirurgia , Quadril/cirurgia , Luxação do Quadril/cirurgia , Humanos , Procedimentos Ortopédicos/métodos , Osteoartrite do Quadril/cirurgia , Osteotomia/métodos , Cuidados Pós-Operatórios , Estudos Retrospectivos , Resultado do Tratamento
9.
Bone Joint J ; 101-B(12): 1557-1562, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31786990

RESUMO

AIMS: The aim of this study was to present the long-term surgical outcomes, complications, implant survival, and causes of implant failure in patients treated with the modified Harrington procedure using antegrade large diameter pins. PATIENTS AND METHODS: A cohort of 50 consecutive patients who underwent the modified Harrington procedure for periacetabular metastasis or haematological malignancy between January 1996 and April 2018 were studied. The median follow-up time for all survivors was 3.2 years (interquartile range 0.9 to 7.6 years). RESULTS: The five-year overall survival rate was 33% for all the patients. However, implant survival rates were 100% and 46% at five and ten years, respectively. Eight patients survived beyond five years. There was no immediate perioperative mortality or complications. A total of 15 late complications occurred in 11 patients (22%). Five patients (10%) required further surgery to treat complications. The most frequent complication was pin breakage without evidence of acetabular loosening (6%). Two patients (4%) underwent revision for aseptic loosening at 6.5 and 8.9 years after surgery. Ambulatory status and pain level were improved in 83% and 89%, respectively. CONCLUSION: The modified Harrington procedure for acetabular destruction has low complication rates, good functional outcome, and improved pain relief in selected patients Cite this article: Bone Joint J 2019;101-B:1557-1562.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Pinos Ortopédicos , Neoplasias Ósseas/cirurgia , Neoplasias Hematológicas/cirurgia , Falha de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/mortalidade , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Carcinoma/mortalidade , Carcinoma/secundário , Carcinoma/cirurgia , Feminino , Seguimentos , Neoplasias Hematológicas/mortalidade , Humanos , Linfoma/mortalidade , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1467-1473, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823542

RESUMO

Objective: To review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation. Methods: The results of the clinical studies about the AP in treatment of femoral shaft nonunion after intramedullary nail fixation in recent years were widely reviewed and analyzed. Results: The AP has been successfully applied to femoral shaft nonunion after intramedullary nail fixation since 1997. According to breakage of the previous nailing, AP is divided into two categories: AP with retaining the previous intramedullary nail and AP with exchanging intramedullary nail. AP is not only suitable for simple nonunion, but also for complex nonunion with severe deformity. Compared with exchanging intramedullary nail, lateral plate, and dual plate, AP has less surgical trauma, shorter healing time, higher healing rate, and faster returning to society. However, there are still some problems with the revision method, including difficulty in bicortical screw fixation, lack of anatomic plate suitable for femoral shaft nonunion, and lack of postoperative function and quality of life assessment. Conclusion: Compared with other revision methods, AP could achieve higher fracture healing rate and better clinical prognosis for patients with femoral shaft nonunion. However, whether patients benefit from AP in terms of function and quality of life remain uncertain. Furthermore, high-quality randomized controlled clinical studies are needed to further confirm that AP are superior to the other revision fixations.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas não Consolidadas , Pinos Ortopédicos , Placas Ósseas , Consolidação da Fratura , Humanos , Qualidade de Vida , Resultado do Tratamento
11.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1538-1542, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823554

RESUMO

Objective: To analyze the risk factors for postoperative mortality of elder patients with intertrochanteric fractures. Methods: Patients with intertrochanteric fractures who underwent proximal femoral interlocking intramedullary nail fixation between January 2014 and December 2015 were enrolled in the study. Among them, 135 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin, albumin, and total lymphocyte count (TLC), and nutritional status. Univariate analysis and Cox proportional hazards regression model were used to screen the risk factors for postoperative mortality. Results: Twenty-seven patients (20.0%) died within 2 years after surgery, and 16 (11.9%) died within 1 year after surgery. Univariate analysis showed that age, coronary atherosclerotic heart disease, number of comorbidities, preoperative hemoglobin and albumin levels were the influencing factors of postoperative mortality in elder patients with intertrochanteric fractures treated with proximal femoral interlocking intramedullary nail fixation (P<0.05). Multivariate analysis showed that age (≥80 years), combined more than 2 medical diseases, and preoperative albumin (<35 g/L) were the independent risk factors for postoperative mortality (P<0.05). Conclusion: To improve the clinical outcomes, perioperative risk should be comprehensively evaluated and perioperative management strengthened in the elder patients with intertrochanteric fractures, especially those with advanced age, more combined diseases, and low albumin, for the high postoperative mortality.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Pinos Ortopédicos , Fêmur , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Humanos , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco
12.
Georgian Med News ; (294): 17-21, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687942

RESUMO

Treatment of pediatric femoral shaft fractures is actual subject of modern traumatology, because of high frequency and different types of treatment. Nowadays Osteosynthesis by Titanium Elastic intramedullary nails (TEN) is the most popular method of treatment for pediatric shaft fractures. As an other methods of treatment Osteosynthesis by TEN also has some complications. In our study we analyzed 119 patients 2 to 15 years of age with pediatric femoral shaft fractures who underwent operative treatment by TEN. According to Flynn's scoring criteria for TEN our patients had in 87 cases (73%) excellent result, in 29 cases (24%) - satisfactory results and in 3 cases (3%) - poor results. For patients with satisfactory and poor outcome (total 32 patients) the main problem was different degree pain and irritation of soft tissues from nail ends. No one patients had the same problem in who was inserted nail "end cup" (total 25 patients). Average operation duration was 50 minutes (from 25 to 100) and in only 5 cases from 119 (4%) was needed open reduction for fracture. Avarage hospital stay for patients was 3 days (from 2 to 7 days). Patients were permitted begin partial weight bearing avarage for 5 week (range from 4 to 8 weeks). We had no one case of infection complication and non or delaied union. We concluded that with opetration by TEN the coplications is mainly minor and don't affects general outcome of treatment for this particullar kind of fracture. the majority of complications are surgery techniques related and can be avoided by using of end cups for the nails. This technique successfully can be used in heavy children (from 40 to 50 kg) and even in children more than 50 kg with fracture type A3. Osteosynthesis by Titanium elanstin intramedullary nail is excellent method for theatment pediatric femoral diaphyseal fractures.


Assuntos
Pinos Ortopédicos , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas , Titânio , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
13.
J Hand Surg Asian Pac Vol ; 24(4): 428-434, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690195

RESUMO

Background: Although there have been many studies of the vascularized bone graft (VBG) or unloading procedures alone for the treatment of Kienböck disease, little information has been reported about patients treated with VBG combined with unloading procedures. The purpose of this study is to 1) describe the outcomes in patients treated with VBG combined with unloading procedures, 2) compare the outcomes according to the unloading procedures and 3) find any radiologic parameters affecting revascularization in Kienböck disease. Methods: A retrospective review was performed involving in 20 patients undergoing 4th and 5th extensor compartmental VBG with unloading procedures for Kienböck disease from 2010-2015. After VBG in all patients, unloading procedures were additionally performed depending on the ulnar variance. These additional operations included joint leveling procedures (radial and capitate shortening osteotomy) or temporary scaphocapitate pinning. Radiologic outcome was evaluated according to Lichtman stage and presence of revascularization evidence. Clinical evaluations included wrist range of motion, grip strength, visual analogue scale (VAS), and Mayo wrist score. Results: VBG with joint leveling procedures was performed in 11 patients (5 radial shortening and 6 capitate shortening) and VBG with temporary scaphocapitate pinning was performed in 9 patients. Although clinical outcomes were not significantly different according to the unloading procedures, there were significantly more patients with evidence of healing of osteonecrosis on radiographs in joint leveling procedure group than temporary scaphocapitate pinning group. Overall, evidence of healing of osteonecrosis was found on plain radiographs in 11 patients and was not found in 9 patients. However, there were no significant preoperative radiological parameters affecting revascularization on radiographs. Conclusions: Not all patients had evidence of revascularization on radiography after VBG combined with unloading procedures for Kienböck disease. However, among the unloading procedures, joint-leveling procedures positively influenced the revascularization process.


Assuntos
Pinos Ortopédicos , Transplante Ósseo/métodos , Capitato/cirurgia , Osteonecrose/cirurgia , Rádio (Anatomia)/transplante , Osso Escafoide/cirurgia , Articulação do Punho/cirurgia , Adolescente , Adulto , Capitato/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico , Radiografia , Rádio (Anatomia)/irrigação sanguínea , Amplitude de Movimento Articular , Estudos Retrospectivos , Osso Escafoide/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto Jovem
14.
J Bone Joint Surg Am ; 101(18): 1654-1661, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31567802

RESUMO

BACKGROUND: The treatment of a displaced proximal humeral fracture is still a matter of controversy. Minimally invasive techniques are considered promising options. The purpose of this study was to report outcomes at medium to long-term follow-up after surgical treatment with pins stabilized with an external fixator. METHODS: A total of 235 patients (average age, 64 years [95% confidence interval (CI), 62 to 65 years]) were treated with closed or open reduction and fixation with pins stabilized by an external fixator specifically designed for proximal humeral fractures. The pins were inserted using a "pins-crossing-fracture" or a "pins-bridging-fracture" technique. One hundred and eighty-eight patients had a minimum radiographic and clinical follow-up of 2 years. Outcomes were assessed using the Oxford Shoulder Score (OSS), the subjective shoulder value (SSV), a visual analog scale (VAS) for pain, and, for 155 patients, the Constant score. RESULTS: Eighty-one (43%) of the 188 patients had a 2-part fracture, 60 (32%) had a 3-part fracture, and 47 (25%) had a 4-part fracture. The reduction was performed with percutaneous maneuvers in 120 shoulders or a deltopectoral approach, in 68. The external fixator was applied using a "pins-crossing-fracture" technique in 133 shoulders and using a "pins-bridging-fracture" technique in 55. At last follow-up, mean clinical scores were as follows: OSS, 42.6 (95% CI, 42 to 44); SSV, 85.5 (95% CI, 83 to 88); and VAS for pain, 1 (95% CI, 0.7 to 1.2). The complication rate at 3 months was 16% (37 of 235). The most frequent complication was pin-track infection (19 of 235, 8%). A total of 50 patients had ≥1 complication (50 of 188, 27%) and 6 (3%) underwent revision surgery. More complications were observed with the "pins-crossing-fracture" technique. CONCLUSIONS: In our experience, the use of the external fixator has been a valuable option in the treatment of proximal humeral fractures. The complication and revision rates were acceptable. Most of the complications encountered were manageable without revision surgery. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fixadores Externos , Fixação de Fratura/instrumentação , Fraturas do Ombro/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Feminino , Seguimentos , Fixação de Fratura/métodos , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
15.
Saudi Med J ; 40(10): 1058-1062, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31588487

RESUMO

The Precice nail is used to treat limb length discrepancies and has a low complication rate and a high patient satisfaction rate. While the Precice nail can be used for lengthening, unlike other lengthening nails, it can also be used for shortening. We report a 37-year-old female patient with a 14 cm limb length discrepancy that was treated with a new surgical technique using the shortening feature of the Precice nail. Following maximum possible lengthening using the nail and without waiting for union on the osteotomy line, the distal interlocking screws were removed, and the nail was shortened by external remote control with the help of the fixator. The distal interlocking screws were then reattached to continue lengthening. This surgical technique can be used safely and satisfactorily in cases with more shortness as we can correct the extremity length discrepancy using only one nail.


Assuntos
Alongamento Ósseo/métodos , Pinos Ortopédicos , Desigualdade de Membros Inferiores/cirurgia , Tíbia/cirurgia , Adulto , Alongamento Ósseo/instrumentação , Parafusos Ósseos , Feminino , Humanos , Osteotomia
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(11): 1394-1398, 2019 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-31650755

RESUMO

Objective: To investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults. Methods: Between March 2016 and January 2018, 20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing. There were 13 cases and 7 cases, with an average age of 43 years (range, 18-56 years). The causes of injury included the traffic accident in 6 cases, falling in 12 cases, and falling from height in 2 cases. The interval between injury and admission ranged from 1 hour to 2 days (mean, 3.2 hours). The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases. The length of incision, the operation time, the visual analogue scale (VAS) score on the 2nd day after operation, the fracture healing time, the postoperative shoulder function and the Disability of Arm Shoulder and Hand (DASH) score, the complications, and the time of second surgical removal of internal fixator and incision length were recorded. Results: The length of incision was 2-6 cm (mean, 4.7cm). The operation time was 45-120 minutes (mean, 77.2 minutes). The VAS score was 1-5 (mean, 3.2) on the 2nd day after operation. All incisions healed by first intention and no infection or nerve injury occurred. All patients were followed up 12-32 months (mean, 18.6 months). All fractures healed with the healing time of 10-15 weeks (mean, 12.1 weeks). The Constant score was 92-98 (mean, 96.3) and DASH score was 0-6.4 (mean, 3.1). The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation. The internal fixators were removed at 12-26 months (mean, 14.6 months) after operation. And the length of incision was 1-2 cm (mean, 1.3 cm) and the operation time was 5-15 minutes (mean, 9.0 minutes). Conclusion: For the midshaft clavicular fracture in adults, the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision, light pain, rapid fracture healing, small secondary operation injury, and avoiding the risk of clavicular epithelial nerve injury, and can obtain good effectiveness.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas , Fraturas Ósseas , Adolescente , Adulto , Clavícula , Consolidação da Fratura , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
17.
Am J Case Rep ; 20: 1540-1550, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31631172

RESUMO

BACKGROUND Osteogenesis imperfecta is a rare inherited connective tissue disorder that is mainly characterized by long bone deformities and increased susceptibility to bone fractures. The aim of this study was to present a surgical technique in a child suffering from osteogenesis imperfecta and progressive, severe bowing deformity of both tibias, as an alternative method to advanced, innovative surgical systems. CASE REPORT A 9-year-old child (male) was referred to our orthopedic clinic for inability to walk independently due to extreme anterior bowing of both tibias. After the diagnosis of osteogenesis imperfecta type III was established, bilateral surgical treatment with multiple osteotomies and intramedullary, flexible Titanium Elastic Nail System (TENS) nails was decided. Six months post-operatively callus formation was obvious in x-rays and at the latest follow-up (1 year post-operatively) the patient regained the ability to walk independently. CONCLUSIONS In types of osteogenesis imperfecta which are characterized by extreme deformities (type III) surgical intervention seems to be the only solution for these patients to walk again. We present a relatively simple technique of correcting such deformities, indicating that no matter which technique will be used (simple or more complicated) the final goal should be to restore the walking ability with as little complications as possible.


Assuntos
Osteogênese Imperfeita/cirurgia , Osteotomia/métodos , Tíbia/anormalidades , Tíbia/cirurgia , Pinos Ortopédicos , Criança , Humanos , Masculino , Titânio , Resultado do Tratamento , Caminhada
18.
Zhongguo Gu Shang ; 32(9): 824-829, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31615179

RESUMO

OBJECTIVE: To compare the clinical efficacy of proximal femoral nail anti-rotation(PFNA) and dynamic hip screw(DHS) for the treatment of unstable intertrochanteric fractures in the elderly. METHODS: From January 2012 to December 2015, 83 elderly patients with unstable intertrochanteric fracture of femur were divided into 45 cases treated with PFNA and 38 cases treated with DHS. In the PFNA group, there were 24 males and 21 females, aged 82 to 94(88.35±6.12) years old, duration was 1.5 to 10 (4.33±1.07) h, causes of injury involved 33 traffic accidents, 10 falls at high altitude, 2 falls; Evans-Jensen classification involved 21 cases of IIIA, 18 cases of IIIB and 6 cases of IV. In DHS group, there were 20 males and 18 females, aged 83 to 95 (88.77±5.52) years old, duration was 1 to 10 (4.37±1.05) h, 27 traffic accidents, 10 high-altitude falls and 1 fall injury, and Evans-Jensen classification involved 18 cases of IIIA, 15 cases of IIIB and 5 cases of IV. The operation time, intraoperative bleeding volume and discharged complications were observed and compared between the two groups. The Mos 36-item Short Form Health Survey (SF-36) was used to measure the quality of life before and 12 months after operation. Harris score was used to evaluate hip function 12 months after operation. RESULTS: The operation time, intraoperative bleeding volume and complication rate in PFNA group were significantly lower than those in DHS group(P<0.05); both groups were followed up for 12 months without falling off. The Harris score and SF-36 score at 12 months after operation in both groups were higher than those before operation(P<0.05), and the excellent and good rate in PFNA group was significantly higher than that in DHS group(P<0.05). CONCLUSIONS: Compared with DHS, PFNA is more simple, less traumatic, less complications, better short-term survival rate and better quality of life for elderly patients with unstable intertrochanteric fracture of femur. PFNA can be used as an optimal treatment for elderly patients with unstable intertrochanteric fracture of femur.


Assuntos
Pinos Ortopédicos , Fraturas do Quadril , Idoso de 80 Anos ou mais , Parafusos Ósseos , Feminino , Fêmur , Fraturas do Quadril/cirurgia , Humanos , Masculino , Qualidade de Vida , Estudos Retrospectivos
19.
J Coll Physicians Surg Pak ; 29(10): 942-945, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564266

RESUMO

OBJECTIVE: To compare the efficacy of intramedullary nailing (IMN) and minimally invasive percutaneous plate osteosynthesis (MIPO) in treatment of humeral shaft fractures. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Orthopedics, Zhejiang Hospital, China, during March 2010 to December 2016. METHODOLOGY: The study included patients with humeral shaft fractures who received surgery by IMN or MIPO. The intraoperative outcomes including operation time, bleeding volume, and the postoperative outcomes were also recorded. The Constant-Murley scores were used for assessment of function of shoulder joint and Mayo score was used for measurement of elbow joint function. RESULTS: Among a total of 436 patients with humeral shaft fractures, 204 cases received MIPO and 232 cases received IMN. The follow-up duration ranged from 16~36 months with a mean duration of 25.8 ±6.1 months. The mean operation time, mean bleeding volume, mean hospitalisation time and mean healing time showed no significant difference between MIPO and IMN groups. No significant difference was observed in Mayo scores, but the Constant-Murley scores of MIPO group was significantly higher that the IMN group. Fracture nonunion was observed for 15 (6.5%) cases in IMN group; however, only 1 (0.5%) case was found to be nonunion in MIPO group. Meanwhile, 9 (4.4%) cases showed radial nerve injury in the MIPO group, with no significant difference compared to the IMN group of 15 (6.5%) cases. CONCLUSION: Both the two methods were effective; however, MIPO method might be better for recovery of shoulder function and might reduce the nonunion rate.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Úmero/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Adulto , Perda Sanguínea Cirúrgica , China , Feminino , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Estudos Retrospectivos
20.
Pediatr Cardiol ; 40(8): 1728-1734, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31549187

RESUMO

We evaluated the efficacy of bioresorbable sternal reinforcement device (poly-L-lactide sternal pins) on sternal healing after median sternotomy in young children (with body weight less than 10 kg) with congenital heart disease (CHD). Data from 85 patients, who underwent CHD surgery through median sternotomy from October 2016 to May 2018, were collected and analyzed. Sternal pins were utilized in 85 patients (10 mm × 1 mm × 1 mm for patients with body weights less than 5 kg and 15 mm × 2 mm × 2 mm for those weighing between 5 and 10 kg) in addition to sternum closure with Ethicon PDSTMII running sutures (Group A), while 84 patients received the Ethicon sternal closure (Group B) with no pins. The occurrence of sternal dehiscence, anterior-posterior displacement, and high-low displacement was evaluated by physical examination and three-dimensional computed tomography at one month postoperatively. No anterior-posterior sternal displacement (0%) was observed in Group A, while 10 anterior-posterior displacements (11.9%) were observed in Group B (P < 0.01). The number of sternal caudal-cranial displacements in Groups A and B was 4 (4.71%) and 5 (5.35%), respectively (P = 0.870). While no sternal dehiscence (0%) was observed in Group A, 7 out of 84 patients (8.33%) in Group B exhibited obvious sternal dehiscence (P < 0.01). The bioresorbable poly-L-lactide sternal pins reduced an anterior-posterior sternal displacement and sternal dehiscence, which was accompanied by a significant improvement of an early sternal fixation.


Assuntos
Pinos Ortopédicos , Esternotomia/métodos , Esterno/cirurgia , Estudos de Casos e Controles , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Imagem Tridimensional , Lactente , Masculino , Poliésteres/uso terapêutico , Esternotomia/estatística & dados numéricos , Deiscência da Ferida Operatória/prevenção & controle , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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