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1.
JBJS Case Connect ; 12(1)2022 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-35108224

RESUMO

CASE: Thoracic penetration of the medial half of clavicle fracture is rare and can be life-threatening and limb-threatening because of its proximity to the pleura and neurovascular structures. We report an unusual presentation of the medial portion of clavicle fracture locked under the first rib associated with the pneumothorax and global brachial plexus palsy successfully reduced by gentle manipulation. Partial injury to the subclavian vein was repaired. Nerve transfer was performed for brachial plexus palsy. The patient showed good functional recovery. CONCLUSION: Reduction of locked intrathoracic clavicle fracture was performed safely by gentle manipulation. Subsequent appropriate interventions for the brachial plexus palsy led to a good outcome.


Assuntos
Neuropatias do Plexo Braquial , Plexo Braquial , Fraturas Ósseas , Plexo Braquial/lesões , Neuropatias do Plexo Braquial/etiologia , Clavícula/lesões , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Costelas
2.
Rev. Odontol. Araçatuba (Online) ; 43(2): 12-15, maio-ago. 2022. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1361784

RESUMO

O papilomavírus humano (HPV) é a doença sexualmente transmissível mais comum em todo o mundo, mais de 150 tipos de HPV já foram identificados, sendo que 25 tipos estão associados a lesões em cavidade oral e genital. O diagnóstico e tratamento precoce das lesões por HPV são importantes para um melhor prognóstico do paciente. O presente estudo objetiva relatar o caso clínico de uma paciente com papiloma de células escamosas. Trata-se portanto de um tumor benigno, onde o tratamento consiste na remoção completa da lesão com a devida margem de segurança. Recidivas são incomuns, contudo o paciente deve manter acompanhamento odontológico periódico, e encaminhado para acompanhamento médico(AU)


Human papillomavirus (HPV) is the most common sexually transmitted disease worldwide, with more than 150 types of HPV identified. Among types, 25 of which are associated with lesions in the oral and genital cavity. Early diagnosis and treatment of HPV lesions are important for a better patient prognosis. The study aim to report the clinical case of a patient with squamous cell papilloma. It is, therefore, a benign tumor, where treatment consists of complete removal of the lesion with the necessary safety margin. Relapses are uncommon, but the patient must maintain periodic dental care and be referred for medical follow-up(AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Papiloma , Papillomaviridae , Neoplasias de Cabeça e Pescoço , Palato Mole/lesões , Infecções Sexualmente Transmissíveis , Assistência Odontológica
3.
Rev. Odontol. Araçatuba (Online) ; 43(2): 29-34, maio-ago. 2022. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1362016

RESUMO

A articulação temporomandibular está vunerável a várias condições de anormalidades já bastante conhecidas, dentre elas, o deslocamento do disco articular sem redução, considerado pela literatura o mais comum das patologias desta região. A deterioração do quadro pode ser um indicativo da necessidade cirúrgica. Em específico, no deslocamento de disco sem redução, o reposicionamento definitivo pode ser adquirido através de discopexia e artrocentese. O presente trabalho tem como objetivo relatar um caso clínico de deslocamento de disco articular bilateral sem redução, apresentando a importância da fisioterapia associada à abordagem cirúrgia na recuperação da função mandibular, bem como, reforçar a importância de uma abordagem conjunta entre análise clínica e imaginológica para resolução de casos. Paciente feminino cursando com diversos sintomas em face e pescoço de forma progressiva ao longo de dois anos foi submetida a cirurgia na articulação temporo-mandibular, onde foi feita a discopexia através de ancoragem dos discos articulares com parafusos. A avaliação física, assim como, a imaginológica, ajudaram na confirmação do diagnóstico. A abordagem cirurgica adotada no tratamento deste caso foi descrita na literatura desde o final do século XIX. Conclui-se que, o método utilizado no tratamento do deslocamento de disco sem redução deve ser baseado nos sinais e sintomas do paciente, cuja abordagem deve ser readequada de acordo com as mudanças do quadro apresentado. Nesta análise, a abordagem cirúrgica associada à fisioterapia específica para as estruturas musculoesquelética da face trouxeram resultados positivos(AU)


The temporomandibular joint is responsible for several well-known conditions of abnormalities, among them, the joint disc displacement without reduction, considered by the literature the most common pathology of this region. Deterioration of the condition may be indicative of surgical need. Specifically, in displacement disc without reduction, definitive repositioning can be achieved through discopexy and arthrocentesis. The aim of the present study is to report a case of unilateral articular disc displacement without reduction, as well the importance of physiotherapy associated with the surgical approach in the recovery of mandibular function, as well as reinforcing the importance of a joint approach between clinical and imaging analysis for case resolution. Female patient with several symptoms in the face and neck progressively over two years, underwent surgery in the temporomandibular joint, where discopexy was performed by anchoring the articular discs with screws. The physical assessment, as well as the imaging, helped to confirm the diagnosis. The surgical approach adopted in the treatment of this case has been described in the literature since the end of the 19th century. In conclusion, the method used to treat articular disc displacement without reduction should be based on the patient's signs and symptoms, whose approach should be readjusted according to the changes in the presented picture. In this analysis, the surgical approach associated with specific physiotherapy for the musculoskeletal structures of the face brought positive results(AU)


Assuntos
Humanos , Feminino , Adulto , Disco da Articulação Temporomandibular , Disco da Articulação Temporomandibular/lesões , Luxações Articulares , Articulação Temporomandibular/lesões , Modalidades de Fisioterapia , Disco da Articulação Temporomandibular/cirurgia , Disco da Articulação Temporomandibular/diagnóstico por imagem , Artrocentese
4.
BMC Musculoskelet Disord ; 23(1): 756, 2022 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-35933337

RESUMO

BACKGROUND: The aim of the present study was to compare the clinical efficacy of arthroscopic-assisted fixation using the Tight-rope system and clavicular hook plate fixation in the treatment of Neer IIB distal clavicle fractures. METHODS: We enrolled 48 consecutive patients with Neer IIB distal clavicle fractures who were treated at our institution from February 2016 and August 2020. These patients were divided into 2 groups based on the fixation method (16 cases with Tight-rope system and 32 cases with clavicular hook plate), and demographics and clinical characteristics of patients in different groups were compared. RESULTS: All 48 patients had functional outcome scores of the affected shoulder available at a mean of 23.8 ± 5.1 months, and there was a statistically significant improvement in the constant score, American shoulder and elbow surgeons (ASES) score, visual analogue scale (VAS) score at the end of follow-up (p < 0.001 respectively). However, the smaller length of skin incision, less estimated blood loss and shorter hospital stay were detected in the Tight-rope technique group patients than those of clavicular hook plate group patients (p < 0.001, respectively). Furthermore, the constant score, ASES score and VAS score were significantly improved in the Tight-rope technique group patients than those of clavicular hook plate group patients (p < 0.05, respectively). CONCLUSIONS: Both Tight-rope technique and clavicular hook plate fixation can provide satisfactory clinical and radiological results in the treatment of distal clavicular Neer IIB fracture. However, arthroscopic-assisted fixation using the Tight-rope technique showed better results in terms of length of hospital stay, surgical trauma, clinical scores, and diagnose and treat concomitant glenohumeral pathologies. LEVELS OF EVIDENCE: III, Case-control study Retrospective comparative study.


Assuntos
Clavícula , Fraturas Ósseas , Placas Ósseas , Estudos de Casos e Controles , Clavícula/diagnóstico por imagem , Clavícula/lesões , Clavícula/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
5.
Arthroscopy ; 38(8): 2425-2426, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35940740

RESUMO

Accurate diagnosis of the etiology of ulnar-sided wrist pain and injury to the triangular fibrocartilage complex, particularly Palmar 1B tears, can prove to be challenging. Multiple peer-reviewed studies have demonstrated that accurate diagnosis and treatment of tears of the triangular fibrocartilage complex through nonoperative and operative means, including arthroscopy, can result in improved patient outcomes and function. One of the keys to successful treatment, however, is accurate diagnosis. While our current imaging modalities help to provide additional data for the assessment of this pathology, magnetic resonance imaging and computed tomography scans have limitations. Thus, employing the power of artificial intelligence and deep learning to ultrasound assessment of this injury is appealing. Efficient integration of this technology into daily practice has potential to bolster diagnostics not only in large medical centers but also in underserved areas with limited access to magnetic resonance imaging and computed tomography.


Assuntos
Fibrocartilagem Triangular , Traumatismos do Punho , Artroscopia , Inteligência Artificial , Humanos , Imageamento por Ressonância Magnética/métodos , Fibrocartilagem Triangular/lesões , Punho/patologia , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho
6.
Front Endocrinol (Lausanne) ; 13: 927344, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35937839

RESUMO

Clinical vertebral fractures and femoral neck fractures are severe osteoporotic fractures that increase morbidity and mortality. Anthropometric variables are associated with an increased risk of osteoporotic fractures, but it is not clear whether body surface area (BSA) has an effect on clinically severe osteoporotic fractures. The study included total of 3,694 cases of clinical vertebral fractures and femoral neck fractures (2,670 females and 1,024 males) and 3,694 controls without fractures who were matched with the cases by sex and age. There was a significant positive correlation between BSA and bone mineral density (BMD) in female and male fracture patients (females: r = 0.430-0.471, P < 0.001; males: r = 0.338-0.414, P < 0.001). There was a significant systematic increase in BMD in both genders at various skeletal sites, grouped by BSA quartile. The osteoporosis rates of the lumbar spine (97.9%), femoral neck (92.4%) and total hip (87.1%) in the female Q1 group were significantly higher than those in the Q4 group (P < 0.001), which were 80.0%, 57.9% and 36.9%, respectively, in the Q4 group; the osteoporosis rates of the lumbar spine, femoral neck, and total hip were 53.9%, 59.4%, and 36.3% in the male Q1 group, and 15.2%, 21.9%, and 7.03% in the Q4 group, which were significantly lower than those in the Q1 group (P < 0.001). In age-adjusted Cox regression models, the risk of fracture in the remaining three groups (Q2, Q3, and Q4) for weight, BMI, and BSA for both genders, compared with the highest quartile (Q1 by descending quartile stratification) were significantly higher. In models adjusted for age and BMD, only men in the BSA Q3 (HR = 1.55, 95% CI = 1.09-2.19) and BSA Q4 groups (HR = 1.41, 95% CI = 1.05-1.87) had significantly higher fracture risks. In models adjusted for age, height, weight, BMI, and BSA, low BMD was the greatest fracture risks for both sexes. Our results showed that BSA was closely related to BMD, prevalence of osteoporosis, and fracture risk, and that a decline in BSA may be a new potential risk factor for osteoporotic fractures in Chinese men.


Assuntos
Fraturas do Colo Femoral , Osteoporose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Superfície Corporal , Densidade Óssea , China/epidemiologia , Feminino , Fraturas do Colo Femoral/complicações , Humanos , Vértebras Lombares/lesões , Masculino , Osteoporose/complicações , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia
7.
Bone Joint J ; 104-B(8): 963-971, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35909382

RESUMO

AIMS: Heterotopic ossification (HO) is a common complication after elbow trauma and can cause severe upper limb disability. Although multiple prognostic factors have been reported to be associated with the development of post-traumatic HO, no model has yet been able to combine these predictors more succinctly to convey prognostic information and medical measures to patients. Therefore, this study aimed to identify prognostic factors leading to the formation of HO after surgery for elbow trauma, and to establish and validate a nomogram to predict the probability of HO formation in such particular injuries. METHODS: This multicentre case-control study comprised 200 patients with post-traumatic elbow HO and 229 patients who had elbow trauma but without HO formation between July 2019 and December 2020. Features possibly associated with HO formation were obtained. The least absolute shrinkage and selection operator regression model was used to optimize feature selection. Multivariable logistic regression analysis was applied to build the new nomogram: the Shanghai post-Traumatic Elbow Heterotopic Ossification Prediction model (STEHOP). STEHOP was validated by concordance index (C-index) and calibration plot. Internal validation was conducted using bootstrapping validation. RESULTS: Male sex, obesity, open wound, dislocations, late definitive surgical treatment, and lack of use of non-steroidal anti-inflammatory drugs were identified as adverse predictors and incorporated to construct the STEHOP model. It displayed good discrimination with a C-index of 0.80 (95% confidence interval 0.75 to 0.84). A high C-index value of 0.77 could still be reached in the internal validation. The calibration plot showed good agreement between nomogram prediction and observed outcomes. CONCLUSION: The newly developed STEHOP model is a valid and convenient instrument to predict HO formation after surgery for elbow trauma. It could assist clinicians in counselling patients regarding treatment expectations and therapeutic choices. Cite this article: Bone Joint J 2022;104-B(8):963-971.


Assuntos
Traumatismos do Braço , Articulação do Cotovelo , Ossificação Heterotópica , Estudos de Casos e Controles , China/epidemiologia , Cotovelo , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Humanos , Masculino , Nomogramas , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco
8.
Bone Joint J ; 104-B(8): 953-962, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35909381

RESUMO

AIMS: There has been an increasing use of early operative fixation for scaphoid fractures, despite uncertain evidence. We conducted a meta-analysis to evaluate up-to-date evidence from randomized controlled trials (RCTs), comparing the effectiveness of the operative and nonoperative treatment of undisplaced and minimally displaced (≤ 2 mm displacement) scaphoid fractures. METHODS: A systematic review of seven databases was performed from the dates of their inception until the end of March 2021 to identify eligible RCTs. Reference lists of the included studies were screened. No language restrictions were applied. The primary outcome was the patient-reported outcome measure of wrist function at 12 months after injury. A meta-analysis was performed for function, pain, range of motion, grip strength, and union. Complications were reported narratively. RESULTS: Seven RCTs were included. There was no significant difference in function between the groups at 12 months (Hedges' g 0.15 (95% confidence interval -0.02 to 0.32); p = 0.082). The complication rate was higher in the operative group and involved more serious complications. CONCLUSION: We found no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively. The complication rate was higher with operative treatment. Cite this article: Bone Joint J 2022;104-B(8):953-962.


Assuntos
Fraturas Ósseas , Traumatismos da Mão , Osso Escafoide , Traumatismos do Punho , Adulto , Moldes Cirúrgicos , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Resultado do Tratamento , Traumatismos do Punho/cirurgia
9.
Bone Joint J ; 104-B(8): 946-952, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35909374

RESUMO

AIMS: This study aims to report the outcomes in the treatment of unstable proximal third scaphoid nonunions with arthroscopic curettage, non-vascularized bone grafting, and percutaneous fixation. METHODS: This was a retrospective analysis of 20 patients. All cases were delayed presentations (n = 15) or failed nonoperatively managed scaphoid fractures (n = 5). Surgery was performed at a mean duration of 27 months (7 to 120) following injury with arthroscopic debridement and arthroscopic iliac crest autograft. Fracture fixation was performed percutaneously with Kirschner (K)-wires in 12 wrists, a headless screw in six, and a combination of a headless screw and single K-wire in two. Clinical outcomes were assessed using grip strength, patient-reported outcome measures, and wrist range of motion (ROM) measurements. RESULTS: Intraoperatively, established avascular necrosis of the proximal fragment was identified in ten scaphoids. All fractures united within 16 weeks, confirmed by CT. At a mean follow-up of 31 months (12 to 64), there were significant improvements in the Patient-Rated Wrist Evaluation, Mayo Wrist Score, abbreviated Disabilities of the Arm, Shoulder and Hand score, wrist ROM, grip strength, and the patients' subjective pain score. No peri- or postoperative complications were encountered. CONCLUSION: Our data indicate that arthroscopic bone grafting and fixation with cancellous autograft is a viable method in the treatment of proximal third scaphoid nonunions, regardless of the vascularity of the proximal fragment. Cite this article: Bone Joint J 2022;104-B(8):946-952.


Assuntos
Fraturas não Consolidadas , Doenças Musculoesqueléticas , Osso Escafoide , Transplante Ósseo/métodos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Fraturas não Consolidadas/cirurgia , Humanos , Estudos Retrospectivos , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Tomografia Computadorizada por Raios X
10.
Can Vet J ; 63(8): 830-834, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35919475

RESUMO

A dog was examined because of acute onset of respiratory distress following a cervical dog bite. Physical examination revealed a deep ventral cervical bite wound associated with localized mild subcutaneous emphysema. Thoracic radiographs showed moderate pneumomediastinum. Medical management consisting of oxygen therapy, antibiotics, and anti-inflammatories was initiated. After 2 days, respiratory distress suddenly worsened. Tracheoscopy showed a discontinuity between the tracheal rings of the cervical trachea; however, the inner tracheal wall appeared intact. Computed tomography scan revealed a ~3-cm complete rupture of all layers of the trachea. Surgical resection and anastomosis of the trachea were performed successfully. Follow-up 15 days after surgery showed complete resolution of respiratory signs, as well as subcutaneous emphysema. A mild ventral angulation of the trachea at the surgical site was noticed on thoracic radiographs. This is the first case report of a pseudotrachea in a dog. Persistence of a pseudotrachea may initially result in only minor clinical signs responsive to medical therapy despite tracheal rupture. In the presence of a pseudotrachea, tracheal rupture may be difficult to identify with tracheoscopy alone. Therefore, CT scan should be proposed in every patient with suspected tracheal trauma. Key clinical message: This case report highlights the importance of including a tracheal rupture in the differential diagnosis of cervical subcutaneous emphysema, even if the amount is small and not associated with significant respiratory signs. The presence of a pseudotrachea may result in less severe clinical signs than expected based on the actual degree of tracheal injury; however, the clinical status may rapidly deteriorate and become life-threatening. This case report also underlines the importance of a CT scan as a complement to tracheoscopy, which may not be sufficient to identify a tracheal rupture in the presence of a pseudotrachea.


Rupture trachéale cervicale avec persistance d'une pseudotrachée chez un chien. Un chien a été présenté pour une dyspnée aiguë modérée consécutive à des morsures cervicales par un autre chien. L'examen clinique révéla une plaie cervicale ventrale profonde associée à un emphysème sous-cutané localisé léger. Les radiographies thoraciques ont montré un pneumomédiastin modéré. Un traitement médical consistant en une oxygénothérapie, des antibiotiques et des anti-inflammatoires a été initié. Après deux jours, la dyspnée s'aggrava brutalement. Une trachéoscopie révéla une discontinuité entre les anneaux trachéaux malgré la persistance d'une paroi trachéale interne intègre. L'examen par tomodensitométrie montra une rupture trachéale cervicale complète dans toute son épaisseur, sur 3 cm de long. Une chirurgie de résection-anastomose de la trachée a été réalisée avec succès.Il s'agit de la première description de pseudotrachée chez un chien. La persistance d'une pseudotrachée peut initialement ne provoquer que des signes cliniques mineurs, notamment un emphysème sous-cutané léger et une dyspnée répondant au traitement médical, malgré une lésion trachéale en réalité importante. Par conséquent, un examen par tomodensitométrie de la trachée doit être envisagé chez tous les patients pour lesquels un traumatisme trachéal est suspecté.Message clinique clé :Ce cas souligne l'importance d'inclure une rupture trachéale dans le diagnostic différentiel de l'emphysème souscutané cervical, et cela même s'il n'est présent qu'en petite quantité et associé à faibles signes cliniques respiratoires. La persistance d'une pseudotrachée peut entraîner des signes cliniques moins importants qu'une rupture trachéale complète, cependant l'état respiratoire de l'animal peut rapidement s'aggraver et devenir une urgence vitale.Ce cas souligne de plus l'importance de l'examen par tomodensitométrie en complément de la trachéoscopie, qui peut parfois s'avérer insuffisante pour le diagnostic des ruptures trachéales, en particulier en présence d'une pseudotrachée.(Traduit par les auteurs).


Assuntos
Doenças do Cão , Enfisema Mediastínico , Síndrome do Desconforto Respiratório , Enfisema Subcutâneo , Animais , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/cirurgia , Cães , Dispneia/veterinária , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/veterinária , Síndrome do Desconforto Respiratório/veterinária , Ruptura/cirurgia , Ruptura/veterinária , Enfisema Subcutâneo/complicações , Enfisema Subcutâneo/veterinária , Traqueia/lesões , Traqueia/cirurgia
11.
Ghana Med J ; 56(1): 51-54, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35919783

RESUMO

Amputation of the penis is a rare and devastating injury. The etiologies vary from accidental, self-inflicted to attacks due to sexual jealousy and revenge. In the present era of microvascular surgery, replantation is the standard care. However, replantation of the penis comes with its own set of difficulties and complications. Knowledge of the anatomy and prior knowledge of the possible complications makes the surgeon aware of the course of events after a replantation. It helps in devising strategies to overcome these challenges methodically. We present a case of penile replant with the complications that we encountered, and the measures are taken to counter them on our way to a successful outcome. Funding: No external funding.


Assuntos
Amputação Traumática , Amputação , Amputação Traumática/etiologia , Amputação Traumática/cirurgia , Humanos , Masculino , Microcirurgia , Pênis/lesões , Pênis/cirurgia , Reimplante
12.
Sports Med Arthrosc Rev ; 30(3): 118-140, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35921595

RESUMO

PURPOSE: Regular sports activities are associated with multiple physical and psychological health benefits. However, sports also may lead to injuries and the development of osteoarthritis (OA). This systematic review investigated the association between sports activity, sports type, and the risk of developing OA. METHODS: A systematic review was performed by assessing studies that have investigated the risk of OA development in sports. Data extracted included general information, study design, number of participants, related body mass index, sports type, and assessment of OA. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. RESULTS: A total of 63 studies were included in this systematic review. The overall Newcastle-Ottawa Scale score was 6.46±1.44 demonstrating a good methodological quality of the articles included in the present study. A total of 628,036 participants were included, with a mean follow-up of 8.0±8.4 years. The mean age of the included athletes was 45.6±15.8, with a mean body mass index of 24.9±2.3 kg/m 2 . CONCLUSION: Football and soccer players seem to be at higher risk for the development of OA, although the injury status of the joint should be considered when assessing the risk of OA. High equipment weight and increased injury risk also put military personnel at a higher risk of OA, although elite dancing leads to more hip labral tears. Femoroacetabular impingement was also often diagnosed in ice-hockey players and ballet dancers.


Assuntos
Impacto Femoroacetabular , Hóquei , Osteoartrite , Futebol , Atletas , Impacto Femoroacetabular/complicações , Humanos , Osteoartrite/epidemiologia , Osteoartrite/etiologia , Futebol/lesões
15.
Ulus Travma Acil Cerrahi Derg ; 28(8): 1170-1179, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920413

RESUMO

BACKGROUND: The purpose of the study was to compare the functional and radiological results of the conservatively and surgically treated displaced acetabular fractured patients. METHODS: The study included 61 patients with a displaced acetabulum fracture over the age of 18, who have been treated con-servatively or surgically for acetabular fractures, between 2000 and 2014. Patients were divided into two groups according to their treatment type. Group 1 consisted of conservatively treated 31 between 2000 and 2010 patients and Group 2 consisted of surgically treated 30 patients between 2010 and 2014. The fractures were classified according to Judet and Letournel classification. Clinical evaluation of the patients was conducted according to Modified Merle D'Aubigne Score, SF-36, and Harris Hip Score. Radiological evaluation was evaluated according to Matta's Radiological Evaluation Criteria. Kolmogorov-Smirnov, t-test, Mann-Whitney U-test, and two Wilcoxon paired sample tests were used for statistical analysis. The significance limit was chosen as p<0.05. RESULTS: The mean follow-up time was 10 years for the conservative group and 5.5 years for the surgery group. There was no statistically significant difference in functional scores between both groups (p>0.05), Matta's radiological staging score was significantly higher in the operated group (p=0.023). CONCLUSION: Radiological scores are not directly correlated with the functional capacity. We obtained good radiological and functional scores in the surgical group, operative treatment should be considered when absolute indications are there. The outcome of conservatively managed fractures is not bleak. We think that there is an alternative to surgical treatment in displaced acetabular fractures and that similar functional results can be obtained in selected cases.


Assuntos
Fraturas Ósseas , Fraturas do Quadril , Lesões do Pescoço , Fraturas da Coluna Vertebral , Acetábulo/diagnóstico por imagem , Acetábulo/lesões , Acetábulo/cirurgia , Adulto , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
16.
Ulus Travma Acil Cerrahi Derg ; 28(8): 1142-1147, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920419

RESUMO

BACKGROUND: The surgical treatment of fifth metacarpal fractures, especially using Kirschner (K) wire techniques, has recently become popular because it provides for early hand movement. Successful anatomical reduction of the fracture is often achieved with surgery; however, an anatomical reduction cannot always be achieved and, according to 30° oblique radiography, the fracture is fixed with an apex dorsal angulation below 40°. The aim of this study was to evaluate the stability of such fractures postoperatively and compare the two different angulation options that provide early movement of the hand and wrist. METHODS: Thirty consecutive cases of neck fractures of the fifth metacarpal were treated intramedullarly with one K wire. Cases were divided into two groups: One fixed with anatomical reduction (Group 1) and the other (Group 2) fixed in apex dorsal angulation below 40°, according to 30° oblique radiography. Angulation, shortening, and functional outcome as Quick DASH scores and grip strengths were evaluated at 6 months. RESULTS: The mean correction angle was 56.6° (between 30° and 110°) for Group 1 and the residual angle was 0°. The mean cor-rection angle was 42.4° (between 20° and 75°) for group 2 (Figs. 4 and 5) and the residual angle was 23.6° (between 10° and 45°). The mean Quick DASH scores were 1.9 (SD: 1.7) for Group 1 and 5.67 (SD: 2.93) for Group 2 (p<0.05). Grip strength values were similar for both groups. All the patients returned to their previous occupations without any limitations in an average of 4 weeks (SD: 1.4) (range 2-6 weeks). No complications such as correction loosening or shortening were detected. Rotation was not detected during physical examination. CONCLUSION: Our investigation revealed no risk of shortening or rotation of the fracture; the patients were able to return quickly to their everyday activities.


Assuntos
Fraturas Ósseas , Traumatismos da Mão , Ossos Metacarpais , Fios Ortopédicos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Ossos Metacarpais/diagnóstico por imagem , Ossos Metacarpais/lesões , Ossos Metacarpais/cirurgia , Radiografia , Amplitude de Movimento Articular , Resultado do Tratamento
17.
Ulus Travma Acil Cerrahi Derg ; 28(8): 1052-1058, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920432

RESUMO

BACKGROUND: The purpose of this study is to compare biomechanical properties of suprapectineal (SP) plate fixation, in-frapectineal (IP) plate fixation, and both SP and IP plate fixation in anterior column posterior hemitransverse (ACPHT) fractures of the acetabulum using posterior and anterior column screws. METHODS: In 21 hard plastic left hemipelvis models, ACPHT fractures of the acetabulum were created, and in three different fixa-tion groups, the methods were compared: Group 1: SP plating using a 3.5 mm reconstruction plate and cortical screw fixation, Group 2: Infrapectineal plating using 3.5 mm reconstruction plate and cortical screws combined with posterior and anterior column screws, and Group 3: Combined fixation with SP and IP plating using 3.5 mm reconstruction plates and cortical screws. Maximum load to failure (strength) of these three groups was compared between groups. RESULTS: The mean maximum load of failure for three groups was 2921 N, 2018 N, and 3658 N, respectively. When strength was compared considering the force that causing implant failure, it was determined that the strongest fixation was achieved when SP and IP fixation method were applied together, followed by SP only fixation and IP fixation supported by anterior and posterior column screws, respectively. CONCLUSION: The combined application of SP and IP fixation provides the most stable fixation of the ACPHT acetabular frac-tures, and IP fixation does not provide comparable biomechanical stability despite reinforcement with three-column screws placed away from the plate. Although IP fixation supported by anterior and posterior column screws with the limited combined approach is less invasive approach for patients, SP fixation should be included in the surgical treatment method to ensure adequate stability.


Assuntos
Fraturas Ósseas , Fraturas do Quadril , Lesões do Pescoço , Fraturas da Coluna Vertebral , Acetábulo/lesões , Acetábulo/cirurgia , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Humanos
18.
Ulus Travma Acil Cerrahi Derg ; 28(8): 1059-1065, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920433

RESUMO

BACKGROUND: Failure to achieve effective bleeding control and problems related to transfusion in liver surgery are the most common causes of post-operative mortality and morbidity. Various methods/drugs including topical hemostatic agents have been em-ployed for bleeding control in liver surgery. This study was aimed to investigate the hemostatic properties of the herb mixture extract of Inula viscosa and Capsella bursa-pastoris (IvCbp) in rat liver laceration model, which have been traditionally used as antiseptic and hemostatic agents public in Hatay/Tukey. METHODS: Thirty rats were divided into three groups equally and blood samples were taken from all rats for preoperative hemoglobin (Hb) measurements. Then, the standard liver resection model was applied to all rats. Sponge for the first rat group, Ankaferd Blood Stopper® Trend-Tech for the second rat group and IvCbp plant extract mixture for the third group were applied to resection areas for 3 minutes. Liver samples of all rats were evaluated in terms of inflammation and necrosis intensity on the 5th post-operative day. RESULTS: Post-operative Hb values were found as 11.0±1.1 g/dL in the sponge group, 11.9±2.0 g/dL in the Ankaferd group, and 14.1±1.2 g/dL in the IvCbp herb mixture group (p<0.001). In the histopathological examination, less necrosis was observed in the herb mixture group compared to the sponge and Ankaferd groups (p=0.001). In addition, no statistically significant necrosis difference was observed between sponge and Ankaferd groups. While less inflammation was observed in the herb mixture group compared to the other groups, Ankaferd group had the highest inflammation score (p<0.001). CONCLUSION: IvCbp herb mixture extract group provide effective hemostatic control, caused less Hb decrease and resulted in less inflammation and necrosis compared to Ankaferd and sponge groups in a rat liver resection model.


Assuntos
Capsella , Hemostáticos , Inula , Lacerações , Animais , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Hemostáticos/farmacologia , Inflamação , Fígado/lesões , Necrose , Extratos Vegetais/farmacologia , Ratos , Ratos Wistar
19.
Ulus Travma Acil Cerrahi Derg ; 28(8): 1043-1051, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920436

RESUMO

BACKGROUND: Delayed autologous nerve graft reconstruction is inevitable in devastating injuries. Delayed or prolonged repair time has deleterious effects on nerve grafts. We aimed improving and accelerating nerve graft reconstruction process in a rat long nerve defect model with loop nerve graft prefabrication particularly to utilize for injuries with tissue loss. METHODS: Twenty-four Sprague-Dawley rats were allocated into three groups. 1.5 cm long peroneal nerve segment was excised, reversed in orientation, and used as autologous nerve graft. In conventional interpositional nerve graft group (Group 1), nerve defects were repaired in single-stage. In loop nerve graft prefabrication group (Group 2), grafts were sutured end-to-end (ETE) to the proximal peroneal nerve stumps. Distal ends of the grafts were sutured end-to-side to the peroneal nerve stumps 5 mm proximal to the ETE repair sites in first stage. In second stage, distal ends of the prefabricated grafts were transposed and sutured to distal nerve stumps. In staged conventional interpositional nerve graft group (Group 3), grafts were sutured ETE to proximal peroneal nerve stumps in first stage. Distal ends of the grafts and nerve stumps were tacked to the surrounding muscles until the final repair in second stage. Follow-up period was 4 weeks for each stage in Groups 2 and 3, and 8 weeks for Group 1. Peroneal function index (PFI), electrophysiology, and histological assessments were conducted after 8 weeks. P<0.05 was considered significant for statistical analysis. RESULTS: PFI results of Group 1 (-22.75±5.76) and 2 (-22.08±6) did not show statistical difference (p>0.05). Group 3 (-33.64±6.4) had a statistical difference compared to other groups (p<0.05). Electrophysiology results of Group 1 (16.19±2.15 mV/1.16±0.21 ms) and 2 (15.95±2.82 mV/1.17±0.16 ms) did not present statistical difference (p>0.05), whereas both groups had a statistical difference compared to Group 3 (10.44±1.96 mV/1.51±0.15 ms) (p<0.05). Axon counts of Group 1 (2227±260.4) and 3 (2194±201.1) did not have statistical difference (p>0.05), whereas both groups had significantly poor axon counts compared to Group 2 (2531±91.18) (p<0.05). CONCLUSION: Loop nerve graft prefabrication improved axonal regeneration without delay. Loop prefabrication can accelerate prolonged regeneration time for the injuries indicating a delayed nerve reconstruction. Higher axon counts derived with loop nerve prefabrication may even foster its investigation in immediate long nerve defect reconstructions in further studies.


Assuntos
Regeneração Nervosa , Nervos Periféricos , Animais , Regeneração Nervosa/fisiologia , Procedimentos Neurocirúrgicos/métodos , Nervos Periféricos/transplante , Nervo Fibular/lesões , Nervo Fibular/fisiologia , Nervo Fibular/cirurgia , Ratos , Ratos Sprague-Dawley , Nervo Isquiático
20.
Artigo em Chinês | MEDLINE | ID: mdl-35915945

RESUMO

After workers suffer electric shock, the ankylosis and contraction of muscle groups around the shoulder joint are more likely to lead to posterior dislocation and fracture, of which 80% are complicated with reverse Hill-Sachs injury of humeral head. This paper reports a case of bilateral posterior dislocation of shoulder joint combined with Hill-Sachs injury caused by electric shock in the Department of Orthopedics, Affiliated Huzhou Hospital, Zhejiang University School of Medicine in August 2020. The diagnosis of left posterior shoulder dislocation was clear, and the diagnosis of right posterior shoulder dislocation was missed. The patient successfully reconstructed the stability of the shoulder joint by actively performing shoulder arthroscopic surgery to repair the joint capsule. After 6 months of follow-up, there was no further dislocation and the function was good.


Assuntos
Lesões de Bankart , Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Artroscopia/efeitos adversos , Lesões de Bankart/complicações , Lesões de Bankart/cirurgia , Humanos , Cabeça do Úmero/lesões , Cabeça do Úmero/cirurgia , Instabilidade Articular/complicações , Instabilidade Articular/cirurgia , Ombro/cirurgia , Luxação do Ombro/complicações , Luxação do Ombro/diagnóstico , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia
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