RESUMO
BACKGROUND: This study aims to evaluate the relation between coracoclavicular resistance to failure and the distance between clavicular tunnels. The hypothesis is that a greater clavicular bone bridge between tunnels achieves a stronger coracoclavicular fixation. METHODS: Descriptive Laboratory Study. Thirty-six (36) coracoclavicular models were constructed utilizing porcine metatarsals. Coracoclavicular stabilizations were performed using a subcoracoid loop fixation configuration through two clavicular tunnels, tied at the clavicle's superior cortex using a locking knot. Models were randomly assigned to 1 of 3 experimental groups of variable bone bridge length between clavicular tunnels: 5 mm, 10 mm, and 15 mm. Each group had 12 models. Fixation resistance was assessed through the ultimate failure point under an axial load to failure trial. Failure patterns were documented. A one-way ANOVA test was used, and a Tukey post hoc as needed (P < 0.05). FINDINGS: Mean strength per bone bridge length: 5 mm = 312 N (Range: 182-442 N); 10 mm = 430 N (Range: 368-595 N); 15 mm = 595 N (Range: 441-978 N). The 15 mm group had a significantly higher ultimate failure point than the other two groups: 5 mm (P < 0.001) and 10 mm (P < 0.001). All fixations systematically failed by a superior cortex clavicle fracture at the midpoint between tunnels. INTERPRETATION: A direct relationship between bone bridge length and coracoclavicular resistance to failure was demonstrated, being the 15 mm length a significantly higher strength construct in a tied loop model.
Assuntos
Articulação Acromioclavicular , Fraturas Ósseas , Procedimentos de Cirurgia Plástica , Articulação Acromioclavicular/cirurgia , Animais , Fenômenos Biomecânicos , Cadáver , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Ligamentos Articulares/cirurgia , SuínosRESUMO
The case of a patient with clavicular middle third fractures is presented. The aim is explaining the ultrasound guided clavipectoral fascia plane block (CPB). This constitutes a novel technique and an alternative to traditional regional anesthesia of the brachial plexus. The purpose is to provide anesthesia, analgesia, and control over postoperative pain about the pathology mentioned. The technique was first described by L. Valdés in 2017.
Se presenta el caso de una paciente con fractura de tercio medio clavicular con el objetivo de explicar el bloqueo del plano de la fascia clavipectoral guiado por ultrasonido (CPB). Ésta constituye una técnica novedosa y una alternativa a los procedimientos tradicionales de anestesia regional del plexo braquial, con el propósito de brindar anestesia, analgesia y control del dolor posoperatorio sobre dicha patología. Esta técnica fue descrita por primera vez en el año 2017 por L. Valdés.
Assuntos
Humanos , Feminino , Adolescente , Dor Pós-Operatória/terapia , Clavícula/lesões , Fraturas Ósseas/cirurgia , Fáscia , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção , Fixação Interna de Fraturas , Anestésicos Locais/administração & dosagemRESUMO
RESUMEN El síndrome de Scheuthauer Marie Sainton es una enfermedad poco frecuente, que sigue un patrón de herencia autosómico dominante con expresividad variable. Se presenta paciente masculino de 74 años de edad, nacido por parto distócico (cesárea) producto a una desproporción cefalopélvica materna. Acudió a la consulta de Medicina General Integral, del Policlínico Docente "Efraín Mayor Amaro", municipio Cotorro, La Habana, con tos y secreción nasal. Se interpretó como un catarro común para lo cual se le indicó abundantes líquidos, analgésicos, antihistamínicos y vitamina C. En el examen físico se constató que el paciente padecía del síndrome de Scheuthauer Marie Sainton, pues tenía ausencia de ambas clavículas, deformidades óseas y anomalías dentales; además, se detectó tórax acampanado, el cual es evidente en el período de recién nacido. Para el tratamiento de esta enfermedad, el paciente fue remitido a la consulta de estomatología. Desde el punto de vista óseo, no se realizó ninguna cirugía correctora a voluntad del paciente(AU)
ABSTRACT Scheuthauer Marie Sainton syndrome is a rare disease that follows an autosomal dominant pattern of inheritance with variable expressivity. We report a case of a 74-year-old male patient, who was born by dystocic delivery (cesarean section) due to maternal cephalopelvic disproportion. He went to the Comprehensive General Medicine consultation at Efraín Mayor Amaro Teaching Community Clinic, Cotorro municipality, Havana, with a cough and runny nose. It was interpreted as a common cold and he was prescribed abundant fluids, analgesics, antihistamines and vitamin C. On physical examination it was found that the patient suffered from Scheuthauer Marie Sainton syndrome, as he had absence of both clavicles, bone deformities and dental abnormalities. In addition, he was noticed to have flared chest, which is evident in the newborn period. The patient was referred to the stomatology consultation for the treatment of this disease. No corrective bone surgery was performed at the patient's discretion(AU)
RÉSUMÉ Le syndrome de Scheuthauer-Marie-Sainton est une maladie peu fréquente, qui suit un modèle de transmission autosomique dominante à expression variable. Un patient âgé de 74 ans, né par accouchement dystocique (césarienne) dû à une disproportion céphalo-pelvienne maternelle, est présenté. Du fait de la toux et des sécrétions nasales, il est allé à la consultation de médecine générale intégrale, de la polyclinique universitaire Efrain Mayor Amaro, dans la municipalité de Cotorro, à La Havane. Un rhume a été considéré, c'est pourquoi on lui a indiqué de prendre des boissons en abondance, et prescrit des analgésiques, des antihistaminiques et de la vitamine C. Dans l'examen physique, on a pu constater que le patient était atteint de syndrome de Scheuthauer-Marie-Sainton, caractérisé par l'absence complète des clavicules, des difformités osseuses et des anomalies de la denture ; on a aussi trouvé un thorax évasé, très évident chez le nouveau-né. Pour le traitement de cette maladie, le patient a été dirigé à la consultation de stomatologie. Du point de vue osseux, aucune chirurgie de correction n'a été effectuée en respectant la volonté du patient(AU)
Assuntos
Humanos , Masculino , Idoso , Displasia Cleidocraniana/diagnóstico por imagemRESUMO
In this study, the bones forming the poultry skeleton of the Dalmatian pelican were macroscopically examined. For this purpose, three Dalmatian pelicans were used. In the Dalmatian pelicans, the shoulder girdle (Ossa cinguli membri thoracici) is formed by the scapula, os coracoideum and clavicula bones. The scapula bone was short and flat. The humerus was a long bone with a cylindrical, pneumatic structure. Os corocoideum was also in the processus coracoideus tuber. Radius formed a joint with the ulna, and presented a slight slope from proximal to distal direction. Ossa carpi bones (skeleton manus) were composed of os carpi ulnare and os carpi radiale. The phalanx proximalis digiti majoris had a triangular shape on the dorsal side and two blade-shaped phalanxes. The bones that make up the structure of the Dalmatian pelicans wing have significant similarities to other birds, but also to have many particular characteristics.(AU)
Assuntos
Animais , Passeriformes/anatomia & histologia , Passeriformes/crescimento & desenvolvimento , Extremidade Superior , ÚmeroRESUMO
In this study, the bones forming the poultry skeleton of the Dalmatian pelican were macroscopically examined. For this purpose, three Dalmatian pelicans were used. In the Dalmatian pelicans, the shoulder girdle (Ossa cinguli membri thoracici) is formed by the scapula, os coracoideum and clavicula bones. The scapula bone was short and flat. The humerus was a long bone with a cylindrical, pneumatic structure. Os corocoideum was also in the processus coracoideus tuber. Radius formed a joint with the ulna, and presented a slight slope from proximal to distal direction. Ossa carpi bones (skeleton manus) were composed of os carpi ulnare and os carpi radiale. The phalanx proximalis digiti majoris had a triangular shape on the dorsal side and two blade-shaped phalanxes. The bones that make up the structure of the Dalmatian pelicans wing have significant similarities to other birds, but also to have many particular characteristics.
Assuntos
Animais , Extremidade Superior , Passeriformes/anatomia & histologia , Passeriformes/crescimento & desenvolvimento , ÚmeroRESUMO
ResumenEste artículo es una revisión bibliográfica, sobre la determinación de la edad en individuos vivos, desconocidos e indocumentados, en los que resulta fundamental debido a un proceso legal determinar si son mayores de edad. La estimación de la edad, es un estudio relativamente joven de la medicina forense, que tomó importancia en los años noventa, debido a los movimientos migratorios.
SummaryThis is a bibliographical review, on the determination of the age in alive, unknown and undocumented individuals, in which it is fundamental to determine if they are of age. The estimation of the approximate age, is a relatively young study of the forensic medicine, that took importance in the nineties, due to the migratory movements.
Assuntos
Humanos , Osteogênese , Exame Físico , Radiologia , Desenvolvimento Ósseo , Determinação da Idade pelo Esqueleto , Determinação da Idade pelos Dentes , Médicos Legistas , Medicina LegalRESUMO
Introducción: El ligamento de Caldani o coracoclavicular medial ha sido estudiado anatómicamente, pero no hemos hallado mención alguna sobre su identificación imagenológica. El objetivo de este trabajo es presentar una técnica original de resonancia magnética que hemos desarrollado para identificarlo, y describir las imágenes correspondientes. Materiales y Métodos: Se incluyó a siete voluntarios sin patología de hombro conocida. Se utilizó un resonador magnético Philips Ingenia de una intensidad de campo magnético de 1.5 T, versión 4.1, diámetro de Gantry de 70 cm, bobina específica para hombro de 8 canales con imágenes de alta resolución. Se realizaron las secuencias de búsqueda del ligamento en tres planos. Resultados: El ligamento coracoclavicular medial fue identificado en todos los casos, se extendía oblicuamente desde la apófisis coracoides hasta la clavícula, lo que coincide con las descripciones de la bibliografía anatómica consultada. Tuvo una señal hipointensa en todas las secuencias, lo que indica el poco espacio entre fibras y que corresponde a tejido colágeno compacto. Su longitud promedio fue de 41,15 mm (rango 34-47 mm, desviación estándar 4,40). El espesor promedio fue de 2,11 mm (rango 1,3-3,2 mm, desviación estándar 0,66). Conclusiones: El ligamento coracoclavicular medial se puede observar en imágenes de resonancia magnética mediante la técnica original que describimos. La capacidad de localizarlo y observarlo con este estudio por imágenes abre las puertas a futuras investigaciones sobre su posible papel no solo en las compresiones neurovasculares, sino también en las lesiones traumáticas acromioclaviculares, especialmente en las de tipo V de Rockwood. Nivel de Evidencia: II
Introduction: Although Caldani´s ligament or medial coraco-clavicular ligament has been anatomically studied, we have not found any publication regarding its identification in imaging studies. The aim of this research is to present an original technique to locate the medial coraco-clavicular ligament on magnetic resonance imaging, as well as to describe the pertinent findings. Methods: Seven volunteers without any known shoulder pathology were studied by means of this original protocol. A Philips Ingenia magnetic resonance equipment was used, with a magnetic field intensity of 1,5 T, Gantry diameter: 70 cm, and an 8-channel coil for shoulder study. The sequences to locate the ligament were performed in three planes. Results: This ligament was observed in all cases. Its arrangement was similar to that described in previous anatomical studies. Its origin was at the coracoid process, with an oblique path to reach its insertion at the clavicle. The mean length was 41.14 (range 34-47 mm, standard deviation 4.40). The mean thickness was 2.11 mm (range 1.3-3.2 mm, standard deviation: 0.66). Conclusions: The medial coraco-clavicular ligament can be observed in magnetic resonance images using this original procedure. The ability to display this ligament in magnetic resonance images allows for future investigations on its possible role in both thoracic outlet syndrome and traumatic acromioclavicular dislocations, especially the Rockwood type V. Level of Evidence: II
Assuntos
Articulação Acromioclavicular , Imageamento por Ressonância Magnética , Ligamentos ArticularesRESUMO
BACKGROUND: Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. PURPOSE: To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. RESULTS: Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. CONCLUSION: Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.
Assuntos
Clavícula/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Futebol/lesões , Adulto , Argentina , Atletas , Traumatismos em Atletas/cirurgia , Clavícula/diagnóstico por imagem , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Medição da Dor , Estudos Prospectivos , Recuperação de Função Fisiológica , Escala Visual Analógica , Adulto JovemRESUMO
Sex determination plays an essential role in forensic anthropology in the identification of an individual from skeletal remains. The aim of the study was to determine sex of an individual using the clavicle in a KwaZulu-Natal population. Various morphometric and morphological parameters were measured using 100 clavicles of known sex (66 male and 34 female) and age (range 2595 years). The mean maximum length, mid-shaft circumference and maximum breadth of the sternal and acromial ends of the male clavicles were greater in females. However, the mean medial curve of the clavicle was greater in females than in males on both sides, and on the right side the female clavicles also had a greater mean lateral curve than the males. The maximum length and mid-shaft circumference alone could be used to predict sex with an accuracy of 89 %. Therefore, the provision of morphometric data pertaining to the clavicle may assist forensic investigators, anthropologists and anatomists to sex the clavicle.
La determinación del sexo juega un papel esencial en la antropología forense e identificación de un individuo con restos óseos. El objetivo fue determinar el sexo de un individuo mediante la clavícula en una población KwaZulu-Natal. Se midieron varios parámetros morfométricos y morfológicos utilizando 100 clavículas (66 hombres y 34 mujeres) con un rango etario entre 2595 años. La longitud máxima media, circunferencia media del eje y la amplitud máxima de los extremos esternal y acromial de las clavículas de los hombres fueron mayores que en las mujeres. Sin embargo, la curva medial media de la clavícula fue mayor en mujeres que en hombres en ambos lados, y en el lado derecho las mujeres también tenían una curva lateral media de las clavículas mayor que en los hombres. La circunferencia máxima y la circunferencia media del eje por sí solas podrían ser utilizadas para predecir el sexo con una precisión de 89 %. Por tanto, la información de datos morfométricos relativos a la clavícula pueden ayudar a los investigadores forenses, antropólogos y anatomistas en la determinación del sexo.
Assuntos
Humanos , Masculino , Feminino , Clavícula/anatomia & histologia , Determinação do Sexo pelo Esqueleto , África do SulRESUMO
Introducción: La fractura clavicular neonatal es una complicación frecuente, está asociado a múltiples factores y es indicador de calidad de atención del parto institucional. Objetivo: Determinar la incidencia y características clínicas de la fractura clavicular neonatal. Diseño: Cuantitativo, epidemiológico, de estudio estadístico, descriptivo. Lugar: Hospital Nacional Sergio E. Bernales. Participantes: Población: neonatos que presentaron fractura clavicular. Intervenciones: Se elaboró y usó una ficha de recolección de datos. Resultados: En el Hospital Nacional Sergio E. Bernales, durante el período 2009 - 2013, se atendieron 29110 partos, registrándose 252 casos de fractura clavicular neonatal, obteniéndose una incidencia de 0,9 por ciento. Conclusiones: Incidencia de fractura clavicular neonatal en el Hospital Nacional Sergio E. Bernales, durante el periodo 2009 - 2013: 0,9 por ciento. Factores asociados: edad materna entre 20 a 34 años, multiparidad, edad gestacional entre 37 a 42 semanas. La fractura se produjo: partos eutócicos en neonatos a término, sexo femenino, peso mayor a 3500 gramos y perímetro cefálico entre 32 a 36 cm. El diagnóstico clínico fue: por médico especialista entre los días 2do y 3er de vida, localización frecuente fue: clavícula derecha, tercio medio y el tipo de fractura fue: no desplazada.
Introduction: Neonatal clavicle fracture is a common complication, is associated with multiple factors and is an indicator of quality of care in hospital parturition. Objective: To determine the incidence and clinical features of neonatal clavicular fracture. Design: Quantitative, epidemiological, statistical, descriptive study. Location: Sergio E. Bernales National Hospital. Participants: Population: neonates who had clavicular fracture. Interventions: It was developed and used a data collection sheet. Results: Sergio E. Bernales National Hospital during the period 2009 - 2013, 29110 births were attended, recorded 252 cases of neonatal clavicular fracture, yielding an incidence of 0.9 per cent. Conclusions: Incidence of neonatal clavicular fracture Sergio E. Bernales National Hospital during the period 2009 - 2013: 0.9 per cent. Factors associated with maternal age between 20-34 years, multiparity, gestational age between 37-42 weeks. The fracture occurred: normal parturitions in term neonates, female, weight greater than 3500 grams and head circumference between 32-36 cm. The clinical diagnosis was by specialist between the 2nd and 3rd of Iife, frequent location was, right clavicle, middle third and the fracture was, not displaced.
Assuntos
Masculino , Feminino , Humanos , Recém-Nascido , Clavícula/lesões , Complicações do Trabalho de Parto , Estudos Observacionais como Assunto , Estudos Retrospectivos , Estudos TransversaisRESUMO
Introducción: La unión temprana y el rápido retorno a la función previa son la prioridad en los atletas jóvenes con fracturas desplazadas de clavícula distal. Además es esencial evitar la pseudoartrosis en este grupo de pacientes ya que la misma se asocia a dolor persistente, restricción del movimiento y pérdida de la fuerza y resistencia del hombro Diseño: Serie de casos Nivel de evidencia IV Materiales y Métodos: Un total de 21 deportistas con fracturas desplazadas de clavícula distal fueron tratados con reducción cerrada y fijación con doble botón a través de un abordaje mínimamente invasivo entre marzo de 2008 y octubre de 2013. Los pacientes respondieron un cuestionario focalizado en el tiempo de vuelta al deporte. Los resultados funcionales se evaluaron con el score de Constant y la versión corta del score de Discapacidad del brazo, del hombro y de la mano (Quick DASH). El dolor se evaluó con la escala visual análoga. (EVA). Se evaluaron las radiografías postoperatorias para identificar tiempo de consolidación, pseudoartosis y consolidaciones viciosas. Resultados: De los 21 pacientes, 20 retornaron al deporte. Todos retornaron al mismo nivel. El tiempo promedio de vuelta al deporte fue de 78 días (rango 41 -120 días). Cuatro pacientes (19%) volvieron al deporte antes de las seis semanas luego de la cirugía, 14 (67%) retornaron entre las seis y las 12 semanas luego de la cirugía y tres (14%) retornaron luego de las 12 semanas. El score de Constant promedio fue 89,1 ± 4,2 (rango, 79-100). El Quick-DASH promedio fue 0,4 ± 2,6 (rango, 0-7,1). El dolor según la EVA fue de 0,4 ± 1,0 (rango, 0-3) al final del seguimiento. La única complicación fue una pseudoartrosis asintomática. No se requirió retiro del material en ningún paciente. Conclusiones: La reducción cerrada y la fijación con doble botón de las fracturas desplazadas de clavícula a travé...
Background: Early union and rapid return to prior function is the priority in young athletes with lateral clavicular fractures. Furthermore it is essential to avoid nonunion in this subgroup of patients since it is frecuently associated with persistent pain, restriction of movement and loss of strength and endurance of the shoulder. Purpose: The aim of this study was to analyze the time to return-to-sport, functional outcomes and complications of a group of athletes with displaced lateral clavicular fractures treated using close reduction and minimally invasive double button fixation. Study Design: Case series; Level of evidence, 4. Methods: A total of 21 athletes with displaced lateral clavicle fractures were treated with closed reduction and minimally invasive double button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return-to-sport and treatment course. Functional outcomes were assessed with the Constant score and short version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union time, malunion, and nonunion. Results: Of the 21 patients, 20 returned to sports after closed reduction and minimally invasive double button fixation; 100 % returned to the same level. The mean time to return to play was 78 days (range, 41 - 120 days). Four patients (19%) returned to sports in less than 6 weeks after surgery Fourteen (67%) returned to sports between 6 and 12 weeks after surgery and three (14%) returned to sports after 12 weeks. The mean Constant was 89.1 ± 4.2 (range, 79-100) The average Quick-DASH was 0.4 ± 2.6 (range, 0-7.1). Pain was 0.4 ± 1.0 (range, 0-3) at final follow-up according to VAS. The only...
Assuntos
Humanos , Masculino , Feminino , Adulto , Clavícula/cirurgia , Clavícula/lesões , Fixação Interna de Fraturas , Fraturas Ósseas , Procedimentos Cirúrgicos Minimamente Invasivos , Traumatismos em Atletas , Resultado do TratamentoRESUMO
The current study intended to evaluate the accuracy of age estimation from the development of the medial clavicular epiphysis (sternal end of the clavicle) in Egyptian population using computed tomography (CT) and to develop a discriminant formula that can be used in Egyptians. The study was conducted on 142 subjects (84 males and 58 females) after taken informed consent. They were subjected to multi-slice CT on the medial end of clavicles of both sides. The results revealed that the age of non - union was seen at 817 years; incomplete union at 1520 years and complete union was seen at 20 years. It is concluded that the ossification of medial clavicular end could be used for age estimation. Also CT is a good visualization tool to be used. Regression analysis for each and both clavicles in both sexes is specific to Egyptian population and should be used after validation of the results in other ones. The study recommended using stage 1 to be <17 years; stage 2 to be >15 years; Stage 3 to be >15 years; stage 4 of maturation to be >19 years and stage 5 to be >21 years.
El objetivo de esta investigación fue evaluar en la población egipcia, la exactitud de estimación de edad del desarrollo de la extremidad esternal de la clavícula, mediante tomografía computadorizada (TC), y desarrollar una fórmula discriminante que se pueda utilizar en egipcios. La investigación se realizó en 142 pacientes (84 hombres y 58 mujeres) después de obtener el consentimiento informado. Los pacientes fueron sometidos a TC de cortes múltiples en la extremidad esternal de la clavícula en ambos lados. Los resultados revelaron que la no unión fue observada entre los 817 años; la unión incompleta entre 1520 años y la unión completa a los 20 años. Se concluye que la osificación de la extremidad esternal de la clavícula podría ser utilizada para la estimación de la edad utilizando la TC como herramienta de visualización. El análisis de regresión para ambas clavículas en los dos sexos es específico de la población egipcia y se debe utilizar después de validar los resultados. El estudio recomienda el uso de la etapa 1 en <17 años, etapa 2 en >15 años, etapa 3 en >15 años, etapa 4 en la maduración >19 años y la etapa 5 >21 años.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Adulto Jovem , Determinação da Idade pelo Esqueleto , Clavícula/anatomia & histologia , Clavícula/diagnóstico por imagem , Antropologia Forense , Epífises/anatomia & histologia , Epífises/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Distribuição por SexoRESUMO
BACKGROUND: Plate fixation of displaced midshaft clavicular fractures has been shown to decrease nonunion, symptomatic malunion, and residual shoulder disability compared with nonoperative treatment. However hardware-related complications are a problem. The new features of the precontoured locking plates may reduce the need for hardware removal, thus maintaining the advantages of plate fixation. This study evaluated the clinical outcomes of patients with displaced midshaft clavicular fractures treated with precontoured locking plates. MATERIALS AND METHODS: From November 2008 to December 2012, we surgically treated 72 patients with displaced midshaft clavicular fractures. We retrospectively evaluated 68 patients who underwent 68 interventions. Postoperative functional outcomes were assessed with the Constant score, the 11-item version of the Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaire, and radiographs. Pain was subjectively assessed with a visual analog scale. Complications were recorded. Patients were asked if they were able to return to their previous employment level. RESULTS: The mean follow-up period was 23.6 ± 10.7 months. The average values of the Constant, QuickDASH, and visual analog scale scores were 97.8, 1.8, and 0.4 points, respectively. At the last follow-up, 98.5% were able to return to their regular work. Of 15 complications (22.1%) that occurred, only 3 were considered as major: 1 subclavian vein extrinsic compression, 1 nonunion, and 1 hardware loosening. Hardware removal was required in 9 patients (13.2%). CONCLUSIONS: Satisfactory clinical results with a low rate of complications were achieved with precontoured locking plates for displaced midshaft clavicular fractures and a low rate of hardware removal compared with traditional plates.
Assuntos
Placas Ósseas , Clavícula/cirurgia , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Adulto , Clavícula/lesões , Avaliação da Deficiência , Feminino , Humanos , Masculino , Estudos Retrospectivos , Escala Visual AnalógicaRESUMO
BACKGROUND: Recent prospective randomized trials support primary plate fixation of displaced midshaft clavicle fractures. However, the safety and efficacy of this practice have not been well documented in athletes, nor has the time to return-to-sport. PURPOSE: To analyze the time to return-to-sport, functional outcomes, and complications in a group of athletes with displaced midshaft clavicle fractures treated using precontoured locking plates. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 54 athletes with displaced midshaft clavicle fractures were treated with plate fixation between November 1, 2008, and December 31, 2012. The mean follow-up time was 22.4 months. Patients completed a questionnaire focused on the time to return-to-sport and treatment course. Functional outcomes were assessed with the Constant score and short version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union time, malunion, and nonunion. RESULTS: Of the 54 patients, 53 returned to sports after open reduction and internal fixation of their fracture; 94% returned to the same level. The mean time to return-to-sport was 68 days (range, 5-180 days). Nine (16.6%) of the cases returned to sports before 6 weeks after surgery, 40 (74%) returned between 6 and 12 weeks, and 5 patients (9.2%) returned 12 weeks after surgery. The mean Constant score was 94.1 ± 5.2 (range, 78-100), and the mean QuickDASH score was 0.4 ± 4.7 (range, 0-7.1). The mean VAS pain score during follow-up was 0.29 ± 1.0 (range, 0-5). Three major complications occurred: 1 extrinsic compression of the subclavian vein, 1 nonunion, and 1 hardware loosening. Hardware removal was necessary in 5 patients (9.3%). CONCLUSION: Plate fixation of displaced clavicle fractures in athletes is a safe procedure resulting in excellent functional outcomes, with an early return to the same level of sports in the majority of patients.
Assuntos
Placas Ósseas , Clavícula/lesões , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Esportes , Adulto , Atletas , Placas Ósseas/efeitos adversos , Clavícula/cirurgia , Diáfises/lesões , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Fraturas Ósseas/complicações , Fraturas não Consolidadas/etiologia , Humanos , Masculino , Medição da Dor , Recuperação de Função Fisiológica , Inquéritos e Questionários , Fatores de Tempo , Adulto JovemRESUMO
Chondroblastoma is a rare, benign cartilaginous neoplasm that accounts for approximately 1% of all bone tumors, and approximately 4% of all chondroblastomas arise in the clavicle. Here, we report a case of chondroblastoma in the right clavicle. 27-year-old female patient presented with a 12-month history of shoulder pain. Based on radiological and pathological examination, the diagnosis was compatible with chondroblastoma. After resection of the tumor, 1 cm of the distal clavicle was preserved, 15 cm of the non-vascularized fibula was taken from the contralateral leg and placed on the site of the clavicle and fixed with hook plate at distal clavicle and reconstruction plate attached to the sternum. 13 months of follow-up is scheduled for removal of osteosynthesis material, finding full consolidation of sternoclavicular segment and the distal segment. A good functional outcome was apparent after a limited 14-month follow-up, and the patient was highly satisfied with the result. We found no recurrence or metastasis.
RESUMO
BACKGROUND AND OBJECTIVE: The present study aimed to evaluate whether right subclavian vein (SCV) catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC), via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively). METHOD: In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray. RESULTS: L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14±0.53, 2.19±1.17, and -0.45±0.68cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient=0.89). The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm)=-0.037+0.036×Height (cm)+0.903×I-T-IC (cm) (adjusted r(2)=0.64). CONCLUSION: The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.
RESUMO
Background and objective: The present study aimed to evaluate whether right subclavian vein (SCV) catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC), via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively). Method: In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray. Results: L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14±0.53, 2.19±1.17, and -0.45 ±0.68 cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient = 0.89). The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm) = -0.037 + 0.036 × Height (cm) + 0.903 × I-T-IC (cm) (adjusted r2 =0.64). Conclusion: The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation. .
Justificativa e objetivo: O presente estudo teve como objetivo avaliar se a profundidade de inserção de cateter em veia subclávia (VSC) direita pode ser prevista de forma confiável pelas distâncias do local de inserção na VSC até a incisura clavicular ipsilateral (I-IC), passando diretamente pela parte superior do arco da VSC ou da clavícula (denominadas i-T-IC e i-C-IC, respectivamente). Método: No total, 70 cateterismos de VSC foram estudados. As distâncias I-IC, I-T-IC e I-C-IC de cada caso foram mensuradas após a inserção do cateter guiada por ultrassom. O comprimento do cateter entre o local de inserção e a incisura clavicular ipsilateral (L) foi calculado por meio de radiografia. Resultados: As diferenças em centímetros de L em relação às distâncias I-T-IC, I-C-IC e I-IC foram de 0,14±0,53; 2,19±1,17 e 0,45±0,68 respectivamente. A média de I-IC foi significativamente menor que L, enquanto a média de I-C-IC foi significativamente maior. A análise de regressão linear forneceu a seguinte fórmula: Comprimento previsto da inserção de cateter em VSC (cm) = -0,037 + 0,036 × Altura (cm) + 0,903 × I-T-IC (cm) (r2 ajustado = 0,64). Conclusão: A distância I-T-IC pode ser um preditivo confiável do comprimento de inserção ideal para canulação em VSC direita. .
Introducción y objetivo: El presente estudio tuvo como objetivo evaluar si la profundidad de inserción de catéter en vena subclavia (VSC) derecha puede ser prevista de forma confiable por las distancias del lugar de inserción en la VSC hasta la incisión clavicular ipsilateral (denominada I-IC), pasando directamente por la parte superior del arco de la VSC o de la clavícula (denominadas I-T-IC y I-C-IC, respectivamente). Método: En total se estudiaron 70 cateterismos de VSC. Las distancias I-IC, I-T-IC e I-C-IC de cada caso fueron medidas después de la inserción del catéter guiada por ultrasonido. La extensión del catéter entre la región de inserción y la incisión clavicular ipsilateral, denominada L, fue calculada por medio de radiografía. Resultados: Las diferencias en centímetros de L con relación a las distancias I-I- IC, I-C-IC e I-IC fueron de 0,14±0,53, 2,19±1,17 y 0,45±0,68, respectivamente. La media de I-IC fue significativamente menor que L, mientras que la media de I-C-IC fue significativamente mayor. El análisis de regresión linear suministró la siguiente fórmula: Extensión prevista de la inserción de catéter en VSC (cm) = -0,037 + 0,036 × altura (cm) + 0,903 × I-T-IC (cm) (r2 ajustado = 0,64). Conclusión: La distancia I-T-IC puede ser un predictor confiable de la extensión de la inserción ideal para la canalización en la VSC derecha. .
Assuntos
Humanos , Veia Subclávia , Cateterismo Venoso Central/instrumentação , Ultrassom/instrumentação , Radiografia/instrumentaçãoRESUMO
Objetivo: Comparar la calidad de vida en pacientes con luxación acromioclavicular tipo III de Tossy tratados mediante técnica RAFI de placa gancho, técnica Weaver Dunn y técnica Bosworth. Material y métodos: Se realizó una encuesta transversal, analítica, de Enero de 2012 a Abril 2013, en pacientes con diagnóstico de luxación acromioclavicular tipo III de Tossy intervenidos con la técnica de RAFI con placa gancho, técnica Weaver y Dunn y técnica de Bosworth. Se incluyeron a los pacientes con edades de entre 18 y 70 años y cirugía realizada dentro de las primeras tres semanas del diagnóstico. El grado de calidad de vida fue evaluado mediante el cuestionario de DASH heteroadministrado, previo consentimiento informado. Resultados: Se operaron 47 pacientes divididos en 3 grupos, técnica RAFI placa gancho 26 pacientes, técnica Weaver y Dunn 11 pacientes y la técnica de Bosworth, 10 pacientes. El sexo y la edad fueron similares en los tres grupos con una p = 0.137 y p = 0.252 respectivamente. El tiempo de evolución de la cirugía fue similar en los tres grupos, con una p = 0.051. La técnica, RAFI placa gancho fue la más empleada con 26 cirugías; 96.4% de pacientes mostró discapacidad leve y síntomas leves con técnica RAFI placa gancho y 100% en la técnica Bosworth y Weaver y Dunn. Conclusiones: La calidad de vida fue similar con las tres técnicas quirúrgicas con una discapacidad y síntomas leves. La técnica RAFI placa gancho fue la más utilizada.
To compare quality of life in patients with Tossy type III acromioclavicular dislocation treated with the hook-plate ORIF technique, the Weaver & Dunn technique and the Bosworth technique. Material and methods: A cross-sectional analytical survey was conducted from January 2012 to April 2013 in patients with a diagnosis of Tossy type III acromioclavicular dislocation treated surgically with the hook-plate ORIF technique, the Weaver & Dunn technique, and the Bosworth technique. We included patients ages 18 to 70 years old, operated within three weeks after the diagnosis. Quality of life was assessed using the hetero-administered DASH questionnaire once the informed consent was obtained. Results: Forty-seven patients were operated on. They were divided into 3 groups: hook-plate ORIF technique, with 26 patients: Weaver & Dunn technique, 11 patients; and Bosworth technique, 10 patients. Sex and age distribution were similar in all 3 groups, with p = 0.137 and p = 0.252, respectively. Time elapsed after surgery was similar in all 3 groups, with p = 0.051. The hook-plate ORIF technique was the most frequently used one, in 26 surgeries. 96.4% of patients had mild disability and symptoms with the hook-plate ORIF technique, and 100% with the Bosworth and Weaver & Dunn techniques. Conclusions: Quality of life was similar with all 3 surgical techniques and involved mild disability and symptoms. The hook-plate ORIF technique was the most frequently used technique.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Articulação Acromioclavicular/cirurgia , Procedimentos Ortopédicos/métodos , Qualidade de Vida , Luxação do Ombro/cirurgia , Articulação Acromioclavicular/patologia , Estudos Transversais , Procedimentos Ortopédicos/instrumentação , Inquéritos e Questionários , Fatores de TempoRESUMO
La disostosis cleidocraneal (DCC) es un trastorno congénito poco frecuente, que sigue un patrón de herencia autosómico dominante con expresividad variable. Clínicamente se caracteriza por agenesia o disgenesia clavicular, Tórax acampanado, fontanelas amplias, retraso o ausencia en la osificación de las ramas del pubis e hipoplasia de las alas ilíacas. La erupción dental en el período lactante es de aparición tardía al igual que la erupción de la dentición definitiva. La dislocación hombros y la artrosis en el adulto son las complicaciones descritas. No existe un tratamiento específico para esta patología. Se presenta caso clínico y visión de la literatura.
Cleidocranial dysostosis (CCD) is a rare inherited congenital disorder that presents an autosomal dominant pattern with variable expressivity. Clinically, it is characterized by agenesis or dysgenesis of clavicle, bell shaped thorax, large fontanelles, delayed or absent ossification of pubic bones and hypoplasia of iliac wings. Both infant and permanent teeth eruption is delayed. Shoulder dislocation and osteoarthritis are complications described in adults. There is no specific treatment for this condition. Case report and literature reviews are presented.
Assuntos
Humanos , Feminino , Recém-Nascido , Displasia Cleidocraniana , Diagnóstico DiferencialRESUMO
La luxación acromioclavicular es una patología condicionada por problemas traumáticos y aplicación de sobrecarga, que da como resultado una lesión del sistema capsulo-ligamentario y muscular, que conlleva a una lesión incapacitante al individuo que la padece; por lo general son del sexo masculino y por un mecanismo de lesión con contusión directa en la punta del hombro. La técnica de Copeland Kessel, es una alternativa para su estabilización, basándonos en la baja tasa de complicaciones y la reincorporación del paciente a su vida normal al cabo de 12 semanas(AU)
Acromioclavicular dislocation is a condition influenced by trauma and application problems of overload that results in injury to the capsular ligamentous system and muscle that leads to a disabling injury to the person who suffers it, usually are male and the mechanism is a direct contusion injury on the tip of the shoulder. Copeland Kessel technique is an alternative for stabilization, based on the low rate of complications and the patient return to normal alter 12 weeks(AU)