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1.
PLoS One ; 16(6): e0252667, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34111160

RESUMEN

PURPOSE: For displaced distal radius fracture, this trial aimed to compare an above-elbow (AE) and below-elbow (BE) cast at the end of a 24-week follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a primary outcome. METHODS: This is a clinical trial with parallel groups (1:1) and a blinded evaluator. There are two non-surgical interventions: AE and BE. A total of 128 adult patients with acute (up to 7 days) displaced distal radius fracture of type A2-3, C1-3 by the AO classification were included. The follow-up was 24 weeks. The primary outcome was the DASH questionnaire at 24 weeks. Secondary outcomes were the maintenance of reduction by the evaluation of radiographic parameters, pain measured by VAS, PRWE, objective functional evaluation and rate of adverse effects. RESULTS: The difference between the two groups in the DASH score at 24 weeks was not significant, with the mean (95% CI) DASH score being AE: 9.44 (2.70 to 16.17) vs. BE: 9.88 (3.19 to 16.57) (p = 0.895). The above-elbow group had a significantly greater worsening of the mean DASH score from baseline to 2 weeks (p < 0.001). No statistically significant differences were found between the 2 groups in any of the other follow-up assessments. Objective functional evaluation, PRWE, radiographical measures and rates of reduction loss were similar between groups. Above-elbow casting resulted in more adverse effects (mostly shoulder pain; 19 events vs. 9 events); RR = 0.39 (0.19-0.94); p = 0.033 at the end of six-month follow-up. CONCLUSIONS: This study did not demonstrate a difference between above-elbow and below-elbow cast in terms of DASH outcome at 6 months in non-surgical treatment of deviated distal radius fractures. However, below-elbow casting is less debilitating during the treatment period, has comparable performance in maintaining the reduction, and is related to fewer minor adverse effects than above-elbow casting.


Asunto(s)
Tratamiento Conservador , Codo/patología , Fracturas del Radio/terapia , Codo/fisiopatología , Femenino , Fracturas Mal Unidas/fisiopatología , Fuerza de la Mano , Humanos , Masculino , Dolor/etiología , Medición de Resultados Informados por el Paciente , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/fisiopatología , Rango del Movimiento Articular , Escala Visual Analógica
2.
Rev. venez. cir. ortop. traumatol ; 53(1): 35-41, jun. 2021. tab
Artículo en Español | LILACS, LIVECS | ID: biblio-1252919

RESUMEN

El acortamiento y la rotación del peroné son las deformidades más frecuentemente encontradas cuando se presentan maluniones postraumáticas del tobillo resultando en ensanchamiento de la mortaja e inestabilidad astragalina, con consecuentes cambios artrósicos. Los pacientes acuden por presentar dolor y limitación en sus actividades diarias y deportivas. En el presente estudio retrospectivo se hace una evaluación de los resultados clínicos y radiológicos de 9 pacientes que se sometieron a tratamiento quirúrgico posterior a maluniones de fracturas de peroné, en los cuales se realizaron osteotomías de alargamiento y desrotación para reconstrucción del tobillo, en la Unidad de Cirugía de Pie y Tobillo del Hospital Universitario de Caracas, entre junio de 2014 y agosto del 2019. Se realizaron mediciones radiológicas pre y postoperatorias de los ángulos de inclinación astragalina, talocrural y bimaleolar, y se reportaron los cambios degenerativos articulares. Para la evaluación clínica y funcional se aplicó la Escala Análoga Visual (VAS) para el dolor, y la Escala AOFAS de retropié, evidenciándose mejoría en cuanto a dolor, función y alineación. El objetivo del tratamiento fue restituir la longitud inicial del peroné, mediante osteototomías oblicuas en el sitio de la fractura anterior, o transversas suprasindesmales, con lo cual también se corrige la alineación del astrágalo, y de esta manera prevenir o disminuir los síntomas y signos inherentes a degeneración articular progresiva(AU)


The shortening and rotation of the fibula are the most frequent deformities found when post-traumatic ankle malunions occur, resulting in widening of the mortise and talus instability, with consequent arthritic changes. Patients have pain and limitation in their daily activities and sports. In the present retrospective study, an evaluation of the clinical and radiological results of 9 patients who underwent surgical treatment after fibular fracture malunions was performed, in which osteotomies of lengthening and de-rotation were performed for reconstruction of the ankle, in the Unit of Foot and Ankle Surgery at the University Hospital of Caracas, between June 2014 and August 2019. Pre and postoperative radiological measurements of the astragaline, talocrural and bimaleolar inclination angles were performed, and degenerative joint changes were reported. For the clinical and functional evaluation, the Visual Analog Scale (VAS) was applied for pain, and the AOFAS Hindfoot Scale, evidencing improvement in pain, function, and alignment. The objective of the treatment was to restore the initial length of the fibula by means of oblique osteotomies at the site of the previous fracture or suprasindesmal transverse osteotomy, which also corrects the alignment of the talus and thus prevents or decreases the symptoms and signs inherent to joint progressive degeneration(AU)


Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Anciano , Osteotomía , Alargamiento Óseo , Fracturas Mal Unidas , Traumatología , Fracturas Óseas , Peroné/cirugía
3.
Artículo en Español | LILACS, BINACIS | ID: biblio-1353927

RESUMEN

Objetivo: Comunicar los resultados de una serie de adultos con consolidaciones en valgo del codo tratados con una osteotomía en cuña sustractiva monoplanar. materiales y métodos: Se incluyeron 5 pacientes. Se describe la técnica quirúrgica que consistió en un abordaje posterior paratricipital, resección en cuña sustractiva y transposición anterior del nervio cubital. El seguimiento promedio fue de 17 meses. Resultados: Se trató a 4 hombres y una mujer, con una edad promedio de 27 años. La movilidad preoperatoria promedio fue de 138-7° y la posoperatoria, de 138-6°, el puntaje de dolor en la EAV fue de 4 y 1, el MEPS de 71 y 97, y el DASH de 26 y 8, respectivamente. La evaluación radiográfica preoperatoria arrojó un valgo promedio de 30° con un valgo contralateral de 11°. La corrección radiográfica demostró un valgo de 13°. Se obtuvo una corrección promedio de 2° menos que del otro lado. Todas las osteotomías consolidaron, y la medición de la prominencia medial fue, en promedio, un 32% mayor que en el preoperatorio. Según la escala de Oppenheim, el resultado fue excelente en 4 pacientes y bueno en uno. La satisfacción personal fue, en promedio, de 8,6. Conclusiones: La osteotomía en cuña sustractiva para tratar un codo valgo es una buena opción terapéutica, con recuperación de valores angulares comparables con el lado contralateral, y alta tasa de satisfacción de los pacientes. Como es una técnica menos compleja que las osteotomías multiplanares, es nuestra elección ante una consolidación viciosa en valgo del codo del adulto. Nivel de Evidencia: IV


Objective: To report the results of a series of adult patients with a valgus malunion of the elbow treated with a supracondylar subtractive monoplanar wedge osteotomy, materials and methods: 5 patients were included. The surgical technique consisted of a posterior paratricipital approach, with resection of a subtractive wedge and the anterior transposition of the ulnar nerve. The average follow-up was 17 months.Results: 4 patients were men and 1 woman with an average age of 27 years. The preoperative range of motion was 138°-7° and the postoperative range of motion was 138-6°. Pain according to VAS was 4 and 1, MEPS was 71 and 97, and DASH was 26 and 8, respectively. The preoperative radiological evaluation showed an average valgus of 30° with a contralateral valgus of 11º. The final valgus obtained was 13°. The final correction was, on average, 2° less than the contralateral side. All osteotomies healed and the medial prominence was on average 32%, more than before surgery. According to Oppenheim scale, the results were excellent in 4 patients and good in 1. Personal satisfaction was, on average, 8.6. Conclusions: Supracondylar subtractive wedge osteotomy is a good option for the treatment of adult cubitus valgus with a recovery of angular values similar to the contralateral side and a high satisfaction rate. As it is a simpler technique, compared to the multiplanar osteotomies, it is our treatment of choice for adult cubitus valgus. Level of Evidence: IV


Asunto(s)
Adulto , Osteotomía , Resultado del Tratamiento , Deformidades Adquiridas de la Articulación , Fracturas Mal Unidas , Articulación del Codo
4.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(2): 125-132, jun. 2020.
Artículo en Español | BINACIS, LILACS | ID: biblio-1125549

RESUMEN

Objetivo: Evaluar los resultados y las complicaciones de una serie de pacientes con consolidación viciosa de falange. Materiales y Métodos: Se realizó un estudio retrospectivo que incluyó a pacientes con consolidación viciosa de falange tratados mediante osteotomía en el sitio de la deformidad, estabilizados con osteosíntesis rígida. Se registró la movilidad de los dedos. La valoración subjetiva consistió en el puntaje DASH y una escala analógica visual para el dolor en reposo, en actividad y la función. Resultados: Doce pacientes (13 falanges) cumplieron los criterios de inclusión. El tiempo promedio entre la lesión inicial y la osteotomía fue 14 meses y el seguimiento promedio, 34 meses. La movilidad final promedio en flexo-extensión fue 89° metacarpofalángica, 74° interfalángica proximal, 54° interfalángica distal y la distancia pulpejo-palma, 3 mm. El puntaje promedio de la escala analógica visual en reposo fue 0; en actividad, 1 y la función promedio fue de 7 puntos; el puntaje DASH promedio fue 6. No hubo casos de seudoartrosis. Cinco pacientes requirieron el retiro de la placa. Los pacientes con osteotomía articular no presentaron signos de artrosis. Conclusiones: La osteotomía de falange en el sitio de la deformidad es un procedimiento eficaz con un buen resultado objetivo y subjetivo a corto plazo. La utilización de placas y tornillos conlleva una tasa más alta de complicaciones; por lo tanto, los pacientes deben ser advertidos sobre la posibilidad de una segunda intervención quirúrgica. Nivel de Evidencia: IV


Objective: To present the results and complications of a series of phalangeal malunion patients. Materials and Methods: A retrospective study was conducted on phalangeal malunion patients treated with an osteotomy at the deformity site and stabilized with rigid internal fixation. Postoperative mobility of the digit was recorded. The subjective assessment used the Disabilities of the Arm, Shoulder and Hand (DASH) score and a Visual Analogue Scale (VAS) to rate their function and pain at rest and during activity. Results: Twelve patients (13 phalanges) met the inclusion criteria. The average time between fracture and osteotomy was 14 months and the mean follow-up was 34 months. Final mobility in flexo-extension was: 89 degrees for metacarpophalangeal joint, 74 degrees proximal interphalangeal joint, 54 degrees distal interphalangeal joint. The average VAS pain score was 0 at rest and 1 during activity, and the average function was 7 points. The average DASH score was 6. There were no cases of nonunion. Five patients required plate removal. No patients with articular osteotomy presented signs of Osteoarthritis. Conclusions: Phalangeal osteotomy at the deformity site is an effective procedure with good objective and subjective short-term outcomes. Patients should be warned about the possibility of a second procedure in cases of plate fixation due to a higher complication rate associated with plate and screw fixations. Level of Evidence: IV


Asunto(s)
Adulto , Persona de Mediana Edad , Osteotomía , Resultado del Tratamiento , Fracturas Mal Unidas , Falanges de los Dedos de la Mano/cirugía , Fijación Interna de Fracturas
5.
Int. j. morphol ; 38(2): 309-315, abr. 2020. graf
Artículo en Inglés | LILACS | ID: biblio-1056440

RESUMEN

Stability is necessary to ensuring proper bone repair after osteotomies and fractures. The aim of this research was to analyze how the repair of pseudoarthrosis sites was affected by different conditions in related to soft tissue. An experimental study was designed with 18 New Zealand rabbits. Six study groups were formed. An osteotomy was performed on the mandibular body of each animal and muscle was installed at the osteotomy site to model pseudoarthrosis. Fixation by surgery was then carried out, using plates and screws. The animals were submitted to euthanasia after 21, 42 and 63 days to make a descriptive comparison of the histological results. No animal was lost during the experiment. In all the samples, bone formation was observed with different degrees of progress. Defects treated with or without removal of the tissue involved in pseudoarthrosis presented comparable bone repair, showing that stability of the bone segments allows the repair of adjacent tissue. In some samples cartilaginous tissue was associated with greater bone formation. Stabilization of the fracture is the key in bone repair; repair occurs whether or not the pseudoarthrosis tissue is removed.


La estabilidad de las osteotomías y de las fracturas son fundamentales para asegurar la adecuada reparación ósea; el objetivo de esta investigación fue analizar la reparación presente en sitios de pseudoartrosis realizando la limpieza de la zona previo a la fijación o manteniendo el tejido de la nounión en el mismo lugar durante la osteosíntesis. Se diseñó un estudio experimental incluyendo 18 conejos de raza Neozelandesa. Se formaron 6 grupos de estudios a quienes se relizó una osteotomía en el cuerpo mandibular y posterior instalación de músculo en el lugar de la osteotomía para fabricar un modelo de pseudoartrosis. En cirugía posterior se fijó con placa y tornillos. Se realizaron eutanasias a los 42 y 63 días para comparar los resultados de forma descriptiva mediante estudio histológico. No fue perdido ningún animal durante el experimento. En todas las muestras evaluadas se observó formación ósea en diferentes niveles de avance; defectos tratados con o sin el retiro del tejido involucrado en la pseudoartrosis presentaron una condición de reparación ósea comparables, determinando que la estabilidad de los segmentos óseos permite la reparación del tejido adyacente. El tejido cartilaginoso se presentó en algunas muestras asociadas a sectores con mayor presencia de formación ósea. La estabilización de la fractura es clave en la reparación ósea; la reparación se produce manteniendo o retirando el tejido presente en la pseudoartrosis.


Asunto(s)
Animales , Conejos , Curación de Fractura , Fracturas Mal Unidas/terapia , Fracturas Mandibulares/terapia , Osteotomía/efectos adversos , Fracturas Mandibulares/cirugía
6.
Rev. chil. ortop. traumatol ; 61(1): 18-22, mar. 2020. ilus, tab
Artículo en Español | LILACS | ID: biblio-1291846

RESUMEN

OBJETIVOS: Estimar un modelo predictivo para la no-unión en pacientes que presentan fractura de tibia. MATERIALES Y MÉTODOS: Estudio de cohorte retrospectivo, en pacientes con fractura de tibia operadas entre 2012 y 2018, con un mínimo de 12 meses de seguimiento, excluyendo amputaciones traumáticas. Realizamos un modelo de regresión logística con 13 variables descritas en la literatura. Se descartaron las variables estadísticamente no significativas y las que no causaban efecto de confusión. Se evaluó la bondad de ajuste mediante el test de Hosmer-Lemeshow y la discriminación del modelo con la curva ROC. RESULTADOS: Se incluyeron 411 fracturas de tibia, las variables estadísticamente significativas fueron: exposición ósea OR » 2,57(IC:1,15­5,75, p » 0,022), diabetes OR » 3,29 (IC:1,37­7,91, p » 0,008) y uso de tutor externo OR » 1,77(IC:0,81­3,85), el que tuvo efecto de confusión. La bondad de ajuste demostró que los datos se ajustan adecuadamente al modelo (p » 0,35). La curva ROC demuestra un 70,91% de poder discriminatorio. Al evaluar aisladamente las fracturas expuestas, no hubo asociación estadísticamente significativa con ninguna variable. DISCUSIÓN: Al evaluar el modelo, obtuvimos una asociación estadísticamente significativa entre: no unión, exposición ósea, diabetes y uso de tutor externo, información concordante con la literatura. Al estudiar el subgrupo de fracturas expuestas, las demás variables son estadísticamente no significativas. Eso refleja que la exposición ósea es la variable que confiere mayor riesgo. El seguimiento adecuado de esos pacientes es fundamental dado este alto riesgo de evolucionar con no-unión. CONCLUSIÓN: En nuestra serie, la exposición ósea es el factor de riesgo más importante para presentar no unión de tibia.


OBJECTIVES: Estimate a predictive model for non-union in patients presenting with a tibial fracture. MATERIALS AND METHODS: Retrospective cohort study in patients with tibia fractures operated between 2012 and 2018, with a minimum follow-up of 12 months, excluding traumatic amputations. We performed a multivariate logistic regression model with 13 variables described in the literature. The variables that were statistically non-significant and those variables that do not cause confusion, were discarded. Goodness of fit was evaluated using the Hosmer-Lemeshow test and the discrimination of the model with the ROC curve. RESULTS: 411 tibial fractures were included, the statistically significant variables were: bone exposure OR » 2.57(CI:1.15­5.75, p » 0.022), diabetes OR » 3.29(CI:1.37­7.91, p » 0.008) and use of external fixation OR » 1.77(CI:0.81­3.85), being included in the model because of its confounding effect. Goodness of fit demonstrates that the data fit the model adequately(p » 0.35). The ROC curve demonstrates 70.91% discriminatory power. When evaluating the exposed fractures in isolation, there was no statistically significant association with any variable. DISCUSSION: When evaluating the model, we obtained a statistically significant association between non-union, bone exposure, diabetes and use of external fixation, being consistent with the literature. When studying the subset of exposed fractures, the other variables are statistically non-significant. This reflects that bone exposure is the variable that confers the greatest risk. Proper follow-up of these patients is essential given this high risk of evolving with non-union. CONCLUSION: In our series, bone exposure is the most important risk factor for presenting tibial non-union.


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Fracturas de la Tibia/cirugía , Fracturas Mal Unidas/diagnóstico , Fracturas de la Tibia/fisiopatología , Modelos Logísticos , Análisis Multivariante , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Curva ROC , Estudios de Cohortes , Estudios de Seguimiento
7.
J Foot Ankle Surg ; 58(4): 785-791, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31010769

RESUMEN

Subtalar joint distraction arthrodesis has been recommended for the treatment of conditions such as nonunion or malunion of subtalar joint arthrodesis posttraumatic arthritis. Both conditions are difficult to treat, because the deformities created in the frontal and sagittal planes of these conditions are complex. If these malalignments are not addressed, ankle joint instability and wear occur over time. In general, either autograft or allograft bone has been used to perform distraction arthrodesis of the subtalar joint. Although studies have shown successful use, there have been complications. Autografts have resulted in donor site morbidity and limitations on graft size, and allografts have shown high nonunion rates. Both autografts and allografts have shown graft collapse over time. Recent literature has discussed the use of tantalum technology to span large defects in bone healing. Studies have shown that tantalum provides superior strength and bone incorporation compared with autografts and allografts. This case series presents 2 cases in which tantalum truss technology was used for distraction arthrodesis. Although this series is limited in patient numbers, both cases show effective graft incorporation with no loss in height over time and earlier return to activity compared with previous studies that used autograft and allograft wedges.


Asunto(s)
Artritis/cirugía , Artrodesis/métodos , Calcáneo/lesiones , Fracturas Mal Unidas/cirugía , Articulación Talocalcánea/cirugía , Tobillo/diagnóstico por imagen , Artritis/etiología , Calcáneo/diagnóstico por imagen , Femenino , Fracturas Óseas/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Osteogénesis por Distracción , Complicaciones Posoperatorias/cirugía , Radiografía , Rango del Movimiento Articular , Articulación Talocalcánea/diagnóstico por imagen , Titanio , Tomografía Computarizada por Rayos X
8.
Rev. colomb. ortop. traumatol ; 33(S1): 28-33, 2019. ilus.
Artículo en Español | LILACS, COLNAL | ID: biblio-1378915

RESUMEN

Establecer cuales deformidades angulares en el fémur deben ser tratadas con resección ósea intraarticular inusual más artroplastia total de rodilla en artrosis tricompartimental de rodilla es uno de los retos mayores que se enfrenta en cirugía ortopédica. Presentamos el caso de un paciente masculino de 67 años de edad, con antecedente de fractura diafisaria de fémur hace 30 años tratada en forma conservadora con dolor en la rodilla izquierda de 2 años de evolución con un diagnóstico de artrosis tricompartimental de la rodilla asociada a genu valgum de 20° y consolidación viciosa en diáfisis femoral izquierda con valgo femoral de 10°. El tratamiento quirúrgico realizado fue utilizando cortes intraarticulares inusuales y artroplastia total de rodilla. De acuerdo a la escala propuesta por la Knee Society Score el paciente obtuvo 89 al año de la cirugía. Ante deformidades femorales de hasta 20°, suele ser suficiente realizar la corrección con los cortes óseos intraarticulares (inusuales) evitando afectar las inserciones ligamentarias femorales.


To establish the angular deformities in the femur that should be treated with unusual intra-articular bone resection plus total knee arthroplasty in tricompartmental arthrosis of the knee is one of the major challenges faced in orthopaedic surgery. The case is presented of a 67 year-old male patient with a history of diaphyseal fracture of the left femur (30 years ago) treated conservatively with malunion in left femoral diaphysis with 10° femoral valgus and left knee pain of 2 years onset. He was diagnosed with tricompartmental osteoarthritis of the knee associated with genu valgum of 20°. Surgical treatment was performed using intra articular «unusual¼ bone cuts and total knee arthroplasty. According to the scale proposed by the Knee Society Score, the patient obtained a score of 89 one year after surgery. In femoral deformities of up to 20°, it is usually sufficient to perform the correction with intra articular «unusual¼ bone cuts, and avoiding affecting the femoral ligament insertions.


Asunto(s)
Humanos , Fracturas Óseas , Osteoartritis , Telemetría , Fracturas Mal Unidas , Genu Valgum
9.
Rev. cuba. ortop. traumatol ; 32(2): 0-0, jul.-dic. 2018. graf, tab
Artículo en Español | LILACS, CUMED | ID: biblio-1093701

RESUMEN

Introducción: El retardo de consolidación es una complicación que resulta de un proceso de consolidación ósea anormal. Objetivo: Caracterizar a los pacientes con retardo de consolidación, infiltrados con lisado plaquetario autólogo. Métodos: Se realizó un estudio de casos, observacional, descriptivo, transversal y retrospectivo, en el Hospital General Docente Comandante Pinares, de enero 2008 a diciembre de 2017. Se revisaron 186 historias clínicas y se seleccionaron 80, que cumplían los criterios para el estudio. Se infiltró entre 6 mL de lisado plaquetario autólogo en los focos de fracturas, se evaluó el tiempo de consolidación ósea mediante radiografías seriadas y se registraron las complicaciones. Las variables del estudio fueron: edad, sexo, color de la piel, localizaciones óseas afectadas, sitios anatómicos del hueso, tiempo de consolidación ósea, complicaciones. Se empleó la distribución de frecuencias absoluta y relativa en el análisis de las variables cualitativas y la media aritmética para la variable cuantitativa edad. Para la relación entre variables cualitativas independientes se utilizó la prueba de chi-cuadrado. Resultados: Hubo más frecuencia de retardo de la consolidación en hombres de piel blanca, con edades comprendidas entre 26 y 45 años. Predominó en el tercio inferior de la tibia. El hueso que más tiempo requirió para su consolidación fue la tibia, con más de 16 semanas. No se describen complicaciones asociadas al implante. Conclusiones: El retardo de consolidación continúa siendo una complicación de difícil manejo. Es frecuente en hombres jóvenes y blancos. El lisado plaquetario autólogo es un buen coadyuvante en el tratamiento de esta complicación(AU)


Introduction: The delay of consolidation is a complication that results from an abnormal bone consolidation process. Objective: To characterize patients with delayed consolidation infiltrated with autologous platelet lysate. Methods: An observational, descriptive, cross-sectional and retrospective case study was conducted at Comandante Pinares General Teaching Hospital, from January 2008 to December 2017. One hundred eighty six (186) medical records were reviewed and eighty (80) were selected, since they met the study criteria. 6 mL of autologous platelet lysate was infiltrated in the foci of fractures. Serial radiographs were used to assess the bone healing time and complications were recorded. The variables of the study were age, sex, color of the skin, affected bone locations, anatomical sites of the bone, time of bone consolidation, complications. The distribution of absolute and relative frequencies was used in the analysis of qualitative variables and arithmetic mean for the quantitative age variable. Chi-square test was used for the relationship between independent qualitative variables. Results: The delayed consolidation was more frequency in white men, aged between 26 and 45 years. It predominated in the lower third of the tibia. Tibia was the bone that required more time for consolidation, more than 16 weeks. No complications associated with the implant are described. Conclusions: The delayed consolidation continues being a complication of difficult treatment. It is frequent in young and white men. The autologous platelet lysate is a good adjuvant in the treatment of this complication(AU)


Introduction: Le retard de consolidation est une complication résultant d'un processus de consolidation osseuse anormal.Objectif: Caractériser les patients atteints de retard de consolidation qui sont traités par infiltration de lysat plaquettaire autologue. Méthodes: Une étude observationnelle, descriptive, transversale et rétrospective a été réalisée à l'hôpital général universitaire Comandante Pinares, depuis janvier 2008 jusqu'à décembre 2017. Sur 186 dossiers médicaux révisés, on a sélectionné 80 respectant les critères d'inclusion de l'étude. Six millilitres de lysat plaquettaire autologue ont été injectés dans les foyers des fractures ; le temps de consolidation osseuse a été estimé par des radiographies en série, et les complications ont été enregistrées. On a utilisé des variables telles que l'âge, le sexe, la couleur de la peau, les localisations osseuses affectées, le site anatomique de l'os, le temps de consolidation osseuse, et les complications. On a employé la distribution de fréquences absolue et relative pour l'analyse des variables qualitatives et la moyenne d'âge, tandis que pour la relation entre les variables qualitatives indépendantes on a utilisé le test du chi-carré. Résultats: Le retard de consolidation a été beaucoup plus fréquent chez les hommes blancs entre 26 et 45 ans. Le tiers inférieur du tibia a été touché en prédominance. L'os qui a exigé beaucoup plus de temps de consolidation a été le tibia (plus de seize semaines). Des complications associées à l'implant n'ont pas été décrites. Conclusions: Le retard de consolidation demeure une complication difficile à traiter. Il est fréquemment observé chez les hommes jeunes et blancs. Le lysat plaquettaire autologue est un bon adjuvant dans le traitement de cette complication(AU)


Asunto(s)
Humanos , Masculino , Femenino , Fracturas Mal Unidas/terapia , Plasma Rico en Plaquetas , Epidemiología Descriptiva , Estudios Transversales , Estudios Retrospectivos , Estudio Observacional
10.
Unfallchirurg ; 120(10): 837-843, 2017 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-28801809

RESUMEN

The confusingly structured and in many areas corrupt health system in Peru even today provides only a fragmentary and insufficient medical treatment especially for the indigenous population (mainly Quechua Indians). Since October 2007 the Diospi Suyana missionary hospital in Curahuasi (State of Apurímac) has provided an affordable medical treatment at a high level mainly for these indigenous people of Peru; however, so far the hospital could only insufficiently meet the traumatological needs of the region. The establishment of a surgical trauma department aims to meet those needs but is also encumbered by special problems and challenges. Some patients, for example only present at the hospital after the fractures have already incorrectly healed, sometimes many weeks or even months after the trauma either due to a long journey through the country to different hospitals where treatment was not possible or they could not pay for the treatment and sometimes because of inadequate prior treatment, for example by traditional healers. Cultural and infrastructural particularities of the country must be included in the process of choosing the right method of treatment.


Asunto(s)
Países en Desarrollo , Hospitales Religiosos , Misioneros , Servicio de Cirugía en Hospital/organización & administración , Heridas y Lesiones/cirugía , Características Culturales , Fracturas Mal Unidas/cirugía , Gastos en Salud , Accesibilidad a los Servicios de Salud , Humanos , Indígenas Sudamericanos , Medicina Tradicional , Perú , Áreas de Pobreza
11.
J Pediatr Orthop ; 37(7): 504-510, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-26491911

RESUMEN

BACKGROUND: Posttraumatic and congenital forearm deformities in children can be difficult to appreciate in all planes. In cases of distal radioulnar joint instability and loss of forearm rotation, surgical correction is challenging. Advances in 3-dimensional printing allow creation of custom guides at a reasonable cost, enabling precise correction of the deformity in all planes. METHODS: Nineteen children with deformity of the forearm had corrective osteotomies performed using preoperative 3-dimensional computer modeling and patient-specific surgical guides. Surgicase software was used for 3-dimensional planning of the corrective osteotomy, by superimposing a mirror image of the unaffected side as a template. Based upon this planning, patient-specific surgical guides were manufactured. Radiographic and clinical outcomes were assessed. RESULTS: Three patients had a diagnosis of multiple hereditary exostoses, and one of Madelung's deformity. The remaining 15 patients had a diagnosis of fracture malunion. Average preoperative angulation of both the radius and ulna was 23 degrees. For the patients with fracture malunions, the time from injury to surgery ranged from 6 months to 8 years. Twelve patients underwent osteotomies of both the radius and ulna, 5 had osteotomies of the radius alone, and 2 had a single osteotomy of the ulna only. All osteotomies went on to unite and no patient lost range of motion. Preoperative arc of forearm rotation averaged 101 degrees (range 0 to 180 degrees). Postoperatively, this improved to 133 degrees (range 85 to 180 degrees). Eight patients had distal radioulnar instability preoperatively, all of which normalized after surgery. There were 4 complications: 1 hypertrophic scar, 1 subject with extensor pollicis longus weakness, and 2 transient sensory losses in the superficial radial nerve distribution. CONCLUSIONS: This case series demonstrates that 3-dimensional computer modeling permits complex and multiple osteotomies to be done safely to achieve deformity correction in children. Limitations in forearm rotation and distal radioulnar malalignment can be reliably improved using this technique. LEVEL OF EVIDENCE: Level IV-retrospective case series.


Asunto(s)
Simulación por Computador , Traumatismos del Antebrazo/cirugía , Antebrazo/anomalías , Fracturas Mal Unidas/cirugía , Osteotomía/métodos , Fracturas del Radio/cirugía , Cirugía Asistida por Computador/métodos , Adolescente , Niño , Preescolar , Femenino , Antebrazo/diagnóstico por imagen , Humanos , Masculino , Radiografía , Rango del Movimiento Articular , Estudios Retrospectivos , Rotación , Resultado del Tratamiento
12.
Hand Surg Rehabil ; 35S: S89-S94, 2016 12.
Artículo en Francés | MEDLINE | ID: mdl-27890219

RESUMEN

Over-reduction is a classical complication following pinning of distal radius fractures. Indeed, the pinning techniques derived from Kapandji's technique do not allow anterior stabilization. A literature review and our experience show that it is an underestimated complication that can affect up to one-third of cases, but that is well tolerated if the anterior tilt is less than 20°. Excessive angulation of the dorsal intrafocal K-wires becomes a significant risk factor beyond 60°. Volar comminution of the fracture is an obvious predisposing factor. We will outline our ideas on the topic and present a new pinning technique, which has reduced the over-reduction rate to below 3 %: multiple mixed pinning combines two dorsal intrafocal K-wires with two trans-styloid K-wires along the anterior and posterior cortices of the radius to provide true sagittal stabilization of the fracture. This technique is suitable for fractures without major instability or associated anterior comminution-Milliez types 1 and 2 are its best indications. In our practice, there still is a place for pinning of non-complex fractures in young active subjects. More than 20° malunion in flexion can lead to symptoms; in this instance, isolated opening osteotomy of the radius is the most suitable technique.


Asunto(s)
Clavos Ortopédicos , Fijación Interna de Fracturas/efectos adversos , Fracturas Mal Unidas/prevención & control , Complicaciones Posoperatorias/prevención & control , Fracturas del Radio/cirugía , Placas Óseas , Hilos Ortopédicos , Fijación Interna de Fracturas/métodos , Fijación Intramedular de Fracturas , Humanos , Fracturas del Radio/complicaciones
13.
Am J Trop Med Hyg ; 95(4): 894-896, 2016 Oct 05.
Artículo en Inglés | MEDLINE | ID: mdl-27402518

RESUMEN

Zika virus (ZIKV) and chikungunya virus (CHIKV) cocirculate throughout much of the tropical Western Hemisphere; however, few cases of coinfection with these two pathogens have been reported. Herein, we describe three cases of ZIKV-CHIKV coinfection detected at a single center in Ecuador: a patient who developed symptoms on postoperative day 5 from an orthopedic procedure, a woman who had traveled to Ecuador for fertility treatment, and a woman who was admitted for Guillain-Barré syndrome and had ZIKV and CHIKV detected in serum and cerebrospinal fluid. All cases were diagnosed using a multiplex real-time reverse transcription polymerase chain reaction, and ZIKV viremia was detected as late as 16 days after symptom onset. These cases demonstrate the varied clinical presentation of ZIKV-CHIKV coinfections as well as the importance of multiplexed arboviral testing for these pathogens.


Asunto(s)
Fiebre Chikungunya/complicaciones , Coinfección/virología , Turismo Médico , Procedimientos Ortopédicos , Técnicas Reproductivas Asistidas , Viremia/complicaciones , Infección por el Virus Zika/complicaciones , Adulto , Fiebre Chikungunya/sangre , Fiebre Chikungunya/líquido cefalorraquídeo , Virus Chikungunya/genética , Ecuador , Femenino , Fracturas del Fémur/cirugía , Fracturas Mal Unidas/cirugía , Síndrome de Guillain-Barré/líquido cefalorraquídeo , Síndrome de Guillain-Barré/virología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/virología , ARN Viral/sangre , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Viremia/sangre , Virus Zika/genética , Infección por el Virus Zika/sangre , Infección por el Virus Zika/líquido cefalorraquídeo
14.
J Pediatr Orthop ; 36(5): 472-7, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-25887826

RESUMEN

BACKGROUND: Elastic nailing is a common method of fixation for tibial shaft fractures in skeletally immature individuals. Poor outcomes of titanium elastic nails for femoral shaft fractures have been associated with increasing patient age and weight, especially patients weighing >50 kg. Our objective is to determine if there is an upper weight or age limit to the safe and effective use of titanium elastic nails for tibial shaft fractures in the pediatric population. METHODS: This is a retrospective cohort study of patients who underwent stabilization of a tibial shaft fracture with titanium elastic nails at a large tertiary-care pediatric trauma center. Data collected included patient demographics, injury characteristics, and radiographic data. Weight groups were stratified as ≥ or <50 kg, and age groups as 14 years or older or less than 14 years old. Malunion was defined as 10 degrees of angulation in either the sagittal or coronal plane. Union was defined as bridging of ≥3 cortices on orthogonal radiographs. A significant difference in time to union was considered to be 3 weeks. RESULTS: Ninety-five patients were included with a mean age of 12.1 years (range, 6 to 16 y) and a mean weight of 50.2 kg (range, 21 to 122 kg). Malunion rate was similar between weight cohorts: 13.3% (6/45) in the ≥50-kg group and 10% (5/50) in the <50-kg group (P=0.61). Malunion rate was similarly comparable between age groups: 17.6% (6/34) in the 14 years and older group and 8.2% (5/61) in the less than 14-year-old group (P=0.17). There was no statistically significant difference in time to union between weight or age cohorts. In sum, we did not find a significant difference in the rate of malunion or time to healing between younger and older patients or between lighter and heavier patients. CONCLUSION: The use of titanium elastic nails for tibial shaft fractures, unlike for other long bone fractures, seems not to be precluded in older and heavier patients. LEVEL OF EVIDENCE: Level III.


Asunto(s)
Peso Corporal , Clavos Ortopédicos , Fijación Intramedular de Fracturas/métodos , Fracturas de la Tibia/cirugía , Titanio , Adolescente , Factores de Edad , Niño , Femenino , Curación de Fractura , Fracturas Mal Unidas , Humanos , Masculino , Pronóstico , Radiografía , Estudios Retrospectivos , Fracturas de la Tibia/diagnóstico por imagen , Resultado del Tratamiento
15.
Injury ; 46(4): 649-54, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25661107

RESUMEN

Nonunion fractures occur frequently in humans, with profound implications (medical and non-medical). Although there are numerous animal models to study pathogenesis and treatment of nonunion fractures, there is apparently the lack of a definitive model for atrophic nonunion fracture. Therefore, the objective was to develop a low-cost rat model of nonunion fracture with a vascular deficit that enabled standardized quantitative analysis of bone growth and regeneration. The model was developed with two surgeries, performed apart. The first involved osteotomy of the femur diaphysis, removal of periosteum and endosteum, isolation of the fracture site using a latex artefact (Penrose drain tube), and reduction of the fracture using an intramedullary pin, whereas the second surgery was to remove the latex artefact. Based on radiographic imaging, micro-CT and histological analyses done 125 days after the fracture was induced, there was clear evidence of atrophic nonunion fracture, without pin migration or specimen loss. Perceived advantages of this model included low cost, ease of reproducibility, lack of specimen loss, and, finally, the potential to assess bone growth and regeneration under poor vascular conditions.


Asunto(s)
Fracturas del Fémur/patología , Fijación de Fractura , Fracturas Mal Unidas/patología , Microrradiografía , Osteotomía/métodos , Animales , Atrofia , Fenómenos Biomecánicos , Modelos Animales de Enfermedad , Curación de Fractura , Ratas , Reproducibilidad de los Resultados
16.
Acta ortop. bras ; Acta ortop. bras;21(4): 226-232, jul.-ago. 2013. ilus, tab
Artículo en Portugués | LILACS | ID: lil-684079

RESUMEN

Objetivo: apresentar nossas experiências no tratamento de más uniões ou não consolidações talares. Método: entre janeiro de 2000 e setembro de 2009, 26 pacientes com má união ou nãounião depois de fraturas do tálus foram submetidos a tratamento cirúrgico de acordo com os diferentes tipos de deformidade talar. Os desfechos do tratamento foram avaliados pela escala tornozelo-retropé da AOFAS, assim como por radiografias simples. Resultados: 20 pacientes ficaram disponíveis para acompanhamento por 30 (24 a 60) meses. Não houve problema de cicatrização ou infecção das feridas e foram obtidas uniões sólidas em todos os pacientes. As uniões radiológicas foram atingidas em tempo médio de 14 (faixa de 12 a 18) semanas. O tempo médio para concluir o apoio de carga foi 16 (faixa de 14 a 20) semanas. O escore AOFAS médio aumentou significantemente de 36,2 (27 a 43) para 85,8 (74 a 98). Conclusão: as intervenções cirúrgicas das fraturas mal-unidas ou não consolidadas dos tálus podem produzir resultados satisfatórios e o procedimento apropriado deve ser adotado, de acordo com diferentes tipos de deformidades pós-traumáticas. Nível de Evidência: IV, Estudo Retrospectivo.


Objective: To present our experiences of treating talar malunions and nonunions. Method: between January 2000 and September 2009, 26 patients with malunions or nonunions after talar fractures underwent surgical treatment according to different types of talar deformities. The treatment outcomes were evaluated using AOFAS ankle-hindfoot scale as well as plain radiographs. Results: 20 patients were available for follow-up for 30 (range, 24 to 60) months. No wound healing problems or infections occurred and solid unions were achieved in all patients. Radiological unions were achieved at a mean time of 14 (range, 12 to 18) weeks. The mean time to complete weight-bearing was 16 (range, 14 to 20) weeks. The mean AOFAS score increased significantly from 36.2 (range, 27 to 43) to 85.8 (range, 74 to 98). Conclusion: surgical interventions for malunions and nonunions after talar fractures can bring about satisfactory outcomes, and the appropriate procedure should be adopted according to different types of posttraumatic deformities. Level of Evidence: IV, Retrospective Study.


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Persona de Mediana Edad , Curación de Fractura , Fracturas Mal Unidas/cirugía , Fracturas Mal Unidas/terapia , Procedimientos Quirúrgicos Operativos/rehabilitación , Astrágalo/cirugía , Astrágalo/lesiones , Radiografía
17.
J Surg Res ; 183(2): 620-8, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23535114

RESUMEN

BACKGROUND: The bone nonunion is an important complication of bone fracture repair. The existing models developed on small animal species prevent using osteosynthesis materials designed to be implanted in human bones. The goal of this study was to develop a nonunion process in a noncritical segmental tibial defect in sheep, a species analogous in size to humans. MATERIALS AND METHODS: The animals were divided into two groups of four animals each. In Group 1 (experimental), the defect was created by surgically stripping the periosteum from the edges of a distal tibial osteotomy, keeping the edges 5 mm apart, and placing an incomplete O-shaped silicone ring in the gap. Group 2 (control) was intervened with a simple fracture at the distal end of the tibia. In both groups an interlocking nail was used as a fixation system. Over 8 wk after surgery, radiographs and histologic and histomorphometric analyses were performed. RESULTS: The control group showed a typical bone repair process. In contrast, the experimental group showed a fracture line with rounded edges and a scarce callus formation. The bone callus showed reduced amount of bone formation and large content of fibrous tissue (P=0.001). CONCLUSIONS: These results indicate that our model developed an atrophic nonunion in sheep, a species having multiple similarities to humans, such as weight, size, bone structure, and bone remodeling process.


Asunto(s)
Clavos Ortopédicos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Fracturas Mal Unidas/cirugía , Modelos Animales , Fracturas de la Tibia/cirugía , Animales , Curación de Fractura , Fracturas Mal Unidas/diagnóstico por imagen , Masculino , Osteogénesis , Osteotomía , Periostio/cirugía , Radiografía , Ovinos , Tibia/cirugía , Fracturas de la Tibia/diagnóstico por imagen
18.
J Craniomaxillofac Surg ; 41(1): 42-6, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22743222

RESUMEN

INTRODUCTION: Mandibular fractures are frequent, and treatment for these fractures involves rigid fixation. Complications can occur after treatment and may require a new surgical procedure; however, there are limited studies evaluating surgical retreatment. AIM: The purpose of this retrospective study was to evaluate the characteristics and the types of treatment carried out in patients requiring surgical retreatment of mandibular fractures. MATERIALS AND METHODS: From all patients with mandibular fractures treated by rigid internal fixation at a trauma hospital during a 7-year-period, 20 patients (4.7% of the cases) required a second surgery. RESULTS: The most common complaints were pain, infection with the presence of fistula, and abnormal mobility. There was a predominance of Staphylococcus aureus in the bacterial culture. The most frequent radiographic images were diffuse bone resorption, loosening of screws, and a visible fracture line. The diagnoses were nonunion in 10 (50%) cases, soft tissue infection associated with screw loosening or plate exposure in 7 (35%) cases, osteomyelitis in 2 (10%) cases, and malunion in 1 (5%) case. Seven cases of nonunion presented with fistula, and four of these patients had bone sequestration. The required procedures included new fixation in 6 (30%) patients, removal of bone sequestration and new fixation in 4 (20%) patients, surgical exploration and removal of fixation material in 7 (35%) patients, removal of bone sequestration in 2 (10%) patients, and refracture in 1 (5%) patient. CONCLUSION: It was concluded that most cases requiring surgical retreatment of mandibular fractures comprised nonunion or soft tissue infection associated with screw loosening or plate exposure. Consequently, the main procedures needed were new fixation or surgical exploration with the removal of fixation material.


Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas Mandibulares/cirugía , Adolescente , Adulto , Resorción Ósea/etiología , Niño , Fístula Cutánea/etiología , Fístula Cutánea/cirugía , Falla de Equipo , Femenino , Fijación Interna de Fracturas/instrumentación , Fracturas Mal Unidas/etiología , Fracturas Mal Unidas/cirugía , Fracturas no Consolidadas/etiología , Fracturas no Consolidadas/cirugía , Humanos , Masculino , Enfermedades Mandibulares/etiología , Enfermedades Mandibulares/cirugía , Persona de Mediana Edad , Osteomielitis/etiología , Osteomielitis/cirugía , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias/cirugía , Reoperación , Estudios Retrospectivos , Infecciones de los Tejidos Blandos/etiología , Infecciones de los Tejidos Blandos/cirugía , Infecciones Estafilocócicas/cirugía , Dehiscencia de la Herida Operatoria/etiología , Dehiscencia de la Herida Operatoria/cirugía , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/cirugía , Adulto Joven
20.
Int. j. odontostomatol. (Print) ; 6(2): 241-244, ago. 2012. ilus
Artículo en Inglés | LILACS | ID: lil-657697

RESUMEN

In the international literatura exist some information related to temporomandibular joint (TMJ) involvement in condylar fracture malunion; the treatment is variated being executed with a bone reconstruction, ramus vertical osteotomy or condilar plate. This case demonstrates that TMJ replacement with prosthetic joint is technically possible and appropriate in the case of malunion of condylar fracture.


La literatura internacional presenta información asociada a la mal unión de fracturas condilares de laarticulación temporo mandibular; el tratamiento es variado siendo ejecutado con reconstrucciones óseas, osteotomía vertical de rama mandibular o instalación de placas con forma condilar. Este caso demuestra que el reemplazo de ATM con prótesis articular es técnicamente posible y apropiado en casos de malunion de fracturas condilares.


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Fracturas Mal Unidas/cirugía , Fracturas Mal Unidas/etiología , Fracturas Mandibulares/cirugía , Prótesis Articulares , Articulación Temporomandibular , Cóndilo Mandibular/lesiones , Fijación de Fractura/efectos adversos , Resultado del Tratamiento
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