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1.
BMC Musculoskelet Disord ; 25(1): 370, 2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38730370

RESUMO

BACKGROUND: In this study, we present the unique case of a patient with knee osteoarthritis (OA) of the medial compartment and posterior cruciate ligament (PCL) deficiency who underwent simultaneous medial unicompartmental knee arthroplasty (UKA) and PCL reconstruction. CASE PRESENTATION: A 49-year-old male patient presented with a 1-year history of pain and instability in the left knee. The patient had previously experienced a trauma-related injury to the PCL of the left knee that was left untreated. Imaging and physical examination confirmed the presence of left medial knee OA along with PCL rupture. To address these issues, the patient underwent UKA combined with PCL reconstruction. The patient's Lysholm score was 47 before surgery and 81 three months after surgery, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 29 before surgery and 18 three months after surgery, and the International Knee Documentation Committee (IKDC) subjective score was 56.3 before surgery and 74.7 three months after surgery. Six months after surgery, the patient's gait returned to normal, and he was able to jog. CONCLUSION: This case report presents the first instance of UKA combined with PCL reconstruction and introduces a novel treatment approach for patients suffering from medial knee OA and ligament injury.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Humanos , Masculino , Pessoa de Meia-Idade , Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Reconstrução do Ligamento Cruzado Posterior/métodos , Ligamento Cruzado Posterior/cirurgia , Ligamento Cruzado Posterior/lesões , Resultado do Tratamento , Articulação do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem
2.
J Med Case Rep ; 18(1): 240, 2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38730409

RESUMO

BACKGROUND: People with achondroplasia exhibit distinct physical characteristics, but their cognitive abilities remain within the normal range. The challenges encountered during surgical procedures and perioperative care for achondroplastic individuals, are underrepresented in the existing literature. CASE PRESENTATION: In this report, the management of a 26-year-old North-African achondroplastic male is highlighted. The patient suffered a complete intra-articular distal femur fracture (AO/OTA 33-C1) and an ipsilateral patella fracture (AO/OTA 34-C1). The patient's unusual anatomical variations and the lack of suitable orthopedic implants posed significant surgical challenges, particularly in the context of a resource-limited developing country. Facial and spinal deformities, which are common in patients with achondroplasia, further complicated the anesthetic approach. CONCLUSIONS: The limited information on operative management of fractures in achondroplastic patients necessitated independent decision-making and diverging from the convenient approach where clear guidance is available in the literature.


Assuntos
Acondroplasia , Fraturas do Fêmur , Patela , Humanos , Adulto , Masculino , Acondroplasia/complicações , Fraturas do Fêmur/cirurgia , Fraturas do Fêmur/diagnóstico por imagem , Patela/lesões , Patela/cirurgia , Patela/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Fraturas Intra-Articulares/diagnóstico por imagem , Fixação Interna de Fraturas/métodos
3.
Molecules ; 29(9)2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38731435

RESUMO

Self-assembled peptide-based nanobiomaterials exhibit promising prospects for drug delivery applications owing to their commendable biocompatibility and biodegradability, facile tissue uptake and utilization, and minimal or negligible unexpected toxicity. TFF3 is an active peptide autonomously secreted by gastric mucosal cells, possessing multiple biological functions. It acts on the surface of the gastric mucosa, facilitating the repair process of gastric mucosal damage. However, when used as a drug, TFF3 faces significant challenges, including short retention time in the gastric mucosal cavity and deactivation due to degradation by stomach acid. In response to this challenge, we developed a self-assembled short peptide hydrogel, Rqdl10, designed as a delivery vehicle for TFF3. Our investigation encompasses an assessment of its properties, biocompatibility, controlled release of TFF3, and the mechanism underlying the promotion of gastric mucosal injury repair. Congo red/aniline blue staining revealed that Rqdl10 promptly self-assembled in PBS, forming hydrogels. Circular dichroism spectra indicated the presence of a stable ß-sheet secondary structure in the Rqdl10 hydrogel. Cryo-scanning electron microscopy and atomic force microscopy observations demonstrated that the Rqdl10 formed vesicle-like structures in the PBS, which were interconnected to construct a three-dimensional nanostructure. Moreover, the Rqdl10 hydrogel exhibited outstanding biocompatibility and could sustainably and slowly release TFF3. The utilization of the Rqdl10 hydrogel as a carrier for TFF3 substantially augmented its proliferative and migratory capabilities, while concurrently bolstering its anti-inflammatory and anti-apoptotic attributes following gastric mucosal injury. Our findings underscore the immense potential of the self-assembled peptide hydrogel Rqdl10 for biomedical applications, promising significant contributions to healthcare science.


Assuntos
Mucosa Gástrica , Hidrogéis , Peptídeos , Fator Trefoil-3 , Hidrogéis/química , Fator Trefoil-3/química , Fator Trefoil-3/metabolismo , Mucosa Gástrica/metabolismo , Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/lesões , Peptídeos/química , Peptídeos/farmacologia , Animais , Humanos , Sistemas de Liberação de Medicamentos , Camundongos , Cicatrização/efeitos dos fármacos
4.
BMC Surg ; 24(1): 146, 2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38734618

RESUMO

OBJECTIVES: To retrospectively investigate and analyze the characteristics of male bulbar urethral strictures or occlusions resulting from straddle injuries caused by falling from heights and riding activities. METHODS: The study included 56 patients with a history of straddle injury, who were divided into two groups: the falling group (n = 29) and the riding group (n = 27). All patients underwent urethroscopy and X-ray urethrography, followed by urethrotomy and anastomotic procedure. Both urethral and suprapubic catheters were retained for one month postoperatively. Subsequent follow-up assessments were conducted within one month to one year after surgery. RESULTS: The clinical data of two groups were analyzed. The average ages were 40.1 ± 11.2 (falling group, aged 18-59) and 26.8 ± 4.4 (riding group, aged 19-35), P < 0.05. In the falling group, 21 cases (72.4%) had offspring, while in the riding group, only 3 cases (11.1%) had offspring, P < 0.05. The stricture segments in the falling group were predominantly located in the proximal part of the bulbar region (89.7%), whereas in the riding group they mainly found in the distal part (96.3%), P < 0.05. In terms of urethrography results, the average lengths of stricture segments were measured as 17.6 ± 2.8 mm and 15.5 ± 4.6 mm respectively, P < 0.05. During surgery, the average lengths of stricture segments were recorded as 19.0 ± 2.5 mm and 17.4 ± 6.1 mm, P > 0.05. In the falling group, 20 cases (69.0%) involved bulbocavernosus muscle injury, P < 0.05. In the riding group, 5 cases (18.5%) involved corpus cavernosum injury, P < 0.05. After one month of the operation, all cases were able to pass through the 16Fr urethroscope without any apparent urethral strictures or complications observed in urethrography results. The maximum urinary flow rate for all cases exceeded 15 ml/s. Two months and one year after the operation, all cases experienced smooth urinary flow and ejaculation without any disorders reported. 3 cases (10.3%) in the falling group and 7 cases (25.9%) in the riding group complained of urethral stretching pain during erection, P > 0.05. CONCLUSIONS: Male bulbar urethral strictures or occlusions resulting from straddle injuries associated with falling from heights and riding activities exhibit distinct characteristics, necessitating the development of a comprehensive surgical plan tailored to the specific features of each condition and the diverse age groups affected.


Assuntos
Estreitamento Uretral , Humanos , Masculino , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Acidentes por Quedas , Uretra/lesões
5.
Ann Card Anaesth ; 27(1): 85-88, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38722131

RESUMO

ABSTRACT: Tracheal rupture is a very rare but life-threatening complication of endotracheal intubation. It is more common in women and patients older than 50 years old. Overinflation of endotracheal tube cuff and tracheal wall weakening are the most important pathogenetic mechanisms. Laceration sites are located in the posterior membranous wall in most cases. Subcutaneous and mediastinal emphysema and respiratory distress are the most common manifestations. A 55-year-old female presented with postoperative subcutaneous and mediastinal emphysema without dyspnea because of a tear in the posterior tracheal wall. The diagnosis was based on clinical manifestation, chest computer tomography scans (CT), and endoscopic findings. A conservative approach by broad-spectrum antibiotic therapy was decided because of patients' vital signs stability and the absence of esophageal injury. The follow-up showed that there was no lesion in the posterior tracheal wall. Our case showed that in clinically stable patients without mediastinitis and with spontaneous breathing, conservative management of tracheal tears is a safe procedure.


Assuntos
Tratamento Conservador , Intubação Intratraqueal , Lacerações , Tomografia Computadorizada por Raios X , Traqueia , Humanos , Feminino , Pessoa de Meia-Idade , Intubação Intratraqueal/efeitos adversos , Traqueia/lesões , Traqueia/diagnóstico por imagem , Tratamento Conservador/métodos , Lacerações/terapia , Lacerações/etiologia , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Enfisema Subcutâneo/terapia , Enfisema Subcutâneo/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Antibacterianos/uso terapêutico
6.
Medicine (Baltimore) ; 103(19): e38105, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38728515

RESUMO

RATIONALE: Maisonneuve fracture is a specific type of severe ankle injury. To our current knowledge, once a Maisonneuve fracture is diagnosed, the surgery is always recommended for fear of sequelae from inaccurate joint reconstruction. However, in this case, we treated a Maisonneuve fracture with a short leg cast, and the 41-month follow-up showed a favorable outcome with no post-traumatic osteoarthritis, chronic pain, and instability. Therefore, this case provides evidence for the feasibility of conservative treatment of Maisonneuve fracture. PATIENT CONCERNS: A female patient in her early twenties sprained her left ankle while running, suffering regional pain, swelling, and limited mobility. DIAGNOSES: We diagnosed a Maisonneuve fracture with superior fibular fracture and Volkmann tuberosity fracture, a slight separation of inferior tibiofibular syndesmosis (ITS). INTERVENTIONS: The patient rejected our surgical recommendations in favor of nonsurgical treatment, in addition to refusing immobilization of the knee. Consequently, we had to treat her with a short leg cast for 8 weeks and asked her to return for regular follow-up visits. OUTCOMES: At the final follow-up, the radiography showed complete healing of proximal fibula fracture. The patient reported no discernible subjective differences between her bilateral ankles. The range of motion of the left ankle was measured at 22° of dorsiflexion and 40° of plantarflexion. Functional assessments using Olerud-Molander ankle scale and American Orthopedic Foot and Ankle Society Ankle-Hindfoot scale both scored 100 points. Additionally, the radiographic assessment classified arthritis as stage 0 according to Morrey-Wiedeman classification. LESSONS: To avoid missing and misdiagnosing, the physical examination should always extend to 2 neighboring joints. Secondly, if a Maisonneuve fracture is suspected, further computed tomography scans, radiography, and magnetic resonance imaging can help to determine the stability of the ITS and the integrity of the lateral collateral ligaments before making therapeutic decisions. Finally, considering the lateral collateral ligaments may remain intact, we recommend stabilizing ITS by repairing the medial ligaments, which can be conducted arthroscopically and be more minimally invasive, providing an elastic fixation that aligns better with the biomechanics of the ITS which is characterized as a micro-mobile rather than fully fixed joint.


Assuntos
Moldes Cirúrgicos , Humanos , Feminino , Fraturas do Tornozelo/terapia , Fraturas do Tornozelo/diagnóstico por imagem , Fíbula/lesões , Fíbula/diagnóstico por imagem , Adulto Jovem , Seguimentos , Traumatismos do Tornozelo/terapia , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/diagnóstico por imagem , Fraturas da Fíbula
8.
Sci Rep ; 14(1): 9999, 2024 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-38693300

RESUMO

Although tension band wiring (TBW) is popular and recommended by the AO group, the high rate of complications such as skin irritation and migration of the K-wires cannot be ignored. Ding's screw tension band wiring (DSTBW) is a new TBW technique that has shown positive results in the treatment of other fracture types. The objective of this study was to evaluate the stability of DSTBW in the treatment of olecranon fractures by biomechanical testing. We conducted a Synbone biomechanical model by using three fixation methods: DSTBW, intramedullary screw and tension band wiring (IM-TBW), and K-wire TBW, were simulated to fix the olecranon fractures. We compared the mechanical stability of DSTBW, IM-TBW, and TBW in the Mayo Type IIA olecranon fracture Synbone model using a single cycle loading to failure protocol or pullout force. During biomechanical testing, the average fracture gap measurements were recorded at varying flexion angles in three different groups: TBW, IM-TBW, and DSTBW. The TBW group exhibited measurements of 0.982 mm, 0.380 mm, 0.613 mm, and 1.285 mm at flexion angles of 0°, 30°, 60°, and 90° respectively. The IM-TBW group displayed average fracture gap measurements of 0.953 mm, 0.366 mm, 0.588 mm, and 1.240 mm at each of the corresponding flexion angles. The DSTBW group showed average fracture gap measurements of 0.933 mm, 0.358 mm, 0.543 mm, and 1.106 mm at the same flexion angles. No specimen failed in each group during the cyclic loading phase. Compared with the IM-TBW and TBW groups, the DSTBW group showed significant differences in 60° and 90° flexion angles. The mean maximum failure load was 1229.1 ± 110.0 N in the DSTBW group, 990.3 ± 40.7 N in the IM-TBW group, and 833.1 ± 68.7 N in the TBW group. There was significant difference between each groups (p < 0.001).The average maximum pullout strength for TBW was measured at 57.6 ± 5.1 N, 480.3 ± 39.5 N for IM-TBW, and 1324.0 ± 43.8 N for DSTBW. The difference between maximum pullout strength of both methods was significant to p < 0.0001. DSTBW fixation provides more stability than IM-TBW and TBW fixation models for olecranon fractures.


Assuntos
Parafusos Ósseos , Fios Ortopédicos , Fixação Interna de Fraturas , Olécrano , Humanos , Olécrano/lesões , Olécrano/cirurgia , Fenômenos Biomecânicos , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/instrumentação , Fraturas da Ulna/cirurgia , Fraturas da Ulna/fisiopatologia , Fraturas Ósseas/cirurgia , Fratura do Olécrano
9.
Stem Cell Res Ther ; 15(1): 127, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38693589

RESUMO

BACKGROUND: Endometria are one of the important components of the uterus, which is located in the peritoneal cavity. Endometrial injury usually leads to intrauterine adhesions (IUA), accompanied by inflammation and cell death. We previously reported that both the endometrial ferroptosis was increased and monocytes/macrophages were involved in endometrial injury of IUA. Large peritoneal macrophages (LPMs) are recently reported to migrate into the injured tissues and phagocytose dead cells to repair the tissues. We previously demonstrated that mesenchymal stromal cells (MSCs) had made excellent progress in the repair of endometrial injury. However, it is unclear whether MSCs regulate the LPM efferocytosis against ferroptotic monocytes/macrophages in the injured endometria. METHODS: Here, endometrial injury in IUA mouse model was conducted by uterine curettage and LPS injection surgery and the samples were collected at different times to detect the changes of LPMs and ferroptotic monocytes/macrophages. We conducted LPMs depletion assay in vivo and LPMs and Erastin-induced ferroptotic THP-1 cells coculture systems in vitro to detect the LPM efferocytosis against ferroptotic monocytes/macrophages. The IUA model was treated with MSCs, and their effects on LPMs and endometrial repair were analyzed. Flow cytometry, western blotting, quantitative real-time PCR, immunohistochemical analysis, ELISA, and RNA-sequencing were performed. RESULTS: We found that LPMs migrated to the injured uteri in response to the damage in early phase (3 h), and sustained to a later stage (7 days). Astonishingly, we found that ferroptotic monocytes/macrophages were significantly increased in the injured uteri since 12 h after injury. Moreover, LPMs cocultured with Erastin-induced ferroptotic THP-1 cells in vitro, efferocytosis of LPMs against ferroptotic monocytes/macrophages was emerged. The mRNA expression profiles revealed that LPM efferocytosis against ferroptotic monocytes/macrophages was an induction of glycolysis program and depended on the PPARγ-HK2 pathway. Importantly, we validated that MSCs promoted the efferocytic capability and migration of LPMs to the injured uteri via secreting stanniocalcin-1 (STC-1). CONCLUSION: The data collectively demonstrated first the roles of LPMs via removal of ferroptotic monocytes/macrophages and provided a novel mechanism of MSCs in repairing the endometrial injury.


Assuntos
Macrófagos Peritoneais , Células-Tronco Mesenquimais , Monócitos , Feminino , Animais , Camundongos , Células-Tronco Mesenquimais/metabolismo , Células-Tronco Mesenquimais/citologia , Monócitos/metabolismo , Monócitos/citologia , Humanos , Macrófagos Peritoneais/metabolismo , Endométrio/lesões , Endométrio/metabolismo , Endométrio/citologia , Endométrio/patologia , Fagocitose , Camundongos Endogâmicos C57BL , Modelos Animais de Doenças , Eferocitose
10.
BMC Emerg Med ; 24(1): 84, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38760697

RESUMO

BACKGROUND: Strategies to enhance clinicians' adherence to validated imaging decision rules and increase the appropriateness of imaging remain unclear. OBJECTIVE: To evaluate the effectiveness of various implementation strategies for increasing clinicians' use of five validated imaging decision rules (Ottawa Ankle Rules, Ottawa Knee Rule, Canadian C-Spine Rule, National Emergency X-Radiography Utilization Study and Canadian Computed Tomography Head Rule). DESIGN: Systematic review. METHODS: The inclusion criteria were experimental, quasi-experimental study designs comprising randomised controlled trials (RCTs), non-randomised controlled trials, and single-arm trials (i.e. prospective observational studies) of implementation interventions in any care setting. The search encompassed electronic databases up to March 11, 2024, including MEDLINE (via Ovid), CINAHL (via EBSCO), EMBASE (via Ovid), Cochrane CENTRAL, Web of Science, and Scopus. Two reviewers assessed the risk of bias of studies independently using the Cochrane Effective Practice and Organization of Care Group (EPOC) risk of bias tool. The primary outcome was clinicians' use of decision rules. Secondary outcomes included imaging use (indicated, non-indicated and overall) and knowledge of the rules. RESULTS: We included 22 studies (5-RCTs, 1-non-RCT and 16-single-arm trials), conducted in emergency care settings in six countries (USA, Canada, UK, Australia, Ireland and France). One RCT suggested that reminders may be effective at increasing clinicians' use of Ottawa Ankle Rules but may also increase the use of ankle radiography. Two RCTs that combined multiple intervention strategies showed mixed results for ankle imaging and head CT use. One combining educational meetings and materials on Ottawa Ankle Rules reduced ankle injury imaging among ED physicians, while another, with similar efforts plus clinical practice guidelines and reminders for the Canadian CT Head Rule, increased CT imaging for head injuries. For knowledge, one RCT suggested that distributing guidelines had a limited short-term impact but improved clinicians' long-term knowledge of the Ottawa Ankle Rules. CONCLUSION: Interventions such as pop-up reminders, educational meetings, and posters may improve adherence to the Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian CT Head Rule. Reminders may reduce non-indicated imaging for knee and ankle injuries. The uncertain quality of evidence indicates the need for well-conducted RCTs to establish effectiveness of implementation strategies.


Assuntos
Regras de Decisão Clínica , Humanos , Fidelidade a Diretrizes , Sistema Musculoesquelético/lesões , Sistema Musculoesquelético/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
J Bodyw Mov Ther ; 38: 269-273, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38763569

RESUMO

INTRODUCTION: Previous studies have suggested that a reduced length of the biceps femoris long head (BFlh) fascicles may increase the risk of hamstring strain injury (HSI). However, it remains unclear whether the BFlh fascicles of the injured limb are shorter than those of the contralateral limb in athletes with an acute HSI. OBJECTIVE: To investigate the between-limb asymmetry of BFlh fascicle length in amateur athletes with an acute HSI. METHODS: Male amateur athletes were evaluated using ultrasound scans within five days following an HSI. The BFlh fascicle length was estimated using a validated equation. RESULTS: Eighteen injured athletes participated in this study. There was no significant difference (p = 0.27) in the length of BFlh fascicles between the injured limb (9.53 ± 2.55 cm; 95%CI 8.26 to 10.80 cm) and the uninjured limb (10.54 ± 2.87 cm; 95%CI 9.11 to 11.97 cm). Individual analysis revealed high heterogeneity, with between-limb asymmetries (percentage difference of the injured limb compared to the uninjured limb) ranging from -42% to 25%. Nine out of the 18 athletes had a fascicle length that was more than 10% shorter in the injured limb compared to the uninjured limb, five athletes had a difference of less than 10%, and four athletes had a fascicle length that was more than 10% longer in the injured limb compared to the uninjured limb. CONCLUSION: The architecture characteristics of injured and uninjured muscles is not consistent among athletes with HSI. Therefore, rehabilitation programs focused on fascicle lengthening should be evaluated on a case-by-case basis.


Assuntos
Traumatismos em Atletas , Músculos Isquiossurais , Entorses e Distensões , Ultrassonografia , Humanos , Masculino , Músculos Isquiossurais/lesões , Músculos Isquiossurais/fisiologia , Músculos Isquiossurais/fisiopatologia , Adulto Jovem , Traumatismos em Atletas/fisiopatologia , Entorses e Distensões/fisiopatologia , Adulto , Atletas
12.
J Bodyw Mov Ther ; 38: 329-338, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38763577

RESUMO

BACKGROUND: The mechanism of injury and the conservative rehabilitation of the ulnar collateral ligament of the elbow (UCL) are well studied and reported in overhead athletes, while research on gymnastic athletes is sparse. Evidence suggests exercise as the mainstay in UCL injury rehabilitation. With this report, we aimed to provide a complete rehabilitation protocol following a partial UCL tear of an acrobatic athlete, where exercise and adjunct treatments, such as manual therapy, were used in a progressive staged rehabilitation. CASE DESCRIPTION: A 16-year-old female acrobatic athlete was diagnosed with partial tear of the anterior band of UCL. The rehabilitation included progressive exercise loading in conjunction with manual therapy for 10 sessions in 8 weeks. Pain, UCL special tests, the Disabilities of Arm, Shoulder and Hand Score Questionnaire (DASH), and the Upper Limb Functional Index (ULFI) were assessed and administered at baseline and at 3, 6, 10 weeks, and 3 months. RESULTS: Improvement in all outcome measures was noted at the 3-month follow-up indicating a substantial reduction in pain and disability, and an increase in stability of the elbow joint. Return to training was achieved at 8 weeks from the initial visit, while return to sport at the pre-injury level was achieved at 3 months. CONCLUSION: Progressive exercise loading along with the addition of manual therapy is an effective intervention for the rehabilitation and return to sport following a partial UCL tear. A progressive staged rehabilitation guideline for acrobatic athletes with UCL injuries has been provided to be used and guide clinical practice. LEVEL OF EVIDENCE: Level IV.


Assuntos
Traumatismos em Atletas , Ligamento Colateral Ulnar , Lesões no Cotovelo , Humanos , Feminino , Adolescente , Ligamento Colateral Ulnar/lesões , Traumatismos em Atletas/reabilitação , Terapia por Exercício/métodos , Volta ao Esporte , Articulação do Cotovelo/fisiopatologia , Ginástica/lesões , Manipulações Musculoesqueléticas/métodos
13.
Adv Skin Wound Care ; 37(6): 1-7, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38767429

RESUMO

OBJECTIVE: To investigate the clinical effect of human acellular dermal matrix (HADM) combined with split-thickness skin graft in repairing lacunar soft tissue defects of the lateral heel after calcaneal fracture. METHODS: From June 2018 to October 2020, providers repaired 11 cases of lacunar soft tissue defects at the lateral part of the heel using HADM combined with split-thickness skin graft. After thorough debridement, the HADM was trimmed and filled into the lacunar defect area. Once the wound was covered, a split-thickness skin graft and negative-pressure wound therapy were applied. Providers evaluated the appearance, scar, ductility of the skin graft site, appearance of the donor site, healing time, and any reoperation at follow-up. RESULTS: Of the 11 cases, 8 patients achieved successful wound healing by primary intention. Three patients showed partial necrosis in the edge of the skin graft, but the wound healed after standard wound care. Evaluation at 6 and 12 months after surgery showed that all patients had wound healing and mild local scarring; there was no obvious pigmentation or scar formation in the donor skin area. The average healing time was 37.5 days (range, 24-43 days). CONCLUSIONS: The HADM combined with split-thickness skin graft is a simple and effective reconstruction method for lacunar soft tissue defect of the lateral heel after calcaneal fracture. In this small sample, the combination demonstrated few infections, minor scar formation, few donor site complications, and relatively short hospital stays.


Assuntos
Derme Acelular , Calcâneo , Calcanhar , Transplante de Pele , Lesões dos Tecidos Moles , Cicatrização , Humanos , Masculino , Feminino , Calcâneo/lesões , Calcâneo/cirurgia , Adulto , Calcanhar/lesões , Calcanhar/cirurgia , Transplante de Pele/métodos , Pessoa de Meia-Idade , Cicatrização/fisiologia , Lesões dos Tecidos Moles/cirurgia , Fraturas Ósseas/cirurgia
15.
Artigo em Inglês | MEDLINE | ID: mdl-38768051

RESUMO

INTRODUCTION: Diabetes mellitus (DM) is a risk factor of infection. Although DM has been associated with worse functional outcomes after acetabular fracture, literature regarding the effect of DM on surgical site infection and other early complications is lacking. METHODS: A 20-year registry from a level 1 trauma center was queried to identify 134 patients with DM and 345 nondiabetic patients with acetabular fractures. RESULTS: The diabetic patient population was older (57.2 versus 43.2; P < 0.001) and had higher average body mass index (33.6 versus 29.5; P < 0.001). Eighty-three patients with DM and 270 nondiabetics were treated surgically (62% versus 78%; P < 0.001). Diabetic patients who were younger (54.6 versus 61.4; P = 0.01) with fewer comorbidities (1.7 versus 2.2; P = 0.04) were more frequently managed surgically. On univariate analysis, patients with DM more commonly developed any early infection (28.4% versus 21%; P = 0.049) but were no more likely to develop surgical site infection, or other postoperative complications. Older patient age, length of stay, baseline pulmonary disease, and concurrent abdominal injury were independent predictors of postoperative infection other than surgical site infection. Diabetics that developed infection had more comorbidities (2.4 versus 1.5; P < 0.001) and higher Injury Severity Score (24.1 versus 15.8; P = 0.003), and were more frequently insulin-dependent (72.7% versus 41%; P = 0.01). DISCUSSION: Independent of management strategy, diabetic patients were more likely to develop an infection after acetabular fracture. Insulin dependence was associated with postoperative infection on univariate analysis. Optimal selection of surgical candidates among patients with DM may limit postoperative infections.


Assuntos
Acetábulo , Fraturas Ósseas , Sistema de Registros , Infecção da Ferida Cirúrgica , Centros de Traumatologia , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Fraturas Ósseas/cirurgia , Fraturas Ósseas/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Acetábulo/lesões , Acetábulo/cirurgia , Idoso , Diabetes Mellitus/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Complicações do Diabetes
16.
Int J Mol Sci ; 25(9)2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38732212

RESUMO

The skin wound healing process consists of hemostatic, inflammatory, proliferative, and maturation phases, with a complex cellular response by multiple cell types in the epidermis, dermis, and immune system. Magnesium is a mineral essential for life, and although magnesium treatment promotes cutaneous wound healing, the molecular mechanism and timing of action of the healing process are unknown. This study, using human epidermal-derived HaCaT cells and human normal epidermal keratinocyte cells, was performed to investigate the mechanism involved in the effect of magnesium on wound healing. The expression levels of epidermal differentiation-promoting factors were reduced by MgCl2, suggesting an inhibitory effect on epidermal differentiation in the remodeling stage of the late wound healing process. On the other hand, MgCl2 treatment increased the expression of matrix metalloproteinase-7 (MMP7), a cell migration-promoting factor, and enhanced cell migration via the MEK/ERK pathway activation. The enhancement of cell migration by MgCl2 was inhibited by MMP7 knockdown, suggesting that MgCl2 enhances cell migration which is mediated by increased MMP7 expression. Our results revealed that MgCl2 inhibits epidermal differentiation but promotes cell migration, suggesting that applying magnesium to the early wound healing process could be beneficial.


Assuntos
Diferenciação Celular , Movimento Celular , Queratinócitos , Magnésio , Metaloproteinase 7 da Matriz , Cicatrização , Cicatrização/efeitos dos fármacos , Humanos , Movimento Celular/efeitos dos fármacos , Queratinócitos/efeitos dos fármacos , Queratinócitos/metabolismo , Diferenciação Celular/efeitos dos fármacos , Magnésio/farmacologia , Magnésio/metabolismo , Metaloproteinase 7 da Matriz/metabolismo , Metaloproteinase 7 da Matriz/genética , Pele/metabolismo , Pele/efeitos dos fármacos , Pele/lesões , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Linhagem Celular , Epiderme/efeitos dos fármacos , Epiderme/metabolismo , Cloreto de Magnésio/farmacologia
17.
Jt Dis Relat Surg ; 35(2): 315-323, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38727110

RESUMO

OBJECTIVES: This study aims to investigate the influence of parents and children's psychological attributes and previous fracture history on upper extremity fractures in school-aged and adolescent children. PATIENTS AND METHODS: Between January 2022 and January 2023, a total of 194 participants consisting of 97 cases with upper extremity fractures (23 males, 74 females; median age: 10 years; range, 6 to 16 years) and 97 age-matched controls suffering from growing pains (47 males, 50 females; median age: 10 years; range, 6 to 16 years) were included in this case-control study. Both cases and controls were of school-age or over. The parents of the children were interviewed face-to-face using psychological scales including the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS), the Autism-Spectrum Quotient (AQ), the Short Form of the Conners' Parent Rating Scale-Revised (CPRS-R:S), and the Developmental Coordination Disorder Questionnaire 2007 (DCDQ'07). The results derived from these scales and the demographics of the participants were evaluated in terms of their association with the risk of upper extremity fractures. RESULTS: A household income below the official minimum monthly wage (MMW) and a previous fracture history showed a higher risk for upper extremity fractures (odds ratio [OR]=2.38, 95% confidence interval [CI]: 1.07-5.26 and OR=24.93, 95% CI: 3.27-189.98, respectively). In the univariate analyses, elevated scores on the hyperactivity subscale of CPRS-R:S (CPRS-R:SHS) were associated with a higher fracture risk (OR=1.14, 95% CI: 1.05-1.24). Furthermore, both a household income below MMW, a previous fracture history, and higher CPRS-R:S-HS scores were found as independent risk factors for upper extremity fractures in the multivariate regression analysis (OR=2.78, 95% CI: 1.13-6.86, OR=21.79, 95% CI: 2.73-174.03), and OR=1.11, 95% CI: 1.02-1.22, respectively). CONCLUSION: Our study results highlight the importance of known risk factors for upper extremity fractures such as lower monthly wage and the presence of previous fractures. The psychological states of parents and children should be evaluated together.


Assuntos
Fraturas Ósseas , Pais , Humanos , Masculino , Feminino , Criança , Adolescente , Estudos de Casos e Controles , Fraturas Ósseas/psicologia , Fraturas Ósseas/epidemiologia , Pais/psicologia , Fatores de Risco , Extremidade Superior/lesões , Ossos da Extremidade Superior/lesões , Inquéritos e Questionários
18.
Jt Dis Relat Surg ; 35(2): 347-353, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38727114

RESUMO

OBJECTIVES: This study aimed to present our experiences with cross-leg flap surgery, which demonstrates successful outcomes in lower limb soft tissue defects without the necessity of microsurgical intervention. PATIENTS AND METHODS: The retrospective study included 26 patients (18 males, 8 females; mean age: 35.6±12.2 years; range, 18 to 65 years) between January 2015 and September 2019. A fasciocutaneous cross-leg flap was applied to the recipient extremity, and the extremities were immobilized by a tubular external fixator. Flap divisions were performed on the 21st postoperative day. At least two years of clinical outcomes were presented. RESULTS: Twenty-five flaps survived and recovered completely without any complication at the donor site, flaps, or the recipient area. In one diabetic patient, partial flap loss was encountered, which granulated with secondary healing. All patients demonstrated stable wound coverage, with none demanding additional soft tissue surgeries. All patients resumed normal ambulation and physical activity without any residual joint stiffness. CONCLUSION: Cross-leg flap method is an effective and respectable option for extremity salvage as a good alternative to free flaps for the management of traumatic complex lower limb defects. This method is simple, provides abundant blood supply to the wound, and does not require microsurgical experience or a good working recipient artery.


Assuntos
Procedimentos de Cirurgia Plástica , Lesões dos Tecidos Moles , Retalhos Cirúrgicos , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Adolescente , Adulto Jovem , Idoso , Procedimentos de Cirurgia Plástica/métodos , Lesões dos Tecidos Moles/cirurgia , Traumatismos da Perna/cirurgia , Resultado do Tratamento , Extremidade Inferior/cirurgia , Extremidade Inferior/lesões , Extremidade Inferior/irrigação sanguínea , Salvamento de Membro/métodos
19.
Jt Dis Relat Surg ; 35(2): 361-367, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38727116

RESUMO

OBJECTIVES: This study aims to compare the radiological, biomechanical, and histopathological results of microfracture treatment and osteochondral damage repair treatment with a new scaffold product produced by the three-dimensional (3D) bioprinting method containing gelatin-hyaluronic acid-alginate in rabbits with osteochondral damage. MATERIALS AND METHODS: A new 3D bioprinted scaffold consisting of gelatin, hyaluronic acid, and alginate designed by us was implanted into the osteochondral defect created in the femoral trochlea of 10 rabbits. By randomization, it was determined which side of 10 rabbits would be repaired with a 3D bioprinted scaffold, and microfracture treatment was applied to the other knees of the rabbits. After six months of follow-up, the rabbits were sacrificed. The results of both treatment groups were compared radiologically, biomechanically, and histopathologically. RESULTS: None of the rabbits experienced any complications. The magnetic resonance imaging evaluation showed that all osteochondral defect areas were integrated with healthy cartilage in both groups. There was no significant difference between the groups in the biomechanical load test (p=0.579). No statistically significant difference was detected in the histological examination using the modified Wakitani scores (p=0.731). CONCLUSION: Our study results showed that 3D bioprinted scaffolds exhibited comparable radiological, biomechanical, and histological properties to the conventional microfracture technique for osteochondral defect treatment.


Assuntos
Alginatos , Bioimpressão , Cartilagem Articular , Gelatina , Ácido Hialurônico , Articulação do Joelho , Impressão Tridimensional , Alicerces Teciduais , Animais , Coelhos , Alginatos/química , Gelatina/química , Ácido Hialurônico/química , Ácido Hialurônico/uso terapêutico , Alicerces Teciduais/química , Cartilagem Articular/patologia , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Articulação do Joelho/cirurgia , Articulação do Joelho/patologia , Bioimpressão/métodos , Modelos Animais de Doenças , Fenômenos Biomecânicos , Imageamento por Ressonância Magnética , Artroplastia Subcondral/métodos
20.
Jt Dis Relat Surg ; 35(2): 368-376, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38727117

RESUMO

OBJECTIVES: The study aimed to examine the histopathological and biomechanical effects of papaverine administered intraperitoneally and locally on Achilles tendon healing in a rat model. MATERIALS AND METHODS: Forty-eight adult male Sprague-Dawley rats (range, 300 to 400 g) were used in this study conducted between October and November 2022. The rats were divided into three groups, with each group further subdivided into two for sacrifice on either the 15th (early period) or 30th (late period) day after surgery. The first (control) group received no treatment following Achilles tendon repair, while papaverine was intraperitoneally administered every other day for 10 days in the second group and locally in the third group after surgery. On the 15th and 30th days, the rats were sacrificed, and their Achilles tendons were subjected to biomechanical testing and histopathological evaluation. RESULTS: Histopathologically, there were no significant differences among the groups on the 15th day. However, on the 30th day, the locally applied papaverine group exhibited superior histopathological outcomes compared to the control group (p<0.05). Concerning the highest tensile strength values before rupture, the biomechanical assessment showed that the group receiving local papaverine treatment in the early period and both the group with systemic papaverine treatment and the one with local papaverine treatment in the late period displayed a statistically significant advantage compared to the control group (p<0.05). CONCLUSION: Locally administered papaverine has positive biomechanical effects in the early period and exhibits a positive correlation both histopathologically and biomechanically in the late period. Novel therapeutic options may be provided for patients through these findings.


Assuntos
Tendão do Calcâneo , Papaverina , Ratos Sprague-Dawley , Traumatismos dos Tendões , Cicatrização , Animais , Tendão do Calcâneo/lesões , Tendão do Calcâneo/efeitos dos fármacos , Tendão do Calcâneo/patologia , Tendão do Calcâneo/cirurgia , Papaverina/farmacologia , Papaverina/administração & dosagem , Papaverina/uso terapêutico , Masculino , Aderências Teciduais/tratamento farmacológico , Aderências Teciduais/patologia , Cicatrização/efeitos dos fármacos , Traumatismos dos Tendões/tratamento farmacológico , Traumatismos dos Tendões/patologia , Traumatismos dos Tendões/cirurgia , Ratos , Resistência à Tração/efeitos dos fármacos , Injeções Intraperitoneais , Fenômenos Biomecânicos/efeitos dos fármacos , Modelos Animais de Doenças
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