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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(7): 862-866, 2024 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-39013825

RESUMO

Objective: To analyze the effectiveness of external fixator combined with Kirschner wire (EF-KW) fixation in the treatment of oblique and comminuted distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children. Methods: A clinical data of 22 children with DHMDJ fractures who met the selection criteria between April 2021 and December 2023 was retrospectively analyzed. All patients were treated with EF-KW fixation. There were 14 boys and 8 girls with an average age of 6.8 years (range, 1.5-12.0 years). The time from injury to operation was 14-38 hours (mean, 24.2 hours). There were 18 cases of comminuted fractures and 4 cases of oblique fractures; and 1 case of median nerve injury and 1 case of radial nerve injury before operation. The occurrence of postoperative complications was recorded. At last follow-up, the function of the affected elbow joint was evaluated according to the Mayo elbow joint function score, and the Baumann's angle (BA) and humero-capitellar angle (HCA) of the affected and healthy sides were recorded and compared. Results: All fractures were successfully treated with closed reduction and no complications such as nerve injury occurred. Superficial infection occurred in 4 cases after operation and healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 9-24 months (mean, 13.8 months). At last follow-up, according to the Mayo elbow joint function score, the elbow joint function was rated as excellent in 15 cases, good in 6 cases, and fair in 1 case, with an excellent and good rate of 95.5%. The neurologic injury before operation recovered gradually. X-ray films reexamination showed that all fractures healed, and the healing time of fractures ranged from 29 to 61 days, with an average of 35.6 days. At last follow-up, there was no significant difference in BA and HCA between the healthy side and the affected side ( P>0.05). During follow-up, 1 case developed mild cubitus varus, while the other patients had no serious complications. Conclusion: EF-KW fixation for oblique and comminuted DHMDJ fractures in children has the advantages of less trauma, simple operation, easy reduction, good stability after reduction, low incidence of serious complications, and good elbow functional recovery.


Assuntos
Fios Ortopédicos , Fixadores Externos , Fraturas Cominutivas , Fraturas do Úmero , Humanos , Masculino , Feminino , Criança , Fraturas do Úmero/cirurgia , Estudos Retrospectivos , Fraturas Cominutivas/cirurgia , Pré-Escolar , Lactente , Resultado do Tratamento , Amplitude de Movimento Articular , Articulação do Cotovelo/cirurgia , Fixação de Fratura/métodos , Complicações Pós-Operatórias , Consolidação da Fratura , Diáfises/lesões , Diáfises/cirurgia
2.
BMC Musculoskelet Disord ; 25(1): 544, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39010006

RESUMO

OBJECTIVE: We aimed to compare the clinical efficacy of inverted triangular cannulated compression screws combined with Gotfried positive or negative buttress reduction in the healing of femoral neck fractures. METHODS: Between October 2017 and March 2021, 55 patients with femoral neck fractures underwent treatment using inverted triangular cannulated compression screws combined with Gotfried positive or negative buttress reduction. Among these patients, 29 received inverted triangular cannulated compression screws combined with Gotfried positive buttress reduction treatment. This group consisted of 16 males and 13 females, with an average age of 43.45 ± 8.23 years. Additionally, 26 patients received inverted triangular cannulated compression nails combined with Gotfried negative buttress reduction treatment. This group included 14 males and 12 females, with an average age of 41.96 ± 8.69 years. Postsurgery, various measurements were taken, including the degree of shortening of the femoral neck, degree of bone nonunion, degree of fixation failure, degree of ischemic necrosis of the femoral head, and Harris score of the hip joint. RESULTS: All patients were followed up for a minimum of 18 months. The group that underwent treatment with an inverted triangular cannulated compression screw combined with Gotfried positive buttress reduction did not experience any cases of bone nonunion, fixation failure, or ischemic necrosis of the femoral head. In the group that received treatment with inverted triangle cannulated compression screws combined with Gotfried negative buttress reduction, there was one case of bone nonunion, three cases of early fixation failure, and one case of ischemic necrosis. Ultimately, five patients (19.23% of the total) underwent joint replacement surgery. The average shortening lengths in the vertical plane were 4.07 ± 1.98 mm and 8.08 ± 3.54 mm, respectively. In the horizontal plane, the average shortening lengths were 3.90 ± 1.57 mm and 7.77 ± 3.31 mm, respectively. At the last follow-up, the group that received Gotfried positive buttress reduction had a greater Harris hip joint score. CONCLUSION: The success rate of combining inverted triangular cannulated compression screws with Gotfried positive buttress reduction surgery is relatively high. This surgical approach effectively prevents femoral neck shortening and improves hip joint function. Moreover, it is crucial to avoid negative buttress reduction when managing femoral neck fractures.


Assuntos
Parafusos Ósseos , Fraturas do Colo Femoral , Consolidação da Fratura , Humanos , Fraturas do Colo Femoral/cirurgia , Fraturas do Colo Femoral/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Resultado do Tratamento , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/instrumentação , Estudos Retrospectivos , Seguimentos
3.
J Orthop Trauma ; 38(8): 447-451, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39007662

RESUMO

OBJECTIVES: The aim of this study was to report experience of a major trauma center utilizing circular frames as definitive fixation in patients sustaining Gustilo-Anderson 3B open tibial fractures. DESIGN: A prospectively maintained database was retrospectively interrogated. SETTING: Single major trauma center in the United Kingdom. PATIENT SELECTION CRITERIA: All patients over the age of 16 sustaining an open tibial fracture with initial debridement performed at the study center. All patients also received orthoplastic care for a soft tissue defect (via skeletal deformation or a soft tissue cover procedure) and subsequent definitive management using an Ilizarov ring fixator. Patients who received primary debridement at another center, had preexisting infection, sustained a periarticular fracture, or those who did not afford a minimum of 12-month follow-up were excluded. Case notes and radiographs were reviewed to collate patient demographics and injury factors. OUTCOME MEASURES AND COMPARISONS: The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventions. RESULTS: Two hundred twenty-five patients met inclusion criteria. Mean age was 43.2 year old, with 72% males, 34% smokers, and 3% diabetics. Total duration of frame management averaged 6.4 months (SD 7.7). Eight (3.5%) patients developed a deep infection and 41 (20%) exhibited signs of a pin site infection. Seventy-nine (35.1%) patients had a secondary intervention, of which 8 comprised debridement of deep infection, 29 bony procedures, 8 soft tissue operations, 30 frame adjustments, and 4 patients requiring a combination of soft tissue and bony procedures. Bony union was achieved in 221 cases (98.2%), 195 (86.7%) achieved union in a single frame without the need for secondary intervention, 26 required frame adjustments to achieve union. Autologous bone grafts were used in 10 cases. CONCLUSIONS: Orthoplastic care including circular frame fixation for Gustilo-Anderson-3B fractures of the tibia resulted in a low rate of deep infection (3.5%) and achieved excellent union rates (98.2%). LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fraturas Expostas , Fraturas da Tíbia , Centros de Traumatologia , Humanos , Fraturas da Tíbia/cirurgia , Masculino , Fraturas Expostas/cirurgia , Feminino , Adulto , Resultado do Tratamento , Pessoa de Meia-Idade , Fixadores Externos , Reino Unido , Estudos Prospectivos , Adulto Jovem , Estudos Retrospectivos , Bases de Dados Factuais , Desbridamento , Adolescente , Consolidação da Fratura , Fixação de Fratura/métodos , Infecção da Ferida Cirúrgica/epidemiologia
4.
J Orthop Trauma ; 38(8): 452-458, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39007663

RESUMO

OBJECTIVES: To determine (1) the rate of positive cultures in presumed aseptic nonunions, (2) the rate and microbial spectrum of positive cultures that represented occult infection, and (3) rates of nonunion healing. DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS SELECTION CRITERIA: Adult patients with a presumed aseptic nonunion treated with single-stage revision between 2002 and 2022. OUTCOME MEASURES AND COMPARISONS: The rate of positive cultures compared for 2 protocols: old: 1-2 samples cultured 7 days versus new: 5 samples cultured 14 days. The rate of positive cultures meeting occult infection criteria with the new protocol (≥2 samples with phenotypically indistinguishable microorganisms, or ≥1 sample with a high virulent microorganism). Nonunion healing rates between protocols and between groups based on culture results with the new protocol. RESULTS: One hundred seventy-nine patients were included. The rate of positive cultures was 14% (n = 15/105) with the old protocol and 51% (n = 38/74) with the new protocol (P < 0.001). With the new protocol, the rate of positive cultures meeting occult infection criteria was 19% (n = 14/74), and coagulase-negative staphylococci (48%) and Cutibacterium acnes (38%) were the most common microorganisms. Nonunion healing rates after the primary revision did not differ between protocols (old: 82% vs. new: 86%, P = 0.41) and groups based on culture result (sterile: 86% vs. occultly infected: 93%, P = 0.66). The final overall nonunion healing rate was 97%. CONCLUSIONS: Occult infections were identified in 1 in 5 presumed aseptic nonunions using a standardized protocol with 5 intraoperative samples cultured 14 days and were predominantly caused by slow growing, gram-positive microorganisms. The local spectrum and antimicrobial sensitivity of occult infections should be considered when developing empiric antimicrobial protocols. Patients with presumed aseptic nonunions can expect high healing rates, regardless of the culture result. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fraturas não Consolidadas , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Fraturas não Consolidadas/microbiologia , Fraturas não Consolidadas/cirurgia , Adulto , Idoso , Consolidação da Fratura , Estudos de Coortes , Resultado do Tratamento , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/diagnóstico , Reoperação , Fixação Interna de Fraturas
5.
J Cell Mol Med ; 28(13): e18522, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38957040

RESUMO

Bone non-union is a common fracture complication that can severely impact patient outcomes, yet its mechanism is not fully understood. This study used differential analysis and weighted co-expression network analysis (WGCNA) to identify susceptibility modules and hub genes associated with fracture healing. Two datasets, GSE125289 and GSE213891, were downloaded from the GEO website, and differentially expressed miRNAs and genes were analysed and used to construct the WGCNA network. Gene ontology (GO) analysis of the differentially expressed genes showed enrichment in cytokine and inflammatory factor secretion, phagocytosis, and trans-Golgi network regulation pathways. Using bioinformatic site prediction and crossover gene search, miR-29b-3p was identified as a regulator of LIN7A expression that may negatively affect fracture healing. Potential miRNA-mRNA interactions in the bone non-union mechanism were explored, and miRNA-29-3p and LIN7A were identified as biomarkers of skeletal non-union. The expression of miRNA-29b-3p and LIN7A was verified in blood samples from patients with fracture non-union using qRT-PCR and ELISA. Overall, this study identified characteristic modules and key genes associated with fracture non-union and provided insight into its molecular mechanisms. Downregulated miRNA-29b-3p was found to downregulate LIN7A protein expression, which may affect the healing process after fracture in patients with bone non-union. These findings may serve as a prognostic biomarker and potential therapeutic target for bone non-union.


Assuntos
Biomarcadores , MicroRNAs , Humanos , MicroRNAs/genética , MicroRNAs/sangue , Biomarcadores/sangue , Redes Reguladoras de Genes , Consolidação da Fratura/genética , Perfilação da Expressão Gênica , Biologia Computacional/métodos , Feminino , Masculino , Ontologia Genética , Regulação da Expressão Gênica , Fraturas não Consolidadas/genética , Pessoa de Meia-Idade
6.
J Nanobiotechnology ; 22(1): 411, 2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-38997706

RESUMO

The fracture healing outcome is largely dependent on the quantities as well as osteogenic differentiation capacities of mesenchymal stem cells (MSCs) at the lesion site. Herein, macrophage membrane (MM)-reversibly cloaked nanocomplexes (NCs) are engineered for the lesion-targeted and hierarchical co-delivery of short stromal derived factor-1α peptide (sSDF-1α) and Ckip-1 small interfering RNA (Ckip-1 siRNA, siCkip-1) to promote bone repair by concurrently fostering recruitment and osteogenic differentiation of endogenous MSCs. To construct the NCs, a membrane-penetrating α-helical polypeptide first assembles with siCkip-1, and the cationic NCs are sequentially coated with catalase and an outer shell of sSDF-1α-anchored MM. Due to MM-assisted inflammation homing, intravenously injected NCs could efficiently accumulate at the fractured femur, where catalase decomposes the local hydrogen peroxide to generate oxygen bubbles that drives the shedding of sSDF-1α-anchored MM in the extracellular compartment. The exposed, cationic inner core thus enables robust trans-membrane delivery into MSCs to induce Ckip-1 silencing. Consequently, sSDF-1α-guided MSCs recruitment cooperates with siCkip-1-mediated osteogenic differentiation to facilitate bone formation and accelerate bone fracture healing. This study provides an enlightened strategy for the hierarchical co-delivery of macromolecular drugs into different cellular compartments, and it also renders a promising modality for the management of fracture healing.


Assuntos
Diferenciação Celular , Consolidação da Fratura , Macrófagos , Células-Tronco Mesenquimais , Osteogênese , Células-Tronco Mesenquimais/metabolismo , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/citologia , Osteogênese/efeitos dos fármacos , Diferenciação Celular/efeitos dos fármacos , Animais , Consolidação da Fratura/efeitos dos fármacos , Macrófagos/metabolismo , Macrófagos/efeitos dos fármacos , Camundongos , RNA Interferente Pequeno , Masculino , Membrana Celular/metabolismo , Humanos , Células RAW 264.7
7.
BMC Musculoskelet Disord ; 25(1): 522, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-38970051

RESUMO

BACKGROUND: For the treatment of coronoid process fractures, medial, lateral, anterior, anteromedial, and posterior approaches have been increasingly reported; however, there is no general consensus on the method of fixation of coronal fractures. Here, we present a highly-extensile minimally invasive approach to treat coronoid process fractures using a mini-plate that can achieve anatomic reduction, stable fixation, and anterior capsular repair. Further, the study aimed to determine the complication rate of the anterior minimally invasive approach and to evaluate functional and clinical patient-reported outcomes during follow-up. METHODS: Thirty-one patients diagnosed with coronoid fractures accompanied with a "terrible triad" or posteromedial rotational instability between April 2012 and October 2018 were included in the analysis. Anatomical reduction and mini-plate fixation of coronoid fractures were performed using an anterior minimally invasive approach. Patient-reported outcomes were evaluated using the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), and the visual analog score (VAS). The time of fracture healing and complications were recorded. RESULTS: The mean follow-up time was 26.7 months (range, 14-60 months). The average time to radiological union was 3.6 ± 1.3 months. During the follow-up period, the average elbow extension was 6.8 ± 2.9° while the average flexion was 129.6 ± 4.6°. According to Morrey's criteria, 26 (81%) elbows achieved a normal desired ROM. At the last follow-up, the mean MEPI score was 98 ± 3.3 points. There were no instances of elbow instability, elbow joint stiffness, subluxation or dislocation, infection, blood vessel complications, or nerve palsy. Overall, 10 elbows (31%) experienced heterotopic ossification. CONCLUSION: An anterior minimally invasive approach allows satisfactory fixation of coronoid fractures while reducing incision complications due to over-dissection of soft tissue injuries. In addition, this incision does not compromise the soft tissue stability of the elbow joint and allows the patient a more rapid return to rehabilitation exercises.


Assuntos
Placas Ósseas , Articulação do Cotovelo , Fixação Interna de Fraturas , Fraturas Cominutivas , Amplitude de Movimento Articular , Fraturas da Ulna , Humanos , Masculino , Feminino , Fraturas da Ulna/cirurgia , Fraturas da Ulna/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/instrumentação , Pessoa de Meia-Idade , Adulto , Fraturas Cominutivas/cirurgia , Fraturas Cominutivas/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Resultado do Tratamento , Estudos Retrospectivos , Seguimentos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Consolidação da Fratura , Idoso , Medidas de Resultados Relatados pelo Paciente , Adulto Jovem
8.
ScientificWorldJournal ; 2024: 7446251, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38854678

RESUMO

This paper explores the role of botulinum neurotoxin in aiding fracture recovery through temporary muscle paralysis. Specifically, it investigates the effects of botulinum neurotoxin-induced paralysis of the sternocleidomastoid muscle on clavicle fractures in rats. The research aims to assess safety, effectiveness, and the impact on fracture healing. Healthy male Albino Wistar rats were divided into four groups: clavicle fracture, botulinum neurotoxin injection, both, and control. Surgeries were conducted under anaesthesia, and postoperatively, animals were monitored for 28 days. Euthanasia and radiological assessment followed, examining fracture healing and muscle changes, while tissues were histopathologically evaluated. The modified Lane-Sandhu scoring system was used for the radiographic evaluation of clavicle fractures, and the results varied from complete healing to nonunion. Histopathological examination at 28 days postfracture showed fibrous tissue, mesenchymal cells, and primary callus formation in all groups. Despite varied callus compositions, botulinum neurotoxin administration did not affect clavicle healing, as evidenced by similar scores to the control group. Several studies have explored botulinum neurotoxin applications in fracture recovery. Research suggests its potential to enhance functional recovery in certain types of fractures. Theoretical benefits include managing muscle spasticity, aiding reduction techniques, and preventing nonunion. However, botulinum neurotoxin's transient effect and nonuniversal applications should be considered. The present study found that botulinum toxin had no clear superiority in healing compared to controls, while histological evaluation showed potential adverse effects on muscle tissue. Further research is essential to understand its risk-benefit balance and long-term effects.


Assuntos
Toxinas Botulínicas Tipo A , Consolidação da Fratura , Fraturas Ósseas , Ratos Wistar , Animais , Toxinas Botulínicas Tipo A/farmacologia , Toxinas Botulínicas Tipo A/administração & dosagem , Ratos , Masculino , Consolidação da Fratura/efeitos dos fármacos , Fraturas Ósseas/tratamento farmacológico , Tratamento Conservador/métodos , Clavícula/lesões , Clavícula/efeitos dos fármacos , Modelos Animais de Doenças
9.
J Orthop Traumatol ; 25(1): 31, 2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38864994

RESUMO

BACKGROUND: The aim of this study was to explore the efficacy of a novel intramedullary fixation technique using the ortho-bridge system (OBS) for midshaft clavicle fractures. METHODS: A total of 63 patients were included in this study: 35 underwent plate internal fixation (LP group) and 28 underwent OBS intramedullary fixation (OBS group). Surgical time, intraoperative blood loss, incision length, fracture healing time, removal of the internal fixation agent, visual analog scale (VAS) score for shoulder pain, Constant-Murley shoulder score and complication occurrence were compared between the two groups. RESULTS: Preoperative general data, such as sex, age and fracture type, were not significantly different between the two groups (P > 0.05). However, the OBS group exhibited better outcomes than the LP group exhibited in terms of surgical time, intraoperative blood loss and total incision length (P < 0.05). Additionally, the OBS group exhibited a significantly shorter fracture healing time and internal-fixation removal time than the LP group exhibited (P < 0.05). The VAS scores on postoperative day 1, week 1, month 1 and month 3 were lower in the OBS group than in the LP group (P < 0.05). Furthermore, the Constant-Murley shoulder scores at 1, 3, and 6 months postoperatively were higher in the OBS group than in the LP group (P < 0.05), with no significant difference at 1 year after surgery (P > 0.05). None of the patients in the OBS group experienced scarring of the surgical incision, and 6 patients in the LP group experienced scarring of the surgical incision. Finally, the complication incidence in the OBS group was lower than that in the LP group. CONCLUSION: For midshaft clavicle fractures, OBS intramedullary fixation is better than locking-plate internal fixation because it led to less trauma, a faster recovery, better efficacy, and better esthetic outcomes and comfort. Therefore, this technique may have potential as a novel treatment for midshaft clavicle fractures. LEVEL OF EVIDENCE: III, retrospective observational study.


Assuntos
Placas Ósseas , Clavícula , Fixação Intramedular de Fraturas , Consolidação da Fratura , Fraturas Ósseas , Duração da Cirurgia , Humanos , Clavícula/lesões , Clavícula/cirurgia , Masculino , Feminino , Estudos Retrospectivos , Fraturas Ósseas/cirurgia , Adulto , Fixação Intramedular de Fraturas/métodos , Pessoa de Meia-Idade , Resultado do Tratamento , Medição da Dor , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Fixação Interna de Fraturas/métodos
10.
BMC Musculoskelet Disord ; 25(1): 456, 2024 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-38851687

RESUMO

BACKGROUND: Osteosynthesis using antegrade intramedullary nailing for humeral shaft fractures yields satisfactory bone union rates; however, it may adversely affect postoperative shoulder function. To date, factors affecting mid- or long-term shoulder functional outcomes following intramedullary nail fixation have not been clarified. In this study, we aimed to identify the risk factors for poor mid-term functional outcomes over 5 years postoperatively following antegrade intramedullary nail osteosynthesis for humeral shaft fractures. METHODS: We retrospectively identified 33 patients who underwent surgery using an antegrade intramedullary nail for acute traumatic humeral shaft fractures and were followed up for at least 5 years postoperatively. We divided the patients into clinical failure and no clinical failure groups using an age- and sex-adjusted Constant score of 55 at the final follow-up as the cutoff value. We compared preoperative, perioperative, and postoperative factors between the two groups. RESULTS: Five of the 33 patients had poor shoulder functional outcomes (adjusted Constant score < 55) at a mean follow-up of 7.5 years postoperatively. Proximal protrusion of the nail at the time of bone union (P = 0.004) and older age (P = 0.009) were significantly associated with clinical failure in the univariate analyses. Multivariate analysis showed that proximal protrusion of the nail (P = 0.031) was a risk factor for poor outcomes. CONCLUSIONS: The findings of this study provide new information on predictive factors affecting mid-term outcomes following osteosynthesis using antegrade nails. Our results demonstrated that proximal protrusion of the nail was significantly associated with poor mid-term functional shoulder outcomes. Therefore, particularly in older adults, it is essential to place the proximal end of the intramedullary nail below the level of the articular cartilage.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas , Fraturas do Úmero , Humanos , Estudos Retrospectivos , Feminino , Masculino , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Úmero/cirurgia , Pessoa de Meia-Idade , Adulto , Seguimentos , Fatores de Risco , Idoso , Resultado do Tratamento , Amplitude de Movimento Articular , Articulação do Ombro/cirurgia , Articulação do Ombro/fisiopatologia , Consolidação da Fratura , Recuperação de Função Fisiológica , Adulto Jovem
11.
Front Immunol ; 15: 1384783, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38911851

RESUMO

Bone regeneration is a complex pathophysiological process determined by molecular, cellular, and biomechanical factors, including immune cells and growth factors. Fracture healing usually takes several weeks to months, during which patients are frequently immobilized and unable to work. As immobilization is associated with negative health and socioeconomic effects, it would be desirable if fracture healing could be accelerated and the healing time shortened. However, interventions for this purpose are not yet part of current clinical treatment guidelines, and there has never been a comprehensive review specifically on this topic. Therefore, this narrative review provides an overview of the available clinical evidence on methods that accelerate fracture healing, with a focus on clinical applicability in healthy patients without bone disease. The most promising methods identified are the application of axial micromovement, electromagnetic stimulation with electromagnetic fields and direct electric currents, as well as the administration of growth factors and parathyroid hormone. Some interventions have been shown to reduce the healing time by up to 20 to 30%, potentially equivalent to several weeks. As a combination of methods could decrease the healing time even further than one method alone, especially if their mechanisms of action differ, clinical studies in human patients are needed to assess the individual and combined effects on healing progress. Studies are also necessary to determine the ideal settings for the interventions, i.e., optimal frequencies, intensities, and exposure times throughout the separate healing phases. More clinical research is also desirable to create an evidence base for clinical guidelines. To make it easier to conduct these investigations, the development of new methods that allow better quantification of fracture-healing progress and speed in human patients is needed.


Assuntos
Consolidação da Fratura , Humanos , Animais , Fraturas Ósseas/terapia , Regeneração Óssea , Magnetoterapia/métodos
12.
Med Sci Monit ; 30: e943946, 2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38887008

RESUMO

BACKGROUND The objective of this investigation was to assess the effectiveness of using T-shaped steel plates through the anterior lateral approach and Gerdy's tubercle osteotomy for treating posterior lateral tibial plateau fractures. MATERIAL AND METHODS A retrospective analysis was conducted on clinical data from 20 patients, aged on average 53.9±10.36 years, who were admitted for tibial plateau fractures involving the posterior lateral condyle between January 2019 and October 2022. The fixation and reduction of the posterior lateral bone block were performed using the anterior lateral approach combined with Gerdy's tubercle osteotomy to address the posterior lateral tibial plateau fracture. Post-surgery assessment was conducted using the Hospital for Special Surgery (HSS) knee combined score. RESULTS During the 12-24 (14.2±1.7) month postoperative period, we conducted 20 surgeries. Within 9 to 12 weeks, fracture healing transpired without any complications such as incision infection, nerve injury, or fracture displacement being detected. Assessment of knee joint function at the final follow-up was conducted using the HSS knee combined score, with results indicating 16 cases rated as excellent, 3 cases as good, and 1 case as fair. CONCLUSIONS In tibial plateau fractures impacting the posterior lateral condyle, the anterior lateral approach, combined with Gerdy's tubercle osteotomy, allows for direct exposure and manipulation of the posterior lateral bone block fracture. Using a T-shaped support plate and a lateral locking plate provides a reliable method for fracture fixation, aiding in convenient surgical positioning and intraoperative fluoroscopy. The treatment approach effectively manages fractures located on the posterior lateral aspect of the tibial plateau.


Assuntos
Fixação Interna de Fraturas , Osteotomia , Fraturas da Tíbia , Humanos , Osteotomia/métodos , Fraturas da Tíbia/cirurgia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Resultado do Tratamento , Fixação Interna de Fraturas/métodos , Idoso , Placas Ósseas , Articulação do Joelho/cirurgia , Tíbia/cirurgia , Consolidação da Fratura , Fraturas do Planalto Tibial
13.
Trials ; 25(1): 420, 2024 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-38937792

RESUMO

BACKGROUND: Treatment of displaced distal forearm fractures in children has traditionally been closed reduction and pin fixation, although they might heal and remodel without surgery with no functional impairment. No randomized controlled trials have been published comparing the patient-reported functional outcome following non-surgical or surgical treatment of displaced paediatric distal forearm fractures. METHODS: A multicentre non-inferiority randomized controlled trial. Children aged 4-10 years with a displaced distal forearm fracture will be offered inclusion, if the on-duty orthopaedic surgeon finds indication for surgical intervention. They will be allocated equally to non-surgical treatment (intervention) or surgical treatment of surgeon's choice (comparator). Follow-up will be 4 weeks and 3, 6, and 12 months. The primary outcome is the between-group difference in 12 months QuickDASH score. We will need a sample of 40 patients to show a 15-point difference with 80% power. DISCUSSION: The results of this trial may change our understanding of the healing potential of paediatric distal forearm fractures. If non-inferiority of non-surgical treatment is shown, the results may contribute to a reduction in future surgeries on children, who in turn can be treated without the risks and psychological burdens associated with surgery. TRIAL REGISTRATION: www. CLINICALTRIALS: gov (ID: NCT05736068). Date of registry: 17 February 2023.


Assuntos
Anestesia Geral , Moldes Cirúrgicos , Estudos Multicêntricos como Assunto , Ensaios Clínicos Pragmáticos como Assunto , Fraturas do Rádio , Humanos , Criança , Pré-Escolar , Fraturas do Rádio/cirurgia , Fraturas do Rádio/terapia , Resultado do Tratamento , Fraturas da Ulna/cirurgia , Fraturas da Ulna/terapia , Estudos de Equivalência como Asunto , Feminino , Masculino , Fatores de Tempo , Consolidação da Fratura , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Fatores Etários , Traumatismos do Antebraço/cirurgia , Traumatismos do Antebraço/terapia , Recuperação de Função Fisiológica , Fraturas do Punho
14.
Iowa Orthop J ; 44(1): 179-184, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38919353

RESUMO

Background: Provisional stabilization of high-energy tibia fractures using temporary plate fixation (TPF) or external fixation (ex-fix) prior to definitive medullary nailing (MN) is a strategy common in damage control orthopaedics. There is a lack of comprehensive data evaluating outcomes between these methods. This study compares outcomes of patients stabilized with either TPF or ex-fix, and with early definitive MN only, assessing complications including nonunion and deep infection. Methods: A retrospective review was performed on adult patients with tibia fractures treated with MN followed until fracture union (≥3 months) at a single level-1 trauma center from 2014 to 2022. Medical records were evaluated for nonunion and deep infection. Demographics, injury characteristics, and fixation methods were recorded. Significance between patients who underwent TPF and ex-fix was compared with a matched cohort of early MN using Pearson's exact tests, independent t-tests, and one-way ANOVA, depending on the appropriate variable. Results: 81 patients were included; 27 were temporized with TPF (n = 12) or ex-fix (n = 15). 54 early MN cases defined the matched cohort. All groups had similar patient and fracture characteristics. The difference in rates of nonunion between groups was significant, with TPF, ex-fix, and early MN groups at 17, 40, and 11% respectively (p = 0.027). Early MN had lower rates of nonunion (11% vs. 40%, p = 0.017) and deep infection (13% vs. 40%, p = 0.028) compared to ex-fix. Conclusion: Temporary ex-fix followed by staged MN was associated with higher rates of nonunion and deep infection. There was no difference in complication rates between TPF and early definitive MN. These data suggest that ex-fix followed by MN of tibia fractures should be avoided in favor of early definitive MN when possible. If temporization is needed, TPF may be a better option than ex-fix. Level of Evidence: IV.


Assuntos
Placas Ósseas , Fraturas da Tíbia , Humanos , Fraturas da Tíbia/cirurgia , Masculino , Estudos Retrospectivos , Feminino , Adulto , Pessoa de Meia-Idade , Resultado do Tratamento , Fixação de Fratura/métodos , Fixadores Externos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura , Idoso , Fraturas não Consolidadas/cirurgia
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(6): 703-709, 2024 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-38918191

RESUMO

Objective: To compare the effectiveness of long and short proximal femoral nail anti-rotation (PFNA) in the treatment of type A2.3 intertrochanteric fracture of femur (IFF). Methods: The clinical data of 54 patients with type A2.3 IFF admitted between January 2020 and December 2022 were retrospectively analyzed. According to the length of PFNA nail used in the operation, they were divided into long nail group (PFNA nail length>240 mm, 24 cases) and short nail group (PFNA nail length≤240 mm, 30 cases). There was no significant difference in baseline data such as gender, age, fracture side, body mass index, and time from fracture to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, intraoperative reduction quality score, fracture healing, and complications of the two groups were recorded and compared. Harris score was used to evaluate the hip function of patients at 1 year after operation. According to the relationship between the fracture line of type A2.3 IFF and the lesser trochanter, the two groups of patients were divided into type Ⅰ(the fracture line extends to the level of the lesser trochanter), type Ⅱ(the fracture line extends to less than 2 cm below the lesser trochanter), and type Ⅲ (the fracture line extends to more than 2 cm below the lesser trochanter), and the postoperative stability and internal fixator loosening of each subtype were evaluated. Results: The operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency in short nail group were significantly less than those in long nail group ( P<0.05). There was no significant difference in the intraoperative reduction quality score between the two groups ( P>0.05). Patients in both groups were followed up 12-18 months, with an average of 13.5 months. The postoperative stability score of short nail group was significantly lower than that of long nail group ( P<0.05). The Harris score in the long nail group was significantly higher than that in the short nail group at 1 year after operation ( P<0.05), but there was no significant difference in Harris score grading between the two groups ( P>0.05). Complications occurred in 3 cases of the long nail group (including 1 case of coxa varus caused by external nail entry point and 2 cases of loose internal fixator), and 7 cases of the short nail group (including 1 case of coxa varus caused by external nail entry point and 6 cases of loose internal fixator). Neither group had any anterior femoral arch damage, there was no significant difference in the incidence of complications between the two groups ( P>0.05). The number of type Ⅲ patients was relatively small and not included in the statistics; there was no significant difference in the postoperative stability score and the incidence of internal fixator loosening between the long and short nail groups in type Ⅰ patients ( P>0.05). In type Ⅱ patients, the postoperative stability score and the incidence of internal fixation loosening in the long nail group were significantly better than those in the short nail group ( P<0.05). Conclusion: Long PFNA fixation for type A2.3 IFF has longer operation time and more intraoperative blood loss, but the overall stability of fracture is better after operation. For type A2.3 IFF with fracture line extending to less than 2 cm below the lesser trochanter, long PFNA is used for fixation, although the surgical trauma is large, but the postoperative stability is better than that of short PFNA; for type A2.3 IFF with fracture line extending to the lesser trochanter, there is no significant difference in postoperative stability between long and short PFNAs.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas , Fraturas do Quadril , Duração da Cirurgia , Humanos , Fraturas do Quadril/cirurgia , Resultado do Tratamento , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/instrumentação , Feminino , Masculino , Consolidação da Fratura , Perda Sanguínea Cirúrgica , Fêmur/cirurgia , Estudos Retrospectivos , Rotação , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/instrumentação , Complicações Pós-Operatórias/epidemiologia , Idoso
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(6): 723-727, 2024 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-38918194

RESUMO

Objective: To investigate the effectiveness of Allgöwer-Donati suture in open reduction and internal fixation of Schatzker type Ⅴ and Ⅵ tibial plateau closed fractures. Methods: A clinical data of 60 patients with Schatzker type type Ⅴ and Ⅵ tibial plateau closed fractures, who met the selection criteria and admitted between May 2022 and May 2023, was retrospectively analyzed. After open reduction and internal fixation via double incisions, the incisions were closed with conventional mattress suture in 30 cases (control group) and Allgöwer-Donati suture in 30 cases (observation group). There was no significant difference in gender, age, fracture side and type, time from injury to operation, body mass index, and other baseline data between the two groups ( P>0.05). The incidence of incision-related complications after operation, visual analogue scale (VAS) score of incision at 3 days and 1 and 2 weeks after operation, and the short-form 36 health survey scale (SF-36) [physical functioning (PF), role physical (RP), bodily pain (BP), and general health (GH)] at 12 weeks after operation were compared between the two groups. Results: All operations of the two groups successfully completed. All patients were followed up 6-14 months (mean, 12 months). Incision fluid leakage occurred in 1 case of observation group and 7 cases of control group within 1 week after operation, and the incisions healed after symptomatic treatment. The incisions of other patients healed by first intention. The incidence of early incision complications in observation group was significantly lower than that in control group ( P<0.05). No late incision complications was found in the two groups. There was no significant difference in VAS scores at each time point between the two groups ( P>0.05). The VAS score significantly decreased with the increase of time in the two groups, showing significant differences between the different time points ( P<0.05). There was no significant difference in SF-36 scores (PF, RP, BP, and GH) between the two groups at 12 weeks after operation ( P>0.05). Conclusion: Compared with conventional mattress suture, Allgöwer-Donati suture is effective in open reduction and internal fixation via double incisions for Schatzker type Ⅴand Ⅵ tibial plateau closed fractures, which can reduce the incidence of early incision complications.


Assuntos
Fixação Interna de Fraturas , Técnicas de Sutura , Fraturas da Tíbia , Humanos , Fixação Interna de Fraturas/métodos , Fraturas da Tíbia/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Fraturas Fechadas/cirurgia , Feminino , Masculino , Suturas , Consolidação da Fratura , Medição da Dor , Pessoa de Meia-Idade
17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(6): 728-733, 2024 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-38918195

RESUMO

Objective: To compare the effectiveness of intramedullary nailing fixation via suprapatellar approach and medial parapatellar approach in semi-extended position in the treatment of multiple tibial fractures. Methods: The clinical data of 43 patients with multiple tibial fractures treated with intramedullary nailing fixation between July 2018 and December 2022 were retrospectively analyzed, including 23 patients treated with suprapatellar approach in semi-extended position (group A) and 20 patients with medial parapatellar approach in semi-extended position (group B). There was no significant difference in gender, age, cause of injury, time from injury to operation, AO/Orthopaedic Trauma Association (AO/OTA) classification, preoperative visual analogue scale (VAS) score, and range of motion (ROM) of the knee joint between the two groups ( P>0.05). The operation time, intraoperative blood loss, incision length, intraoperative fluoroscopy frequency, and fracture healing time were recorded and compared. The VAS score and ROM of the knee joint were analyzed at 4, 8, and 12 weeks after operation, and the incidence of postoperative complications was observed; knee function was evaluated by Lysholm score at last follow-up. Results: The operations were successfully completed in both groups, and there was no complication such as nerve and blood vessel injury during operation, and all incisions healed by first intention. There was no significant difference in operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency between the two groups ( P>0.05), but the incision length in group B was significantly longer than that in group A ( P<0.05). Patients in both groups were followed up 12-30 months, with an average of 21.1 months. The VAS score decreased and ROM increased gradually in both groups with time after operation, showing significant differences between different time points ( P<0.05). The VAS score of group B was significantly lower than that of group A at 4 and 8 weeks after operation ( P<0.05); there was no significant difference in VAS score and ROM between the two groups at other time points ( P>0.05). There was no significant difference in fracture healing time between the two groups ( P>0.05). During the follow-up, there was no complication such as internal fixator loosening, breakage, and loss of fracture reduction. At last follow-up, the Lysholm score in group B was significantly better than that in group A ( P<0.05). Conclusion: Both the suprapatellar approach and the medial parapatellar approach in semi-extended position can achieve satisfactory results in the treatment of multiple tibial fractures. The medial parapatellar approach has lower symptoms of early knee pain and better long-term function.


Assuntos
Fixação Intramedular de Fraturas , Articulação do Joelho , Amplitude de Movimento Articular , Fraturas da Tíbia , Humanos , Fraturas da Tíbia/cirurgia , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/instrumentação , Masculino , Feminino , Resultado do Tratamento , Articulação do Joelho/cirurgia , Consolidação da Fratura , Duração da Cirurgia , Patela/cirurgia , Patela/lesões , Fraturas Múltiplas/cirurgia , Estudos Retrospectivos , Pinos Ortopédicos , Pessoa de Meia-Idade , Adulto
18.
Cells ; 13(12)2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38920674

RESUMO

Bone/fracture healing is a complex process with different steps and four basic tissue layers being affected: cortical bone, periosteum, fascial tissue surrounding the fracture, and bone marrow. Stem cells and their derivatives, including embryonic stem cells, induced pluripotent stem cells, mesenchymal stem cells, hematopoietic stem cells, skeletal stem cells, and multipotent stem cells, can function to artificially introduce highly regenerative cells into decrepit biological tissues and augment the healing process at the tissue level. Stem cells are molecularly and functionally indistinguishable from standard human tissues. The widespread appeal of stem cell therapy lies in its potential benefits as a therapeutic technology that, if harnessed, can be applied in clinical settings. This review aims to establish the molecular pathophysiology of bone healing and the current stem cell interventions that disrupt or augment the bone healing process and, finally, considers the future direction/therapeutic options related to stem cells and bone healing.


Assuntos
Regeneração Óssea , Consolidação da Fratura , Humanos , Regeneração Óssea/fisiologia , Animais , Células-Tronco/citologia , Transplante de Células-Tronco/métodos
19.
Calcif Tissue Int ; 115(2): 169-173, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38907093

RESUMO

Teriparatide is an anabolic drug sometimes administered to patients who have atypical femoral fracture (AFF). However, whether teriparatide has beneficial effects on bone healing remains uncertain. The present study aimed to analyze the association between teriparatide and bone healing in complete AFF. A total of 59 consecutive cases (58 patients) who underwent intramedullary nailing for complete AFF were categorized based on postoperative use of teriparatide into the non-teriparatide (non-TPTD, n = 34) and teriparatide groups (TPTD, n = 25). Time-to-bone union was evaluated and compared between the two groups. Additionally, multiple regression analysis was performed to evaluate factors affecting time-to-bone union. All participants were women, with a mean age of 77.6 years (range: 62-92). No significant difference in time-to-bone union was found between the non-TPTD and TPTD groups (5.5 months vs. 5.8 months, p = 0.359). Two patients in the non-TPTD group underwent reoperation (p = 0.503) due to failure caused by inadequate fixation, and both achieved bone healing after additional fixation with blocking screws. Multiple regression analysis revealed that the anterior gap of the fracture site postoperatively was a factor affecting time-to-bone union (p = 0.014). The beneficial effect of teriparatide on bone healing in complete AFF could not be confirmed. Additional randomized controlled trials are required. Nonetheless, appropriate techniques, including efforts to reduce the gap on the tensile side during the surgery, are important for reliable bone healing.


Assuntos
Conservadores da Densidade Óssea , Fraturas do Fêmur , Consolidação da Fratura , Teriparatida , Humanos , Teriparatida/uso terapêutico , Teriparatida/farmacologia , Feminino , Fraturas do Fêmur/tratamento farmacológico , Idoso , Consolidação da Fratura/efeitos dos fármacos , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/uso terapêutico , Conservadores da Densidade Óssea/farmacologia , Pessoa de Meia-Idade , Fixação Intramedular de Fraturas/métodos , Resultado do Tratamento , Estudos Retrospectivos
20.
J Orthop Surg Res ; 19(1): 370, 2024 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-38907263

RESUMO

BACKGROUND: Long non-coding RNAs (LncRNAs) are recognized as a pivotal element in the processes of fracture healing and the osteogenic differentiation of stem cells. This study investigated the molecular mechanism and regulatory significance of lncRNA MAGI2-AS3 (MAGI2-AS3) in fracture healing. METHODS: Serum levels of MAGI2-AS3 in patients with normal and delayed fracture healing were verified by RT-qPCR assays. The predictive efficacy of MAGI2-AS3 for delayed fracture healing was analyzed by ROC curve. Osteogenic markers were quantified by RT-qPCR assays. MC3T3-E1 cell viability was detected using CCK-8 assay, and flow cytometry was utilized to measure cell apoptosis. The dual-luciferase reporter gene assay was used to determine the targeted binding between MAGI2-AS3 and miR-223-3p. RESULTS: Serum MAGI2-AS3 expression was decreased in patients with delayed fracture healing compared with patients with normal healing. Elevated MAGI2-AS3 resulted in an upregulation of the proliferative capacity of MC3T3-E1 cells and a decrease in mortality, along with increased levels of both osteogenic markers. However, after transfection silencing MAGI2-AS3, the trend was reversed. Additionally, miR-223-3p was the downstream target of MAGI2-AS3 and was controlled by MAGI2-AS3. miR-223-3p mimic reversed the promoting effects of MAGI2-AS3 overexpression on osteogenic marker levels and cell growth, and induced cell apoptosis. CONCLUSION: The upregulation of MAGI2-AS3 may expedite the healing of fracture patients by targeting miR-223-3p, offering a novel biomarker for diagnosing patients with delayed healing.


Assuntos
Regulação para Baixo , Consolidação da Fratura , MicroRNAs , RNA Longo não Codificante , Adulto , Animais , Feminino , Humanos , Masculino , Camundongos , Proteínas Adaptadoras de Transdução de Sinal/genética , Apoptose/genética , Diferenciação Celular/genética , Proliferação de Células/genética , Consolidação da Fratura/genética , Consolidação da Fratura/fisiologia , MicroRNAs/genética , Osteogênese/genética , RNA Longo não Codificante/genética
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