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1.
Molecules ; 26(5)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652632

RESUMO

The use of bioresorbable fracture fixation plates made of aliphatic polyesters have good potential due to good biocompatibility, reduced risk of stress-shielding, and eliminated need for plate removal. However, polyesters are ductile, and their handling properties are limited. We suggested an alternative, PLAMA (PolyLActide functionalized with diMethAcrylate), for the use as the matrix phase for the novel concept of the in situ curable bioresorbable load-bearing composite plate to reduce the limitations of conventional polyesters. The purpose was to obtain a preliminary understanding of the chemical and physical properties and the biological safety of PLAMA from the prospective of the novel concept. Modifications with different molecular masses (PLAMA-500 and PLAMA-1000) were synthesized. The efficiency of curing was assessed by the degree of convergence (DC). The mechanical properties were obtained by tensile test and thermomechanical analysis. The bioresorbability was investigated by immersion in simulated body fluid. The biocompatibility was studied in cell morphology and viability tests. PLAMA-500 showed better DC and mechanical properties, and slower bioresorbability than PLAMA-1000. Both did not prevent proliferation and normal morphological development of cells. We concluded that PLAMA-500 has potential for the use as the matrix material for bioresorbable load-bearing composite fracture fixation plates.


Assuntos
Fixação de Fratura/métodos , Fraturas Ósseas/terapia , Lactose/análogos & derivados , Poliésteres/farmacologia , Ácidos Polimetacrílicos/farmacologia , Implantes Absorvíveis/efeitos adversos , Placas Ósseas/efeitos adversos , Proliferação de Células/efeitos dos fármacos , Humanos , Lactose/química , Lactose/farmacologia , Teste de Materiais , Poliésteres/química , Ácidos Polimetacrílicos/química , Estresse Mecânico , Resistência à Tração , Suporte de Carga
2.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431528

RESUMO

A 13-year-old girl presented to the clinic with a midshaft refracture of both forearm bones adjacent to the site of a prior forearm fracture that had been treated with plating. She was treated with hardware removal and placement of elastic intramedullary nails. Flexible intramedullary nailing can be successful for a skeletally mature adolescent in treatment of refracture surrounding plate fixation of a midshaft forearm fracture. This technique allows for additional protection of the entire length of the affected bones, while avoiding the extensive dissection needed for extended plating.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Rádio/cirurgia , Prevenção Secundária/instrumentação , Fraturas da Ulna/cirurgia , Adolescente , Placas Ósseas/efeitos adversos , Feminino , Consolidação da Fratura , Humanos , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/lesões , Fraturas do Rádio/diagnóstico , Recidiva , Reoperação/instrumentação , Resultado do Tratamento , Ulna/diagnóstico por imagem , Ulna/lesões
3.
Bone Joint J ; 102-B(10): 1412-1418, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993328

RESUMO

AIMS: Eight-plates are used to correct varus-valgus deformity (VVD) or limb-length discrepancy (LLD) in children and adolescents. It was reported that these implants might create a bony deformity within the knee joint by change of the roof angle (RA) after epiphysiodesis of the proximal tibia following a radiological assessment limited to anteroposterior (AP) radiographs. The aim of this study was to analyze the RA, complemented with lateral knee radiographs, with focus on the tibial slope (TS) and the degree of deformity correction. METHODS: A retrospective, single-centre study was conducted. The treatment group (n = 64 knees in 44 patients) was subclassified according to the implant location in two groups: 1) medial hemiepiphysiodesis; and 2) lateral hemiepiphysiodesis. A third control group consisted of 25 untreated knees. The limb axes and RA were measured on long standing AP leg radiographs. Lateral radiographs of 40 knees were available for TS analysis. The mean age of the patients was 10.6 years (4 to 15) in the treatment group and 8.4 years (4 to 14) in the control group. Implants were removed after a mean 1.2 years (0.5 to 3). RESULTS: No significant differences in RA (p = 0.174) and TS (p = 0.787) were observed. The limb axes were significantly corrected in patients with VVD (p < 0.001). The change in tibial slope (∆TS) did not correlate (r = -0.026; p = 0.885) to the plate's position on the physis when assessed by lateral radiographs. CONCLUSION: We were not able to confirm the reported change in the bony morphology of the proximal tibia on AP radiographs in our patient population. In addition, no significant change in TS was detected on the lateral radiographs. A significant correction of the VVD in the lower limb axes was evident. Position of the implant did not correlate with TS change. Therefore, eight-plate epiphysiodesis is a safe and effective procedure for correcting VVD in children without disturbing the knee joint morphology. Cite this article: Bone Joint J 2020;102-B(10):1412-1418.


Assuntos
Artrodese/efeitos adversos , Placas Ósseas/efeitos adversos , Epífises/cirurgia , Complicações Pós-Operatórias/classificação , Tíbia/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Geno Valgo/cirurgia , Genu Varum/cirurgia , Humanos , Desigualdade de Membros Inferiores/cirurgia , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Tíbia/diagnóstico por imagem
4.
Medicine (Baltimore) ; 99(39): e22284, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991430

RESUMO

BACKGROUND: Plate fixation and intramedullary nail/Knowles pin fixation methods are commonly used to treat displaced midshaft clavicle fractures. However, the differences between these 2 methods are unclear. OBJECTIVE: This meta-analysis aimed to compare plate fixation and intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fractures. METHODS: We searched PubMed, EBM reviews, and Ovid Medline online for studies related to comparison of plate fixation versus intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fracture from inception to June 30, 2019. Relevant literature search, data extraction, and quality assessment will be performed by 2 researchers independently. The methodological quality of all included studies was appraised using the Cochrane system for randomized trials. The RevMan 5.2 software was used for heterogeneity assessment, generating funnel-plots, data synthesis, sensitivity analysis, and determining publication bias. The fixed-effects or random-effects model was used to calculate mean difference (MD)/relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: This meta-analysis included 839 patients from 12 randomized controlled trials. We found that compared to plate fixation, intramedullary nail/Knowles pin fixation yielded a higher shoulder constant score [MD = -2.43, 95% CI (-3.46 to -1.41), P < .00001] and lower disabilities of the arm, shoulder and hand (DASH) score [MD = 2.98, 95% CI (0.16-5.81), P = .04], and lower infection rates [RR = 2.05, 95% CI (1.36-3.09), P = .003], operation time [MD = 20.20, 95% CI (10.80-29.60), P < .0001], incision size [MD = 6.09, 95% CI (4.54-7.65), P < .00001], and hospital stay [MD = 1.10, 95% CI (0.56-1.64), P < .00001] but with a higher removal rate [RR = 0.52, 95% CI (0.41-0.65), P < .00001] compared to plate fixation. There were no significant differences in nonunion, reintervention, or revision and refracture between these two methods. The limitation is that many studies did not demonstrate the random generated details, and only English articles were enrolled in this meta-analysis. CONCLUSIONS: Intramedullary nail/Knowles pin fixation might be an optimum choice for treating displaced midshaft clavicle fractures, with similar performance in terms of the nonunion, reintervention, or revision and refracture, and better shoulder constant and DASH scores, infection rates, and operative parameters.


Assuntos
Placas Ósseas/efeitos adversos , Clavícula/patologia , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Adulto , Pinos Ortopédicos/efeitos adversos , Avaliação da Deficiência , Feminino , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/classificação , Fraturas não Consolidadas/epidemiologia , Humanos , Infecções/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Risco , Sensibilidade e Especificidade , Ferida Cirúrgica/classificação , Ferida Cirúrgica/epidemiologia
5.
J Craniomaxillofac Surg ; 48(10): 994-1003, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32893092

RESUMO

The aim of this paper is to identify risk factors associated with the development of osteosynthesis plates' related complications in fibula free flap reconstructions. This is a case series study of consecutive fibula free flaps. Clinical and radiological variables were recorded. Patient outcomes were evaluated with special attention to osteosynthesis plates' related complications; these included plate exposure, plate fracture, loosening of screws, non-union, bone resorption, oro-cutaneous fistulas, and bone exposure. We have done a descriptive analysis, univariate analysis, and multivariate logistic regression model to explore possible risk factors for osteosynthesis plates' related complications. Data analysis was performed using R software (version 3.5.0). 111 fibula free flaps were studied. 29 patients (26.1%) developed osteosynthesis plates' related complications. The mean time to osteosynthesis plates' related complications was 22 months; range (1-120); the median and mode were 12 months. Patients with preoperative radiotherapy (34% vs 14%, p = 0.021), and secondary reconstruction (31% vs 15%, p = 0.053) had a higher incidence of osteosynthesis plates' related complications. In the univariate analysis, "preoperative radiotherapy" (OR 3.07, 95%CI = 1.139-8.242, p = 0.025) and "extraoral soft-tissue defect" (OR 2.907, 95%CI = 1.032-8.088, p = 0.042) were risk factors for osteosynthesis plates' related complications. We have observed an interaction effect: patients with mandibular Brown's classes III + IV and "secondary reconstruction" have a higher risk for osteosynthesis plates' related complications; more than 47.30 times compared to Brown's class I and "primary reconstruction" (p = 0.026). Different factors may contribute to the development of osteosynthesis plates' related complications. Our study adds important information about these. Patients with higher risk of developing complications should be informed that a second intervention to remove the plates might be necessary.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reconstrução Mandibular , Placas Ósseas/efeitos adversos , Transplante Ósseo , Fíbula , Fixação Interna de Fraturas/efeitos adversos , Humanos , Mandíbula , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 99(31): e21481, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756174

RESUMO

RATIONALE: Severe bone defect could often occur after removing the fractured fixation plates of comminuted fracture in the distal humerus. The reoperation of internal fixation or conventional total elbow arthroplasty could hardly restore the anatomy structure and function of the elbow. However, a novel exploration of 3-dimensional (3D) printed personalized elbow prosthesis was presented in this work. This is a rare and successful treatment for the severe bone defect after removing the fractured fixation plates of comminuted distal humerus fracture. PATIENT CONCERNS: A 60-year-old male patient was admitted to the hospital with the chief complaint of right elbow joint pain and limitation of motion for 10 years. He suffered from an open reduction with internal fixation surgery 10 years ago due to a fall injury-induced right distal humerus fracture. DIAGNOSES: Plain radiographs and computed tomography scan revealed fracture lines, fracture displacement, and fixator breakage in the right distal humerus. Pain, swelling, and limitation of motion could be found in the physical examination. Fixation failure and nonunion after internal fixation of comminuted distal humerus fracture were considered. INTERVENTIONS: The patient was treated with 3D printed personalized TEA and functional rehabilitation exercises. OUTCOMES: No severe complications were observed during the 36 months follow-up. The patient could complete the daily activities without pain. The hospital for special surgery score increased from 15 points before surgery to 90 points 36 months after surgery. LESSONS: The 3D printed personalized prosthesis could successfully reconstruct the anatomical structures and function of the elbow joint with a severe bone defect. The 3D printed personalized total elbow arthroplasty might provide a feasible method for treating the complex elbow joint diseases in the elderly.


Assuntos
Artroplastia de Substituição do Cotovelo/instrumentação , Prótese de Cotovelo , Fraturas Cominutivas/cirurgia , Fraturas do Úmero/cirurgia , Impressão Tridimensional , Reoperação/instrumentação , Artroplastia de Substituição do Cotovelo/métodos , Placas Ósseas/efeitos adversos , Cotovelo/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta/efeitos adversos , Reoperação/métodos , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(27): e21053, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629731

RESUMO

Internal fixation such as elastic stable intramedullary(ESIN) nail and submuscular plate (SMP) is gaining popularity for femoral shaft fractures in school-aged children. However, external fixation (ExFix) might be a valuable option for the distal third femoral shaft fractures, where the fracture heals rapidly, but it is crucial to avoid angular malunion. This study aims to compare the clinical outcomes, postoperative complications of distal third femoral shaft fractures in school-aged children treated by ESIN versus ExFix.Patients aged 5 to 11 years with distal third femoral shaft fractures treated at our institute from January 2014 to January 2016 were included and categorized into ESIN (n = 33) and ExFix (n = 38) group. The preoperative data, including baseline information of the patients, radiographic parameters, and type of surgical procedure, were collected from the hospital database, and postoperative data, including complications, were collected during the follow-up visit.In all, 33 patients (average, 8.0 ±â€Š2.1 years, male 20, female 13) in the ESIN group and 38 patients (average, 8.3 ±â€Š2.3 years, male 23, female 15) in the ExFix group were included in this study. There was significantly less operative time for the ExFix group (45.4 ±â€Š7.8 min) as compared to the ESIN group (57.8 ±â€Š11.3 min) (P < .01), reduced estimated blood loss (EBL) in the ExFix group (9.9 ±â€Š3.5) as compared to the ESIN group (16.4 ±â€Š6.5) (P < .01). As for the frequency of fluoroscopy, there was a significant difference between the ExFix group (13.9 ±â€Š2.4) and the ESIN group (15.5 ±â€Š3.2) (P = .02). The rate of major complications was not significantly different between the 2 groups (P = .19). The rate of implant irritation was significantly higher in the ExFix group (28/38, 73.7%) than the ESIN group (12/33, 36.4%) (P < .01). The rate of surgical site infection (SSI) is significantly higher in the ExFix group (18/38, 47.4%)) than the ESIN group (1/33, 3%) (P < .01). The rate of scar concern was significantly higher in the ExFix (9/38, 23.7%) than the ESIN (2/33, 6.1%), (P = .04). According to the Flynn scoring system, 30(90.9%) patients in the ESIN group and 24(89.5%) patients in the ExFix group were rated as excellent. None of the patients had poor outcomes.Both ESIN and ExFix produced satisfactory outcomes in distal third femoral shaft fractures. ExFix remains a viable choice for selected cases, especially in resource-challenged and austere settings.


Assuntos
Pinos Ortopédicos/efeitos adversos , Placas Ósseas/efeitos adversos , Fixadores Externos/efeitos adversos , Fraturas do Fêmur/cirurgia , Assistência ao Convalescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pinos Ortopédicos/normas , Placas Ósseas/normas , Criança , Pré-Escolar , China/epidemiologia , Diáfises/diagnóstico por imagem , Diáfises/patologia , Fixadores Externos/normas , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fluoroscopia/estatística & dados numéricos , Fixação de Fratura/métodos , Fixação de Fratura/tendências , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
8.
Bone Joint J ; 102-B(4): 530-538, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228080

RESUMO

AIMS: Dual plating of distal femoral fractures with medial and lateral implants has been performed to improve construct mechanics and alignment, in cases where isolated lateral plating would be insufficient. This may potentially compromise vascularity, paradoxically impairing healing. This study investigates effects of single versus dual plating on distal femoral vascularity. METHODS: A total of eight cadaveric lower limb pairs were arbitrarily assigned to either 1) isolated lateral plating, or 2) lateral and medial plating of the distal femur, with four specimens per group. Contralateral limbs served as matched controls. Pre- and post-contrast MRI was performed to quantify signal intensity enhancement in the distal femur. Further evaluation of intraosseous vascularity was done with barium sulphate infusion with CT scan imaging. Specimens were then injected with latex medium and dissection was completed to assess extraosseous vasculature. RESULTS: Quantitative MRI revealed a mean reduction of 21.2% (SD 1.3%) of arterial contribution in the lateral plating group and 25.4% (SD 3.2%) in the dual plating group (p = 0.051); representing a mean decrease in arterial contribution of 4.2%. The only significant difference found between both experimental groups was regionally, at the lateral aspect of the distal femur with a mean drop in arterial contribution in the lateral plating group of 18.9% (SD 2.6%) versus 24.0% (SD 3.2%) in the dual plating group (p = 0.048), representing a mean decrease in arterial contribution of 5.1%. Gross dissection revealed complete destruction of periosteal vessels underneath either medial or lateral plates in both groups. The network of genicular branches contributing to the posterior and distal femoral condyles was preserved in all specimens. A medial vascular pedicle was found dividing from the superficial femoral artery at a mean 12.7 cm (SD 1.7) proximal to the medial epicondyle and was undisrupted in the dual plating group. CONCLUSION: Lateral locking-plate application resulted in mean 21.2% reduction in distal femur vascularity. Addition of medial plates did not further markedly decrease vascularity. As such, the majority of the vascular insult occurred with lateral plating alone. Supplemental medially based fixation did not lead to marked devascularization of the distal femur, and should therefore be considered in the setting of comminution and poor bone stock in distal femoral fractures. Further clinical research is required to confirm the results of this study. Cite this article: Bone Joint J 2020;102-B(4):530-538.


Assuntos
Placas Ósseas/efeitos adversos , Fraturas do Fêmur/cirurgia , Fêmur/irrigação sanguínea , Traumatismos do Joelho/cirurgia , Adulto , Cadáver , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Tomografia Computadorizada por Raios X/métodos
9.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(2): 125-129, mar.-abr. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-196241

RESUMO

El tratamiento retentivo de material protésico sobreinfectado por gérmenes resistentes es un desafío, especialmente cuando el agente causal es Staphylococcus aureus resistente a meticilina. Presentamos el manejo conservador satisfactorio de material de osteosíntesis implantado por fractura de tobillo a un paciente añoso y que sufrió sobreinfección por el citado microorganismo, en el que el tratamiento antimicrobiano consistió en la combinación de antibioterapia sistémica guiada por antibiograma (tras un primer ciclo empírico ineficaz), junto a irrigaciones tópicas de sevoflurano, aplicación de crema de sulfadiazina de plata y posteriormente cobertura del defecto cutáneo con terapia de presión negativa. Destacamos el novedoso papel del sevoflurano como analgésico y como antimicrobiano tópico (sumado a la crema de sulfadiazina de plata) en la evolución favorable de la herida, especialmente en el período en el que la antibioterapia empírica era ineficaz y todavía no se había comenzado con terapia de presión negativa


Retentive treatment of prosthetic material superinfected by resistant microorganisms is a challenge, especially when the causative agent is a methicillin-resistant Staphylococcus aureus. We present the successful conservative management of osteosynthesis material implanted due to ankle fracture in an elderly patient who suffered superinfection by the aforementioned microorganism, in which the antimicrobial treatment consisted of the combination of antibiotic-guided systemic antibiotics (after a first ineffective empirical cycle), together with topical irrigations of sevoflurane, applications of silver sulfadiazine cream, and subsequently coverage of the skin defect with negative pressure therapy. We highlight the novel role of sevoflurane as an analgesic and as a topical antimicrobial agent (in addition to silver sulfadiazine) in the favourable evolution of the wound, especially in the period in which the empirical antibiotic therapy was ineffective and negative pressure therapy had not yet been applied


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Placas Ósseas/efeitos adversos , Tratamento Conservador/métodos , Staphylococcus aureus Resistente à Meticilina , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Superinfecção/terapia , Infecção da Ferida Cirúrgica/terapia , Placas Ósseas/microbiologia , Coinfecção/diagnóstico , Coinfecção/microbiologia , Coinfecção/terapia , Terapia Combinada , Fixação Interna de Fraturas/instrumentação , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Superinfecção/diagnóstico , Superinfecção/microbiologia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia
10.
Arch Orthop Trauma Surg ; 140(5): 665-673, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32193674

RESUMO

In the recent years, treatment of distal radius fractures (DRF) has advanced considerably. Surgical fixation with palmar angular stable plate has gained popularity, due to a reported lower complication rate when compared to dorsal fixation. The type of trauma or injury, surgical procedure and impaired bone quality are all contributors to complications in DRF. The main aim of this review is to summarize the most common complications and possible therapeutic solutions. In addition, strategies for minimizing these complications will be discussed.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias , Fraturas do Rádio/cirurgia , Humanos
11.
Orthopedics ; 43(3): 141-146, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32191948

RESUMO

The aim of this study was to evaluate risk factors for symptomatic hardware and removal of hardware (ROH) after olecranon open reduction and internal fixation (ORIF) and to assess differences between olecranon locking plate and screws (P&S) or tension band (TB) wire cohorts. The medical records of 331 patients with olecranon fractures treated at two academic level I trauma centers with ORIF from 2012 to 2016 were reviewed. A total of 189 patients were included in the study. Complications, ROH, and subsequent surgery were assessed and compared between cohorts. There were 124 cases in the P&S cohort and 65 in the TB cohort. The overall reoperation rate was 31.2% (59 of 189). The overall incidence of ROH for all cases was 29.1% (55 of 189). Patients who required ROH or developed symptomatic hardware were significantly younger than those who did not (P&S, P<.003; TB, P<.004). Age and body mass index (BMI) were associated with ROH plus symptomatic hardware after P&S. Age (but not BMI) was associated with ROH/symptomatic hardware after TB. Measured hardware prominence was not associated with ROH or ROH plus symptomatic hardware for either the P&S or the TB cohort. Risk factors including patient age and BMI were found to be significantly associated with hardware-related complications. [Orthopedics. 2020;43(3):141-146.].


Assuntos
Placas Ósseas/efeitos adversos , Parafusos Ósseos/efeitos adversos , Remoção de Dispositivo , Fixação Interna de Fraturas/efeitos adversos , Olécrano/cirurgia , Complicações Pós-Operatórias/epidemiologia , Fraturas da Ulna/cirurgia , Adulto , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Olécrano/lesões , Redução Aberta/efeitos adversos , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco
12.
Plast Reconstr Surg ; 145(4): 969-976, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221216

RESUMO

BACKGROUND: This study assessed the risk and factors of complications after volar locking plate fixation of distal radius fractures. METHODS: A single-institution retrospective review of patients undergoing volar locking plate fixation of distal radius fractures between May of 2000 and May of 2015 was undertaken. Demographic data, major complications, minor complications, and radiographic parameters were evaluated. RESULTS: Six hundred forty-seven distal radius fractures managed with volar plate fixation in 636 patients were reviewed. Mean follow-up was 9.1 months. Mean age was 56.5 years. Mean body mass index was 28.0, and 14.6 percent of patients had a body mass index greater than 35. Fractures were classified as Arbeitsgemeinschaft für Osteosynthesefragen class 23-C (67.2 percent), 23-A (26.6 percent), and 23-B (6.2 percent). The incidence of major and minor complications was 13.8 percent and 17.5 percent, respectively. The most common complication was transient paresthesia (9.7 percent). The incidence of tendon rupture or irritation was 0.5 percent or 2.5 percent, respectively. Hardware removal for painful/symptomatic hardware occurred in 6.2 percent at an average of 427.8 days after surgery. Major complications and minor complications were increased 2.2- and 1.9-fold, respectively, in patients with a body mass index greater than 35. Major complications were also increased 3.19 times in patients with residual intraarticular step-off. Hardware removal was 3.3 times more likely in patients with Soong grade 2 plate prominence and 2.9 times more likely in patients with a history of diabetes mellitus. CONCLUSIONS: Volar plate osteosynthesis of distal radius fractures is associated with an overall low complication rate. Patient factors, including diabetes mellitus and obesity, and intraoperative factors, including intraarticular fracture alignment and plate prominence, were associated with a higher rate of complications or revision surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Placas Ósseas/efeitos adversos , Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Ruptura Espontânea/etiologia , Tendinopatia/etiologia , Fatores de Tempo , Adulto Jovem
13.
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
15.
Injury ; 51(2): 193-198, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31703961

RESUMO

OBJECTIVES: To biomechanically compare plated constructs using nonlocking bone-screw-fasteners with interlocking threads versus locking screws with traditional buttress threads in geriatric female bone. METHODS: Eleven matched pairs of proximal and distal segments of geriatric female cadaveric tibias were used to create a diaphyseal fracture model. Nonlocking bone-screw-fasteners or locking buttress threaded screws were applied to a locking compression plate on the anterolateral aspect of the tibia placed in bridge mode. Specimens were subjected to incrementally increasing cyclic axial load combined with constant cyclic torsion. Total cycles to failure served as a primary outcome measure, with failure defined as 2 mm of displacement or 10 degrees of rotation. Secondary outcome measures included initial stiffness in compression and torsion determined from preconditioning testing and overall rigidity as determined by maximum peak-to-peak axial and rotational motion at 500 cycle intervals during cyclic testing. Group comparisons were made using paired Student's t-tests. Significance was set at p < 0.05. RESULTS: Bone-screw-fastener constructs failed at an average of 40,636 ± 22,151 cycles and locking screw constructs failed at an average of 37,773 ± 8433 cycles, without difference between groups (p = =0.610). Total cycles to failure was higher in the bone-screw-fasteners group for 7 tibiae out of the eleven matched pairs tested. During static and cyclic testing, bone-screw-fastener constructs demonstrated increased initial torsional stiffness (7.6%) and less peak-to-peak displacement and rotation throughout the testing cycle(p < 0.05). CONCLUSIONS: In female geriatric bone, constructs fixed with bone-screw-fasteners incorporate multiplanar interlocking thread geometry and performed similarly to traditional locked plating. These novel devices may combine the benefits of both nonlocking and locking screws when plating geriatric bone.


Assuntos
Fenômenos Biomecânicos/fisiologia , Placas Ósseas/efeitos adversos , Parafusos Ósseos/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Absorciometria de Fóton/métodos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Fraturas Ósseas/cirurgia , Geriatria , Humanos , Avaliação de Resultados em Cuidados de Saúde , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
16.
World Neurosurg ; 134: e249-e255, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31629142

RESUMO

OBJECTIVE: To analyze hardware-related problems and their prognoses after anterior cervical discectomy and fusion (ACDF) using cages and plates for degenerative and traumatic cervical disc diseases. METHODS: The study included 808 patients who underwent anterior cervical discectomy and fusion for degenerative and traumatic disc diseases with >1 year of follow-up. We investigated time of onset and progression of problems associated with instrumentation and cage usage. The mean follow-up time was 3.4 years. Type of plate, range and level of fusion, patient factors (age, sex, body mass index, and bone mineral density), and local kyphosis were evaluated. RESULTS: Complications were found in 132 cases (16.5%), including subsidence in 69 cases, plate loosening in 8 cases, screw loosening in 8 cases, screw breakage in 1 case, and multiple complications in 36 cases. In 3 cases, additional posterior cervical surgery was performed. One case needed hardware revision. There were no esophageal, tracheal, or neurovascular structural injuries secondary to metal failure. There were no significant differences in type of plate, level of surgery, or patient factors. The greater the number of fusion segments, the greater the incidence of complications (P = 0.001). The clinical outcomes improved regardless of the complications (P = 0.083). CONCLUSIONS: Most hardware-related complications are not symptomatic and can be treated conservatively. Only a few cases need revision surgery. Precise surgical techniques are needed in multilevel anterior cervical discectomy and fusion (>3 levels) because of the increased complication rate.


Assuntos
Placas Ósseas/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Discotomia/efeitos adversos , Falha de Prótese/efeitos adversos , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas/tendências , Vértebras Cervicais/cirurgia , Discotomia/instrumentação , Discotomia/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Falha de Prótese/tendências , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Fusão Vertebral/tendências , Adulto Jovem
18.
Injury ; 51(2): 389-394, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31668577

RESUMO

INTRODUCTION: Nonunions of trochanteric femoral fractures are uncommon due to a good blood supply of the cancellous bone of the trochanteric region. Nevertheless, if a nonunion occurs, complex revision procedures usually become necessary. The purpose of this study was to evaluate a series of aseptic trochanteric nonunions in patients aged 60 years or older, looking at outcomes regarding healing rate, implant-related complications and secondary surgeries. MATERIAL AND METHODS: We conducted a retrospective chart review of patients with aseptic femoral trochanteric nonunions aged over 60 years. Nonunion treatment consisted of implant removal, debridement of the nonunion, and restoration of the neck shaft angle, followed by DCS plating. An additional 4.5-mm limited contact dynamic compression plate was placed in twelve patients anteriorly. The primary outcome measure was bony healing and time to healing in months. Secondary outcome measures included postoperative complications related to the index procedure, range of motion of the affected hip and postoperative mobility. RESULTS: A total of 21 patients with a mean age of 69.1 years met the inclusion criteria. After a mean follow-up of 21.62 months, 17 of the 21 nonunions healed successfully. The mean healing time was 6.59 months. A total of six of the 21 patients needed secondary revision surgery. At the final follow-up, a full range of motion of the hip was seen in 17 of the 21 hips. CONCLUSIONS: DCS treatment and preservation of the patient's femoral head can be successful for patients aged over 60 years with a well-preserved femoral head and acetabulum. However, preservation of the hip joint and revision plating might be associated with higher revision rates.


Assuntos
Placas Ósseas/efeitos adversos , Prótese Ancorada no Osso/efeitos adversos , Fraturas não Consolidadas/etiologia , Fraturas não Consolidadas/cirurgia , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas/estatística & dados numéricos , Parafusos Ósseos , Prótese Ancorada no Osso/microbiologia , Feminino , Seguimentos , Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/microbiologia , Fraturas do Quadril/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Amplitude de Movimento Articular/fisiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
19.
Injury ; 51(2): 490-496, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31676074

RESUMO

OBJECTIVES: To evaluate a new surgical technique concerning titanium cage packing with xenograft demineralized bone matrix bovine augmentation in the management of subchondral bone defects associated with tibial plateau fractures. METHODS: All patients underwent plate fixation augmentation using titanium cage packing with xenograft, with the help of digital medical software of Mimics and 3-matic preoperatively. Duration of the surgical procedure, intraoperative bleeding volume, bone union time, quality of reduction and alignment, fracture healing, complications, and functional outcomes based on Oxford knee outcome score were recorded. RESULTS: A total of 18 patients were followed for average 18.1 months (range, 12-24 months). The average radiographic bony union time was 12.8 weeks (range, 11-17 weeks) and full weight bearing time was 13.4 weeks (range, 11-16 weeks) respectively. At one-year follow-up, the mean degrees of knee extension were 2.7° (range, 0-6) and the mean degrees of knee flexion were 122.0° (range, 112-134). The articular step-off was unchanged from 0.9 ±â€¯0.6 mm (range, 0-1.8 mm) to 1.0 ±â€¯0.6 mm (0-1.9 mm) (P = 0.512). All the cases had satisfactory reduction. No secondary loss of reduction was found over the time period studied. Superficial infection was found in one case, and resolved with closed treatment. No implant failures were noted. The average Oxford knee score was 19.9 ±â€¯5.4 (range, 12-30) at the final follow-up. CONCLUSION: Fixation augmentation using titanium cage packing with xenograft augmentation is a safe and effective way to treat the depressed tibial plateau fractures.


Assuntos
Matriz Óssea/transplante , Fixação Interna de Fraturas/instrumentação , Xenoenxertos/transplante , Fraturas da Tíbia/cirurgia , Titânio/efeitos adversos , Adulto , Animais , Placas Ósseas/efeitos adversos , Bovinos , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Amplitude de Movimento Articular , Estudos Retrospectivos , Fraturas da Tíbia/classificação , Fraturas da Tíbia/diagnóstico por imagem , Resultado do Tratamento , Suporte de Carga
20.
Orthop Traumatol Surg Res ; 106(1S): S79-S87, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31680016

RESUMO

Proximal femur fractures have significant functional repercussions in both older adults (sometimes life-threatening) and younger adults (socioeconomic). This study will review the early mechanical complications (EMC) associated with the fixation of femoral neck (FNF) and trochanteric (TF) fractures. What is the nature of these complications? They consist of incorrect fracture fixation, secondary displacement and/or fixation failure (FNF: 3-10%; TF: 5-7%), and more rarely, secondary fractures distal to the implant. What are the risk factors and how can they be controlled? They are related to the patient (osteoporosis), to the type of fracture (FNF: posterior comminution, magnitude of displacement, vertical fracture line, fracture of calcar/TF: comminution of calcar, lesser trochanter fracture, metaphyseal comminution, lateral cortex fracture, greater trochanter comminution), to the chosen treatment (FNF: triple screw fixation or screw-plate are preferable/TF: all implants suitable for simple fractures, cervicomedullary implants for complex fractures), and to the surgical technique (quality of reduction, implant positioning). How should they be treated? Early revision of internal fixation can be difficult and increases the infection risk. Inter- or subtrochanteric valgus osteotomy leads to satisfactory results but is difficult to carry out. Secondary arthroplasty, which is the preferred option in older adults, leads to good outcomes but is technically more difficult, and has a higher complication rate in EMC of trochanteric fractures. LEVEL OF EVIDENCE: V.


Assuntos
Placas Ósseas/efeitos adversos , Parafusos Ósseos/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Fraturas do Fêmur/diagnóstico , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/lesões , Colo do Fêmur/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Fatores de Tempo
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