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1.
BMJ Case Rep ; 16(1)2023 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-36697113

RESUMO

The following case report outlines the impact of motor tics linked to Tourette's syndrome on dental development and healing following a dental injury to a maxillary central incisor. Emergency care and splinting of a mobile extruded maxillary left central incisor tooth was carried out at the local dentist on the same day as the dental trauma. A subsequent referral was made to the paediatric dental department for continued mobility of the maxillary central incisor on splint removal approximately 2 weeks later. A clinical and radiographic examination revealed shortened root length and apical root blunting associated with both maxillary anterior teeth. Further questioning revealed the likely cause of this to be related to the clenching and biting oral tics which the patient has experienced over the past 4 years. A removable splint has been fabricated for night-time wear and a mouthgaurd has been recommended for use during contact sports. Regular reviews will be conducted using a shared care approach between the patient's local dentist and the paediatric dental department.


Assuntos
Tiques , Avulsão Dentária , Fraturas dos Dentes , Síndrome de Tourette , Criança , Humanos , Tiques/etiologia , Síndrome de Tourette/complicações , Síndrome de Tourette/terapia , Incisivo/diagnóstico por imagem , Incisivo/lesões
2.
Artigo em Inglês | MEDLINE | ID: mdl-36673875

RESUMO

One of the most challenging issues professional football players face throughout their careers is injuries. Those injuries often result from suboptimal training programs that were not designed according to the players' individual needs. This prospective study aimed to examine in detail the effects of sports injuries on professional football players' weekly external load performances. Thirty-three male professional football players were monitored using 10-Hz Global Positioning System (GPS) units (Apex pro series, StatSports) during an entire season. The variables considered in the analysis were total distance (TD), high-speed running (HSR), accelerations (ACC), and decelerations (DEC). The comparisons were made between the four-week block before injury (-4T), four-week block after return (+4T), and players' season averages (S). Players displayed significantly higher values of TD, HSR, ACC, and DEC in the -4T, compared to the other two moments (+4T and S). Furthermore, the comparison between the +4T and S showed no significant variations in the GPS metrics. It was shown that a significant increase in players' weekly external load performance over a four-week period may have a negative effect on the occurrence of injuries from a professional football standpoint. Future research should consider the effects of injury severity on players' external load variations.


Assuntos
Traumatismos em Atletas , Futebol Americano , Futebol , Humanos , Masculino , Traumatismos em Atletas/epidemiologia , Estudos Prospectivos , Futebol/lesões , Aceleração
4.
Biomed Res Int ; 2023: 8956803, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36654870

RESUMO

Percutaneous minimally invasive surgery involving Achilles tendon (AT) repair has the advantages of a low rerupture rate and fewer postoperative complications. However, due to the inability to operate under direct vision, the injury of the small saphenous vein (SSV) and sural nerve (SN) remains largely a high risk involving many challenges. We propose to introduce the preoperative application and advantages of ultrasonography in percutaneous minimally invasive surgery for acute AT rupture. Our results indicated that ultrasonography could locate the position of the SN more accurately and reduce the risk of iatrogenic nerve injury. Compared with the traditional surface markers, the preoperative localization and marking of AT, SSV, and SN in ultrasonography significantly reduced the risk of intraoperative accidental injury to blood vessels and nerves, which could reduce postoperative complications and promote early rehabilitation of patients. We ultimately exploit the properties of ultrasonography in percutaneous minimally invasive surgery to treat Achilles tendon rupture.


Assuntos
Tendão do Calcâneo , Traumatismos dos Tendões , Humanos , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/cirurgia , Tendão do Calcâneo/lesões , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ultrassonografia , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/cirurgia , Doença Aguda , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento , Técnicas de Sutura
5.
J Cardiothorac Surg ; 18(1): 19, 2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36631825

RESUMO

BACKGROUND: Traumatic aortic pseudoaneurysms (PSAs) classified as grade III aortic injuries are conventionally repaired as procedural emergencies, generally within 24 h of arrival. These patients typically require adequate resuscitation and treatment of multiple traumatic injuries, which complicate optimal management strategies of aortic PSAs. This study reviews the experience of an Asian single center to evaluate the efficacy and safety of delayed (> 24 h) endovascular repair for PSAs. METHODS: Twenty-seven patients with blunt aortic injury (BTAI) were brought to our institution between February 2014 and May 2020. Patients with other grades of aortic injuries (grade I, II, or IV) were excluded from the study, and the remaining patients with grade III aortic injuries were placed into the early (< 24 h) and delayed (> 24 h) groups according to the timing of repair. Medical records and follow-up computed tomography (CT) scans were reviewed to document the outcomes of the procedures. Primary outcomes included mortality and complications. RESULTS: During this period, there were 14 patients (13 males and 1 females) with aortic PSAs, and each patient received thoracic endovascular aortic repair (TEVAR). Of these 14 patients, 1 underwent emergent TEVAR, and 13 underwent delayed repair (median 7 days, range, 3-14 days). Over a period of 8 years, the overall survival of our series was 100%. No paraplegia, stroke, ischemia of limb or other serious procedural complications were observed during the duration of follow-up. CONCLUSION: The experience of our center indicates that delayed repair for selected PSAs could be permissible, which enables a repair in more controlled circumstances.


Assuntos
Falso Aneurisma , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aorta Torácica/lesões , Implante de Prótese Vascular , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Estudos Retrospectivos , Traumatismos Torácicos/cirurgia , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgia
6.
BMC Musculoskelet Disord ; 24(1): 8, 2023 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-36604726

RESUMO

BACKGROUND: Bipolar clavicle injury is a rare injury involving any combination of dislocation and/or fracture at both ends of the clavicle. Most reports of bipolar clavicle injury have been based on a single case, and treatment of this injury remains controversial. The present study was performed to evaluate the efficacy of surgical management with internal plating for bipolar clavicle injuries. METHODS: We performed internal plating to treat seven consecutive bipolar clavicle injuries with different injury patterns from May 2013 to June 2021. A clavicle hook plate was used for five sternoclavicular joint injuries (including a revision surgery) and three acromioclavicular joint dislocations, a T plate was used for one sternoclavicular joint injury, and an anatomic plate was used for one distal clavicle fracture. At follow-up, radiographs were assessed for bone alignment, joint congruity, fracture union or malunion, and implant failure or migration. Clinical evaluation included determination of the Disability of the Arm, Shoulder, and Hand (DASH) score; Constant-Murley score; visual analog scale (VAS) score; and complications. RESULTS: The patients were regularly followed up after the operation, and functional parameters were assessed over time. At a mean follow-up of 28.1 ± 22.0 months, each fracture had solid bone union, and each dislocation showed no sign of recurrent instability. The mean shoulder forward flexion was 159.3° ± 7.9°, and the mean DASH score was 8.8 ± 5.1. The mean Constant-Murley score was 88.9 ± 7.9, with six cases assessed as excellent and one case assessed as good. The mean VAS score was 1.0 ± 1.5, and the mean patient satisfaction score was 9.3 ± 0.8. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfied with their treatment. CONCLUSIONS: In the present study, internal plating for bipolar clavicle injury allowed early mobilization and resulted in good joint function. We recommend fixation of the more severely affected side first because the other side may be passively reduced and acquire stability once the more severely affected side has been fixed. Internal fixation of the other end may therefore be unnecessary unless residual instability exists.


Assuntos
Fraturas Ósseas , Luxações Articulares , Luxação do Ombro , Humanos , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Clavícula/lesões , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Luxação do Ombro/cirurgia , Placas Ósseas , Resultado do Tratamento
7.
Clin Ter ; 174(1): 97-108, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36655652

RESUMO

Background: The diagnosis of neck lesions remains a medico-legal diagnostic challenge because of the complexity of the anatomical relationship of the neck's organs and their anthropometric morphological variability. We compared the multidisciplinary approach using autopsy and postmortem computed tomography (PMCT), postmortem fine preparation (PMFP), postmortem micro-computed tomography (micro-CT), and postmortem magnetic resonance (PMMR) with the performance of a single diagnostic method among them evaluating the significance of different results. The multidisciplinary approach significantly reduced the number of unidentified neck lesions. The analysis demonstrates the need to better define the scan protocols and compose forensic guidelines for radiological application. The results of this study point out the need to compare the different diagnostic approaches in deceased subjects to better define the radiological scan protocol based on a multidisciplinary approach, including autopsy and radiological methods and the radiological scan protocols. Methods: We performed a systematic electronic search of retrospective scientific articles in PubMed, the Scopus database, and the Cochrane Library. The following combinations of words were used: "hyoid fracture"; "comparison between PMCT AND autopsy"; "hyoid fracture PMCT AND autopsy"; "hyoid bone fracture AND forensic imaging"; "hyoid fracture AND PMCT"; "neck fracture PMCT AND autopsy"; "laryngohyoid lesions"; "postmortem CT AND autopsy in strangulation"; "postmortem AND strangulation Signs "; "strangulation virtopsy"; and "strangulation AND MRI". We selected 16 articles that were published between March 2003 and June 2020. We conducted a meta-analysis with R software to evaluate the rates. We obtained related confidence intervals and a forest plot. Results: Thyroid cartilage damages were significantly more common than hyoid bone fractures (61.7% vs 42.2%) in a sample of 128 subjects. The synergic uses of autopsy/PMCT, autopsy/PMFP, autopsy/microCT, and autopsy/PMMR revealed significantly higher rates than a single investigation. We analyzed the PMCT scan data. The scan parameters evaluated were as follows: row, scan sample, reconstruction, kernel, slice thickness, kVp, and mAs. A lack of uniformity in the application of the protocol was observed. Conclusion: Further studies are needed to better define the radiological scan protocols and to draw guidelines to identify the appropriate radiological methods in relation to the specific case.


Assuntos
Fraturas Ósseas , Lesões do Pescoço , Fraturas da Coluna Vertebral , Humanos , Microtomografia por Raio-X , Estudos Retrospectivos , Cartilagem Tireóidea/lesões , Cartilagem Tireóidea/patologia , Fraturas Ósseas/patologia , Autopsia/métodos , Lesões do Pescoço/patologia
8.
J Orthop Surg Res ; 18(1): 56, 2023 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-36658546

RESUMO

BACKGROUND: Spinopelvic dissociation (SPD) is generally caused by high-energy injury mechanisms, and, in the absence of timely diagnosis and treatment, it can lead to chronic pain and progressive deformity. However, SPD is difficult to manage because of its rarity and complexity. In this study, we re-defined SPD according to the mechanism of injuries and biomechanical characteristics of the posterior pelvic ring and developed new classification criteria and treatment principles based on the classification for SPD. METHODS: Between June 2015 and September 2020, 30 patients with SPD which were selected from 138 patients with pelvic fractures were enrolled. Physical examination was performed, classification criteria (301 SPD classification) were developed, and specific treatment standards were established according to the classifications. RESULTS: The injury mechanisms and co-existing injuries did not significantly differ between the classical SPD patients and expanded SPD patients. The 301 SPD classification criteria covered all the patients. Fixation by biplanar penetration screws was used in 7 patients, 11 patients received fixation by uniplanar penetration screws, 6 patients used sacroiliac compression screws, 3 patients received uniplanar screws combined with sacroiliac compression screws, and open spondylopelvic fixation was used in only 3 patients. According to the Matta criteria, 19, 7, and 4 patients achieved excellent, good, and fair reduction. The Majeed function score of the patients ranged from 9 to 96 points, and the mean score was 72.9 ± 24.6 points. CONCLUSION: The expanded definition for SPD is particularly significant for definite diagnosis and prevention of missing diagnosis, based on which the 301SPD classification criteria can more systemically guide the clinical treatment of SPD, increase the treatment efficacy, and reduce surgical trauma. Chinese Clinical Trial Registry: ChiCTR-IPR-16009340.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Humanos , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Ossos Pélvicos/cirurgia , Ossos Pélvicos/lesões , Pelve , Exame Físico , Estudos Retrospectivos
9.
Zhonghua Yi Xue Za Zhi ; 103(4): 287-290, 2023 Jan 31.
Artigo em Chinês | MEDLINE | ID: mdl-36660790

RESUMO

The clinical data of 20 patients with blunt high-grade pancreatic trauma who were admitted to the Department of Hepatobiliary and Pancreatic Surgery of Changhai Hospital Affiliated to Naval Military Medical University from December 2003 to February 2022 were retrospectively analyzed. There were 15 males and 5 females with a median age of 39 years (range: 14-54 years). The degree of pancreatic injury was graded according to the American Association for the Surgery of Trauma (AAST) scale, including 10 cases of grade Ⅲ (50%), 8 cases of grade Ⅳ (40%), and 2 cases of grade Ⅴ (10%). Then, the strategy of diagnosis and treatment for blunt high-grade pancreatic trauma was summarized. The diagnostic rate of CT was 78.9%. Finally, 17 cases (85%) were cured and 3 cases (15%) died. Among the 10 patients with grade Ⅲ pancreatic injury, 7 cases received distal pancreatectomy and splenectomy, 1 case received distal pancreatectomy with spleen preserved, 1 case received pancreatic duct stent placement under endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous catheter drainage (PCD), and 1 case received only PCD. Among 8 cases of grade Ⅳ, 3 cases underwent Roux-en-Y pancreaticojejunostomy, 1 case received distal pancreatectomy and splenectomy, 1 case underwent distal pancreatectomy with spleen preserved, 2 cases received necrotic tissue removal+external drainage of pancreatic duct+abdominal drainage, and 1 case received exploratory laparotomy and gauze packing hemostasis. For 2 cases of grade Ⅴ, 1 underwent pylorus preserving pancreaticoduodenectomy, and the other case underwent pancreaticoduodenectomy combined with right hemicolectomy and splenectomy. Therefore, the treatment of blunt high-grade pancreatic trauma should follow the individualized treatment strategy, pay attention to the control of bleeding, extensive external drainage, appropriate debridement and resection and rational application of damage control surgery, select appropriate patients for conservative treatment, and ultimately benefit the patient.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Masculino , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Pâncreas/lesões , Pâncreas/cirurgia , Pancreatectomia , Colangiopancreatografia Retrógrada Endoscópica , Pancreaticoduodenectomia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia
10.
Bone Joint J ; 105-B(1): 5-10, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36587253

RESUMO

Injury to the triangular fibrocartilage complex (TFCC) may result in ulnar wrist pain with or without instability. One component of the TFCC, the radioulnar ligaments, serve as the primary soft-tissue stabilizer of the distal radioulnar joint (DRUJ). Tears or avulsions of its proximal, foveal attachment are thought to be associated with instability of the DRUJ, most noticed during loaded pronosupination. In the absence of detectable instability, injury of the foveal insertion of the radioulnar ligaments may be overlooked. While advanced imaging techniques such as MRI and radiocarpal arthroscopy are well-suited for diagnosing central and distal TFCC tears, partial and complete foveal tears without instability may be missed without a high degree of suspicion. While technically challenging, DRUJ arthroscopy provides the most accurate method of detecting foveal abnormalities. In this annotation the spectrum of foveal injuries is discussed and a modified classification scheme is proposed.Cite this article: Bone Joint J 2023;105-B(1):5-10.


Assuntos
Instabilidade Articular , Fibrocartilagem Triangular , Traumatismos do Punho , Humanos , Fibrocartilagem Triangular/diagnóstico por imagem , Fibrocartilagem Triangular/lesões , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho , Ulna , Artroscopia/métodos , Ruptura
11.
Indian J Ophthalmol ; 71(1): 113-118, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36588219

RESUMO

Purpose: To identify the risk factors predisposing posterior capsule rupture (PCR) during mature cataract surgery. Methods: A total of 1302 consecutive mature cataract cases were included in this retrospective study. A detailed examination was performed for each patient and risk factors including age, gender, systemic diseases, ocular comorbidities, surgeon, and surgery method were recorded. Cases with PCR during surgery were classified as complicated. Multivariate logistic regression analysis with a generalized estimating equations method was applied for statistical analysis. Results: The overall rate of PCR was 7.30% (n=95 eyes). After adjusting for confounders, factors that remained significant on multivariate analysis were strabismus (odds ratio [OR]: 5.70, 95% confidence interval [CI]: 2.17-14.97; P < 0.001), phacodonesis (OR: 4.62, 95% CI: 2.59-8.22; P < 0.001), history of trauma (OR: 4.46, 95% CI: 1.64-12.12; P = 0.003), surgery method (extracapsular cataract extraction/phacoemulsification) (OR: 2.61, 95% CI: 1.60-4.26; P < 0.001), and pseudoexfoliation (OR: 1.94, 95% CI: 1.20-3.16; P = 0. 007). Conclusion: Strabismus, phacodonesis, history of trauma, extracapsular cataract extraction method, and pseudoexfoliation were found to be important risk factors for developing PCR. Appropriate preoperative and perioperative precautions for these higher-risk cases can reduce complications.


Assuntos
Extração de Catarata , Catarata , Cápsula do Cristalino , Doenças do Cristalino , Facoemulsificação , Estrabismo , Humanos , Estudos Retrospectivos , Acuidade Visual , Extração de Catarata/efeitos adversos , Extração de Catarata/métodos , Facoemulsificação/efeitos adversos , Facoemulsificação/métodos , Catarata/complicações , Cápsula do Cristalino/cirurgia , Cápsula do Cristalino/lesões , Doenças do Cristalino/etiologia , Fatores de Risco , Estrabismo/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
12.
Indian J Ophthalmol ; 71(1): 300-302, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36588258

RESUMO

Facial foreign body (FB) is common after trauma, but iatrogenic orbital FB is a rare and unexpected complication of facial FB removal surgery. We present the case of a 43-year-old man with a glass FB in his nose. During the operation, this FB broke into two pieces, and the larger one pierced into the left orbit, close to the eyeball. A three-dimensional (3D) model was made that accurately recreated the shape and position of the FB in the orbit, according to which the FB was removed. 3D-printing technology is a great tool when dealing with complex facial FB.


Assuntos
Corpos Estranhos no Olho , Masculino , Humanos , Adulto , Corpos Estranhos no Olho/diagnóstico , Corpos Estranhos no Olho/etiologia , Corpos Estranhos no Olho/cirurgia , Órbita/diagnóstico por imagem , Órbita/cirurgia , Órbita/lesões , Nariz , Olho , Doença Iatrogênica
13.
Indian J Ophthalmol ; 71(1): 321, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36588276

RESUMO

Background: A measurable burden to the emergency ophthalmology department is represented by ocular trauma in pediatric patients. Traumatic cataracts still result in visual disability despite great advancements in diagnostic and treatment methods. Cataract surgery with intraocular lens (IOL) implantation aids in the improvement of visual acuity in such cases. Duration of trauma is an important prognostic factor for recovery of visual acuity before amblyopia sets in young patients with penetrating ocular injury. Purpose: This video deals with the management of a case of partially absorbed traumatic cataract in a scenario of an old and neglected penetrating injury. This case had a corneal scar, ruptured anterior lens capsule, and posterior synechiae formation between the posterior pigmented epithelium of the iris and the lens capsule. Synopsis: In a case of penetrating ocular injury, one should always suspect violation of posterior lens capsule, weakened or broken zonules and retained intraocular foreign body. In this case, a circular capsulorhexis is difficult to attain. After staining the capsule with trypan blue dye, viscoelastic substance is instilled in the anterior chamber to have good control over the rhexis and to avoid rhexis run out. In case the rhexis runs off to the equator, a pair of Vannas scissors is used to cut the extended flap. The cataract is partially absorbed, white and soft in nature and is easily mobilized from the bag and eaten up via phacoaspiration. Before implantation of posterior chamber intraocular lens (PCIOL) in the sulcus, posterior synechiae are released by swiping a cyclodialysis spatula in the sulcus area. Visual axis is cleared by giving nicks in the posterior capsule to remove the central dense posterior plaque. Automated anterior vitrectomy is done and a three-piece PCIOL is implanted safely in the ciliary sulcus. Retained viscoelastic substance is washed, intracameral antibiotic is instilled, and the anterior chamber is subsequently formed via stromal wound hydration. Highlights: Through this video, we tried to show how one should proceed with phacoaspiration with intraocular lens implantation in a case of traumatic cataract post penetrating injury in a sequential manner. Video Link: https://youtu.be/20DbYUn_Fd8.


Assuntos
Extração de Catarata , Catarata , Corpos Estranhos no Olho , Cristalino , Humanos , Criança , Implante de Lente Intraocular/métodos , Catarata/complicações , Catarata/diagnóstico , Cristalino/cirurgia , Cristalino/lesões , Extração de Catarata/efeitos adversos , Corpos Estranhos no Olho/cirurgia , Substâncias Viscoelásticas , Complicações Pós-Operatórias/cirurgia
14.
Am J Sports Med ; 51(1): 169-178, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36592020

RESUMO

BACKGROUND: Epidemiological studies of lateral ankle sprains in NCAA sports are important in appraising the burden of this injury and informing prevention efforts. PURPOSE: To describe the epidemiology of lateral ankle sprains in NCAA sports during the 2014-15 through 2018-19 seasons. STUDY DESIGN: Descriptive epidemiology study. METHODS: Injury and exposure information collected within the NCAA Injury Surveillance Program (ISP) were examined. Counts, rates, and proportions of lateral ankle sprains were used to describe injury incidence by sport, event type (practices, competitions), season segment (preseason, regular season, postseason), injury mechanism (player contact, noncontact, and surface contact, injury history (new, recurrent), and time loss (time loss [≥1 day], non-time loss). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions. RESULTS: A total of 3910 lateral ankle sprains were reported (4.61 per 10,000 athlete exposures) during the study period, and the overall rate was highest in men's basketball (11.82 per 10,000 athlete exposures). The competition-related injury rate was higher than the practice-related rate (IRR, 3.24; 95% CI, 3.04-3.45), and across season segments, the overall rate was highest in preseason (4.99 per 10,000 athlete exposures). Lateral ankle sprains were most often attributed to player-contact mechanisms in men's (43.2%) and women's sports (35.1%), although injuries were more prevalently attributed to player contact in men's than in women's sports (IPR, 1.23; 95% CI, 1.13-1.34). Overall, 49.7% of all lateral ankle sprains were time loss injuries. CONCLUSIONS: The findings of this study are consistent with previous epidemiological investigations of lateral ankle sprains among NCAA athletes. Results offer additional context on differential injury mechanisms between men's and women's sports and on injury risk across the competitive season. Future research may examine the effectiveness of deploying injury prevention programs before the start of a season.


Assuntos
Traumatismos do Tornozelo , Traumatismos em Atletas , Basquetebol , Ligamentos Colaterais , Entorses e Distensões , Masculino , Humanos , Feminino , Estados Unidos/epidemiologia , Entorses e Distensões/epidemiologia , Tornozelo , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/complicações , Universidades , Atletas , Basquetebol/lesões , Traumatismos do Tornozelo/epidemiologia , Traumatismos do Tornozelo/etiologia , Incidência , Ligamentos Colaterais/lesões
15.
Gastroenterol. hepatol. (Ed. impr.) ; 46(1): 69-79, Ene. 2023. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-214373

RESUMO

La colangiopancreatografía retrógrada endoscópica (CPRE) es la técnica de elección para el tratamiento de la patología biliopancreática. Sin embargo, las imágenes fluoroscópicas no siempre permiten un diagnóstico adecuado. Por otra parte, algunos cálculos de gran tamaño no se pueden extraer con los métodos habituales. En estas situaciones, la colangioscopia ha mostrado ser una herramienta fundamental para el diagnóstico de las estenosis biliares y el tratamiento de los cálculos de gran tamaño. Además, su papel en la patología pancreática está en creciente aumento. El desarrollo de un colangioscopio de un único operador y desechable ha permitido expandir la técnica entre buena parte de los hospitales que realizan CPRE. Por este motivo, la Sociedad Española de Endoscopia Digestiva ha desarrollado este documento de consenso sobre la utilización del colangioscopio Spyglass-DS. El documento ha sido elaborado por un grupo de endoscopistas expertos en colangioscopia, revisando la evidencia científica de las principales indicaciones actuales de la colangiopancreatoscopia.(AU)


Endoscopic retrograde cholangiopancreatography (ERCP) is the technique of choice for the treatment of biliopancreatic pathology. However, fluoroscopic imaging does not always allow an adequate diagnosis. On the other hand, some large stones cannot be removed by the usual methods. In these situations, cholangioscopy has proven to be an essential tool for the diagnosis of biliary strictures and the treatment of large stones. Its role in pancreatic pathology is also increasing. The development of a single-operator, disposable cholangioscope has made it possible to expand the technique to a large number of hospitals that perform ERCP. For this reason, the Spanish Society of Digestive Endoscopy has developed this consensus document on the use of the Spyglass-DS cholangioscope. The document has been prepared by a group of endoscopists with expertise in cholangioscopy, reviewing the scientific evidence on the main current indications for cholangiopancreatoscopy.(AU)


Assuntos
Humanos , Consenso , Endoscopia do Sistema Digestório , Colangiopancreatografia Retrógrada Endoscópica , Constrição Patológica , Neoplasias Intraductais Pancreáticas , Espanha , Pâncreas/lesões
16.
BMC Musculoskelet Disord ; 24(1): 53, 2023 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-36681796

RESUMO

BACKGROUND: Surgeons often encounter recurrent kyphosis of Cobb angle following thoracolumbar burst fracture surgery. Some factors affecting postoperative correction loss have been studied in previous studies, but few have examined the relationship between laminar fractures and postoperative loss of correction. METHODS: The clinical data of 86 patients with thoracolumbar burst fracture who met the inclusion criteria and were admitted to our Department of Spine Surgery between 2013 and 2020 was retrospectively analyzed. To examine the association between laminar fracturs and postoperative correction loss, demographic and radiographic characteristics of the two groups were analyzed. RESULTS: The presence or absence of laminar fractures was statistically different between the two groups (P < 0.05). Binary logistic regression analysis showed that laminar fractures and preoperative Cobb were statistically significant in the two groups. There were statistically significant differences in the degree of injury of laminar fractures in the coronal plane between the two groups (P < 0.05). CONCLUSION: This study investigated that the presence or absence of laminar fractures and preoperative Cobb contribute to loss of correction after thoracolumbar burst fracture surgery. There was a statistically significant difference between full-length and partial-length laminar fractures on the loss of postoperative correction of thoracolumbar burst fractures with laminar fractures.


Assuntos
Fraturas Ósseas , Fraturas Cominutivas , Cifose , Fraturas da Coluna Vertebral , Humanos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Fixação Interna de Fraturas , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Vértebras Lombares/lesões , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Vértebras Torácicas/lesões , Cifose/diagnóstico por imagem , Cifose/etiologia , Cifose/cirurgia , Resultado do Tratamento
17.
Ann Plast Surg ; 90(2): 144-150, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36688857

RESUMO

BACKGROUND: Obstetric brachial plexus injury (OBPI) remains a fairly common problem in newborns despite the improved obstetric care. Children who do not show complete recovery often present with residual shoulder deformity of limited external rotation and abduction. Secondary interventions in the form of tendon transfer and soft tissue release are aimed at correcting the implicated muscular imbalance to restore shoulder function. AIM: The aim of this work was to compare the results of latissimus dorsi versus teres major tendon transfer in patients with OBPI with limited shoulder external rotation. PATIENTS AND METHODS: This study included 40 patients admitted to El Hadara University Hospital with OBPI and limited shoulder abduction and external rotation aged between 1.5 and 4 years. Half of the patients had a latissimus dorsi transfer, and the other half, a teres major one. Children with limited preoperative passive external rotation in both groups required a subscapularis slide. Patients were evaluated preoperatively, at 6 months, and 12 months postoperatively using the Gilbert scale. RESULTS: Teres major tendon transfer showed better results in restoring limited shoulder abduction and external rotation than latissimus dorsi transfer. Limited shoulder internal rotation was the main complication occurring postoperatively. Loss of the last degree of internal rotation occurred in most patients who had subscapularis slide. Most patients regained functional midline abilities with physiotherapy and required no further interventions. CONCLUSIONS: Isolated teres major transfer has shown better results in improving the range of external rotation and abduction compared with isolated latissimus dorsi tendon transfer. Age of the patients did not affect the overall final improvement in shoulder range of motion. Limited internal rotation is the main complication postoperatively, which was prevalent in patients who required a subscapularis slide but was not statistically significant.


Assuntos
Neuropatias do Plexo Braquial , Plexo Braquial , Articulação do Ombro , Músculos Superficiais do Dorso , Recém-Nascido , Criança , Humanos , Lactente , Pré-Escolar , Ombro , Neuropatias do Plexo Braquial/cirurgia , Resultado do Tratamento , Articulação do Ombro/cirurgia , Plexo Braquial/lesões , Transferência Tendinosa/métodos , Amplitude de Movimento Articular
18.
Langenbecks Arch Surg ; 408(1): 61, 2023 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-36690777

RESUMO

AIM: To determine the risk of hepatic pseudoaneurysm after liver trauma in relation to the severity of liver injury. METHODS: We performed a systematic review and meta-analysis in compliance with PRISMA statement standards (Registration Number: CRD42022328834). A search of electronic information sources was conducted to identify all studies reporting the risk of hepatic pseudoaneurysm after liver trauma. The JBI assessment tool was used to assess the risk of bias of the included studies. Random-effects models were applied to calculate pooled outcome data. RESULTS: A total of 2030 patients from six studies were included. Based on the American Association for the Surgery of Trauma classification system, 21% had grade I injury; 33% grade II injury; 28% grade III injury; 12% grade IV injury and 5% grade V injury. The pooled risk of hepatic pseudoaneurysm was 1.8% (95% CI 1.1-2.5%). The risk was 0.4% (0-1.2%) in patients with grade I injury, 0.7% (0-1.7%) in patients with grade II injury; 1.5% (0.4-2.7%) in patients with grade III injury; 4.6% (1.4-7.7%) in patients with grade IV injury and 10.6% (1.8-22.9%) in patients with grade V injury. The average time between liver injury and detection of hepatic pseudoaneurysm was 6 days (95% CI 1-10) CONCLUSIONS: The risk of hepatic pseudoaneurysm after liver trauma increases as the severity of liver injury increases. Hepatic pseudoaneurysms are rare after grade I or grade II injuries, and increasingly common after grades III, IV and V injuries. We recommend routine surveillance imaging in patients with grade III to V injuries.


Assuntos
Falso Aneurisma , Ferimentos não Penetrantes , Humanos , Ferimentos não Penetrantes/cirurgia , Resultado do Tratamento , Fígado/lesões , Análise de Regressão , Estudos Retrospectivos , Escala de Gravidade do Ferimento
20.
N Engl J Med ; 388(3): 203-213, 2023 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-36652352

RESUMO

BACKGROUND: Clinical guidelines recommend low-molecular-weight heparin for thromboprophylaxis in patients with fractures, but trials of its effectiveness as compared with aspirin are lacking. METHODS: In this pragmatic, multicenter, randomized, noninferiority trial, we enrolled patients 18 years of age or older who had a fracture of an extremity (anywhere from hip to midfoot or shoulder to wrist) that had been treated operatively or who had any pelvic or acetabular fracture. Patients were randomly assigned to receive low-molecular-weight heparin (enoxaparin) at a dose of 30 mg twice daily or aspirin at a dose of 81 mg twice daily while they were in the hospital. After hospital discharge, the patients continued to receive thromboprophylaxis according to the clinical protocols of each hospital. The primary outcome was death from any cause at 90 days. Secondary outcomes were nonfatal pulmonary embolism, deep-vein thrombosis, and bleeding complications. RESULTS: A total of 12,211 patients were randomly assigned to receive aspirin (6101 patients) or low-molecular-weight heparin (6110 patients). Patients had a mean (±SD) age of 44.6±17.8 years, 0.7% had a history of venous thromboembolism, and 2.5% had a history of cancer. Patients received a mean of 8.8±10.6 in-hospital thromboprophylaxis doses and were prescribed a median 21-day supply of thromboprophylaxis at discharge. Death occurred in 47 patients (0.78%) in the aspirin group and in 45 patients (0.73%) in the low-molecular-weight-heparin group (difference, 0.05 percentage points; 96.2% confidence interval, -0.27 to 0.38; P<0.001 for a noninferiority margin of 0.75 percentage points). Deep-vein thrombosis occurred in 2.51% of patients in the aspirin group and 1.71% in the low-molecular-weight-heparin group (difference, 0.80 percentage points; 95% CI, 0.28 to 1.31). The incidence of pulmonary embolism (1.49% in each group), bleeding complications, and other serious adverse events were similar in the two groups. CONCLUSIONS: In patients with extremity fractures that had been treated operatively or with any pelvic or acetabular fracture, thromboprophylaxis with aspirin was noninferior to low-molecular-weight heparin in preventing death and was associated with low incidences of deep-vein thrombosis and pulmonary embolism and low 90-day mortality. (Funded by the Patient-Centered Outcomes Research Institute; PREVENT CLOT ClinicalTrials.gov number, NCT02984384.).


Assuntos
Anticoagulantes , Aspirina , Quimioprevenção , Fraturas Ósseas , Heparina de Baixo Peso Molecular , Adulto , Humanos , Pessoa de Meia-Idade , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Aspirina/efeitos adversos , Aspirina/uso terapêutico , Quimioprevenção/métodos , Extremidades/lesões , Fraturas Ósseas/complicações , Fraturas Ósseas/mortalidade , Hemorragia/etiologia , Heparina de Baixo Peso Molecular/efeitos adversos , Heparina de Baixo Peso Molecular/uso terapêutico , Fraturas do Quadril/complicações , Fraturas do Quadril/mortalidade , Ossos Pélvicos/lesões , Ensaios Clínicos Pragmáticos como Assunto , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/mortalidade , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/tratamento farmacológico , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
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