RESUMEN
Use of dual pre-contoured plates has been accepted as the treatment of choice in distal humerus fractures despite challenges especially in very distal or highly fragmented fractures. Aiming to improve results in such instances, our newly proposed method uses several K-wires fixated by a small reconstruction plate. Drawing on the results of previous finite element studies, the current study aims to compare the stiffness of three clinically common variations of this method using biomechanical testing in cadaveric humeri. 24 samples were divided into three groups and fractures were simulated. Groups I and II used 1.5 mm K-wires in differing configurations while 2 mm wires were used in group III. All samples underwent compression, anterior and posterior bending, and torsional testing as well as failure testing. Our results indicated that Group III had significantly higher stiffness in flexion, extension, and torsion (p < 0.05). In failure, group III had the highest mean stiffness in anterior bending and torsion (861.2 N, 30.9 Nm). Based on previous and current results, this new Persian fixation method, especially when implemented using 2 mm K-wires, shows promise in achieving suitable stability and may be useful as an alternative approach in complex distal humerus fractures.
Asunto(s)
Fracturas Humerales Distales , Fracturas del Húmero , Humanos , Fracturas del Húmero/cirugía , Fijación Interna de Fracturas/métodos , Fenómenos Biomecánicos , Húmero/cirugía , CadáverRESUMEN
Distal humerus fractures commonly occur in adults with low bone mineral density causing major technical challenges for orthopedic surgeons. Persian fixation method was introduced as a novel technique to stabilize small fragments in comminuted distal humerus fractures using a set of K-wires and a reconstruction plate. The present study aims to measure this technique's stiffness and stability of this technique and analyze the effect of influential parameters with numerical simulation and biomechanical testing on a cadaveric specimen. Validation of the finite element (FE) model was conducted based on results of experiments. The results indicated that Delta configuration mainly led to a higher stiffness in the case of axial loading and anterior bending compared to L configuration. Analyzing the influential factors of this technique suggests that changes in diameter and number of K-wires have a similarly significant effect on the construct stiffness while the height of plate had a slight influence. Also, the diameter of wires was the most effective parameter for implant failure, particularly in the 3-pin construct, which caused a reduction in failure risk by about 60%. The results revealed that the Persian fixation method would achieve suitable stability compared to the dual-plating technique.
Asunto(s)
Fracturas Humerales Distales , Fracturas del Húmero , Humanos , Fenómenos Biomecánicos , Fijación Interna de Fracturas/métodos , Placas Óseas , Húmero , Fracturas del Húmero/cirugíaRESUMEN
PURPOSE: Fragility fractures are characterized by a low energy trauma and should be considered as potentially osteoporosis-related fractures. This study aimed to determine whether the orthopedic surgeons' awareness could increase the osteoporosis management rate in patients with fragility fractures. METHOD: This study was undertaken in three phases: evaluation of existing practice patterns, educational intervention and evaluation of the effect of the training. During the study period, orthopedic surgeons who worked at academic hospitals attended five educational sessions and were provided with posters and brochures. Patients were interviewed at sixth and twelfth months after discharge using an evaluation questionnaire regarding their perceptions of the barriers to osteoporosis treatment. RESULTS: Seventy-two orthopedic surgeons volunteered to participate in the study between June 2008 and December 2011. The patients were followed for a minimum of 1 year. Rate of calcium and vitamin D prescriptions increased from 10 to 91 %. The rate of bisphosphonate administration reached to 73 %. The number of follow-up evaluations did not differ significantly. CONCLUSION: The detection and medication rates for osteoporosis in patients with fragility fractures increased more than tenfold after the intervention program.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Educación Continua , Fracturas Óseas/tratamiento farmacológico , Ortopedia/educación , Osteoporosis/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Calcio/uso terapéutico , Competencia Clínica , Difosfonatos/uso terapéutico , Femenino , Fracturas Óseas/etiología , Fracturas Óseas/terapia , Adhesión a Directriz , Humanos , Masculino , Persona de Mediana Edad , Osteoporosis/complicaciones , Osteoporosis/terapia , Pautas de la Práctica en Medicina , Práctica Profesional , Vitamina D/uso terapéuticoRESUMEN
PURPOSE: Kienböck disease is characterized by avascular necrosis of the lunate bone, which is usually progressive without treatment. This study examined lunate core decompression for its treatment potential. METHODS: We surgically treated 20 patients with stage 1 to 3b Kienböck disease with lunate core decompression. We evaluated pain, range of motion, functional disability, and radiographic indices in these patients at baseline and 5 years after surgery. RESULTS: The mean age of the patients was 29 years; 16 were men. Ten patients had Lichtman stage 1 disease, 6 had stage 2 disease, 3 had stage 3a, and 1 had stage 3b disease. Range of motion scores showed meaningful improvement. Two patients did not improve with this technique and were revised with radial shortening procedures. CONCLUSIONS: Lunate core decompression is a simple surgical procedure that is effective in the treatment of Kienböck disease. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Asunto(s)
Descompresión Quirúrgica , Hueso Semilunar/cirugía , Osteonecrosis/cirugía , Adulto , Femenino , Humanos , Masculino , Osteonecrosis/fisiopatología , Dimensión del Dolor , Extremidad Superior/fisiopatología , Adulto JovenRESUMEN
This is a descriptive analysis, performed on victims of Iran's December 26, 2003 Bam earthquake that were referred to tertiary referral trauma management centre in Tehran. Two hundred and ten patients were included in this study. Associated musculoskeletal injuries and renal function of the patients were recorded. The mean time under rubble was 1.9 h in our patients with a mean rescue to first medical aid time of 13.5 h. We had 19 cases of compartment syndrome and 6.7% of patients had impaired renal function. The incidence of compartment syndrome had a direct relation to the time under rubble and the incidence of renal failure was directly related to rescue to first medical aid time. Axial skeleton fractures, amongst them the lateral compression type pelvic fractures, were particularly common. Fracture associated neural injuries were also common. Institution of renal protective protocols from the very first hours after injury more conservative approaches to treatment of fractures in these crush trauma patients are strongly recommended.
Asunto(s)
Desastres , Sistema Musculoesquelético/lesiones , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Adolescente , Adulto , Anciano , Traumatismos del Brazo/epidemiología , Traumatismos del Brazo/etiología , Niño , Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/etiología , Traumatismos Craneocerebrales/epidemiología , Traumatismos Craneocerebrales/etiología , Femenino , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Humanos , Incidencia , Irán/epidemiología , Traumatismos de la Pierna/epidemiología , Traumatismos de la Pierna/etiología , Masculino , Persona de Mediana Edad , Pelvis/lesiones , Estudios Retrospectivos , Traumatismos Vertebrales/epidemiología , Traumatismos Vertebrales/etiología , Factores de TiempoRESUMEN
Multiple ruptures of the extensor and flexor tendons of the fingers, thumb and wrist at the musculotendinous junctions are reported after a blast injury.