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1.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 67(2): 125-133, Mar-Abr. 2023. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-217110

RESUMO

Objetivo: Comprobar si la aplicación de fijación externa mediante barra curva conectada a clavos de Schanz supraacetabulares confiere mayor estabilidad al anillo pélvico con una lesión tipo Tile C1 cuando se realiza el montaje con la barra pretensada que con el montaje estándar (sin pretensar). Material y métodos: Pelvis sintéticas (N=5) con lesión verticalmente inestable estabilizada con ambos montajes, se sometieron a carga axial progresiva. Se midieron las fuerzas aplicadas y las variaciones en las posiciones de marcadores situados en la articulación sacroilíaca y la sínfisis se registraron con un sistema óptico. Se determinaron los desplazamientos relativos entre las superficies lesionadas, la rigidez, la resistencia y el modo de fallo de cada montaje. Resultados: Con el fijador pretensado, la rigidez del montaje en la articulación sacroilíaca resultó muy superior a la del montaje convencional (p=0,043) multiplicándola por 3,45, siendo 2,06 veces mayor en la sínfisis. La resistencia ante el fallo también fue superior, multiplicándola por 2 (p=0,043). Discusión: El aumento de estabilidad a carga axial con el fijador externo pretensado concuerda con su capacidad de producir compresión activa simultánea en los elementos posteriores y anteriores del anillo pélvico, demostrada previamente. Este resultado soporta los excelentes resultados clínicos preliminares obtenidos como tratamiento provisional. Conclusiones: El fijador externo pretensado aumenta la estabilidad axial de los elementos óseos posteriores del anillo pélvico con lesión tipo Tile C1 en modelo sintético, sin disminuir la capacidad de estabilización anterior propia de la fijación externa anterior.(AU)


Objective: The aim of our work is to check if the use of a pre-tensed bar connected to 2supra-acetabular Schanz pins is more stable in a pelvic with a tile C1 injury. Material and methods: We used synthetic pelvis (N=5) with a unstable vertical injury, stabilized with both the standard and the pre-tensed system. They both were submitted to axial loading. We measured applied forces and the position of markers that were positioned in the sacroiliac and symphysis joints. We determined the relative movements between injured surfaces, rigidity, resistance and when each system failed. Results: When using the pre-tensed fixator, the rigidity was much higher in the sacro-iliac joint (P=.043) being 3.45 times higher, being also 2.06 times higher in pubic symphysis (P=.043). The resistance against failure was 2 times higher too (P=.043). Discussion: The increased axial stability with the pre-tensed external fixator accords with its ability to make active compression in both posterior and anterior elements of the pelvic ring, which was previously demonstrated. This result supports the preliminary clinic outcomes that were obtained. Conclusions: The pre-tensed external fixator increases the axial stability of the pelvic ring's posterior elements in a synthethic pelvis with a Tile C1 injury, without decreasing it's capacity to achieve an anterior stability.(AU)


Assuntos
Humanos , Suporte de Carga , Fenômenos Biomecânicos , Pelve/cirurgia , Fixadores Externos , Fraturas Ósseas , Fixação de Fratura , Traumatologia , Ortopedia
2.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 67(2): T125-T133, Mar-Abr. 2023. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-217111

RESUMO

Objetivo: Comprobar si la aplicación de fijación externa mediante barra curva conectada a clavos de Schanz supraacetabulares confiere mayor estabilidad al anillo pélvico con una lesión tipo Tile C1 cuando se realiza el montaje con la barra pretensada que con el montaje estándar (sin pretensar). Material y métodos: Pelvis sintéticas (N=5) con lesión verticalmente inestable estabilizada con ambos montajes, se sometieron a carga axial progresiva. Se midieron las fuerzas aplicadas y las variaciones en las posiciones de marcadores situados en la articulación sacroilíaca y la sínfisis se registraron con un sistema óptico. Se determinaron los desplazamientos relativos entre las superficies lesionadas, la rigidez, la resistencia y el modo de fallo de cada montaje. Resultados: Con el fijador pretensado, la rigidez del montaje en la articulación sacroilíaca resultó muy superior a la del montaje convencional (p=0,043) multiplicándola por 3,45, siendo 2,06 veces mayor en la sínfisis. La resistencia ante el fallo también fue superior, multiplicándola por 2 (p=0,043). Discusión: El aumento de estabilidad a carga axial con el fijador externo pretensado concuerda con su capacidad de producir compresión activa simultánea en los elementos posteriores y anteriores del anillo pélvico, demostrada previamente. Este resultado soporta los excelentes resultados clínicos preliminares obtenidos como tratamiento provisional. Conclusiones: El fijador externo pretensado aumenta la estabilidad axial de los elementos óseos posteriores del anillo pélvico con lesión tipo Tile C1 en modelo sintético, sin disminuir la capacidad de estabilización anterior propia de la fijación externa anterior.(AU)


Objective: The aim of our work is to check if the use of a pre-tensed bar connected to 2supra-acetabular Schanz pins is more stable in a pelvic with a tile C1 injury. Material and methods: We used synthetic pelvis (N=5) with a unstable vertical injury, stabilized with both the standard and the pre-tensed system. They both were submitted to axial loading. We measured applied forces and the position of markers that were positioned in the sacroiliac and symphysis joints. We determined the relative movements between injured surfaces, rigidity, resistance and when each system failed. Results: When using the pre-tensed fixator, the rigidity was much higher in the sacro-iliac joint (P=.043) being 3.45 times higher, being also 2.06 times higher in pubic symphysis (P=.043). The resistance against failure was 2 times higher too (P=.043). Discussion: The increased axial stability with the pre-tensed external fixator accords with its ability to make active compression in both posterior and anterior elements of the pelvic ring, which was previously demonstrated. This result supports the preliminary clinic outcomes that were obtained. Conclusions: The pre-tensed external fixator increases the axial stability of the pelvic ring's posterior elements in a synthethic pelvis with a Tile C1 injury, without decreasing it's capacity to achieve an anterior stability.(AU)


Assuntos
Humanos , Suporte de Carga , Fenômenos Biomecânicos , Pelve/cirurgia , Fixadores Externos , Fraturas Ósseas , Fixação de Fratura , Traumatologia , Ortopedia
3.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 67(2): 160-169, Mar-Abr. 2023. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-217120

RESUMO

Las fracturas del maléolo posterior están presentes en 7-44% del total de fracturas de tobillo.El objetivo de esta revisión es conocer la evidencia actual sobre las indicaciones de fijación interna y la elección del abordaje quirúrgico para el tratamiento de estas fracturas.Las indicaciones clásicas de fijación eran el tamaño mayor a 25-30% de la superficie articular y el desplazamiento mayor a 2 mm; sin embargo, la evidencia actual sugiere que, en lugar del tamaño, se deben considerar factores tales como la inestabilidad sindesmal, el escalón articular mayor a 1-2 mm, la impactación de la superficie articular y la presencia de fragmentos intercalares.Al comparar las vías de abordaje, la bibliografía apoya el uso de los abordajes posteriores, reservando la recomendación de abordaje anterior para casos excepcionales.Para el tratamiento de esta lesión es fundamental conocer la anatomía del tobillo y considerar los factores descritos, además de la presencia de lesiones concomitantes.(AU)


Posterior malleolus fractures are frequent injuries, present in 7–44% of all ankle fractures.The objective of this study is to review the evidence to indicate the fixation of this fracture and to choose the appropriate surgical approach.The classic indications for fixation were fragment size greater than 25–30% of the articular surface and displacement greater than 2 mm. However, current evidence suggests that, rather than size, factors such as syndesmotic instability, intra-articular step-off greater than 1–2 mm, plafond impaction and the presence of intercalary fragments should be considered.When comparing the different surgical approaches, the literature supports the use of posterior approaches and reserves the recommendation of the traditional approach for exceptional cases.For the treatment of this injury it is essential to know the anatomy of the ankle and to consider all the factors described above, in addition to the presence of concomitant injuries.(AU)


Assuntos
Humanos , Fraturas do Tornozelo/cirurgia , Fixação de Fratura , Ossos do Tarso , Ortopedia , Traumatologia
4.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 67(2): T160-T169, Mar-Abr. 2023. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-217121

RESUMO

Las fracturas del maléolo posterior están presentes en 7-44% del total de fracturas de tobillo.El objetivo de esta revisión es conocer la evidencia actual sobre las indicaciones de fijación interna y la elección del abordaje quirúrgico para el tratamiento de estas fracturas.Las indicaciones clásicas de fijación eran el tamaño mayor a 25-30% de la superficie articular y el desplazamiento mayor a 2 mm; sin embargo, la evidencia actual sugiere que, en lugar del tamaño, se deben considerar factores tales como la inestabilidad sindesmal, el escalón articular mayor a 1-2 mm, la impactación de la superficie articular y la presencia de fragmentos intercalares.Al comparar las vías de abordaje, la bibliografía apoya el uso de los abordajes posteriores, reservando la recomendación de abordaje anterior para casos excepcionales.Para el tratamiento de esta lesión es fundamental conocer la anatomía del tobillo y considerar los factores descritos, además de la presencia de lesiones concomitantes.(AU)


Posterior malleolus fractures are frequent injuries, present in 7–44% of all ankle fractures.The objective of this study is to review the evidence to indicate the fixation of this fracture and to choose the appropriate surgical approach.The classic indications for fixation were fragment size greater than 25–30% of the articular surface and displacement greater than 2 mm. However, current evidence suggests that, rather than size, factors such as syndesmotic instability, intra-articular step-off greater than 1–2 mm, plafond impaction and the presence of intercalary fragments should be considered.When comparing the different surgical approaches, the literature supports the use of posterior approaches and reserves the recommendation of the traditional approach for exceptional cases.For the treatment of this injury it is essential to know the anatomy of the ankle and to consider all the factors described above, in addition to the presence of concomitant injuries.(AU)


Assuntos
Humanos , Fraturas do Tornozelo/cirurgia , Fixação de Fratura , Ossos do Tarso , Ortopedia , Traumatologia
5.
Bone Joint J ; 105-B(4): 361-364, 2023 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-36924163

RESUMO

Benefits of early stabilization of femoral shaft fractures, in mitigation of pulmonary and other complications, have been recognized over the past decades. Investigation into the appropriate level of resuscitation, and other measures of readiness for definitive fixation, versus a damage control strategy have been ongoing. These principles are now being applied to fractures of the thoracolumbar spine, pelvis, and acetabulum. Systems of trauma care are evolving to encompass attention to expeditious and safe management of not only multiply injured patients with these major fractures, but also definitive care for hip and periprosthetic fractures, which pose a similar burden of patient recumbency until stabilized. Future directions regarding refinement of patient resuscitation, assessment, and treatment are anticipated, as is the potential for data sharing and registries in enhancing trauma system functionality.


Assuntos
Fraturas do Fêmur , Traumatismo Múltiplo , Humanos , Fraturas do Fêmur/cirurgia , Fixação de Fratura , Fêmur/lesões , Acetábulo/lesões
6.
J Mech Behav Biomed Mater ; 140: 105740, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36863197

RESUMO

Computational predictions of stiffness and peri-implant loading of screw-bone constructs are highly relevant to investigate and improve bone fracture fixations. Homogenized finite element (hFE) models have been used for this purpose in the past, but their accuracy has been questioned given the numerous simplifications, such as neglecting screw threads and modelling the trabecular bone structure as a continuum. This study aimed to investigate the accuracy of hFE models of an osseointegrated screw-bone construct when compared to micro-FE models considering the simplified screw geometry and different trabecular bone material models. Micro-FE and hFE models were created from 15 cylindrical bone samples with a virtually inserted, osseointegrated screw (fully bonded interface). Micro-FE models were created including the screw with threads (=reference models) and without threads to quantify the error due to screw geometry simplification. In the hFE models, the screws were modelled without threads and four different trabecular bone material models were used, including orthotropic and isotropic material derived from homogenization with kinematic uniform boundary conditions (KUBC), as well as from periodicity-compatible mixed uniform boundary conditions (PMUBC). Three load cases were simulated (pullout, shear in two directions) and errors in the construct stiffness and the volume average strain energy density (SED) in the peri-implant region were evaluated relative to the micro-FE model with a threaded screw. The pooled error caused by only omitting screw threads was low (max: 8.0%) compared to the pooled error additionally including homogenized trabecular bone material (max: 92.2%). Stiffness was predicted most accurately using PMUBC-derived orthotropic material (error: -0.7 ± 8.0%) and least accurately using KUBC-derived isotropic material (error: +23.1 ± 24.4%). Peri-implant SED averages were generally well correlated (R2 ≥ 0.76), but slightly over- or underestimated by the hFE models and SED distributions were qualitatively different between hFE and micro-FE models. This study suggests that osseointegrated screw-bone construct stiffness can be predicted accurately using hFE models when compared to micro-FE models and that volume average peri-implant SEDs are well correlated. However, the hFE models are highly sensitive to the choice of trabecular bone material properties. PMUBC-derived isotropic material properties represented the best trade-off between model accuracy and complexity in this study.


Assuntos
Parafusos Ósseos , Osso Esponjoso , Fixação de Fratura , Osseointegração , Fenômenos Biomecânicos , Osso Esponjoso/fisiopatologia , Análise de Elementos Finitos , Osseointegração/fisiologia , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos
7.
Injury ; 54(4): 1041-1046, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36792402

RESUMO

Open pelvic ring injuries are rare clinical entities that require multidisciplinary care. Due to the scarcity of this injury, there is no well-defined treatment algorithm. As a result, conflicting evidence surrounding various aspects of care including wound management and fecal diversion remain. Previous studies have shown mortality reaching 50% in open pelvic ring injuries, nearly five times higher than closed pelvic ring injuries. Early mortality is due to exsanguinating hemorrhage, while late mortality is due to wound sepsis and multiorgan system failure. With advancements in trauma care and ATLS protocols, there has been an improved survival rate reported in published case series. Major considerations when treating these injuries include aggressive resuscitation with hemorrhage control, diagnosis of associated injuries, prevention of wound sepsis with early surgical management, and definitive skeletal fixation. Classification systems for categorization and management of bony and soft tissue injury related to pelvic ring injuries have been established. Fecal diversion has been proposed to decrease rates of sepsis and late mortality. While clear indications are lacking due to limited studies, previous studies have reported benefits. Further large-scale studies are necessary for adequate evaluation of treatment protocols of open pelvic ring injuries. Understanding the role of fecal diversion, avoidance of primary closure in open pelvic ring injuries, and importance of well-coordinated care amongst surgical teams can optimize patient outcomes.


Assuntos
Fraturas Ósseas , Fraturas Expostas , Ossos Pélvicos , Sepse , Humanos , Ossos Pélvicos/cirurgia , Ossos Pélvicos/lesões , Pelve , Fraturas Expostas/cirurgia , Fixação de Fratura , Sepse/terapia , Fraturas Ósseas/cirurgia , Fraturas Ósseas/complicações , Estudos Retrospectivos
9.
J Orthop Surg Res ; 18(1): 142, 2023 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-36843092

RESUMO

BACKGROUND: Operative treatment of humeral shaft fractures (AO/OTA 12) is being performed more frequently. Accordingly, it is important to understand the complications associated with plate fixation. This study analyzes risk factors associated with mechanical failure following plate fixation of humeral shaft fractures in order to further elucidate the mode and location of failure. METHODS: A retrospective review of 351 humeral shaft fractures was completed at a single level I trauma center. Eleven of eighty-five humeral shaft fractures had aseptic mechanical failure requiring revision (12.9%), following initial plate fixation. Fracture characteristics (AO type, comminution, location) and fracture fixation (plate type, multiplanar, number of screws proximal and distal to the fracture) were compared between aseptic mechanical failure and those without failure. A forward stepwise logistic regression analysis was performed to determine any significant predictors of aseptic mechanical failure. RESULTS: There was significant differences in fixation between the aseptic mechanical failure group and those without failure, specifically in the number of screws for proximal fixation (p = 0.008) and distal fixation (p = 0.040). In the aseptic mechanical failure group, patients tended to have less than < 8 cortices of proximal fixation (82%) and less than < 8 cortices of distal fixation (64%). Conversely, in patients without mechanical failure there was a tendency to have greater than > 8 cortices in both the proximal (62%) and distal fixation (70%). A forward stepwise logistic regression analysis found that less than < 8 cortices of proximal fixation was a significant predictor of aseptic failure, OR 7.96 (p = 0.011). We think this can be accounted for due to the variable bone quality, thinner cortices and multiple torsional forces in the proximal shaft that may warrant special consideration for fixation. CONCLUSION: The current dogma of humeral shaft fracture stabilization is to use a minimum of 3 screws proximal and distal to the fracture, however the current study demonstrates this is associated with higher rates of mechanical failure. In contrast, 4 bicortical screws or more of fixation on either side of the fracture had lower failure rates and may help to reduce the risk of mechanical failure. Level of Evidence Level III.


Assuntos
Fraturas do Úmero , Fraturas do Ombro , Humanos , Fraturas do Úmero/cirurgia , Úmero/cirurgia , Fixação de Fratura , Fatores de Risco , Placas Ósseas/efeitos adversos , Parafusos Ósseos/efeitos adversos , Estudos Retrospectivos , Fixação Interna de Fraturas/efeitos adversos , Fraturas do Ombro/cirurgia
10.
J Cardiothorac Surg ; 18(1): 61, 2023 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-36747271

RESUMO

BACKGROUND: Rib fractures are a common injury in trauma. Potential complications include pain, pneumonia, respiratory failure, disability, and death. Surgical stabilization of rib fractures (SSRF) has become an available treatment option, and complete video-assisted thoracoscopic surgery (VATS) for SSRF is gradually accepted because of minimally invasive and pain relief. To our knowledge, complete uni-port VATS for SSRF has not yet been reported. CASE PRESENTATION: A 53-year-old man accidentally fell off a three-meter high scaffolding while working resulting in severe chest pain and shortness of breath. He was found with left 7th through 11th rib fractures with a pulmonary contusion from computed tomography (CT). A 4 cm incision was made in the 7th intercostal space in the midaxillary line, and complete uni-port VATS for SSRF were operated. The patient's pain was significantly relieved after the operation, and the scar was tiny and unapparent. CONCLUSIONS: Complete uni-port VATS for SSRF is a novel and modificatory method of operation with the benefit of minimal invasion, meanwhile, intrathoracic injuries could be treated at the same time. Further study is warranted.


Assuntos
Fraturas das Costelas , Parede Torácica , Masculino , Humanos , Pessoa de Meia-Idade , Fraturas das Costelas/cirurgia , Fraturas das Costelas/complicações , Cirurgia Torácica Vídeoassistida/métodos , Fixação de Fratura/métodos , Dor , Estudos Retrospectivos
11.
JBJS Case Connect ; 13(1)2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36735806

RESUMO

CASE: External fixation has an established use in humeral lengthening and deformity correction. An 11-year-old boy presented with left-sided humeral shortening, proximal varus deformity, and glenohumeral dislocation. Anatomical and functional corrections were achieved through innovative monorail external fixation, including bifocal osteotomies of the surgical neck and diaphysis proximal to the deltoid insertion. CONCLUSION: Monorail external fixation with bifocal osteotomies of the surgical neck and diaphysis proximal to the deltoid insertion may improve the anatomical and functional outcomes in humeral shortening and proximal varus deformity with glenohumeral dislocation.


Assuntos
Fixadores Externos , Luxação do Ombro , Masculino , Humanos , Criança , Resultado do Tratamento , Luxação do Ombro/complicações , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/cirurgia , Fixação de Fratura , Úmero/cirurgia
12.
Trials ; 24(1): 78, 2023 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-36732808

RESUMO

BACKGROUND: Lateral compression type1 (LC-1) fragility fractures are a common, painful injury in older adults resulting in reduced mobility. The incidence of these fractures is increasing with the growing older adult population. The current standard of care is non-surgical management; however, patients with this injury are at risk of long-term immobility and related complications. INFIX is a pelvic fixation device used in younger patients with high-energy fractures. The device is fitted via a percutaneous technique with no external pin sites and has good purchase even in osteoporotic bone. It therefore has the potential to be well tolerated in patients with LC-1 fragility fractures. INFIX could improve patients' ability to mobilise and reduce the risk of immobility-related complications. However, there is a risk of complications related to surgery, and robust evidence is required on patient outcomes. This study will investigate the clinical and cost-effectiveness of surgical fixation with INFIX compared to non-surgical management of LC-1 fragility fractures in older adults. METHODS: A multi-centre randomised controlled trial of 600 patients allocated 1:1 to non-surgical management or INFIX surgery. The study will have a 12-month internal pilot to assess recruitment and trial feasibility. The primary outcome will be the patient quality of life over 6 months, measured by the patient-reported EQ-5D-5L. The secondary outcomes will include physical function, mental health, pain, delirium, imaging assessment, resource use, and complications. DISCUSSION: The L1FE study aims to compare the clinical and cost-effectiveness of surgical and non-surgical management of people aged 60 years and older with LC-1 fragility fractures. The trial is sufficiently powered and rigorously designed to inform future clinical and patient decision-making and allocation of NHS resources. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Registry ISRCTN16478561. Registered on 8 April 2019.


Assuntos
Fraturas Ósseas , Qualidade de Vida , Idoso , Humanos , Pessoa de Meia-Idade , Fraturas Ósseas/cirurgia , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Placas Ósseas , Fixação Interna de Fraturas/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
13.
J Pediatr Orthop ; 43(3): 187-191, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36728393

RESUMO

BACKGROUND: Surgery to achieve long bone lengthening and deformity correction in skeletally immature patients is traditionally performed through external fixators. The incidence of infection during treatment is high. Hydrotherapy is highly beneficial during external fixation management, but the infection rates may impact its utilization. The objective of this paper is to document the incidence and duration of infection in patients who participated in a full hydrotherapy program when performed under medical supervision and in accordance with strict follow-up protocols. METHODS: In this retrospective study, we documented the key characteristics of patients who participated in hydrotherapy after lower limb external fixation surgery including age, sex, diagnosis and surgery site, the incidence and duration of pin site infections, and the percentage of cases, which were able to comply with a full hydrotherapy protocol. RESULTS: The hydrotherapy pool met all daily water quality metrics. Thirty-four children (19 males and 15 females) had a mean±SD age of 10.9±4.6 years. Of the cases, 80% were unilateral and 20% were bilateral. Diagnoses included congenital hereditary (eg, achondroplasia), congenital nonhereditary conditions (eg, fibular hemimelia), and acquired conditions (eg, traumatic). The location of osteotomy site was quite evenly spread between the femur and the tibia/fibula. Three out of the 34 patients were unable to receive hydrotherapy due to continuous secretions; 2 patients did not miss any sessions. The mean number of treatments was 3 per week. During the entire period, a total of 1200 treatments were performed for these patients with only 32 cancellations (about 3%) due to secretions or other signs of infection. Spearman correlation coefficients showed significantly high correlations between the duration of external fixation and the duration of hydrotherapy. There are no significant correlations between infections and other factors (sex, age segment, whether the problem is unilateral or /bilateral, diagnosis, and duration of treatment). CONCLUSIONS: This is the first report, to our knowledge, that documents the low prevalence of infectious events during hydrotherapy treatment and demonstrates its feasibility. LEVEL OF EVIDENCE: Level III; retrospective, comparative study.


Assuntos
Fixadores Externos , Hidroterapia , Masculino , Criança , Feminino , Humanos , Adolescente , Estudos Retrospectivos , Fixação de Fratura , Resultado do Tratamento , Tíbia/cirurgia
14.
Ugeskr Laeger ; 185(4)2023 Jan 23.
Artigo em Dinamarquês | MEDLINE | ID: mdl-36760150

RESUMO

Distal radius fractures in children are the most common fractures in children. There is no consensus on when and how to treat these fractures. This review summarises the present knowledge. Children have a capacity to remodel and the remodeling of the bone is reverse correlated to the child's age. The remodeling potential allows us to accept some degree of malunion before intervention. Solely a cast applied with a 3-point fixation can treat most distal radius fractures. It is therefore essential to increase focus on educating doctors in applying a correct molded cast. Unstable fractures can usually be fixated with k-wires alone.


Assuntos
Fraturas do Rádio , Fraturas do Punho , Traumatismos do Punho , Humanos , Criança , Fixação de Fratura , Fraturas do Rádio/cirurgia , Fios Ortopédicos , Fixação Interna de Fraturas
15.
Artigo em Inglês | MEDLINE | ID: mdl-36834390

RESUMO

The aim of this study was to compare the clinical effectiveness and complications of different treatment modalities for elderly patients with distal radius fracture (DRF). METHODS: We performed a network meta-analysis (NMA) of randomized clinical trials (RCTs). Eight databases were searched. The eligibility criteria for selecting studies were RCTs that compared different treatment modalities (surgical or nonoperative) in patients older than 60 years with displaced or unstable intra-articular and/or extra-articular DRFs. RESULTS: Twenty-three RCTs met the eligibility criteria (2020 patients). For indirect comparisons, the main findings of the NMA were in volar locking plate (VLP) versus cast immobilization, with the mean differences for the patient-rated wrist evaluation (PRWE) questionnaire at -4.45 points (p < 0.05) and grip strength at 6.11% (p < 0.05). Additionally, VLP showed a lower risk ratio (RR) of minor complications than dorsal plate fixation (RR: 0.02) and bridging external fixation (RR: 0.25). Conversely, VLP and dorsal plate fixation showed higher rates of major complications. CONCLUSIONS: Compared with other treatment modalities, VLP showed statistically significant differences for some functional outcomes; however, most differences were not clinically relevant. For complications, although most differences were not statistically significant, VLP was the treatment modality that reported the lowest rate of minor and overall complications but also showed one of the highest rates of major complications in these patients. PROSPERO Registration: CRD42022315562.


Assuntos
Fraturas do Rádio , Fraturas do Punho , Idoso , Humanos , Fixação de Fratura , Metanálise em Rede , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Resultado do Tratamento , Ensaios Clínicos como Assunto
16.
Medicine (Baltimore) ; 102(7): e32798, 2023 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-36800615

RESUMO

RATIONALE: Retroperitoneal bleedings are the result of injury to parenchymal tissue or vascular structures within retroperitoneal cavity. This may arise spontaneously, as a result of trauma or iatrogenically. Patients usually do not manifest clinically apparent signs and symptoms until a substantial amount of blood loss has occurred. Therefore, it is associated with high morbidity and mortality. Herein we present and discuss a case of fatal iatrogenic retroperitoneal bleeding following open reduction and internal fixation of an unstable pelvic ring injury. PATIENT CONCERNS: A 66-year-old female patient presented to the Level I regional trauma center with severe pelvic pain after a pedestrian collision by a car. DIAGNOSES: In initial radiography and computed tomography, she was diagnosed with unstable pelvic ring injury. INTERVENTIONS: Definitive surgery for open reduction and internal fixation through the anterior approach to the sacroiliac joint and anterior intrapelvic approach was performed on the 8th day after the injury. OUTCOMES: Patient died 3 days after the surgery due to a massive retroperitoneal bleeding from iliolumbar artery. LESSONS: Insidious retroperitoneal bleeding from the small vessel may lead to fatal massive retroperitoneal hematoma. Therefore, active retroperitoneal bleeding should be suspected in cases of unexplained unstable hemodynamic status following orthopedic pelvic and acetabular surgery.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Feminino , Humanos , Idoso , Fraturas Ósseas/cirurgia , Ossos Pélvicos/cirurgia , Ossos Pélvicos/lesões , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fixação de Fratura/métodos , Artérias
17.
JBJS Case Connect ; 13(1)2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36706197

RESUMO

CASE: A 17-year-old boy presented with an open talus fracture complicated by soot contamination after a chimney-related accident. Standard irrigation and debridement (I&D) methods were used, but complete removal of soot was not possible. At the latest follow-up, there was no evidence of infection, hardware failure, or avascular necrosis. CONCLUSION: There is a lack of well-established guidelines regarding I&D of traumatic wounds contaminated with fine particulates. A review of potential debridement methods is discussed. Orthoapedic surgeons should be aware of hydrosurgical debridement as a potential treatment approach in these unique scenarios.


Assuntos
Fraturas do Tornozelo , Traumatismos do Tornozelo , Fraturas Expostas , Luxações Articulares , Tálus , Masculino , Humanos , Adolescente , Tálus/diagnóstico por imagem , Tálus/cirurgia , Traumatismos do Tornozelo/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Fixação de Fratura , Luxações Articulares/cirurgia , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/cirurgia
18.
J Orthop Surg Res ; 18(1): 65, 2023 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-36707900

RESUMO

BACKGROUND: Severe knee valgus/varus or complex multiplanar deformities are common in clinic. If not corrected in time, cartilage wear will be aggravated and initiate the osteoarthritis due to lower limb malalignment. Internal fixation is unable to correct severe complex deformities, especially when combined with lower limb discrepancy (LLD). Based on the self-designed digital six-axis external fixator Q spatial fixator (QSF), which can correct complex multiplanar deformities without changing structures, accuracy of correction can be improved significantly. METHODS: This retrospective study included 24 patients who suffered from complex knee deformity with LLD treated by QSF and internal fixation at our institution from January 2018 to February 2021. All patients had a closing wedge distal femoral osteotomy with internal fixation for immediate correction and high tibia osteotomy with QSF fixation for postoperative progressive correction. Data of correction prescriptions were computed by software from postoperative CT scans. RESULTS: Mean discrepancy length of operative side was 2.39 ± 1.04 cm (range 0.9-4.4 cm) preoperatively. The mean difference of lower limb was 0.32 ± 0.13 cm (range 0.11-0.58 cm) postoperatively. The length of limb correction had significant difference (p < 0.05). The mean MAD and HKA decreased significantly (p < 0.05), and the mean MPTA and LDFA increased significantly (p < 0.05). There were significant increase (p < 0.05) in the AKSS-O, AKSS-F and Tegner Activity Score. The lower limb alignment was corrected (p < 0.05). The mean time of removing external fixator was 112.8 ± 17.9 days (range 83-147 days). CONCLUSIONS: Complex knee deformity with LLD can be treated by six-axis external fixator with internal fixation without total knee arthroplasty. Lower limb malalignment and discrepancy can be corrected precisely and effectively by this approach.


Assuntos
Fixadores Externos , Fixação de Fratura , Humanos , Estudos Retrospectivos , Articulação do Joelho/cirurgia , Extremidade Inferior , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
19.
J Bone Joint Surg Am ; 105(3): 207-213, 2023 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-36622896

RESUMO

BACKGROUND: The aim of this single-center randomized controlled trial was to compare primary wound closure using a suture with secondary wound healing of pin sites after removal of temporary external fixation. METHODS: This noninferiority trial included all patients who were treated with a temporary external fixator on an upper or lower extremity at 1 institution. The primary outcome was pin-site infection. Secondary outcomes were measured at 2, 6, 12, 24, and 52 weeks and included all other complications, time to pin-site wound healing (in weeks), the most satisfactory pin site as rated by the patient, the visual analog scale (VAS) score for pain, and the Vancouver Scar Scale (VSS). The most proximal pin site was randomly allocated (1:1) to either primary closure or secondary wound healing, and the other pin sites were treated alternately. RESULTS: Seventy patients, providing 241 pin sites, were included between January 1, 2019, and March 1, 2020. A total of 123 pin sites were treated with primary closure and 118, with secondary wound healing. The median age was 55 years (interquartile range, 46 to 67 years), 44% were male, and the median duration of the external fixation was 6 days (interquartile range, 4 to 8 days). There were no pin-site infections in either group. Wound healing was significantly faster in the primary closure group (median of 2 versus 6 weeks, p = 0.013). The VSS and patient satisfaction showed no differences between groups. There was 1 case of fracture-related infection not related to any pin site. CONCLUSIONS: Primary closure of temporary external fixator pin sites did not result in higher infection rates compared with secondary wound healing, and pin sites healed significantly faster after primary closure. Primary closure should therefore be considered in patients treated with a temporary external fixator. LEVEL OF EVIDENCE: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fixadores Externos , Fraturas Ósseas , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Resultado do Tratamento , Cicatrização , Fraturas Ósseas/etiologia , Fixação de Fratura/efeitos adversos , Cicatriz/etiologia
20.
Injury ; 54(3): 991-995, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36621359

RESUMO

The role of external fixation in Damage Control Orthopaedics has been well described. Temporary external fixation has been recommended to provide relative bone stability while the soft tissue heals, prior to formal open reduction and internal fixation. Temporary bridging external fixation, that spans the joint, is recommended as primary skeletal stabilization in complex intra-articular and peri-articular fractures, in extensive peri-articular soft-tissue damage around the knee, ankle, elbow and wrist joints. Works devoted to temporary trans-hip external fixation in treatment of complex high-energy injuries are relatively rare. The purpose of this article is to present our experience in using temporary hip spanning external fixation during primary treatment of six patients suffered from complex open intra-articular and peri-articular fractures of the proximal femoral bone with extensive soft tissue damage due to war blast or high-velocity gunshot trauma. Primary management was based on the concept of Advanced Trauma Life Support and Damage Control Orthopaedics. Conversion to definitive bone reconstruction was performed on the next stage of the treatment after general and local stabilization.


Assuntos
Fraturas Intra-Articulares , Ortopedia , Fraturas da Tíbia , Humanos , Fixação de Fratura , Fixadores Externos , Resultado do Tratamento , Seguimentos , Fraturas da Tíbia/cirurgia , Fixação Interna de Fraturas , Fraturas Intra-Articulares/cirurgia
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