Comparison of single- and double-plate fixation techniques in the treatment of nonunions of the humeral shaft / Comparação de técnicas de fixação de placa simples e dupla no tratamento de pseudoartrose do corpo do úmero

ABSTRACT Introduction Humerus shaft fractures may be treated conservatively or surgically. In 2.5% to 13% of cases, nonunion is observed, and it leads to severe pain and morbidity. Plate osteosynthesis has become popular in the treatment of nonunion of the humeral shaft. In this study, we compared the clinical outcomes of patients with humerus shaft nonunion whom we treated with single- or double-plate fixation. Materials and Methods Fifty-three patients diagnosed with aseptic humeral shaft nonunion and treated with plate fixation were included in the study. Patients were evaluated according to the number of plates (single vs. double plates). The two groups were subjected to statistical evaluation according to their clinical and radiographical results. Results The average age of the patients was 53 years (range: 1-86); 28 (52.8%) were female and 25 (47.2%) were male. The union rate was 90.32% for single plate and 90.91% for double plate fixation. There was no statistically significant difference between single and double plates in the clinical and radiographical results (union time, union rate, Q-DASH score) (p > 0.05). There was a significant correlation between age and union times / Q-DASH scores according to the Spearman correlation test (p < 0.05). Transient radial nerve neuropraxia developed in 2 patients and 1 patient suffered from an infection that was treated with debridement and antibiotic therapy. Conclusion In our study, similar good results were obtained with single and double plates. In treatment of humeral shaft nonunions, a second plate is not needed if enough stability is provided with single plate fixation. Level of evidence III, Retrospective comparative study.

RESUMO Introdução As fraturas do corpo do úmero podem ser tratadas de modo conservador ou cirúrgico. Em 2,5% a 13% dos casos, observa-se pseudoartrose, que causa dor intensa e morbidade. A osteossíntese com placas tornou-se popular para tratamento da não união da diáfise do úmero. Neste estudo, comparamos os resultados clínicos de pacientes com pseudoartrose do corpo do úmero que tratamos com fixação de placa simples ou dupla. Materiais e Métodos Cinquenta e três pacientes com diagnóstico de pseudoartrose asséptica do corpo do úmero tratados com placa de fixação foram incluídos no estudo. Os pacientes foram avaliados de acordo com o número de placas (placa simples vs. dupla). Os dois grupos foram submetidos à avaliação estatística de acordo com seus resultados clínicos e radiográficos. Resultados A média de idade dos pacientes foi de 53 anos (variação: 1 a 86); 28 (52,8%) eram do sexo feminino e 25 (47,2%) do sexo masculino. A taxa de união foi de 90,32% para placa simples e 90,91% para placa dupla. Não houve diferença estatisticamente significante entre a osteossíntese com placas simples ou duplas nos resultados clínicos e radiográficos (tempo de união, taxa de consolidação e escores do Q-DASH) (p > 0,05). Houve correlação significativa entre idade e tempo de união/escores do Q-DASH, de acordo com o teste de correlação de Spearman (p < 0,05). A neuropraxia transitória do nervo radial desenvolveu-se em dois pacientes e um paciente teve infecção tratada com desbridamento e antibioticoterapia. Conclusões Em nosso estudo, resultados igualmente bons foram obtidos tanto com placas simples quanto duplas. No tratamento de pseudoartroses do corpo do úmero, uma segunda placa não é necessária se houver estabilidade suficiente com a fixação com placa única. Nível de evidência III, Estudo comparativo retrospectivo.

Biomechanics in DALK: Big bubble vs manual lamellar dissection / Biomecânica no DALK: grande bolha versus dissecção manual lamelar

ABSTRACT Purpose: The present study's aim was to compare the biomechanical properties of corneal tissue in patients who underwent deep anterior lamellar keratoplasty (DALK) surgery, with successful big bubble formation and manual lamellar dissection, during failed big bubble formation. Methods: This retrospective comparative study included 60 eyes from 60 keratoconus patients who previously underwent DALK surgery. These patients were categorized as big bubble (+) or big bubble (−) based on the success or failure of big bubble formation during the surgery. The big bubble (+) group included 42 eyes, while the big bubble (−) group had 18 eyes. Moreover, the patients were regrouped as 0.25 mm and 0.50 mm to evaluate the effects of the disparity between donor and trephine punches on the biomechanical properties of the cornea. These biomechanical properties, characterized by corneal hysteresis and the corneal resistance factor, were measured using the Ocular Response Analyzer 12 months after the surgery. Results: There was no statistically significant difference between the big bubble (+) and big bubble (−) groups in the biomechanical properties of the cornea (corneal hysteresis: 10.06, 10.25; p=0.716/corneal resistance factor: 10.15, 10.07; p=0.805, respectively). In addition, pachymetry results were not statistically different between the two groups. Multivariate regression analysis revealed that corneal hysteresis and corneal resistance factor were positively associated with central corneal thickness (p<0.001/r2=0.506; p<0.001/r2=0.561, respectively). However, the study did not demonstrate a relationship between any of the punch sizes and corneal hysteresis or between the punch sizes (p=0.673) and the corneal resistance factor (p=0.643). Conclusions: The corneal hysteresis and corneal resistance factor values were similar in big bubble and manual lamellar dissection after DALK. Thus, manual lamellar dissection was not a disadvantage considering the cornea's biomechanical properties.

RESUMO Objetivo: O objetivo do estudo foi comparar pa râmetros biomecânicos corneanos de pacientes com cirurgia de ceratoplastia lamelar anterior profunda com formação bem-sucedida de bolha e dissecção lamelar manual, frente à falha de formação da grande bolha. Métodos: Este estudo comparativo retrospectivo incluiu 60 olhos de 60 pacientes com ceratocone submetidos à cirurgia de ceratoplastia lamelar anterior profunda. Os pacientes foram agrupados como grande bolha (+) e grande bolha (-) de acordo com o sucesso da formação da grande bolha durante a cirurgia. O grupo grande bolha (+) incluiu 42 olhos, enquanto o grupo grande bolha (-) tinha 18 olhos. Além disso, para a avaliação dos efeitos da disparidade entre alterações individuais nas propriedades biomecânicas da córnea, reagrupamos os pacientes em 0,25 mm e 0,50 mm. Parâmetros biomecânicos da córnea, caracterizados por histerese corneana e fator de resistência corneana foram medidos com o ORA 12 meses após a cirurgia. Resultados: Não houve diferença estatisticamente significativa entre os grupos grande bolha (+) e grande bolha (-) em relação aos parâmetros biomecânicos da córnea (histerese corneana: 10,06, 10,25, p=0,716/fator de resistência da córnea: 10,15, 10,07, p=0,805, respectivamente). Além disso, os resultados de paquimetria não diferiram estatisticamente entre os dois grupos. A análise de regressão multivariada demonstrou que a histerese da córnea e o fator de resistência corneana estavam associados positivamente com a espessura corneana central (p<0,001/r2=0,506, p<0,001/r2=0,561 respectivamente). No entanto, o estudo não revelou associação entre qualquer um dos tamanhos de punção e histerese corneana, bem como entre os tamanhos de punção e o fator de resistência corneano (p=0,673, p=0,643). Conclusões: A histerese da córnea e os valores do fator de resistência da córnea foram comparáveis com formação de grande bolha e dissecção manual lamelar na ceratoplastia lamelar anterior profunda. Assim, a dissecção manual lamelar não foi uma desvantagem, considerando os fatores biomecânicos da córnea.

Early postoperative recovery after intracranial surgical procedures. Comparison of the effects of sevoflurane and desflurane

ABSTRACT PURPOSE: To compared the effects of sevoflurane and desflurane on early anesthesia recovery in patients undergoing to craniotomy for intracranial lesions. METHODS: After IRB approval, the study included 50 patients aged 18-70 years who had ASA physical statuses of I-II and were scheduled for intracranial surgery. Patients were randomly divided into two groups: sevoflurane and desflurane. Anaesthesia was routinely induced in all patients followed by desflurane 5%-6% or sevoflurane 1%-2%. Moreover remifentanil infusion (0.05-0.2 mcg/kg/min) was adjusted to maintain mean arterial pressure (MAP) within 20% baseline and heart rate <90 bpm. Postoperatively, patients were evaluated over time for responses to painful stimulus, eye opening, hand squeezing, extubation, orientation and time required to achieve a Modified Aldrete Score of 9-10. Parametric and non-parametric data were assessed using Student's t- and Mann-Whitney U tests, respectively. A p<0.05 was taken as statistically significant. RESULTS: The times to responses to painful stimuli (7.7±2.7 vs. 4.8±1.7 min.; p<0.001), emergence (9.5±2.81 vs. 6.3±2.2 min.; p<0.001), hand-squeezing (12.1±2.9 vs. 8.2±2.3 min.; p<0.001), extubation (10.1±2.87 vs. 7.1±1.6 min.; p<0.001), orientation (15.3±3.2 vs. 10.3±2.7 min.; p<0.001) and Aldrete score of 9-10 (23.3±6.1 vs. 15.8±3.8 min.; p<0.001) were significantly lower with desflurane-based anaesthesia vs. sevoflurane-based anaesthesia. CONCLUSION: Desflurane yields early recovery functions and facilitates early postoperative neurologic examinations of intracranial surgery patients.