Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.078
Filtrar
1.
Medicine (Baltimore) ; 99(8): e19195, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080105

RESUMO

RATIONALE: Less-Invasive Stabilization System (LISS) plate is an internal fixation commonly used for the periprosthetic distal femur fractures. Failure associated with LISS plate has been rarely reported, and the reasons for LISS plate failure are multitudinous. Various advantages have been reported, but failures continue. PATIENT CONCERNS: We present 3 cases illustrating the failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures. The shaft screws of the LISS plate broke in 2 cases, and the plate placement was incorrect in 1 case. Early weight bearing, obesity, osteoporosis, and lateral collateral ligament injury due to incorrect plate placement constituted the etiologies of LISS plate failure. DIAGNOSIS: Failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures after Total knee arthroplasty. INTERVENTIONS: Three patients underwent Less-Invasive Stabilization System plates removal with replacement of the total knee arthroplasty revision surgery with rotating hinged knee prosthesis. OUTCOMES: After completing the total knee arthroplasty revision surgery, all patients underwent regular follow-up examinations. Case 2 could walk unaided, without pain, final union was confirmed for both case 1 and case 3. CONCLUSION: Less-Invasive Stabilization System (LISS) plate provides satisfactory results in periprosthetic fractures after Total knee arthroplasty (TKA). The LISS plate has many advantages, but failures continue to occur. The causes for failure were early weight bearing, obesity, osteoporosis, and lateral collateral ligament (LCL) injury due to incorrect plate placement in our series. We recommend that protection or properly delay of weight-bearing, active anti-osteoporosis treatment, and intraoperative fluoroscopy are the effective methods to avoid failure.


Assuntos
Placas Ósseas/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Periprotéticas/cirurgia , Idoso , Artroplastia do Joelho/métodos , Falha de Equipamento , Feminino , Fraturas do Fêmur/epidemiologia , Humanos , Obesidade/epidemiologia , Osteoporose/epidemiologia , Fraturas Periprotéticas/epidemiologia , Suporte de Carga/fisiologia
2.
J Hand Surg Asian Pac Vol ; 24(4): 392-399, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690191

RESUMO

Background: The aim of this study was to identify the risk factors for median nerve dysfunctions after volar locking plate (VLP) fixation for distal radius fracture (DRF). Methods: We prospectively assessed the incidence of median nerve symptoms (MNS) such as numbness, pain, paresthesia, or hypesthesia in the area innervated by the median nerve and evaluated post-operative nerve conduction (NC) in 91 hands of 121 patients after VLP fixation for DRF. Multivariate logistic regression analysis was conducted to identify factors independently associated with MNS and abnormal NC in the injured wrist. Results: There were 18 cases (20%) of MNS on the injured side, 9 hands (10%) of both MNS and abnormal NC, 11 hands (12%) with only abnormal NC, and 9 hands with only MNS. Sensitivity, specificity, and diagnostic accuracy of abnormal NC for diagnosing MNS were 50%, 86%, and 78%, respectively. Four cases did not respond to conservative treatment and received carpal tunnel release concomitantly with plate removal. Logistic regression examination revealed that volar placement of the plate and short stature were significant independent predictors of MNS, while patient age was the sole independent predictor of abnormal NC. Conclusions: Our study demonstrated that plate prominence, short stature, and age were significant independent risk factors for median nerve dysfunctions after VLP fixation for DRF.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Nervo Mediano/fisiopatologia , Traumatismos dos Nervos Periféricos/diagnóstico , Fraturas do Rádio/complicações , Idoso , Eletromiografia , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Nervo Mediano/lesões , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/epidemiologia , Traumatismos dos Nervos Periféricos/etiologia , Complicações Pós-Operatórias , Estudos Prospectivos , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/cirurgia
3.
J Orthop Surg Res ; 14(1): 295, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484547

RESUMO

OBJECTIVE: To investigate the incidence of postoperative overall complications or secondary procedures following distal radius fractures treated by volar locking plate (VLP) METHODS: Electronic medical records (EMR) of 1152 patients with 1175 distal radius fractures treated by volar locking plate between January 2013 and September 2018 were retrospectively reviewed and the data were extracted. The picture archiving and communication system (PACS) was inquired to assess the fracture severity and to determine the fracture type. Univariate and multivariate logistic regression analyses were used to identify the associated risk factors. RESULTS: During the median follow-up period of 6 months, a total of 138 complications in 131 patients were determined, indicating the accumulated rate of 11.7%; there were 68 cases of secondary procedures, with the rate of 5.8%. The independent associated factors for postoperative overall complications were AO type C fracture (OR, 2.6; 95%CI, 1.2 to 4.0), open fracture (OR, 4.2; 95%CI, 1.9 to 6.5), and significant collapse of the lunate fossa (OR, 2.9; 95%CI, 13 to 4.3), and for secondary procedures were significant collapse of the lunate fossa (OR, 3.7; 95%CI, 1.7 to 6.4) and the low-volume of surgeons (OR, 95%CI, 1.2 to 3.6) CONCLUSIONS: Identification of these factors is of importance for the risk assessment of postoperative complications and the additional need of surgery. For patients with the above factors, especially those with combined risk factors, optimized operation scheme and high-volume surgeon should be considered to prevent or reduce the complications.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/cirurgia , Reoperação/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Arch Orthop Trauma Surg ; 139(10): 1461-1470, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31432205

RESUMO

BACKGROUND: The simultaneous occurrence of periprosthetic fracture (PPF) and periprosthetic joint infection (PJI) is among the most devastating complications in arthroplasty and carries the risk of limb loss. For the first time, this study will describe the characteristics, treatment concepts, and outcomes of this complication. METHODS: Patients were consecutively included who were treated at our specialized interdisciplinary department between 2015 and 2016 with a PJI and an additional PPF of the hip. The treatment algorithm followed a three-step procedure: the complete removal of any foreign material (step 1), fracture stabilization by plate, intramedullary rod osteosynthesis or cerclages using an additional spacer (step 2), and reimplantation of a new prosthesis (step 3). RESULTS: Overall, eight cases [four male, four female, mean age 77 years (55-91)] were included. The mean follow-up was 34 ± 8 months. The fractures included one PPF Vancouver B1, three B2/3, and four type C. Most frequent microbes were CNS (Coagulase-negative staphylococci) (n = 4), Cutibacterium (n = 2) and Staphylococcus aureus (n = 2). Mixed infections (≥ 2 microorganisms) occurred in five cases. The time between explanation and reimplantation was 42 ± 34 (range 7-123) days. A re-infection took place in one, a re-revision in four cases, and in five cases fracture healing was noticed. In all eight cases, freedom from the infection and limb preservation could be achieved. CONCLUSION: PPF in the case of a PJI is a devastating situation and a huge challenge. Extremity preservation should be the primary goal. The described procedure offers a possible solution.


Assuntos
Artrite Infecciosa/terapia , Artroplastia de Quadril/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Periprotéticas/terapia , Complicações Pós-Operatórias/terapia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Artrite Infecciosa/microbiologia , Placas Ósseas/efeitos adversos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/cirurgia , Complicações Pós-Operatórias/microbiologia , Estudos Prospectivos
5.
J Orthop Traumatol ; 20(1): 29, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31432281

RESUMO

BACKGROUND: Plate protrusion is a risk factor for flexor pollicis longus (FPL) rupture following volar locking plate (VLP) surgery. However, plate prominence on follow-up radiographs is common. We hypothesised that a VLP that does not touch the FPL tendon can appear as a plate prominence projected over the volar ridge on lateral radiographs. MATERIALS AND METHODS: We studied six current designs of widely used plates in formalin-fixed cadavers. Each plate was placed in six cadavers. We analysed 36 different plate-cadaver combinations. The main aim of plate fixation was to position the plate in the most distal position without FPL tendon contact. Radiographs were obtained using fluoroscopy. We evaluated plate prominence from the volar ridge according to the Soong grading system. RESULTS: Soong grades 0 (plate did not extend beyond volar ridge), 1 (plate protruded beyond volar ridge) and 2 (plate directly on or located beyond the volar ridge) were observed in 23 (63.9%), 9 (25.0%) and 4 (11.1%) cadavers, respectively. VariAx, DVR and VALCP showed grade 1 prominence, whereas Acu-Loc2, HYBRIX and MODE showed grade 2 prominence. CONCLUSIONS: Implant protrusion was observed in 36% of plate-cadaver combinations, even if the plate did not touch the FPL. Estimating the risk of FPL rupture using lateral radiographs alone is likely insufficient. Our findings can be applied to accurately identify the presence of implant prominence following VLP surgery.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Placa Palmar/cirurgia , Fraturas do Rádio/cirurgia , Traumatismos dos Tendões/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Radiografia , Fatores de Risco , Traumatismos dos Tendões/etiologia
6.
BMC Musculoskelet Disord ; 20(1): 381, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421675

RESUMO

BACKGROUND: Our hypothesis was that minimally invasive plate osteosynthesis (MIPO) using long philos plate (LPP) would show better clinical and radiological outcomes and less complications than narrow locking compression plate (NLCP) for spiral humerus shaft fractures with or without metaphyseal fracture extension. METHODS: From January 2009 to May 2016, we retrospectively studied 35 patients who underwent MIPO for spiral humerus shaft fractures with or without metaphyseal fracture extension (AO classification 12 A, B, C except A3). Eighteen patients underwent MIPO with a 4.5 mm NLCP (group I) in the early period of this study, while 17 patients underwent MIPO with LPP (group II) in the later period. Range of motion (ROM), pre- and post-operative anteroposterior (AP) and lateral angulation of the fracture, operation time, amount of bleeding, and functional outcomes including American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, and Simple Shoulder Test score were analyzed at the final follow up. RESULTS: All patients had complete bony union and achieved satisfactory functional outcomes except 2 patients. In LPP group, better outcomes in postoperative fracture angulation on X-ray and operation time (p < 0.05) were shown. But, two revision surgery with NLCP and bone graft was performed owing to 2 metal failures. CONCLUSIONS: In spiral humeral shaft fractures, LPP group showed better fracture reduction on X-ray and shorter operation time except metal failure owing to weak fixation. Even though MIPO technique using LPP is easier and more accurate reduction method, rigid fixation should be considered.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fraturas do Úmero/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Falha de Prótese , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/fisiopatologia , Úmero/diagnóstico por imagem , Úmero/lesões , Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Período Pós-Operatório , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(33): e16836, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415405

RESUMO

RATIONALE: Isolated fracture of clavicle is usually treated with nonoperative conservative treatment. However, surgical treatment, customized for individual patient's need, is increasingly done. With regard to the surgery of the clavicle fracture, pneumothorax is a possible, but rare complication. PATIENT CONCERNS: We report the case of a 32-year-old healthy female patient who underwent minimally invasive plate osteosynthesis (MIPO) due to a clavicle fracture. To avoid direct exposure of fracture site, the pre-contoured plate was inserted through the lateral incisional port to reach the medial incisional port. There was no problem during the surgery, but the patient complained of dyspnea in the post-anesthesia care unit. DIAGNOSES: A chest radiograph was taken immediately, and a definitive finding of pneumothorax was revealed. INTERVENTIONS: A tube was inserted at the right chest. OUTCOMES: The patient's dyspnea was resolved. On the 6th day after the surgery, the chest radiograph revealed that pneumothorax was nearly resolved, enabling to remove the chest tube. On the 9th day after the surgery, the patient was discharged without complication. LESSONS: After clavicle surgery requiring strong dissection like MIPO, the possibility of pneumothorax is suspected and the patient should be carefully observed.


Assuntos
Clavícula/lesões , Fixação Interna de Fraturas/efeitos adversos , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Fraturas do Ombro/cirurgia , Adulto , Placas Ósseas/efeitos adversos , Feminino , Fixação Interna de Fraturas/métodos , Humanos
8.
Vet Comp Orthop Traumatol ; 32(4): 297-304, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31319431

RESUMO

OBJECTIVE: The aim of this study was to evaluate the biomechanical properties of three different miniature locking plate systems used to fixate radial and ulnar fractures in toy breed dogs. Implant size, shape, material and locking systems differ, and their influence on the fracture healing process is unknown. In the present study, we aimed to investigate this matter in vivo using rabbit radial and ulnar fracture models. STUDY DESIGN: Eighteen rabbits were randomly divided into three groups, and the left radius and ulna were osteotomized to create fracture models. The osteotomies were then fixated using either the TITAN LOCK 1.5, Fixin micro or LCP 1.5 system. Radiographs were obtained 2, 3 and 4 weeks after surgery. Four weeks after surgery, the radiuses were collected and used for biomechanical testing or histological examinations. RESULTS: During the 4 weeks of observation, no adverse effects due to the implants occurred. The radiographic scores in each group did not differ significantly at any time point. The maximum load in the LCP group was significantly higher than that in the TITAN and Fixin groups. There was no significant difference in bending stiffness or work to failure among the groups. Initial fracture healing via woven bone was evident at histological evaluation. CONCLUSIONS: All three miniature locking plate systems provided adequate fracture stabilization 4 weeks after surgery, despite their differences, in rabbit models.


Assuntos
Placas Ósseas/veterinária , Coelhos , Fraturas do Rádio/veterinária , Fraturas da Ulna/veterinária , Animais , Fenômenos Biomecânicos , Placas Ósseas/efeitos adversos , Modelos Animais de Doenças , Cães , Consolidação da Fratura , Masculino , Miniaturização , Período Pós-Operatório , Radiografia/veterinária , Fraturas do Rádio/tratamento farmacológico , Fraturas do Rádio/patologia , Fraturas do Rádio/cirurgia , Distribuição Aleatória , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/patologia , Fraturas da Ulna/cirurgia
9.
Medicine (Baltimore) ; 98(25): e15767, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232918

RESUMO

BACKGROUND: The purpose of this study is to evaluate the rate of dysphagia between zero-profile spacer versus cage-plate for the treatment of multilevel cervical spondylotic myelopathy (CSM). METHODS: The authors searched electronic databases for relevant studies that compared the clinical effectiveness of zero-profile spacer versus cage-plate for the treatment of patients with multilevel CSM. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) score and fusion rate, dysphagia rate, adjacent segment degeneration, and cervical lordosis. Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of each study. Data extraction and quality assessment were conducted, and RevMan 5.2 was used for data analysis. RESULTS: A total of 10 studies were included in our meta-analysis. Our pooled data revealed that zero-profile spacer was associated with decreased dysphagia rate at postoperatively 1, 3, and 6 months, and the final follow-up when compared with cage-plate group. No significant difference was observed in terms of postoperative JOA score, NDI score, and fusion rate. Compared with zero-profile spacer, the postoperative adjacent segment degeneration was significant higher in cage-plate. Pooled data from the relevant studies revealed that cervical lordosis was significantly lower in zero-profile spacer compared with cage-plate. CONCLUSIONS: Our meta-analysis reveals zero-profile spacer is better than the cage-plate in terms of dysphagia. This suggests zero-profile spacer is a superior alternative invention for the treatment of multilevel CSM to reduce the risk of dysphagia.


Assuntos
Placas Ósseas/efeitos adversos , Transtornos de Deglutição/etiologia , Discotomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos , Espondilose/cirurgia , Vértebras Cervicais/cirurgia , Discotomia/instrumentação , Desenho de Equipamento , Humanos , Fusão Vertebral/instrumentação
10.
Vet Comp Orthop Traumatol ; 32(5): 401-407, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31216586

RESUMO

OBJECTIVES: The aim of this study was to describe the use of locking compression plates (LCP) in Y-T humeral condyle fractures and to evaluate their clinical outcome. METHODS: This study involved a retrospective review, including clinical, radiographical and canine brief pain inventory outcome evaluation. RESULTS: Eighteen consecutive dogs met the inclusion criteria, and 15/18 were considered to have humeral intracondylar fissure. Twelve of 18 dogs had simple fractures, and the remaining six had comminuted fractures. Postoperative radiographs revealed accurate intracondylar reconstruction (articular step defect [ASD] < 1 mm) in 17/18 of patients. Short-term outcome was considered fully functional in 9/13 and acceptable in 3/13 patients. Complications were diagnosed in 2/13; infection in one with resolution after antibiotic treatment, and one case of implant failure. Nine of 18 owners provided postoperative questionnaire responses (median 25; range: 14-52 months) and 8/9 clients perceived the treatment to have resulted in an excellent overall outcome. CLINICAL SIGNIFICANCE: Repair of Y-T humeral fractures with LCP allowed for hybrid fixation and monocortical screw placement in distal fracture fragments. There was no significant ASD at the intracondylar fracture line in most cases. ASD using combined medial and lateral approaches depends upon the accuracy of supracondylar reduction, particularly on the side that is reduced and stabilized first, and the use of locking screws may have been influential in minimizing primary loss of reduction, potentially maintaining the initial fragment reduction.


Assuntos
Placas Ósseas/veterinária , Cães/lesões , Fraturas do Úmero/veterinária , Animais , Placas Ósseas/efeitos adversos , Cães/cirurgia , Feminino , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Masculino , Radiografia/veterinária , Estudos Retrospectivos , Resultado do Tratamento
11.
Arch Orthop Trauma Surg ; 139(9): 1235-1244, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31020411

RESUMO

INTRODUCTION: Several scores were introduced to diagnose and to classify osteomyelitis in practice. Mouse models are often used to study the pathophysiology of bone infection and to test therapeutic strategies. Aim of the present study was to design a score to diagnose and quantify implant-associated infection in a murine experimental model. MATERIALS AND METHODS: Four independent parameters were developed: existence of callus, consolidation of the fracture, structural changes of the medullary cavity and number of bacteria. The score was assessed in a standardized implant-associated mouse model with 35 BALB/c-mice. The left femur was osteotomized, fixed by a titanium locking plate and infection was induced by inoculation of Staphylococcus aureus into the fracture gap. For the sham group, the procedure was performed without inoculation of bacteria. The score was assessed on days 7, 14 and 28. Each item of the score showed lower values for the infection group compared to the controls after 4 weeks. RESULTS: Regardless of the assessed time point, the overall total score was significantly higher in the control group compared to the infection group (p < 0.0001). Analysis revealed a sensitivity of 0.85, specificity of 1.0, negative predictive value of 0.67 and positive predictive value of 1.0. CONCLUSION: The proposed score assessing severity of fracture-related infection in an implant-associated murine model was easy to access, feasible to diagnose and estimate bone healing and infection in a murine bone infection with a high sensitivity. Therefore, this score might be a useful tool to quantify infection-related changes after fracture in further future preclinical studies.


Assuntos
Placas Ósseas/efeitos adversos , Modelos Animais de Doenças , Osteomielite , Infecções Relacionadas à Prótese , Infecções Estafilocócicas , Animais , Fêmur/cirurgia , Camundongos , Camundongos Endogâmicos BALB C , Osteomielite/classificação , Osteomielite/diagnóstico , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/classificação , Infecções Relacionadas à Prótese/diagnóstico , Índice de Gravidade de Doença , Infecções Estafilocócicas/classificação , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus
12.
J Med Case Rep ; 13(1): 127, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31029151

RESUMO

BACKGROUND: Plate breakage is one form of construct failure after a clavicle fracture treated with an open reduction and plate fixation. A recent study evaluated construct failure after an open reduction and plate fixation and reported a construct failure rate of 6.9% of which 1.9% were related to broken plates. Plate breakage is rare, thus, there are insufficient data regarding risk factors, pathogenesis, or how to avoid it. CASE PRESENTATION: This case report presents an unusual case of a 35-year-old Caucasian man, 7 weeks after open reduction and internal plate fixation of a fracture in the middle third of his clavicle, who developed breakage of the implant. Surgery was advised, the implant was retrieved, the fracture was reduced, and a new bridging locking plate was implanted. CONCLUSIONS: In the current case it seems that the use of a bridging plate, the fundamental anatomical structure of the clavicle and the forces that are applied on it, the lack of discipline in complying with the postoperative functional restrictions, and an unclear "patient expectation" process were the main reasons for the failure. These aspects should be carefully considered and addressed in clavicle fractures.


Assuntos
Clavícula/lesões , Falha de Equipamento , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Redução Aberta/métodos , Adulto , Placas Ósseas/efeitos adversos , Clavícula/diagnóstico por imagem , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Redução Aberta/efeitos adversos , Reoperação
13.
Vet Surg ; 48(3): 437-443, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30820982

RESUMO

OBJECTIVE: To report the successful use of cerclage cables around the periprosthetic region of a femoral fracture after total hip replacement (THR) in a dog with bone stock too limited for other methods of fixation. STUDY DESIGN: Case report. ANIMAL: 6-year-old male neutered, golden retriever. METHODS: Locking plate fixation of a type-B1 diaphyseal periprosthetic femoral fracture (PFF) failed 14 days after cementless THR and 6 days after initial femoral fracture repair. Total hip replacement implants seemed unchanged on radiographs, but lateral retraction of the screw-plate construct from the proximal segment was evident. Bone stock was assessed as insufficient for adequate screw purchase, prompting revision of the fixation with cerclage cable fixation of the proximal segment; the cables were anchored to the original locking plate construct with threaded positioning pins that screwed into the locking holes. RESULTS: Acceptable union was documented on radiographs by 3 months after revision. No lameness and good range of motion of the hip were observed on clinical examination 13 months after surgery. Radiographs at 13 months documented static implant positioning and remodeling at the fracture site. CONCLUSION: Use of a cable-plate construct to stabilize a type-B1 PFF led to successful long-term outcome in this dog. CLINICAL SIGNIFICANCE: Use of a cable-plate construct may be considered to treat type-B1 PFF with limited bone stock.


Assuntos
Artroplastia de Quadril/veterinária , Fios Ortopédicos , Fraturas do Fêmur/veterinária , Fixação Interna de Fraturas/veterinária , Fraturas Periprotéticas/veterinária , Animais , Artroplastia de Quadril/métodos , Pinos Ortopédicos/efeitos adversos , Placas Ósseas/efeitos adversos , Cães , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Masculino , Fraturas Periprotéticas/cirurgia
14.
World Neurosurg ; 125: 87-92, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30735876

RESUMO

BACKGROUND: A 26-year-old man presented with acute quadriparesis owing to a traffic accident. A computed tomography scan revealed a hangman fracture and locking of the left facet joint at C2-3. Magnetic resonance imaging showed a high signal change of the spinal cord on T2-weighted image and hemorrhage in the C2-3 level. CASE DESCRIPTION: An emergency closed reduction after anterior cervical diskectomy and fusion were performed for spinal stability and decompression of the dural sac. Five months postoperatively, C1-2-3 posterior wiring using an iliac bone graft with the Brook method was performed due to nonunion of C2-3. After using the posterior cervical approach, the patient began complaining about the difficulty in swallowing. A 5 × 2 × 1-cm-sized posterior pharyngeal wall mass was detected on an endoscopic examination. Despite conservative management, the retropharyngeal mass progressed and dysphagia worsened, so the retropharyngeal wall granulation mass was resected by a laryngologist. Despite removal of the granulation mass, dysphagia and throat discomfort persisted for about 2 years. The plate and screws were removed considering their possible correlation with the granulation tissue. One month after plate removal, the retropharyngeal granulation tissue resolved almost spontaneously. At the last follow-up, the radiologic examination showed well-fused C1-2-3 with good alignment. The patient had no residual neurologic deficits or dysphagia. CONCLUSIONS: Retropharyngeal granulation can occur as a late complication associated with plate fixation after anterior cervical diskectomy and fusion. Recurrent retropharyngeal wall granulation caused by plate irritation might only be resolved after plate and screw removal.


Assuntos
Vértebras Cervicais/lesões , Discotomia/efeitos adversos , Granuloma/etiologia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Acidentes de Trânsito , Adulto , Placas Ósseas/efeitos adversos , Parafusos Ósseos/efeitos adversos , Transtornos de Deglutição/etiologia , Remoção de Dispositivo , Discotomia/instrumentação , Humanos , Masculino , Doenças Faríngeas/etiologia , Complicações Pós-Operatórias/etiologia , Quadriplegia/etiologia , Fusão Vertebral/instrumentação
15.
J Hand Surg Asian Pac Vol ; 24(1): 30-35, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30760138

RESUMO

BACKGROUND: This study aimed to identify the effect of the progression of postoperative wrist osteoarthritis on 5 years clinical and radiological outcomes after volar locking plate fixation of distal radius fractures. METHODS: Altogether, 56 patients with distal radius fractures were followed up 5 years after surgery. Clinical assessment was performed using the Mayo modified wrist score, a visual analogue scale of pain, the Japanese version of the Disabilities of the Arm, Shoulder, and Hand score, and Patient-related wrist evaluation. Standardized wrist radiographs were used to assess wrist morphology and the Knirk and Jupiter's degree of osteoarthritis. Multivariate logistic regression was used to analyze postoperative morphological changes in the wrist and carpal alignment regarding their correlation with progression of wrist osteoarthritis. RESULTS: Progression of postoperative wrist osteoarthritis was recognized in 37 of the 56 cases (66.1%). Compared with the clinical outcomes at the time of the fracture union completion, almost clinical outcomes improved up to 5 years follow-up time as well as at 1 year after surgery. The range of wrist flexion at 5 years follow-up was significantly less in the progressive osteoarthritis group than in those with non-progressive osteoarthritis. The persistent step-off immediately after surgery significantly affected the postoperative progression of wrist osteoarthritis. Changes in the radial inclination, volar tilt, and radioscaphoid angle correlated with progression of wrist osteoarthritis. The highest correlation was with the change of radioscaphoid angle. CONCLUSIONS: Good clinical results were maintained at 5 years after surgery, but progression of postoperative wrist osteoarthritis interfered with improvement of wrist flexion. Change in the radioscaphoid angle was the factor that was most highly correlated with progression of postoperative wrist osteoarthritis.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Osteoartrite/etiologia , Complicações Pós-Operatórias , Radiografia/métodos , Fraturas do Rádio/cirurgia , Articulação do Punho , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Osteoartrite/fisiopatologia , Medição da Dor , Amplitude de Movimento Articular , Fatores de Tempo
16.
J Shoulder Elbow Surg ; 28(6): 1183-1192, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30770316

RESUMO

BACKGROUND: Locked plating of displaced proximal humeral fractures is common, but rates of subacromial impingement remain high. This study used a multidisciplinary approach to elucidate the relationships between common surgical parameters, anatomic variability, and the likelihood of plate impingement. METHODS: The experiment was completed in 3 phases. First, a controlled in vitro experiment was conducted to simulate impingement. Second, a dynamic in silico musculoskeletal model modeled changes to implant geometry, surgical techniques, and acromial anatomy, where a collision detection algorithm was used to simulate impingement. Finally, in vivo shoulder kinematics were recorded for 9 activities of daily living. Motions that created a high likelihood of impingement were identified. RESULTS: Of simulated impingement events, 73.9% occurred when the plate was moved proximally, and 84% occurred when acromial tilt was 20° or 25°. Simulations of impingement occurred at cross-body adduction angles between 10° and 50°. Impingement occurred at an average of 162.0° ± 14.8° abduction with 10 mm distal plate placement, whereas the average was 72.1° ± 11.4° with 10 mm proximal placement. A patient may encounter these shoulder angles when performing activities such as combing one's hair, lifting an object overhead, and reaching behind one's head. DISCUSSION AND CONCLUSION: Proximal implant placement and decreases in acromial tilt play major roles in the likelihood of impingement, whereas plate thickness and humeral head center of rotation should also be considered. Careful preoperative planning that includes these factors could help guide operative decision making and improve clinical outcomes.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fraturas do Ombro/cirurgia , Síndrome de Colisão do Ombro/etiologia , Acrômio/anatomia & histologia , Atividades Cotidianas , Idoso , Fenômenos Biomecânicos , Cadáver , Simulação por Computador , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Humanos , Cabeça do Úmero , Masculino , Movimento , Rotação , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Adulto Jovem
17.
Vet Surg ; 48(4): 505-512, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30614018

RESUMO

OBJECTIVE: To determine the influence of 3 fixation systems on complications rate after tibial plateau leveling osteotomy (TPLO) in dogs >45.4 kg. STUDY DESIGN: Retrospective case series. SAMPLE POPULATION: Dogs (N = 287, 342 stifles) >45.4 kg with cranial cruciate ligament tear treated with TPLO. METHODS: The medical records of dogs treated with TPLO were reviewed for fixation and postoperative complications, with a follow-up of at least 6 weeks. A random effects logistic regression model was used to evaluate the association between the type of TPLO fixation system and complications. RESULTS: The fixation systems included a 3.5-mm broad TPLO plate alone (8P; 78.4%), a 3.5-mm broad TPLO plate with SOP (String of Pearls) plate (8AP; 14.9%), and a 3.5-mm standard TPLO plate (6P; 6.7%). Among the included stifles, 214 (62.6%) fixation systems were classified as locking, and 128 (37.4%) were classified as nonlocking. The fixation system was predictive of complications. The 8P had the lowest odds ratio for complication among the 3 fixation systems. Odds of developing complications were higher with the 8AP fixation system than with the 8P fixation system. Locking fixation eliminated the association between weight and complication rate. CONCLUSION: Fixation of a TPLO with the 8AP increased the risk of complications compared with the 8P in this population of large dogs. CLINICAL SIGNIFICANCE: Locking fixation of TPLO with a 3.5-mm broad TPLO plate alone should be considered in large dogs because it may reduce complications.


Assuntos
Lesões do Ligamento Cruzado Anterior/veterinária , Ligamento Cruzado Anterior/cirurgia , Placas Ósseas/veterinária , Doenças do Cão/cirurgia , Osteotomia/veterinária , Animais , Lesões do Ligamento Cruzado Anterior/cirurgia , Placas Ósseas/efeitos adversos , Cães , Feminino , Modelos Logísticos , Masculino , Osteotomia/instrumentação , Osteotomia/métodos , Complicações Pós-Operatórias/veterinária , Estudos Retrospectivos , Joelho de Quadrúpedes/cirurgia , Tíbia/cirurgia
18.
BMC Musculoskelet Disord ; 20(1): 20, 2019 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-30630465

RESUMO

BACKGROUND: Proximal humeral fractures (PHFs) are the third most common fracture in older patients. The purpose of the study was to prospectively evaluate the outcomes of PHF fixation with a locking blade nail (LBN) or locking plate (PHILOS) osteosynthesis in a homogeneous elderly patient population. METHODS: Inclusion criteria were an age > 60 years and the capacity to give informed consent. Patients with isolated tuberosity fractures, previous trauma or surgery, advanced osteoarthritis, fracture dislocation, pathological fractures, open fractures, neurological disorders, full-thickness rotator cuff tears, fracture line at the nail entry point or severely reduced bone quality intra-operatively were excluded. Eighty one patients with PHFs were randomised to treatment using LBN or PHILOS. Outcome measures comprised Constant score, age and gender adjusted Constant score, DASH score, VAS for pain, subjective overall condition of the shoulder (1-6) and active shoulder range-of-motion in flexion and abduction. Plain radiographs were obtained in two planes. All data were collected by an independent observer at 3, 6 and 12 months postoperatively. RESULTS: Thirteen patients were excluded intra-operatively due to rotator cuff tears, fracture morphology or poor bone-quality. Of the remaining 68 patients, 27 in the LBN and 28 in the PHILOS group completed the full follow-up. Mean age at surgery was 75.6 years and the majority of PHFs were three-part fractures (49 patients). Baseline demographics between groups were comparable. All outcome measures improved between assessments (p < 0.001). The LBN group showed improved DASH scores as compared to PHILOS at 12 months (p = 0.042) with fewer incidences of secondary loss of reduction and screw cut-out (p = 0.039). A total of 29 complications (in 23 patients) were recorded, 13 complications (in 12 patients) in the LBN group and 16 complications (in 11 patients) in the PHILOS group (p = 0.941). No significant inter-group difference was observed for any other outcome measures, nor was fracture morphology seen to be associated with clinical outcome or complication rate. CONCLUSIONS: At short-term follow-up, LBN osteosynthesis yielded similar outcomes and complication rates to PHILOS plate fracture fixation in an elderly patient population, though with a significantly lower rate of secondary loss of reduction and screw cut-out. REGISTRATION TRIAL: No. DRKS00015245 at Deutsches Register Klinischer Studien, registered: 22.08.2018, retrospectively registered.


Assuntos
Pinos Ortopédicos/efeitos adversos , Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Complicações Pós-Operatórias/epidemiologia , Fraturas do Ombro/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Amplitude de Movimento Articular , Fraturas do Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiologia , Resultado do Tratamento , Suporte de Carga
19.
Neurosurg Rev ; 42(2): 511-518, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29916066

RESUMO

In contrast to a one-level cervical corpectomy, a multilevel corpectomy without posterior fusion is accompanied by a high material failure rate. So far, the adequate surgical technique for patients, who receive a two-level corpectomy, remains to be elucidated. The aim of this study was to determine the long-term clinical outcome of patients with cervical myelopathy, who underwent a two-level corpectomy. Outcome parameters of 21 patients, who received a two-level cervical corpectomy, were retrospectively analyzed concerning reoperations and outcome scores (VAS, Neck Disability Index (NDI), Nurick scale, modified Japanese Orthopaedic Association score (mJOAS), Short Form 36-item Health Survey Questionnaire (SF-36)). The failure rate was determined using postoperative radiographs. The choice over the surgical procedures was exercised by every surgeon individually. Therefore, a distinction between two groups was possible: (1) anterior group (ANT group) with a two-level corpectomy and a cervical plate, (2) anterior/posterior group (A/P group) with two-level corpectomy, cervical plate, and additional posterior fusion. Both groups benefitted from surgery concerning pain, disability, and myelopathy. While all patients of the A/P group showed no postoperative instability, one third of the patients of the ANT group exhibited instability and clinical deterioration. Thus, a revision surgery with secondary posterior fusion was needed. Furthermore, the ANT group had worse myelopathy scores (mJOASANT group = 13.5 ± 2.5, mJOASA/P group = 15.7 ± 2.2). Patients with myelopathy, who receive a two-level cervical corpectomy, benefitted from surgical decompression. However, patients with a sole anterior approach demonstrated a very high rate of instability (33%) and clinical deterioration in a long-term follow-up. Therefore, we recommend to routinely perform an additional posterior fusion after two-level cervical corpectomy.


Assuntos
Vértebras Cervicais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Adulto , Idoso , Placas Ósseas/efeitos adversos , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Fusão Vertebral/métodos
20.
J Prosthodont ; 28(2): e811-e816, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28872729

RESUMO

PURPOSE: After marsupialization of benign tumors and jawbone cysts, insertion of an obturator prosthesis maintains the surgical opening and improves hygiene. To date, there have been no reports clarifying the relationship between the obturator design and treatment outcomes. The purpose of this study was to examine the survival rate of three types of obturator, and to investigate the factors that expedite the removal of the obturator. MATERIALS AND METHODS: The subject group comprised 100 patients who had an obturator inserted after marsupialization at Kagoshima University Hospital between May 31, 2012 and March 31, 2015; 73 patients with lesions in the mandible were eligible. Three types of mandibular obturator were designed and inserted, considering the teeth missing, the anteroposterior position of the lesion, and the buccolingual direction of marsupialization. The endpoint of this study was defined as the removal of the obturator. The analyzed predictor values for the endpoint were age, gender, remaining teeth, nature of primary disease, anteroposterior location of primary disease, buccolingual direction of marsupialization, type of obturator, and dates of insertion and removal. RESULTS: No significant differences were found in the cumulative survival rate among the three types of obturator. Early obturator removal was more frequent in patients with cysts, anterior lesions, and/or marsupialization from the occlusal direction CONCLUSIONS: Because obturator design had minimal effect on the ability of the appliance to maintain the surgical opening, it is preferable to use the least invasive design. Our findings also suggest that the follow-up examination should account for the type of primary disease, the anteroposterior location of the lesion, and the buccolingual direction of marsupialization.


Assuntos
Placas Ósseas , Doenças Maxilomandibulares/cirurgia , Adulto , Fatores Etários , Placas Ósseas/efeitos adversos , Feminino , Humanos , Arcada Osseodentária/diagnóstico por imagem , Arcada Osseodentária/patologia , Cistos Maxilomandibulares/cirurgia , Neoplasias Maxilomandibulares/cirurgia , Masculino , Falha de Prótese , Radiografia Panorâmica , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA