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Introducción: Las fracturas de tibia son lesiones frecuentes. En los niños existe una mayor capacidad de curación debido al mayor grosor y mejor vascularización que presenta su periostio. Como resultado, la mayoría pueden tratarse de manera exitosa de forma no quirúrgica. Está descrito el tratamiento funcional para estas fracturas, siguiendo los principios desarrollados por Sarmiento. Dada la falta de evidencia actual acerca del tratamiento funcional en este grupo etario, realizamos el análisis del mismo mediante una serie de casos tratados siguiendo este método. Materiales y métodos: Se incluyeron pacientes que cumplieron con los criterios de inclusión y exclusión, tratados mediante tratamiento funcional siguiendo los principios desarrollados por Sarmiento. Se evaluaron clínica y radiográficamente. Se evaluó la técnica registrando tiempos para cada período en este grupo etario, así como la satisfacción con el tratamiento de los pacientes y padres y/o tutores. Todas las complicaciones relacionadas fueron documentadas. Resultados: Evaluamos un total de 15 pacientes, con al menos 6 meses de seguimiento. La edad promedio fue de 11.7 años. Todas las fracturas consolidaron, el tiempo promedio hasta la consolidación fue de 7.6 semanas. El período agudo de 3.4 semanas y el período funcional de 4.2 semanas promedio respectivamente. Todas las fracturas consolidaron con una reducción aceptable. Existió un 100% de satisfacción tanto de los pacientes como de los padres ó tutores con el tratamiento implementado. Dos pacientes presentaron complicaciones menores. Conclusión: El tratamiento funcional para las fracturas de pierna en niños entre 10 y 15 años es una técnica segura, reproducible, con buenos resultados funcionales, que le permite tanto a los pacientes y a sus cuidadores gran independencia durante el período de curación.
Introduction: Tibial fractures are frequent injuries. In children there is a greater healing capacity due to the greater thickness and better vascularization of their periosteum. As a result, most of them can be successfully treated non-surgically. Functional treatment for these fractures is described, following the principles developed by Sarmiento. Given the lack of current evidence on functional treatment in this age group, we analyzed a series of cases treated following this method. Materials and methods: We included patients who met the inclusion and exclusion criteria, treated by functional treatment following the principles developed by Sarmiento. They were evaluated clinically and radiographically. The technique was evaluated by recording times for each period in this age group, as well as the satisfaction with the treatment of the patients and parents and/or guardians. All related complications were documented. Results: We evaluated a total of 15 patients, with at least 6 months of follow-up. The average age was 11.7 years. All fractures consolidated, the average time to consolidation was 7.6 weeks. The acute period of 3.4 weeks and the functional period of 4.2 weeks average respectively. All fractures healed with acceptable reduction. There was 100% satisfaction of both patients and parents or guardians with the treatment implemented. Two patients presented minor complications. Conclusion: Functional treatment for leg fractures in children between 10 and 15 years of age is a safe, reproducible technique, with good functional results, which allows both patients and their caregivers great independence during the healing period.
Introdução: As fracturas da tíbia são lesões comuns. Nas crianças existe uma maior capacidade de cicatrização devido à maior espessura e melhor vascularização do periósteo. Como resultado, a maioria pode ser tratada com sucesso de forma não cirúrgica. É descrito o tratamento funcional destas fracturas, seguindo os princípios desenvolvidos por Sarmiento. Dada a falta de evidência atual sobre o tratamento funcional neste grupo etário, procedeu-se à análise de uma série de casos tratados por este método. Material e métodos: Foram incluídos pacientes que preencheram os critérios de inclusão e exclusão, tratados por tratamento funcional seguindo os princípios desenvolvidos por Sarmiento. Foram avaliados clínica e radiograficamente. A técnica foi avaliada através do registro dos tempos para cada período nessa faixa etária, bem como a satisfação com o tratamento por parte dos pacientes e dos pais e/ou responsáveis. Todas as complicações relacionadas foram documentadas. Resultados: Avaliámos um total de 15 doentes, com pelo menos 6 meses de seguimento. A idade média foi de 11,7 anos. Todas as fracturas cicatrizaram, sendo o tempo médio de cicatrização de 7,6 semanas. O período agudo foi de 3,4 semanas e o período funcional de 4,2 semanas, em média, respetivamente. Todas as fracturas foram curadas com uma redução aceitável. Os doentes e os pais/encarregados de educação ficaram 100% satisfeitos com o tratamento efectuado. Dois doentes tiveram complicações ligeiras. Conclusão: O tratamento funcional das fracturas da perna em crianças com idades compreendidas entre os 10 e os 15 anos é uma técnica segura, reprodutível e com bons resultados funcionais, que permite aos doentes e aos seus cuidadores uma grande independência durante o período de cura.
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Purpose: This study examined the influence of metal artifact reduction (MAR), the application of sharpening filters, and their combination on the diagnosis of horizontal root fracture (HRF) in teeth adjacent to a zirconia implant on cone-beam computed tomography (CBCT) examinations. Materials and Methods: Nineteen single-rooted teeth (9 with HRF and 10 without) were individually positioned in the right central incisor socket of a dry human maxilla. A zirconia implant was placed adjacent to each tooth. Imaging was performed using an OP300 Maxio CBCT (Instrumentarium, Tuusula, Finland) unit with the following settings: a current of 8 mA, both MAR modes (enabled and disabled), a 5×5 cm field of view, a voxel size of 0.085 mm, and a peak kilovoltage of 90 kVp. Four oral and maxillofacial radiologists independently evaluated the CBCT scans under both MAR conditions and across 3 levels of sharpening filter application (none, Sharpen 1×, and Sharpen 2×). Diagnostic metrics were calculated and compared using 2-way analysis of variance (α=5%). The weighted kappa test was used to assess intra- and inter-examiner reliability in the diagnosis of HRF. Results: MAR tool activation, sharpening filter use, and their combination did not significantly impact the area under the receiver operating characteristic curve, sensitivity, or specificity of HRF diagnosis (P>0.05). Intra- and inter-examiner agreement ranged from fair to substantial. Conclusion: The diagnosis of HRF in a tooth adjacent to a zirconia implant is not affected by the activation of MAR, the application of a sharpening filter, or the combination of these tools.
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Objectives: Evaluate the prevalence of hospital mortality in older adult patients with femoral fracture undergoing surgical treatment during the COVID-19 pandemic period, and to evaluate whether COVID-19 infection, clinical, and orthopedic factors interfered with mortality. Material and Methods: A retrospective study was conducted by reviewing medical records. Patients over 60 years of age with proximal femoral fracture undergoing surgical treatment were included. Overall mortality was calculated, as well as mortality whose primary or secondary cause was COVID-19 infection, to determine if infection influenced patient mortality. Clinical and orthopedic factors that interfered with mortality were evaluated. Categorical variables were compared using the Chi-square test or Fisher's exact test. Both unpaired t-test (parametric variables) and Mann-Whitney test (non-parametric variables) were used. The Kaplan-Meier mortality curve was constructed. Conclusion: The mortality of older adult patients with femoral fracture undergoing surgical treatment during the COVID-19 pandemic was 4.2%. Male sex, older age, and those who underwent blood transfusion had higher mortality rates. COVID-infected patients had ten times more chance of death and died twice as fast as the non-infected population. Level of Evidence II, Retrospective Study.
Objetivos: Avaliar a mortalidade hospitalar de pacientes idosos com fratura de fêmur submetidos ao tratamento cirúrgico durante o período pandêmico de covid-19. Avaliar se a infecção pelo vírus do covid-19 e os fatores clínicos e ortopédicos interferiram na mortalidade. Material e Métodos: Realizou-se um estudo retrospectivo por levantamento de prontuários. Foram incluídos pacientes acima de 60 anos associados a fratura da extremidade proximal do fêmur e que submetidos a tratamento cirúrgico. Calculou-se a mortalidade geral e também aquela cuja causa principal ou secundária foi a infeção pelo covid-19 para determinar se essa influenciou na mortalidade dos pacientes. Foram avaliados se os fatores clínicos e ortopédicos interferiram na mortalidade e variáveis categóricas foram comparadas pelo teste de Qui-quadrado ou exato de Fisher, utilizando tanto o teste t não pareado (variáveis paramétricas) como o teste de Teste Mann-Whitney (variáveis não paramétricas). Por fim, construiu-se a curva de mortalidade de Kaplan-Meier. Conclusão: A taxa de mortalidade de pacientes idosos com fratura de fêmur submetidos ao tratamento cirúrgico durante a pandemia de Covid foi de 4,2%. Pacientes do sexo masculino, idosos e os que foram submetidos à transfusão sanguínea evoluíram com maior mortalidade. Pacientes infectados pelo Covid tiveram dez vezes mais chance de evoluir para óbito e de forma duas vezes mais rápida que a população não infectada. Nível de Evidência II, Estudo Retrospectivo.
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Objective: To evaluate the epidemiological profile of open fractures treated at the University Hospital of Lagarto in the years 2019 and 2020. Methods: This is an observational, retrospective study, using data from electronic medical records. Results: In total, 312 patients met the inclusion criteria for this research and were included. The mean age of affected patients was 36.8 years. The main segment affected were the fingers, mostly affecting males (89%) and predominantly the left side (57.62%). Conclusions: The male sex was the most affected by open fractures, and the most prevalent trauma mechanism was motorcycle accidents. Moreover, we found that the fundamental criteria for care in open fracture cases were not always considered by the professionals, resulting in a lack of uniformity in the adopted procedures and discrepancies with the guidelines recommended in the specific literature. Level of Evidence III, Comparative retrospective study.
Objetivo: Avaliar o perfil epidemiológico das fraturas expostas atendidas no Hospital Universitário de Lagarto nos anos de 2019 e 2020. Métodos: Trata-se de um estudo observacional, retrospectivo, por análise de dados de prontuário médico eletrônico. Resultados: Foram incluídos 312 (trezentos e doze) pacientes que atenderam aos critérios de inclusão para esta pesquisa. A média de idade dos pacientes acometidos foi de 36,8 anos. O principal segmento acometido foram os dedos das mãos, conforme Tabela 1, em maior número no sexo masculino (89%) e predominando no lado esquerdo (57,62%). Conclusões: O gênero mais acometido por fraturas expostas foi o masculino, e o mecanismo de trauma mais prevalente foi o acidente motociclístico. Todavia, nem sempre os critérios foram levados em conta pelos profissionais, não apresentando homogeneidade nas condutas adotadas, bem como desencontro com as condutas orientadas na literatura específica. Nível de Evidência III, Estudo Retrospectivo Comparativo .
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Flexible intramedullary nailing and external fixation have become the main methods to surgically treat femur fractures in children. This study aimed to search the current literature and evaluate the clinical and radiographic results of surgical treatment by comparing these methods and investigating their associated complications. This systematic review was carried out following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) recommendations. Searches were carried out on the PubMed, Embase, and Web of Science databases. The search for journals in these databases was carried out from January 2023 to August 2023, retrieving 695 studies. This systematic review included 11 articles, which encompassed 718 patients who underwent surgical external fixation and flexible nailing. The most frequently observed complications referred to late or malunion, superficial and deep infections, skin irritation, angular deformity, and length discrepancy between lower limbs. Both methods of stabilization of pediatric femoral fractures can provide good clinical and radiographic results. However, the choice of treatment with flexible nails is certainly more valid and has greater acceptance than external fixation. Level of Evidence III, Systematic Review .
Para o tratamento cirúrgico das fraturas do fêmur em crianças, as hastes intramedulares flexíveis e os fixadores externos tornaram-se os principais métodos utilizados. Este estudo teve como objetivo pesquisar a literatura atual e avaliar os resultados clínicos e radiográficos do tratamento cirúrgico confrontando estes métodos e investigar as complicações associadas. Trata-se de uma revisão sistemática, realizada segundo as recomendações PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), cujas buscas foram realizadas nas bases de dados (PubMed, Embase e Web of Science). A busca dos periódicos nessas bases de dados foi realizada entre janeiro de 2023 e agosto de 2023, e foram encontrados 695 estudos. Um total de 11 artigos foram incluídos nesta revisão sistemática, que engloba 718 pacientes que foram operados pelas técnicas cirúrgicas de fixação externa e haste flexível. As complicações mais frequentemente observadas foram a consolidação tardia ou viciosa, infecção superficial e profunda, irritação da pele, deformidade angular e discrepância no comprimento entre os membros inferiores. Verificou-se que ambos os métodos de estabilização das fraturas femorais pediátricas podem proporcionar bons resultados clínicos e radiográficos. No entanto, a escolha do tratamento com hastes flexíveis é certamente mais válida e tem maior aceitação, comparada à fixação externa. Nível de evidência III, Revisão Sistemática.
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PURPOSE: This multicenter, retrospective cohort study aimed to compare the risk of ulnar nerve injury in pediatric supracondylar humeral fractures treated with percutaneous lateral-pins, blinded-crossed-pins, and crossed-pins with a mini-incision. METHODS: Data were collected from 1705 children treated between January 2010 and December 2023 at four orthopedic centers in Colombia. The incidence of postoperative ulnar nerve injury was compared among three fixation techniques: lateral-pin, blinded-crossed-pin, and crossed-pin with a mini-incision. RESULTS: A statistically significant difference in nerve injury rates was observed between the lateral-pin and both blinded-crossed-pin and mini-incision crossed-pin techniques (p < 0.001), with the lateral-pin technique demonstrating a significantly lower risk of injury. No significant difference was found between the blinded-crossed-pin and mini-incision crossed-pin techniques (p = 0.67). CONCLUSION: Crossed-pin fixation was associated with a higher incidence of ulnar nerve injury, regardless of the use of a mini-incision. The lateral-pin technique remains the safest option for minimizing iatrogenic nerve injury. There is insufficient evidence to support the mini-incision as a safer alternative to traditional crossed-pin fixation.
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Hilos Ortopédicos , Fijación Interna de Fracturas , Fracturas del Húmero , Nervio Cubital , Humanos , Fracturas del Húmero/cirugía , Niño , Estudios Retrospectivos , Masculino , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Nervio Cubital/lesiones , Preescolar , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Incidencia , Clavos Ortopédicos/efectos adversos , Colombia/epidemiologíaRESUMEN
INTRODUCTION: In low- and middle-income countries such as Haiti, musculoskeletal injuries are the leading cause of morbidity and mortality. Untreated injuries can contribute to decreased mobility, leading to disability and reduced productivity for individuals. The accessibility of timely fracture care poses a substantial challenge in Haiti, where socioeconomic instability and recent surges in gang violence exacerbate an already strained healthcare infrastructure. This manuscript delves into the intricate barriers to sustainable fracture care in Haiti, shedding light on the sociopolitical landscape and clinical challenges that influence the delivery of orthopedic services. ETHICAL DISCUSSION: The ethical considerations in providing fracture care in Haiti are multifaceted, including classic medical principles, self-preservation in the face of violence, issues of justice in resource and service allocation, and concerns of nonmaleficence in the context of international volunteers. These ethical dilemmas arise from the complex interplay of limited resources, the dangers posed by the current sociopolitical climate, and the involvement of international aid in a vulnerable healthcare system. CONCLUSION: To address the clinical and ethical conflicts of providing fracture care in Haiti, solutions include education and training of Haitian orthopedic surgeons, capacity building of healthcare facilities, and establishing ethical standards for international volunteers. This comprehensive approach is vital for advancing sustainable fracture care in Haiti and other resource-limited settings.
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Fracturas Óseas , Haití , Humanos , Fracturas Óseas/terapia , Accesibilidad a los Servicios de Salud/ética , Política , Atención a la Salud/éticaRESUMEN
Study Design: Cross-sectional study. Objective: The prevalence and etiology of facial fractures differ in each country. The aim of this study was to determine the patterns, trauma mechanism, and treatment of midface and mandible fractures in a government hospital in Mexico City. Methods: A three-year cross-sectional study was done at Balbuena General Hospital in Mexico City. The variables of interest were age, gender, place of origin, fracture site, trauma mechanism, and treatment. Between 2016 and 2019, physical and electronic data records of patients that exhibited facial fractures were included. Statistical analyses performed included descriptive analysis and a chi-square test. Results: A total of 490 cases of fractures in the maxillofacial region were reviewed, of which 237 (47%) cases presented fractures in the midface. A higher male ratio (M: F 12:1) was observed. The age range varied between 18 and 80 years, with a mean of 35.58 ± 14 years. The most frequent diagnosis was a zygomatic complex fracture, 37.97%. (n = 90). The most frequent trauma mechanism was interpersonal violence at 55.93% (n = 132) in both places of origin (P = .06). Conservative treatment was more frequent at 71.67% in intrapersonal violence (P = .019). Interpersonal violence was more frequent in males at 61.64%, and motor vehicle accident was more frequent in female at 61.11% (P = .028). Conclusions: The analysis provides information that can help to focus preventive measures regarding facial fractures, especially on efforts to reduce interpersonal violence.
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What are the fractures associated with osteoporosis in Colombian persons over 50 years of age? Through the analysis of the Ministry of Health databases, Colombians over 50 years of age with osteoporosis fracture the forearm the most, followed by the thoracolumbar vertebrae and then the hip. We describe the differences between men and women. PURPOSE: The aim of this study was to determine the frequency of all bone fractures among adults aged 50 and above, both with and without osteoporosis, using data from SISPRO (Integrated Information System for Social Protection), the administrative database of the Colombian Ministry of Health. METHODS: Information was collected for the years 2017 to 2021 for all bone fractures (except cranial or face fractures), and how many of them occurred in patients who had the diagnosis of osteoporosis. Prevalence ratios (PR) were estimated separately for males and females by dividing the prevalence in those with by the prevalence of those without osteoporosis. RESULTS: For the period from 2017 to 2021, 303,037 adults over 50 years of age (females 279,057, 92.1%) were diagnosed with osteoporosis in Colombia, for a prevalence of 39.4 per thousand women and 4.14 in men; 40,823 of these women (14.6%) presented a fracture in the period, as well as 4020 of men (16.7%). Osteoporosis was present in 7.5% of the 596.618 (females 369.795; 62.0%) who suffered any fracture (1.8% of males and 11.0% of females). Overall PR was 3.4 (males 4.3; females 3.3). In men with osteoporosis, the most frequent fractures were hip (902), followed by lumbar vertebrae (842), ribs (648), and forearm (538), while in women, forearm (11,001), followed by hip (6885), lumbar vertebra (4813), and thoracic vertebra (2701) were the most common. PR in men was 21.9 for dorsal vertebrae fracture, 21.3 for lumbar vertebrae, 11.8 for ribs, and 7.7 for hip fracture. In women, PR was 15.7 for thoracic vertebrae, 13.3 for lumbar vertebrae, 3.3 for hip fracture, and 2.2 for forearm fracture. CONCLUSION: Osteoporosis is a highly prevalent disease in Colombia where women are more affected. Although fractures were more common in women, men with osteoporosis have a higher PR of associated fractures.
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Osteoporosis , Fracturas Osteoporóticas , Humanos , Colombia/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Prevalencia , Anciano , Osteoporosis/epidemiología , Osteoporosis/complicaciones , Fracturas Osteoporóticas/epidemiología , Anciano de 80 o más Años , Distribución por SexoRESUMEN
Introduction: Lateral locking plates are commonly employed for the fixation of distal femur fractures. However, scenarios involving medial comminution, extremely distal fractures, periprosthetic fractures, or nonunion could necessitate medial augmentation. This study explores the possibility of using lateral distal femoral locking plate systems for medial fixation by employing the contralateral plate. Methods: This study presents a technical note on the application of lateral distal femur locking systems for medial augmentation in patients as indicated by current literature findings. Postoperative imaging modalities, including radiography and computed tomography (CT), were used to assess the plates' fit to the distal femur. Three cases following the specified technical note are presented. Results: The various plate systems, all comprising distal femur locking systems, demonstrated adaptability to the medial femur anatomy as confirmed by intraoperative visualization and postoperative radiographs, including two-dimensional and three-dimensional CT scans. It has also been possible to achieve at least 3 independent fixation points regardless of the size of the medial condyle. Conclusions: Locking distal femoral plates can be a viable option for medial augmentation in indicated cases, achieving anatomical adaptation to the distal femur. This provides robust augmentation without the need for additional instruments beyond those used for the lateral cortex.
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Osteoporosis (OP) is a chronic disease that affects older adults' quality of life, with fragility fractures (FF) being its most significant consequence due to their impact on healthcare systems in terms of morbidity, and economic and caregiving burden. FF are defined as fractures resulting from low-energy trauma, defined as falls from a standing height or less, and are usually considered osteoporotic (1). World demographic projections warn of a significant increase in adults aged 65 and older by 2050. These demographic changes mean that OP and FF will soon become an even greater challenge for healthcare systems, where prevention programs should be a priority. In Mexico, FF is also a public health challenge, with an initial reported incidence of nearly 2,000 cases per 100,000 population, and a projected seven-fold increase by 2050. Given this scenario, there is an urgent need for policy- and decision-makers to change their approach and formulate health policies that guarantee that people aged 65 and older are screened for fractures and have access to appropriate care. These policies should be part of a strategy to minimize FF and ensure active and healthy aging according to the WHO's Decade of Healthy Ageing. In this context, a group of Mexican experts representing different health organizations interested in the burden of OP and FF met to discuss possible strategies to reduce their burden for the next decade and summarize them in this Call to Action to promote public policies that prioritize an evidence-based approach to the prevention and treatment of OP and FF.
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Objective To perform a radiographic assessment of the quality of supracondylar fracture fixation by identifying the factors that have contributed to inadequate reduction and increased the chance of reduction loss during outpatient follow-up. The variables analyzed were as follows: fracture line, initial displacement, time of day the surgery was performed, and chosen fixation technique. Methods Review of electronic medical records and radiographic evaluation of supracondylar fractures operated from January 2017 to December 2022. The radiograph assessment was based on the Baumann angle and the anterior humeral line. Determination of fixation quality was based on the number of cortices, crossing site, and wire divergence. Results We evaluated 194 cases, and postoperative reduction was poor in 17% of the subjects. Reduction loss occurred in 39 cases (20.10%), and 19 (48.7%) of these patients presented insufficient fixation ( p = 0.002). Among the cases operated during the day, 12.5% lost the reduction compared with 32% of the patients who underwent surgery at night and early in the morning ( p = 0.001). Conclusion Reduction quality and postoperative fixation loss were closely related to technical errors and the time of day the surgery was performed.
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Objective To identify the predictive factors for the need for transfusion during and after surgery to treat hip fractures in the elderly and to evaluate a protocol to guide the request for blood reserves for surgery. Methods The medical records of 172 elderly patients undergoing surgical treatment for proximal femoral fractures were collected. Data on sex, age, preoperative hemoglobin level, diagnosis, and type of surgery were tested for correlation with blood transfusion. In our sample, we determined the number of units of packed red blood cells reserved, the transfusion rate, and the cross-test:transfusion ratio. We made the same calculations in a hypothetical situation in which the request for blood reserves for our sample followed the criteria of a defined protocol. Results We found a correlation between the American Society of Anesthesiologists (ASA) classification and the occurrence of transfusions, and an inverse correlation between the hemoglobin level on admission and the number of bags transfused. A reserve of 328 units of packed red blood cells was requested for 167 surgeries. Had the proposed protocol been applied, 72 units would have been requested for 61 surgeries. Conclusion We found a correlation regarding the variables ASA classification and preoperative hemoglobin level and the occurrence of transfusion. Applying a proposed protocol to decide between requesting a reserve and only typing for elderly individuals undergoing surgical treatment for hip fracture proved suitable to reduce the number of packed red blood cell reserves.
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STUDY DESIGN: Literature review with clinical recommendations. OBJECTIVE: To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. METHODS: 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. RESULTS: 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. CONCLUSIONS: Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice.
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Background: Evidence concerning the complex foot trauma, especially its definitive management, is scarce. Soft tissue envelope sequalae are the primary parameters that delay or make internal fixation implausible. Stability conferred by external fixators makes them a reasonable initial treatment choice. Although AO or circular fixators can be applied around the foot, this can involve a learning curve and substantial costs, especially for the circular fixator. There is little evidence as to how well external fixators work as a definite method of fixation in patients where progression to internal fixation cannot be made. Methods: We prospectively evaluated 10 adult patients with severe and complex foot trauma who were consecutively treated at our clinic. Initial reduction and stabilization were performed with an external fixator that was initially conceived for distal radius fractures, applied during the initial procedure and mantained throughout the treatment. Results: Fracture healing was obtained in all 10 cases, and both internal and external column length was restored. One of the patients developed chronic osteomyelitis. At the 1-year follow-up visit, these patients averaged 45.6 points in the physical and 44.8 points on the mental status sections of the 12-Item Short Form Health Survey (SF-12). The Foot Function Index findings for pain, disability, and daily activities limitations were 33.3, 39, and 41.5, respectively, which suggest moderate residual impairment. Conclusion: In this relatively small case series of complex foot trauma, we found that the use of simple external fixation as definitive treatment worked reasonably well. Level of Evidence: Level III, prospective cohort study.
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The aim of this systematic review was to investigate the relationship between fractures of the floor of the orbit (blow outs) and their repercussions on eye movement, based on the available scientific literature. In order to obtain more reliable results, we opted for a methodology that could answer the guiding question of this research. To this end, a systematic review of the literature was carried out, using a rigorous methodological approach. The risk of bias was assessed using version 2 of the Cochrane tool for the risk of bias in randomized trials (RoB 2). This systematic review was carried out according to a systematic review protocol previously registered on the PROSPERO platform. The searches were carried out in the PubMed (National Library of Medicine), Scopus, ScienceDirect, SciELO, Web of Science, Cochrane Library and Embase databases, initially resulting in 553 studies. After removing duplicates, 515 articles remained, 7 were considered eligible, of which 3 were selected for detailed analysis. However, the results of the included studies did not provide conclusive evidence of a direct relationship between orbital floor fractures and eye movement.
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Movimientos Oculares , Fracturas Orbitales , Humanos , Movimientos Oculares/fisiologíaRESUMEN
OBJECTIVE: To compare the outcomes of surgical stabilization of pediatric supracondylar humeral fractures with the use of crossed Kirschner wires versus divergent lateral pinning wires. METHODS: This is a systematic review with meta-analysis carried out by searching the MEDLINE/PubMed, Science Direct and Scielo databases. In these, the search for journals was carried out between January and August 2023, where 695 studies were found. To assess the quality of the studies, the Jadad and the MINORS scales were used.. The selection and reading of relevant articles were carried out by the researchers and 11 studies met the selection criteria. RESULTS: From the 11 selected studies, 963 patients who met the criteria for the surgical treatment of these fractures were grouped. After the statistical analysis, we found that the ulnar nerve injury had a higher incidence when the crossed-K wire technique was used; and the lateral fixation is safer for the ulnar nerve. CONCLUSION: Both fixation techniques determine good functional results. However, fixation with lateral Kirschner wires proves to be safer considering the risk of iatrogenic injury to the ulnar nerve. Crossed-K wire fixation is more effective in terms of stability and maintenance of fracture reduction. Level of Evidence II, Systematic Review of Level II or Level I Studies with discrepant results.
Objetivo: Comparar os desfechos da estabilização cirúrgica das fraturas supracondilianas do úmero pediátricas com o uso de fios de Kirschner cruzados versus fios laterais divergentes. Métodos: Trata-se de uma Revisão Sistemática com metanálise realizada pela pesquisa nas bases de dados MEDLINE/PubMed, Science Direct e Scielo. Nessas, a busca dos periódicos foi realizada entre janeiro e agosto de 2023, e foram encontrados 695 estudos. Para a avaliação da sua qualidade, foram utilizadas a escala de Jadad e a escala MINORS. A seleção e a leitura dos artigos pertinentes foram realizadas pelos pesquisadores e 11 estudos preencheram os critérios de escolha. Resultados: Dos estudos selecionados, agrupamos 963 pacientes que preenchiam os critérios para o tratamento cirúrgico das fraturas. Após a análise estatística, observamos que maior incidência de lesão do nervo ulnar quando foi utilizada a técnica de pinagem cruzada; e a fixação lateral demonstrou ser mais segura para tal. Conclusão: Ambas as técnicas de fixação determinam bons resultados funcionais. Entretanto, a fixação com fios de Kirschner laterais demonstra ser mais segura, considerando o risco de lesão iatrogênica do nervo ulnar. A fixação com fios cruzados é mais eficaz, levando em conta a estabilidade e a manutenção da redução das fraturas. Nível de evidência II, Revisão sistemática de Estudos de Nível II ou Nível I com resultados discrepantes.
RESUMEN
OBJECTIVES: To identify the characteristics of patients and femur fractures treated with a stainless steel intramedullary nail (ESIN) in children under 15 years of age. Know the results of using the ESIN of related steel in the service. METHODS: Retrospective study with review of hospital records and organization of data in spreadsheets. RESULT: 24 cases were identified, 17 male cases and 7 female cases. A minimum age of 4 years and a maximum of 11 years were observed (average of 7 years). The 3 most common trauma mechanisms were being run over (n:8, 33%) and falling from a height (n:8, 3%). The most common location of the fractures was in the mid-diaphyseal region (n: 20, 88%), only one case presented a bilateral femur fracture. The most common associated trauma was traumatic brain injury. The observation period observed several months between 2 and 5. With regard to complications, 3 cases were observed (12.5%) being bursitis, vicious construction and loss of reduction. CONCLUSION: Steel HIF shows similar good results. As the study includes the retrospective profile, the absence of a group and the small sample size. Level of Evidence IV, Case series.
OBJETIVOS: Identificar as características dos pacientes e das fraturas de fêmur tratadas com haste intramedular flexível (HIF) de aço inoxidável em menores de 15 anos. A partir disso, conhecer os resultados relacionados ao uso da HIF de aço inoxidável no serviço. Métodos: Estudo retrospectivo, com revisão de prontuários hospitalares e organização dos dados em planilhas. RESULTADO: Identificados 24 casos, sendo 17 do gênero masculino e sete do gênero feminino. Foram observadas idade mínima de 4 anos e máxima de 11 anos (média de 7 anos). Os mecanismos de trauma mais comuns foram atropelamento (n: 8, 33%) e queda de altura (n: 8, 33%). A localização mais comum das fraturas foi na região médio diafisária (n: 20, 88%), apenas um caso apresentou fratura de fêmur bilateral. O trauma associado mais comum foi traumatismo crânio-encefálico. O período de consolidação observado variou entre 2 e 5 meses. No que se refere a complicações, foram observados três casos (12,5%), sendo estes: bursite, consolidação viciosa e perda de redução. Conclusão: A HIF de aço apresenta bons resultados, semelhantes aos das hastes de titânio. As limitações do estudo incluem o perfil retrospectivo, a ausência de grupo controle e o número pequeno da amostra. Nível de evidência IV, Série de casos.
RESUMEN
INTRODUCTION: To evaluate the relationship between initial displacement in proximal humeral fractures and fatty degeneration of the rotator cuff measured by CT according to the Goutallier classification. MATERIAL AND METHODS: This cross-sectional observational study evaluated patients with proximal humeral fractures over a six-month period. The study included patients ≥ 18 years old with complete radiological views (anteroposterior, lateral, and Grashey) and a CT scan of the affected shoulder; previous fracture or ipsilateral shoulder surgery were excluded. Neer's classification system and Goutallier stages were used to evaluate the patients. Demographic data were collected and, two groups were analysed according to age (≤ 50 years and > 50 years). RESULTS: Sixty-two patients were included (m = 36, f = 26, ratio 1.3:1); seven patients were excluded. Male patients (36, 58.1%), patients older than 50 years (33, 53.2%) and a low-energy injury mechanism (36, 58.1%) were the most frequent cases. According to the Neer system, the most common proximal humerus fracture was fracture-dislocation in 17 (27.4%) cases. The most common stage in Goutallier's classification was I (some fatty streaks) in 22 (35.4%) cases. Younger patients (≤ 50 years) had more displaced fractures with low fatty degeneration (p = < 0.001) than older patients (> 50 years), who had minimally displaced fractures with greater fatty degeneration (p = 0.567). CONCLUSIONS: High-energy mechanisms are associated with younger patients and a more displaced fracture according to the Neer classification. Older patients had a more advanced Goutallier stage and lesser displaced fracture. We should consider a more aggressive approach in the treatment of non-displaced fractures in elderly patients, less conservative and more surgical management, to obtain a better clinical evolution after the treatment of these kinds of fractures. LEVEL OF EVIDENCE: IV.