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1.
Orthop Traumatol Surg Res ; 104(3): 377-381, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29414721

RESUMO

Cerclage wire is an effective fracture fixation method. However, its mechanical benefits are countered by local ischemia. Its efficacy for treating femoral periprosthetic fractures has been demonstrated since femoral fixation is possible even there is a stem in the diaphysis. It securely holds the proximal femur typically with an additional plate. The development of minimally-invasive surgery with plate fixation has led to the cerclage wire being inserted percutaneously. Here, we report on a case of secondary femoral ischemia following percutaneous cerclage wire of a periprosthetic femoral fracture. This was a Vancouver type B1 fracture. On the 3rd day after admission, minimally-invasive fixation with a femoral locking plate was performed with five cerclage wires added percutaneously. During the immediate postoperative course, the patient developed ischemia of the operated leg that required vascular surgery after confirmation by CT angiography. An arterial stop was visible with deviation of the superior femoral artery, which was not properly surrounded by the cerclage wire. The latter pulled perivascular tissues towards the femur. When combined with reduced arterial elasticity due to severe atherosclerosis, it resulted in arterial plication. The postoperative course was marked by multiple organ failure and death of the patient. Percutaneous surgery is an attractive option but has risks. The presence of severe atherosclerosis is a warning sign for loss of tissue elasticity. This complication can be prevented by preparing the bone surfaces and carefully positioning the patient on the traction table to avoid forced adduction. The surgeon must also be familiar with alternative techniques to cerclage wire such as polyaxial screws and additional plates.


Assuntos
Fios Ortopédicos/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Isquemia/etiologia , Extremidade Inferior/irrigação sanguínea , Fraturas Periprotéticas/cirurgia , Idoso de 80 Anos ou mais , Placas Ósseas , Evolução Fatal , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos
2.
Orthop Traumatol Surg Res ; 103(6): 835-839, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28655629

RESUMO

BACKGROUND: The long-term outcomes of rotator cuff repair are unclear. Recurrent tears are common, although their reported frequency varies depending on the type and interpretation challenges of the imaging method used. The primary objective of this study was to assess the intra- and inter-observer reproducibility of the MRI assessment of rotator cuff repair using the Sugaya classification 10years after surgery. The secondary objective was to determine whether poor reproducibility, if found, could be improved by using a simplified yet clinically relevant classification. HYPOTHESIS: Our hypothesis was that reproducibility was limited but could be improved by simplifying the classification. MATERIAL AND METHOD: In a retrospective study, we assessed intra- and inter-observer agreement in interpreting 49 magnetic resonance imaging (MRI) scans performed 10years after rotator cuff repair. These 49 scans were taken at random among 609 cases that underwent re-evaluation, with imaging, for the 2015 SoFCOT symposium on 10-year and 20-year clinical and anatomical outcomes of rotator cuff repair for full-thickness tears. Each of three observers read each of the 49 scans on two separate occasions. At each reading, they assessed the supra-spinatus tendon according to the Sugaya classification in five types. RESULTS: Intra-observer agreement for the Sugaya type was substantial (κ=0.64) but inter-observer agreement was only fair (κ=0.39). Agreement improved when the five Sugaya types were collapsed into two categories (1-2-3 and 4-5) (intra-observer κ=0.74 and inter-observer κ=0.68). CONCLUSION: Using the Sugaya classification to assess post-operative rotator cuff healing was associated with substantial intra-observer and fair inter-observer agreement. A simpler classification into two categories improved agreement while remaining clinically relevant. LEVEL OF EVIDENCE: II, prospective randomised low-power study.


Assuntos
Imageamento por Ressonância Magnética , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Seguimentos , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Lesões do Manguito Rotador/classificação , Resultado do Tratamento
3.
Orthop Traumatol Surg Res ; 101(2): 201-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25736196

RESUMO

BACKGROUND: Fractures of the proximal ulna are rare and usually managed surgically. Strong fixation of the harware is essential to obtain good outcomes. We report our experience with pre-contoured locking plate fixation of complex olecranon fractures and present a critical appraisal of the outcomes. HYPOTHESIS: Pre-contoured locking plates provide good outcomes, but their clinical tolerance may be limited in some instances. MATERIALS AND METHODS: From September 2009 to December 2011, 28 patients were managed using a pre-contoured locking compression plate (LCP(®)). Among them, 6 were excluded because of missing data, which left 22 patients (11 males and 11 females) with a mean age of 55.7 years, including 12 who were employed. The fracture was on the dominant side in 11 patients. According to the Mayo Clinic classification, 15 fractures were type II and 7 type III. In addition to the ulnar fracture, a radial head fracture was present in 9 patients and a coronoid process fracture in 5 patients. Functional recovery was assessed using the Broberg-Morrey score and Mayo Elbow Performance Score (MEPS). Radiographs were obtained to evaluate the quality of fracture reduction and fracture healing, as well as to look for ossifications and osteoarthritis. RESULTS: Mean follow-up was 20 months. Flexion was 131°, extension loss was 9.5°, pronation was 79°, and supination was 80.5°. The mean Broberg-Morrey score was 96.7 and the mean MEPS score 96.6. Fracture healing occurred in all patients, within a mean of 10.6 weeks. Evidence of early osteoarthritis was found in 6 patients, ossifications in 3 patients, and synostosis in 1 patient. An infection was successfully treated with lavage and antibiotic therapy in 1 patient. The fixation hardware was removed in 6 patients. No prognostic factors were identified. DISCUSSION-CONCLUSION: Our hypothesis was confirmed. The outcomes are encouraging and comparable to those reported in the literature. The critical issue is the limited clinical tolerance of the plate with a high rate of posterior impingement requiring plate removal (27%). Rigorous technique is essential during plate implantation. LEVEL OF EVIDENCE: Level IV, retrospective study.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Olécrano/lesões , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Fraturas da Ulna/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Olécrano/diagnóstico por imagem , Olécrano/cirurgia , Pronação , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/fisiopatologia , Adulto Jovem
4.
Orthop Traumatol Surg Res ; 101(5): 523-8, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26183087

RESUMO

INTRODUCTION: Since the recent descriptions of the anterolateral ligament (ALL), the role played by the anterolateral peripheral structures in the rotational control of the knee is again being debated. The objective of this study was to identify the structures during internal tibial rotation and then to define their anatomical characteristics. We hypothesized that internal rotation would tighten several anatomical formations, both superficial and deep, with the ALL one part of these structures. MATERIAL AND METHODS: Nine fresh-frozen cadaver knee specimens were studied. The anterolateral structures tightened were identified from superficial to deep at 30° of flexion. Each was selectively dissected, identifying its insertions and orientations, and measuring its size. The length variations of the ALL during internal tibial rotation were measured by applying a 30-N force using a dynamometric torque wrench at the tibiofibular mortise. RESULTS: The superficial structures tightened were the iliotibial tract and the Kaplan fibers. In internal tibial rotation, the Kaplan fibers held the iliotibial tract against the lateral epicondyle, allowing it to play the role of a stabilizing ligament. The Kaplan fibers were 73.11±19.09mm long (range, 63-82mm) and at their femoral insertion they were 12.1±1.61mm wide (range, 10-15mm). The deep structures tightened covered a triangular area including the ALL and the anterolateral capsule. The ALL was 39.11±3.4mm long (range, 35-46mm) in neutral rotation and 49.88±5.3mm long (range, 42-58mm) in internal rotation (p<0.005). Its femoral insertion area was narrow at 5.27±1.06mm (range, 3.5-7mm) and was mainly proximal and posterior at the lateral epicondyle. Its tibial insertion zone was wide, with a clearly differentiated anterior limit but a posterior limit confused with the joint capsule. In the vertical plane, this insertion was located 6.44±2.37mm (range, 2-9) below the joint space. DISCUSSION: This study demonstrates two distinct anterolateral tissue planes tightened during internal rotation of the tibia: a superficial plane represented by the iliotibial tract and the Kaplan fibers, which acts as a ligament structure, and a deep plane represented by a triangular capsular ligament complex within which the ALL and the anterolateral capsule are recruited. LEVEL OF EVIDENCE: Descriptive cadaver study IV.


Assuntos
Articulação do Joelho/fisiologia , Ligamentos Articulares/fisiologia , Rotação , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Articulação do Joelho/anatomia & histologia , Ligamentos Articulares/anatomia & histologia , Masculino , Pessoa de Meia-Idade
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