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1.
Arq. gastroenterol ; 59(1): 9-15, Jan.-Mar. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1374447

ABSTRACT

ABSTRACT Background Chronic hepatic disease is associated with osteoporosis, osteopenia or osteomalacia. Osteoporosis and fractures due to bone fragility present high prevalences and are more frequent in patients with liver cirrhosis than in the general population. The search for a diagnosis of osteopenia and osteoporosis in this population may allow early intervention and modify unfavorable outcomes. Objective To know the prevalence of osteopenia or osteoporosis and of fracture due to bone fragility in individuals with liver cirrhosis, the associated risk factors, and its compromise in their quality of life (QoL). Methods Observational, transversal study performed with 71 liver cirrhosis patients of the Hepatology Service of the Hospital de Base do Distrito Federal, Brasília, DF, Brazil, between July 2017 and December 2018. The patients were submitted to bone densitometry (DXA) of the lumbar spine and of the femoral neck, to x-ray of the lumbosacral spine and to the Chronic Liver Disease Questionnaire (CLDQ) for the evaluation of quality of life (QoL). The Fracture Risk Assessment (FRAX) major was calculated for patients >50 years old. The analyses were performed for the evaluation of the risk factors associated with lumbosacral spine fracture. Results The majority (62%) of the 71 evaluated patients was diagnosed with osteoporosis or osteopenia on DXA. Of the 44 patients with osteopenia or osteoporosis, 52.3% were female, with a mean age of 62.6±9.51 years old, with the majority (72.7%) being Child A, cirrhotics of alcoholic etiology (36.4%), and with an intermediate QoL according to the CLDQ (3.3). Regarding the patients with lumbosacral spine fracture, the mean age was 61.6±11.1 years old, 60% were female, most of them Child A (66.7%), of alcoholic etiology (46.7%), and with an intermediary QoL according to the CLDQ (3.5). The presence of osteopenia and/or osteoporosis was associated with lumbosacral fracture (P<0.001), without correlation with the other analyzed variables: age, body mass index, gender, presence and absence of ascites, Child-Pugh classification, vitamin D, calcium, and phosphorus serum concentration, cirrhosis etiology and FRAX major. Conclusion The prevalence of hepatic osteodystrophy was high, and the occurrence of lumbosacral spine fracture was more associated with osteoporosis and/or osteopenia among the cirrhotic patients studied. The QoL was intermediate and with no differences between cirrhotics with and without fracture.


RESUMO Contexto A doença hepática crônica associa-se com osteoporose, osteopenia ou osteomalácia. A osteoporose e as fraturas por fragilidade óssea têm altas prevalências e são mais frequentes em pacientes com cirrose hepática do que na população geral. A busca por osteopenia e osteoporose nesta população pode permitir a intervenção precoce e modificar os desfechos desfavoráveis. Objetivo Conhecer a prevalência de osteopenia ou osteoporose e de fraturas por fragilidade óssea em portadores de cirrose hepática, fatores de risco associados e seu comprometimento na qualidade de vida. Métodos Estudo observacional e transversal realizado com 71 pacientes portadores de cirrose hepática do Serviço de Hepatologia do Hospital de Base do Distrito Federal, Brasília, DF, Brasil, no período de julho de 2017 a dezembro de 2018. Os pacientes foram submetidos à densitometria óssea de coluna lombar e colo de fêmur, raio-x de coluna lombo sacra e ao questionário Chronic Liver Disease Questionnaire (CLDQ, na sigla em inglês) para avaliação de qualidade de vida. Foi calculado o escore de Fracture Risk Assessment Tool "FRAX Maior" nos pacientes >50 anos. As análises foram realizadas para a avaliação dos fatores de risco associados à fratura de coluna lombo sacra. Resultados Dos 71 pacientes avaliados, a maioria (62%) foi diagnosticada com osteoporose ou osteopenia à densitometria. Dos 44 portadores de osteopenia ou osteoporose, 52,3% eram do sexo feminino, com idade média de 62,6±9,51 anos, sendo a maioria (72,7%) Child A, cirróticos de etiologia alcoólica (36,4%) e com qualidade de vida intermediária ao CLDQ (3,3). Dos pacientes com fratura de coluna lombo sacra, a média de idade foi de 61,6±11,1 anos, 60% eram do sexo feminino, a maioria Child A (66,7%), de etiologia alcoólica (46,7%), e apresentaram qualidade de vida intermediária ao CLDQ (3,5). A presença de osteopenia e/ou osteoporose esteve associada à fratura lombo sacra (P<0,001), sem correlação com as demais variáveis analisadas: idade, índice de massa corporal (IMC), gênero, presença e ausência de ascite, classificação de Child-Pugh, concentrações séricas de vitamina D, cálcio e fósforo, etiologia da cirrose e "FRAX maior". Conclusão A prevalência de osteodistrofia hepática foi elevada, e a ocorrência de fratura de coluna lombo sacra esteve mais associada à osteoporose e/ou osteopenia entre cirróticos estudados. A qualidade de vida se mostrou intermediária e sem diferença entre cirróticos com e sem fratura.

2.
Acta ortop. bras ; 30(1): e250848, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1355585

ABSTRACT

ABSTRACT Introduction Fractures of the distal third of the forearm are common in the pediatric population. Conservative treatment of an ipsilateral fracture of the distal ulna metaphysis is one of the risk factors for loss of reduction. Percutaneous fixation of the fracture with K-wires is recommended. This study aims to evaluate the outcome of percutaneous fixation of both bones performed as the primary treatment. Materials and Methods A randomized, open, prospective, clinical trial was conducted, including skeletally immature patients who underwent surgery for fractures of the distal radius and ulna. They were randomized into two groups, one with fixation only of the radius fracture and the other with fixation of both the radius and the ulna fractures, and they were followed clinically and radiologically for up to 12 weeks postoperatively. Results Sixteen children were selected. In the intraoperative period, fluoroscopy was activated for a longer time when fixing the ulna (p = 0.011) and the surgical time was longer in this group (p = 0.014). In the postoperative evaluations, the group whose surgery involved the fixation of both bones had a lower postoperative pain score (p <0.001) and less time away from school (p <0.001). Conclusions In this study, postoperative pain and absence from school were both less when fixation of the radius and ulna was performed. Evidence Level II; Randomized Controlled Study.


RESUMO Introdução As fraturas do terço distal do antebraço são comuns na população pediátrica. O tratamento conservador da fratura ipsilateral da metáfise distal da ulna é um dos fatores de risco para a perda da redução. Recomenda-se a fixação percutânea da fratura com fios K. Este estudo tem como objetivo avaliar o resultado da fixação percutânea de ambos os ossos realizada como tratamento primário. Materiais e Métodos Foi realizado um estudo clínico randomizado, aberto e prospectivo, que incluiu pacientes com esqueleto imaturo que foram submetidos à cirurgia para fraturas da parte distal do rádio e a ulna. Os participantes foram randomizados em dois grupos, um com fixação apenas da fratura do rádio e outro com fixação das fraturas do rádio e da ulna, e foram acompanhados clínica e radiologicamente por até 12 semanas de pós-operatório. Resultados Dezesseis crianças foram selecionadas. No intraoperatório, a fluoroscopia foi ativada por mais tempo na fixação da ulna (p = 0,011) e o tempo cirúrgico foi maior nesse grupo (p = 0,014). Nas avaliações pós-operatórias, o grupo cuja cirurgia envolveu a fixação de ambos os ossos teve escore de dor menor depois da cirurgia (p < 0,001) e menos tempo de afastamento da escola (p < 0,001). Conclusões Neste estudo, a dor pós-operatória e o afastamento da escola foram menores quando se realizou fixação do rádio e da ulna. Nível de Evidência II; Estudo randomizado controlado.

3.
Rev. nefrol. diál. traspl ; 41(4): 11-20, dic. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1377151

ABSTRACT

RESUMEN Introducción: Las fracturas en el postrasplante renal representan una de las complicaciones que aumentan la morbimortalidad en los pacientes. Objetivo: Determinar los factores de riesgo de trasplante de fracturas no vertebrales en receptores de trasplante renal. Material y métodos: Se analizaron los datos de historias clínicas de 737 pacientes trasplantados renales desde 2009-2015, donde se evaluaron los factores de riesgo de fracturas. Se determinaron como factores generales: edad, sexo; y factores específicos: etiología de la enfermedad renal crónica (ERC), tiempo en diálisis, modalidad de diálisis, características del donante:edad, sexo, tipo de donante vivo y cadavérico (DV, DC), diferentes esquemas de inmunosupresión, rechazos, tratamiento con pulsos de esteroides, uso de bifosfonatos y analitos como parathormona intacta (PTHi), pro-vitamina D (25OHD) y creatininemia (Creats). Criterios de exclusión: pacientes <18 años, retrasplante o trasplantes dobles y menos de 1 año de seguimiento. Resultados: 44 pacientes presentaron 50 fracturas no vertebrales. El 62% de las fracturas se presentaron en los 3 primeros años del trasplante. En el modelo Multivariado se pudo observar que los factores de riesgo generales asociados con riesgo de fracturas fueron la edad avanzada del receptor (aHR por año aumenta 1,03, 95% CI: 1,00-1,05] y el sexo femenino (aHR= 1,60, 95% CI: 0,85-2,99), mientras que los factores de riesgo específicos fueron el tiempo en diálisis (1,07 IC95%:1,02- 1,12), la mayor edad del donante (1,03 IC95:1,00- 1,05) y el déficit de 25OHD (3,17 IC95:1,57- 6,41). Conclusiones: Este estudio permitió evaluar los factores predictivos de fractura en nuestros pacientes con trasplante renal.


ABSTRACT Introduction: Fractures in renal postransplantation represent one of the complications that increase morbidity and mortality in patients. Objective: To determine the risk factors for transplantation of non- vertebral fractures in renal transplant recipients. Methods: The data of clinical histories of 737 renal transplanted patients since 2009 2015 were analyzed, where the risk factors of fractures were evaluated. They were determined as general factors: age, sex; and specific factors: etiology of chronic kidney disease (ERC), dialysis time, dialysis modality, donor characteristics: age, sex, type of donor, living or cadaveric (DV, DC), different immunosuppression treatments, rejections, treatment with steroid pulses, use of bisphosphonates and biochemical parameters like intact parathormone (PTHI), Pro-Vitamin D (25OHD) and Creatininemia (CREATS). Exclusión criteria: patients <18 years, retransplantation or double transplants and follow- up less than 1 year. Results: 44 patients presented 50 non-vertebral fractures. 62% of the fractures were presented in the first 3 years of the transplant. In the multivariate model it was observed that the general risk factors associated with fracture risk were the advanced age of the receptor (aHR per year increases 1.03, 95% CI: 1.00-1.05] and the female sex (aHR = 1.60, 95% CI: 0.85-2.99), while the specific risk factors were dialysis time (1.07 IC95%: 1.02-1.12), the higher age of the donor (1.03 IC95: 1,00-1,05) and the deficit of 25OHD (3.17 IC95: 1.57-6.41). Conclusions: This study allowed to evaluate predictive factors of fracture in our patients with kidney transplantation.

4.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1353181

ABSTRACT

Objetivo: Estimar a utilização de recursos e os custos médicos diretos associados às fraturas por fragilidade, sob as perspectivas do Sistema Único de Saúde (SUS) e do Sistema de Saúde Suplementar (SSS) no Brasil, por meio de abordagem de microcusteio. Métodos: Para a determinação do padrão de utilização de recursos, foi conduzida uma revisão da literatura sobre o manejo das fraturas por fragilidade (fêmur proximal, terço distal do rádio e vértebra). As condutas foram validadas por dois especialistas. Foram considerados apenas custos diretos, sob as perspectivas do SUS e do SSS como fontes pagadoras, a partir de listas oficiais de preços adequadas a cada categoria de custos e a cada perspectiva. Resultados: Os custos finais médios atribuídos ao tratamento cirúrgico da fratura de fêmur proximal, sob as perspectivas do SUS e do SSS, foram de R$ 5.612,13 e R$ 52.384,06, respectivamente. Para as fraturas do terço distal do rádio, os custos médios por paciente para o tratamento conservador e cirúrgico foram de R$ 661,53 e R$ 1.405,21, respectivamente, sob a perspectiva do SUS, e de R$ 8.917,75 e R$ 21.689,92, para a perspectiva privada. Quanto às fraturas vertebrais, os custos por paciente para o tratamento conservador e cirúrgico foram de R$ 1.165,93 e R$ 9.775,56, respectivamente, no cenário do SUS, e de R$ 15.053,32 e R$ 54.596,78, respectivamente, sob a perspectiva do SSS. Conclusões: No Brasil, custos diretos das fraturas por fragilidade são relevantes, justificando a preocupação não apenas clínica, mas também econômica para fontes pagadoras e sociedade


Objective: To estimate the resources utilization, and direct medical costs associated with fragility fractures, from the perspectives of the Unified Healthcare System (SUS) and Supplementary Healthcare System (SSS) in Brazil, through a microcosting approach. Methods: A literature review was conducted regarding the management of fragility fractures (proximal femur, distal radius third of the radius and vertebra) to determine the pattern of resource utilization. The methods were validated by two experts. Only direct costs were considered, from the perspectives of SUS and SSS as paying sources, based on official price lists appropriate to each cost category and perspective. Public bid databases provide the actual market prices for the SUS perspective. Results: The average final costs attributed to the surgical treatment of the proximal femur fractures from the perspectives of SUS and SSS were BRL 5,612.13 and BRL 52,384.06, respectively. For fractures of the distal radius, the average costs per patient for conservative and surgical treatment were BRL 661.53 and BRL 1,405.21, respectively, from the SUS perspective, and BRL 8,917.75 and BRL 21,689.92, from the private perspective. For vertebral fractures, the cost per patient for conservative and surgical treatment were BRL 1.165,93 and BRL 9.775,56, respectively, in the SUS scenario and BRL 15.053,32 and BRL 54.596,78, respectively, under the SSS perspective. Conclusions: In Brazil, direct costs of fragility fractures are substantial, justifying not only clinical but also economic concerns for payers and society

5.
Arq. ciências saúde UNIPAR ; 25(3): 231-235, set-out. 2021.
Article in Portuguese | LILACS | ID: biblio-1348219

ABSTRACT

Objetivo: descrever a aplicação da Sistematização da Assistência de Enfermagem a um paciente com Fratura de Colo de Fêmur no período perioperatório. Metodologia: Relato de experiência realizado no centro cirúrgico de um hospital geral, o qual atende demanda espontânea da capital e do interior do estado da Bahia. O período de realização do estudo foi em agosto de 2019, na cidade de Feira de Santana- BA. Esta experiência foi fruto da vivência de acadêmicos de enfermagem do sexto semestre da Universidade Estadual de Feira de Santana. Foram respeitados os aspectos éticos da Resolução 466/2012. Resultados: Foi aplicada a Sistematização da Assistência de Enfermagem no Perioperatório a paciente idoso com fratura de colo de fêmur, conforme cinco fases do processo de enfermagem: Histórico, Diagnóstico, Planejamento, Implementação e Avaliação. Ressalta-se que o referido caso foi analisado de acordo com as Diretrizes Terapêuticas para Fratura de Colo de Fêmur, que demostraram a importância da aplicação da sistematização para um cuidado diferenciado ao paciente idoso com diagnóstico de fratura de fêmur, considerando que a população idosa cada vez mais vem alcançando a longevidade e as quedas são um dos eventos adversos que mais acometem essa população, seguido pela fratura. Conclusão: Este estudo pretende contribuir como instrumento gerencial e de cuidado relevante para a instituição no centro cirúrgico que visem acelerar o tempo de alta, minimizar o risco de complicações, reduzir os custos e favorecer a qualidade de vida dos pacientes idosos com fratura de fêmur a partir da sistematização da assistência de enfermagem perioperatória.


Objective: Describe the application of Nursing Care Systematization to a patient with a femoral neck fracture during the perioperative period. Methodology: Report of an experience carried out in the operating room of a general hospital, which cares for the spontaneous demand of the capital city and the interior of the state of Bahia. The study was held in August 2019 in the city of Feira de Santana, in the state of Bahia. This was the result of the academic experience of nursing students in the sixth semester at the State University of Feira de Santana. The ethical aspects of Resolution 466/2012 were respected. Results: Perioperative Nursing Care Systematization was applied to an elderly patient with a femoral neck fracture, according to five phases of the nursing process: History, Diagnosis, Planning, Implementation, and Evaluation. It emphasizes whether the case was analyzed according to the Therapeutic Guidelines for Femoral Neck Fractures, which demonstrated the importance of applying systematization for differentiated care for elderly patients diagnosed with femoral fractures, considering that the elderly population is living longer, and falls are one of the adverse events most frequently affecting such population, followed by fracture. Conclusion: This study aims at contributing as a relevant management and care instrument for the institution of any surgical center that aims at speeding up discharge time, minimizing the risk of complications, reducing costs, and favoring the quality of life of elderly patients with femur fracture from the systematization of perioperative nursing care.


Subject(s)
Humans , Male , Aged , Students, Nursing , Femoral Fractures , Nursing Process , Quality of Life , Perioperative Nursing/education , Surgicenters/supply & distribution , Accidental Falls , Aged , Perioperative Period/nursing , Anesthesia/nursing , Nursing Care/organization & administration
6.
Rev. colomb. reumatol ; 28(2): 104-110, abr.-jun. 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1357255

ABSTRACT

RESUMEN Introducción: Las fracturas por fragilidad son una complicación frecuente de la osteoporosis y generan alto impacto en la calidad de vida del adulto mayor. Las fracturas de cuello femoral, radio distal, húmero proximal y vértebras toracolumbares, en el contexto de un traumatismo menor, se consideran fracturas por fragilidad. Objetivo: Identificar la prevalencia de factores de riesgo en personas mayores de 50 arios con fracturas por fragilidad atendidas en un hospital del departamento de Boyacá. Metodología: Estudio observacional, descriptivo y de corte transversal. Se incluyeron 242 pacientes que presentaron fracturas por fragilidad con diagnóstico confirmado por estudio imagenológico. Resultados: El 62,8% de la población fue femenina. La edad condiciona un aumento del número de fracturas de fémur. El 10,7% de la población tenía un antecedente de fractura, con un aumento de la prevalencia a mayor edad. La fractura de radio distal fue la más frecuente en el 36,8% de la población. Cerca del 40% de los pacientes eran hipertensos y el 7,9% tenía diabetes, en tanto que el 9,7% eran consumidores crónicos de inhibidores de la bomba de protones. El 2,4% consumía glucocorticoides previamente al evento. Conclusiones: El comportamiento poblacional de las fracturas por fragilidad en nuestra ins titución es similar al de otros lugares, tanto a escala nacional como internacional. Por tanto, es importante empezar a crear conciencia sobre la prevención secundaria de la osteoporo sis, con el fin de disminuir las complicaciones, mejorar los desenlaces y disminuir los gastos que consigo trae.


ABSTRACT Introduction: Fragility fractures are a frequent complication of osteoporosis and lead to increased morbidity and mortality, as well as decreasing quality of life of the elderly popu lation, and represents high costs for health care systems. After minor trauma, fractures of the femoral neck, distal radius, proximal humerus, and thoraco-lumbar vertebrae are associated with osteoporosis, and are considered fragility fractures. Objective: To identify the prevalence of risk factors in people over 50 years of age with fragility fractures treated at a third level hospital in the department of Boyacá, Colombia. Methodology: Observational, descriptive, retrospective cross-sectional study. An evaluation was made on 242 patients between 50 and 100 years of age with any of the previously mentioned 4 fragility fractures. Fracture diagnosis had to be confirmed by plain radiography or computed tomography. Results: The majority (62.8%) of the study population was female. Age was associated with an increase in the number of femur fractures. A history of previous fractures was observed in 10.7% of the cases, with prevalence increasing with age. Distal radius fracture was the most frequent in 36.8% of the population. About 40% of the patients had hypertension and 7.9% were diabetic. Chronic use of proton pump inhibitors was observed in 9.7%, and 2.4% consumed glucocorticoids prior to the event. Conclusions: The behaviour of fragility fractures of the population in our institution is simi lar to that of other places, both nationally and internationally. It is therefore important to start raising awareness about secondary prevention of osteoporosis, in order to reduce complications, improve outcomes, and reduce associated costs.

7.
ACM arq. catarin. med ; 50(1): 137-143, 13/04/2021.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1354482

ABSTRACT

Fraturas dos ossos da face são injúrias que podem causar graves danos estéticos, funcionais e psicológicos. Os acidentes motociclísticos estão entre os fatores etiológicos mais frequentes de traumatismos no terço médio da face. Este relato de caso objetiva descrever o atendimento de um paciente do sexo masculino, 31 anos, vítima de acidente motociclístico com múltiplas fraturas no terço médio da face. As imagens obtidas por meio da tomografia computadorizada evidenciaram traços de fratura no Complexo Zigomático Orbital esquerdo, palato e na maxila. Sob anestesia geral foram realizados a redução e fixações das fraturas, priorizando uma oclusão dentária funcional e o restabelecimento da projeção facial na região zigomática. Paciente em acompanhamento pós-operatório de 40 dias, apresentando remissão das alterações clínicas decorrentes das fraturas. Fraturas de face desta complexidade devem ser manejadas por profissionais experientes para ofertar a melhor opção de tratamento, visto que o mesmo repercute tanto na estética quanto função.


Fractures of the facial bones are injuries that can cause serious aesthetic, functional and psychological damage. Motorcycle accidents are among the most frequent etiological factors of trauma in the middle third of the face. This case report aims to describe the care of a male patient, 31 years old, victim of a motorcycle accident with multiple fractures in the middle third of the face. The images obtained through computed tomography showed traces of fracture in the left orbital zygomatic complex, palate and in the maxilla. Under general anesthesia, fracture reduction and fixation were performed, prioritizing functional dental occlusion and restoring facial projection in the zygomatic region. Patient undergoing 40-day postoperative follow-up, showing remission of clinical changes resulting from fractures. Face fractures of this complexity must be handled by experienced professionals to offer the best treatment option, since it has an impact on both aesthetics and function.

8.
Acta ortop. bras ; 29(1): 30-33, Jan.-Feb. 2021.
Article in English | LILACS-Express | LILACS | ID: biblio-1152720

ABSTRACT

ABSTRACT Objective: The aim of this work is to provide evidence for the relationship between suspicion and diagnosis of cases of child abuse and fractures, since, in national literature, studies are still scarce on the subject. Methods: Retrospective study involving electronic medical records of a public reference hospital, in a city of the state of São Paulo, in a 8-year period (2010 to 2018). Cases involving children up to 12 years of age were selected when notified as abuse and presenting fractures; data were statistically analyzed. Results: Among 83 cases of abuse, 19 patients (20.5%) had 23 different fractures. The victims were mainly boys (68.42%) with a mean age of 5 years old, who suffered physical aggression (79%). The majority had no identified aggressor (52%) and 21% were related to the mother. The fracture patterns found involved, mostly, skull fractures (43.48%) and diaphysary fractures (34.78%). Seven patients (30.43%) had other associated lesions and four patients died (21%). Conclusion: Despite the number of cases, it was possible to identify relevant characteristics and patterns. These data indicate that the diagnosis is underestimated and show small epidemiological differences compared with international literature. Level of Evidence II, Retrospective study.


RESUMO Objetivo: O objetivo deste trabalho é fornecer evidências para a relação entre suspeita e diagnostico de casos de maus tratos e fraturas infantis, dado que, na literatura nacional, os estudos ainda são escassos sobre o tema. Métodos: Estudo retrospectivo envolvendo prontuário eletrônico de um hospital público de referência, em um município do estado de São Paulo, num período de 8 anos (2010 a 2018). Foram selecionados casos envolvendo crianças de até 12 anos notificados como maus tratos e apresentando fraturas, sendo os dados submetidos análise estatística. Resultados: Dentre 83 casos de maus tratos, um total de 19 pacientes (20.5%) apresentaram 23 fraturas diferentes. As vítimas em 68,42% eram meninos com média de 5 anos de idade que sofreram agressão física (79%). A maioria não teve agressor identificado (52%), sendo 21% relacionado a mãe. Os padrões de fratura encontrados envolveram em sua maioria fraturas de crânio (43,48%) e fraturas diafisárias (34,78%). Sete pacientes (30,43%) tiveram outras lesões associadas e quatro pacientes vieram a óbito (21%). Conclusão: Apesar do número de casos, foi possível identificar características e padrões relevantes. Tais dados apontam que o diagnóstico é subestimado e mostram pequenas diferenças epidemiológicas comparativas a literatura internacional. Nível de Evidência II, Estudo retrospectivo.

9.
Article in English | WPRIM | ID: wpr-879677

ABSTRACT

Fat embolism syndrome (FES) is a serious life-threatening manifestation of the fat embolism phenomenon characterized by Bergman's triad of dyspnea, petechiae and mental confusion. While fat embolization into systemic circulation is common, FES occurs in a meagre 0.05%-3% of patients having isolated long bone fractures. Though visual symptoms are commonly attributed to fat embolism retinopathy and is a later occurrence, it may not always be the case. Cortical blindness has been seldom reported in association with FES, and less so as a presenting complaint. Furthermore, no previous literature has described the same in context of an isolated tibia fracture. We report a 20-year-old gentleman with an isolated right tibia shaft fracture who developed sudden onset diminution of vision in both eyes less than 24 h following trauma with no other complaints. Lack of any remarkable ophthalmoscopic findings or other symptoms left us with a diagnostic conundrum. He later went on to develop altered mentation, hypoxia and generalized tonic-clonic seizures with subsequent MRI revealing multiple cerebral fat emboli also involving both occipital lobes. Supportive measures were instituted and his general condition as well as vision gradually improved following which he underwent plate fixation of the fracture under spinal anaesthesia. The perioperative period was uneventful and he was discharged following staple removal. At one month of follow-up, the patient had no residual visual field defects or neurological deficits. Though FES is rare among isolated tibia fractures, this clinical catastrophe may strike in any unsuspected setting thereby warranting a high index of suspicion to ensure early diagnosis and improved patient outcomes.

10.
Article in Chinese | WPRIM | ID: wpr-912039

ABSTRACT

Objective:To observe the effect of mechanical vibration on the expression of microRNA-214-3p and serum interleukin-1β (IL-1β) in the broken ends of fractured bones in ovariectomized rats.Methods:Thirty 3-month-old female Wistar rats were randomly divided into a control group, a model group, and a vibration group, each of 10. An operation of ovariotomy was performed in those of the model and vibration groups to establish osteoporosis model. Five months later a model of mid femur fracture was made with animals in all the groups. Five days after their fracture, the vibration group received 20 minutes of whole-body vibration treatment at 35Hz for 5 days a week, while the control group and the model group received natural rearing without any additional intervention At 2 and 6 weeks after the operation, the Lane-Sandhu X-ray scoring system was used to evaluate the quality of fracture healing, and reverse-transcription polymerase chain reactions and enzyme-linked immunosorbent assays were used to detect miR-214-3p in the fractured bones and the serum levels of IL-1β.Results:At 2 weeks and 6 weeks after the operation the average growth score of the broken ends in the model group was significantly lower than that of the control group, while that of the vibration group was significantly higher than the model group′s average. Compared with the control group at the same time point, the average miR-214-3p content of the model and vibration groups was significantly higher 2 and 6 weeks after the surgery. Compared with the model group, the average level of miR-214-3p of the fractured ends of the vibration group was significantly lower at 6 weeks. Two and six weeks after the surgery, the average IL-1β of the model group was significantly higher than the control group′s average, and that of the vibration group was significantly lower.Conclusion:Mechanical vibration can promote osteoporotic fracture healing by inhibiting the expression of miR-214-3p and reducing the level of IL-1β at the broken ends of fractured bones.

11.
Braz. J. Vet. Res. Anim. Sci. (Online) ; 58: e182908, 2021. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1363086

ABSTRACT

Many complicated bone fractures can be healed by different techniques including linear external fixation. New generation linear external fixators enhanced the scope of application for bone fractures by mechanical progress. Difficulties include implementing enough pins through fixation clamps to the comminuted fragments or clamp addition and fixing it properly to the rod with the correct pin insertion angle. Effective configurations may not always result. This study sought to reveal the clinical efficiency of modified clamps of a versatile external fixator (VEF) to fix different types of fractures and orthopedic problems according to the radiographic and clinical results. We used this fixator on 17 cats and 17 dogs of different ages and sizes, having different types of antebrachium, humerus, tibia, ulna fractures, and bone-muscle deformities. Clamps had different features to connect fixator pins. Many fixator configurations were created according to the fracture type and body weight of the animals. The most used ones were unilateral and bilateral configurations. The callus formation and visual gait analysis were observed after the operations, until the removal of the fixator. After fixator removal, the visual gait status of the limbs was excellent in 67% of the cases, good in 15%, fair in 12%, and poor in 6%. We found that rods and fixator pins were connected easily by semi-locked clamps. Also, the double pin holding clamps saved space on the fixation rod by the application of two pins through one clamp. We think that clamps of versatile external fixators can easily be constructed to limb fractures and save time during surgery.(AU)


Diversas fraturas ósseas complicadas podem ser tratadas por diferentes técnicas, incluindo fixadores externos lineares. Os fixadores externos lineares de nova geração aumentaram o escopo de aplicação para fraturas ósseas devido ao progresso mecânico. A dificuldade é implementar um número suficiente de pinos através de clamps de fixação aos fragmentos osseos ou adição de clamps com fixação adequadamente à haste com o ângulo correto de inserção do pino. As configurações eficazes nem sempre podem ser realizadas. Este estudo pretendia revelar a eficácia clínica das clamps modificadas de um fixador externo versátil para corrigir diferentes tipos de fraturas e problemas ortopédicos de acordo com os resultados radiográficos e clínicos. O fixador foi utilizado em 17 gatos e 17 cães de diferentes idades e tamanhos, com diferentes tipos de antebraço, úmero, tíbia, fratura de ulna e deformidades ósseo-musculares. Os clamps tinham recursos diferentes para conectar os pinos do fixador. Muitas configurações de fixadores foram criadas de acordo com o tipo de fratura e peso corporal dos animais. As mais utilizadas foram as configurações unilateral e bilateral. A formação do calo e a análise visual da marcha foram observadas após as cirurgias, até a retirada do fixador. Após a retirada do fixador, a utilização dos membros foi excelente em 67% dos casos, bom em 15% dos casos, regular em 12% dos casos, ruim em 6% dos casos. Concluímos que as hastes e os pinos do fixador foram facilmente conectados por clamps semi-travados. Além disso, os clamps de fixação de pino duplo economizaram espaço na haste de fixação com a aplicação de dois pinos em clamp. Acreditamos que os clamps de fixadores externos versáteis podem ser facilmente construídas para fraturas de membros, economizando tempo na cirurgia.(AU)


Subject(s)
Animals , Cats , Dogs , External Fixators/veterinary , Fractures, Bone/therapy , Fractures, Bone/veterinary , Treatment Outcome
12.
Rev. colomb. ortop. traumatol ; 35(1): 21-25, 2021. ilus.
Article in Spanish | LILACS, COLNAL | ID: biblio-1378457

ABSTRACT

Introducción Dentro de la patología ortopédica se encuentran las fracturas y entre ellas se distingue la fractura de clavícula, que suele ser frecuente en su mayoría en la población joven, afectando por lo general al género masculino. Dentro de los objetivos del estudio se busca tener una apreciación más cercana respecto al tratamiento para dichas fracturas enfocados en el manejo no quirúrgico. Materiales & Métodos Se trata de un estudio de tipo descriptivo retrospectivo, llevado a cabo en la Clínica Medilaser de Tunja con recopilación de la información por medio de registros clínicos a pacientes que fueron ingresados entre el 2013 y 2019 con dicha afectación. Resultados Este estudió contó con una población de 134 pacientes, entre ellos 101 varones y 33 mujeres, las edades oscilan entre los 10 y 85 años, de los cuales el 73% estaban satisfechos con su tratamiento, el otro 27% estuvieron inconformes. Discusión La fractura de clavícula, es más frecuente en varones, con edades entre los 20 a 59 años y las causas más comunes fueron las caidas en general, predominando la caída en bicicleta. Del total de pacientes, el 65% se manejaban de manera incruenta, con buena evolución. El 93% de los pacientes refieren dolor residual, el 13% retorna con limitaciones, el 1% cambia de actividad laboral y el 73% estuvieron satisfechos con el tratamiento.


Background Clavicle fracture is particularly prevalent in young population, usually affecting the male gender. Aim of the study is to evaluate outcomes of non-surgical management of clavicle fractures. Methods This is a retrospective descriptive study, carried out at the Tunja Medical Clinic with information gathering through clinical records of patients admitted between 2013 and 2019 with such involvement. Results This study had a population of 134 patients, including 101 men and 33 women, the ages range between 10 and 85 years, of which 73% were satisfied with their treatment, the other 27% were dissatisfied. Discussion Clavicle fracture is more frequent in men, with ages between 20 and 59 years and the most common causes were falls in general, predominantly falling by bicycle. Of the total of patients, 65% were managed in a bloodless way, with good evolution. 93% of patients affected residual pain, 13% return with limitations, 1% change their work activity and 73% satisfied satisfied with the treatment.


Subject(s)
Humans , Clavicle , Shoulder , General Surgery , Acromioclavicular Joint , Fractures, Bone , Conservative Treatment
13.
Ciênc. rural (Online) ; 51(2): e20200352, 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1142747

ABSTRACT

ABSTRACT: Bone trauma triggers an acute inflammatory response, which can alter the serum concentration of acute-phase proteins (PFA). We aimed to evaluate the effectiveness of PFA measurement as a laboratory biomarker for inflammation related to bone regeneration. A partial ostectomy of the right radius was performed on 22 young male rabbits. The complete blood count, albumin, ceruloplasmin, haptoglobin, C-reactive protein, and transferrin levels were recorded and correlated with the radiographic evolution of bone healing. Statistically the best correlations with the inflammatory process and radiological findings were reported with haptoglobin and transferrin compared to the other measured PFAs. Haptoglobin and transferrin showed a maximum peak 24 and 36 hours after surgery, respectively. Transferrin displayed signs of decrease in the first 6 hours after surgery, in advance of the leukocyte response. The measurement of acute-phase proteins proved to be viable, considering the conditions in which the present study was carried out. Among all variables studied, haptoglobin and transferrin showed best correlation with the inflammatory process of bone healing. Additional studies are needed to determine the sensitivity of acute-phase proteins as predictors of complications in the treatment of fractures.


RESUMO: Os traumas ósseos desencadeiam resposta inflamatória aguda e consequentemente alteram a concentração sérica das proteínas de fase aguda (PFA), podendo essas representarem um parâmetro para avaliação da evolução do processo inflamatório relacionado à cicatrização óssea, assim como complicações. Objetivou-se avaliar a inter-relação da mensuração de PFAs com a repação óssea em coelhos submetidos à ostectomia parcial do rádio. Foram utilizados 22 coelhos, machos, jovens (160 a 180 dias) e peso médio (3,8 ± 0,3). Para acompanhamento da evolução do processo inflamatório foram realizados hemograma completo e mensuração de albumina, ceruloplasmina, haptoglobina, proteína C reativa e transferrina, além do acompanhamento radiológico. Foi observado a melhor correlação da haptoglobina e da transferrina junto ao processo inflamatório e achados radiológicos frente às demais PFAs mensuradas. A haptoglobina apresentou pico máximo 24 horas do pós-operatório e a transferrina após 36 horas, entretanto, essa última já mostrou indícios de diminuição nas primeiras 6 horas do pós-cirúrgico, antecipadamente à resposta leucocitária. Nas condições em que o presente estudo foi realizado, a mensuração das proteínas de fase aguda mostrou-se factível. Das proteínas estudadas, a haptoglobina e transferrina foram as que mostraram maior correlação com o processo inflamatório da cicatrização óssea. Estudos adicionais são necessários para determinar a sensibilidade das proteínas de fase aguda como previsores de complicações do tratamento das fraturas.

14.
Rev. bras. cir. plást ; 35(4): 466-471, out.dez.2020. ilus
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1367939

ABSTRACT

Introdução: O trauma é definido como um agravo que leva a alterações na estrutura do indivíduo por causa da troca de energia entre os tecidos e o meio. Por causa da sua localização, o esqueleto maxilofacial é comumente acometido por traumas. Além disso, os estudos existentes que buscam abordar a temática comumente a abordam de maneira fragmentada, focada apenas em uma estrutura óssea. Portanto, o presente estudo foi proposto como tentativa de minorar essa lacuna existente na literatura hodierna. Métodos: A busca foi realizada nas plataformas PubMed, LILACS e Cochrane Library utilizando os descritores: "biomechanical phenomena", "facial injuries" e "fractures, bone", encontrando 321 artigos. Os critérios de inclusão foram: estudos publicados nos últimos 5 anos, disponíveis integralmente, nos idiomas inglês ou português. Após a utilização desses filtros foram encontrados 50 estudos, e após leitura analítica do título e do resumo disponível, foram excluídos 44 estudos. Discussão: A mandíbula é mais vulnerável aos impactos laterais do que frontais, evidenciou-se que nos impactos laterais a maior força de estresse era exercida em estruturas ipsilaterais ao impacto. Também se demonstrou que a ausência parcial ou total de dentição apresentavam maiores forças de estresse ao côndilo. Na órbita há principalmente fraturas de borda e fraturas de globo/assoalho. A primeira são fraturas que tendem a ser menores e dispostas anteriormente, já as de assoalho, seria o inverso. Conclusão: Em suma, existem vários fatores que podem influenciar na ocorrência do trauma de face, dentre elas estão os fenômenos biomecânicos envolvidos.


Introduction: Trauma is defined as an injury that leads to changes in an individual's structure due to the energy exchange between tissues and the environment. Because of its location, the maxillofacial skeleton is commonly affected by trauma. Besides, existing studies that seek to address the theme commonly do so in a fragmented way, focused only on a bone structure. Therefore, the present study was proposed as an attempt to bridge this gap in today's literature. Methods: The search was performed on the platforms PubMed, LILACS, and Cochrane Library using the descriptors: "biomechanical phenomena," "facial injuries" and "fractures, bone," finding 321 articles. The inclusion criteria were: studies published in the last five years, available in full, in English or Portuguese. After using these filters, 50 studies were found, and after analytical reading of the title and available summary, 44 studies were excluded. Discussion: The mandible is more vulnerable to lateral than frontal impacts; it was shown that in lateral impacts, the most significant stress force was exerted on structures ipsilateral to the impact. It was also demonstrated that dentition's partial or total absence presented greater stress forces on the condyle. In the orbit, there are mainly edge fractures and globe/floor fractures. The first are fractures that tend to be smaller and anteriorly arranged, whereas those on the floor would be the opposite. Conclusion: In short, several factors can influence the occurrence of facial trauma; among them are the biomechanical phenomena involved.

15.
Rev. Pesqui. Fisioter ; 10(3): 427-435, ago.2020. tab, ilus
Article in English, Portuguese | LILACS | ID: biblio-1223893

ABSTRACT

Descrever o perfil clínico epidemiológico dos pacientes vítimas de fraturas internados em um hospital universitário do Maranhão. MÉTODOS: Trata-se de um estudo descritivo transversal, retrospectivo e de abordagem quantitativa, realizado a partir da análise de prontuários destes pacientes no Hospital Universitário da Universidade Federal do Maranhão (HU-UFMA) no setor de traumato-ortopedia. RESULTADOS: Foram analisados 251 prontuários, no qual houve predomínio do sexo masculino (52,59%), cor parda (64,1%), residentes em São Luís (57%), solteiros (51%), baixa escolaridade, apresentando maior índice de ensino fundamental incompleto (35,3%) e a média de idade foi de 45,4 anos. O tipo de trauma que mais causou fraturas foram as quedas, com 127 vítimas (50,6%), seguido dos acidentes de trânsito com 27,8% de acidentes motociclísticos, 3,98% de acidentes automobilísticos, 3,98% de atropelamentos. Quanto às regiões corpóreas mais acometidas, observou-se com maior frequência as lesões nos membros inferiores (MMII), sendo 33,47% fraturas de fêmur, 23,11% de tíbia e 11,95% de tornozelo. O tipo de cirurgia mais realizado foi a osteossíntese, para a estabilização do seguimento, com 82,87% de prevalência. Desses pacientes 98,8% obtiveram alta hospitalar após procedimento cirúrgico com mediana de 3 dias de internação e 1,2% evoluíram para óbito. CONCLUSÃO: Houve maior prevalência de fraturas entre os indivíduos do sexo masculino, solteiros, compreendidos na faixa etária de 13 a 38 anos, o mecanismo de trauma com maiores números de casos foram quedas e acidentes de trânsito, com maior acometimento dos membros inferiores.


To describe the clinical epidemiological profile of patients who suffered fractures hospitalized at a university hospital in Maranhão. METHODS: This is a cross-sectional, retrospective and quantitative study based on the analysis of the medical records of these patients at the Federal University Hospital of Maranhão (HU-UFMA) in the orthopedic-trauma sector. RESULTS: A total of 251 medical records were analyzed, with a predominance of males (52.59%), brown (64.1%), residents in São Luís (57%), unmarried individuals (51%), low education, incomplete elementary school index (35.3%) and the mean age was 45,49 years. The type of trauma that caused the most fractures were falls, with 127 victims (50.6%), followed by traffic accidents with motorcycle accidents 3.98%, 3.88% motor vehicle crashes, 3.98% of run over. As for the most affected body regions, lesions in the lower limbs (LL) were observed, 33.47% with fractures of the femur, 23.11% of the tibia and 11.95% of the ankle. The most frequent type of surgery was osteosynthesis, for stabilization of follow-up, with 82.87%. Of these patients, 98.8% were discharged after a surgical procedure with a median of 3 days of hospitalization and 1.2% died. CONCLUSION: There was a higher prevalence among males, single, comprised between 13 and 38 years old, the mechanism of trauma with the highest numbers of cases were falls and traffic accidents, with a higher prevalence of LL involvement.


Subject(s)
Fractures, Bone , Orthopedics , Accidents
16.
Arch. argent. pediatr ; 118(3): e300-e304, jun. 2020. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1116991

ABSTRACT

La osteoporosis es un trastorno para tener en cuenta en niños con patologías crónicas graves o con algunas enfermedades genéticas que predisponen al incremento de la fragilidad ósea. La osteoporosis primaria es una entidad con etiologías emergentes y puede ocurrir en forma sindrómica. La asociación con pliegues retinianos congénitos debe orientar al diagnóstico de osteoporosis-pseudoglioma (OMIM 259770), síndrome poco frecuente (prevalencia de 1/2000000), que se origina por la pérdida de función de la proteína LRP5 (low-density lipoprotein receptor-related protein 5) y compromete la vía de señalización de Wnt/ß-catenina. Se presenta el caso de un niño con pliegues retinianos congénitos, ceguera progresiva y múltiples fracturas cuyo estudio clínico, bioquímico y genético confirmó el diagnóstico de osteoporosis primaria debido a una nueva variante inactivante en el gen LRP5 en homocigosis


Osteoporosis should be considered in children with severe chronic diseases or in association with some genetic diseases that bear an increased risk of bone fragility. Primary osteoporosis is an entity in which emerging aetiologies are being recognized. Its association with congenital retinal folds should guide the diagnosis to the Osteoporosis-Pseudoglioma syndrome (OMIM 259770), a rare disease (prevalence of 1/2000000), caused by the loss of function of the protein LRP5 (low-density lipoprotein receptor-related protein 5) resulting in the alteration of the Wnt/ß-catenin signalling pathway. We report the case of a child with congenital retinal folds, progressive loss of vision and multiple fractures whose clinical, biochemical and genetic studies confirmed the diagnosis of primary osteoporosis due to a novel homozygous inactivating variant in LRP5


Subject(s)
Humans , Male , Child , Osteoporosis/diagnosis , Osteoporosis/therapy , Blindness , Fractures, Multiple
17.
Article | IMSEAR | ID: sea-212268

ABSTRACT

Background: Long bone fractures are frequent occurrence among children and considered a frequent pediatric orthopedic injury requiring hospitalization. Authors aimed to retrospectively analyze the outcome of fixation of long bone fractures with elastic stable intramedullary nailing (ESIN) among children and adolescents.Methods: From 2010 to 2018, ESIN was performed on 128 children aged 2 to 17 years having single shaft fractures of long bones. The data related to associated injuries, postoperative complications, postoperative treatment, till bony union or removal of rods, mal-union, functional deficit, need for secondary surgical intervention and subjective complaints at follow-up originated from postoperative clinical and radiological consultations carried out regularly. The primary end points were time of complete radiological union or removal of rods.Results: The mean age at the time of accident was 9.5 years. There were 37 (28.9%) femoral fractures, 16 (12.5%) of the lower leg, 51 (39.8%) fractures of radius/ulna and 24 (18.8%) of the humerus. In 2 (2.3%) children, reoperation was necessary due to prominent ends of elastic rods and 6 (4.7%) had early removal of rods due to same reasons. End point of the study, removal of rods noted in 126 (82.8%), radiological evidence of union in 7 (5.5%) and 15 (11.7%) cases were lost at follow-up.Conclusions: ESIN fixation of diaphyseal fractures in children and adolescents is safe. ESIN was found to be minimally invasive method, noted to produce excellent functional as well as cosmetic outcomes.

18.
Rev. enferm. UFPI ; 9: e9044, mar.-dez. 2020.
Article in Portuguese | LILACS, BDENF | ID: biblio-1370184

ABSTRACT

Objetivo: analisar os índices de traumas ortopédicos, nos idosos em um Hospital de Referência na cidade de Belém PA. Metodologia: trata-se de estudo descritivo, retrospectivo. Os dados foram coletados por meio do Sistema Estatístico de Internação Hospitalar do Hospital Maradei em Belém do Pará. Foi analisado 1516 idosos internados no ano de 2017. Resultados: Dentre os participantes a maioria é do sexo feminino 70,2%, apresentavam uma faixa etária variável de 60 a 109 anos, com prevalência de idades de 60 a 69 anos 39,70%, realizou-se uma analise do tipos de fraturas que mais acometem a população idosa, verificou-se que relação à área do corpo, o fêmur sobressaiu com 37,5%, porém quando analisado por localização anatômica a maior incidência é das fraturas distal do radio 28%, bem como também representa a fratura mais reincidente 18,2%. Conclusão: Observou-se que as fraturas acometidas dos idosos do estudo, divergem quando comparado com a literatura, uma vez que a incidência ocorrem nas fraturas distal do radio em detrimento das fraturas de colo de fêmur, isso ocorre tanto nos idosos que se fraturam pela primeiramente vez quanto os idoso reincidente de fratura.


Objective:To analyze the rates of orthopedic trauma in the elderly in a Reference Hospital in the city of Belém PA. Methodology: this is a descriptive, retrospective study. Data were collected using the Hospital Admission Statistical System at Hospital Maradei in Belém do Pará. All the 1516 elderly patients admitted in 2017 were analyzed. Results: Among the participants, the majority is female, 70.2%, with an age range variable from 60 to 109 years old, with a prevalence of ages from 60 to 69 years old 39.70%, an analysis was made of the types of fractures that most affect the elderly population, it was found that in relation to the body area, the femur stood out with 37.5%, however when analyzed by anatomical location the highest incidence is of the distal fractures of the radius 28%, as well as representing the most recurrent fracture 18.2%. Conclusion: It was observed that the fractures affected by the elderly in the study , diverge when compared to the literature, since the incidence occurs in distal radius fractures to the detriment of femoral neck fractures, this occurs both in the elderly who fracture for the first time and the elderly who recur from fracture.


Subject(s)
Wounds and Injuries , Aged , Fractures, Bone
19.
Article in English | WPRIM | ID: wpr-811106

ABSTRACT

PURPOSE: Unstable pelvic fracture with bleeding can be fatal, with a mortality rate of up to 40%. Therefore, early detection and treatment are important in unstable pelvic trauma. We investigated the early predictive factors for possible embolization in patients with hemodynamically unstable pelvic trauma.METHODS: From January 2011 to December 2013, 46 patients with shock arrived at a single hospital within 24 hours after injury. Of them, 44 patients underwent CT scan after initial resuscitation, except for 2 who were dead on arrival. Nine patients with other organ injuries were excluded. Seventeen patients underwent embolization. A single radiologist measured the width (longest length in axial view) and length (longest length in coronal view) of pelvic hematoma on CT scans. Demographic, clinical, and radiological data were reviewed retrospectively.RESULTS: Among 35 patients with hemodynamically unstable pelvic fracture, 22 (62.9%) were men. Width (P = 0.002) and length (P = 0.006) of hematoma on CT scans were significantly different between the embolization and nonembolization groups. The predictors of embolization were width of pelvic hematoma (odds ratio [OR], 1.07; P = 0.028) and female sex (OR, 10.83; P = 0.031). The cutoff value was 3.35 cm. More embolization was performed (OR, 12.00; P = 0.003) and higher mortality was observed in patients with hematoma width >3.35 cm (OR, 4.96; P = 0.048).CONCLUSION: Patients with hemodynamically unstable pelvic trauma have a high mortality rate. CT is useful for the initial identification of the need for embolization among these patients. The width of pelvic hematoma can predict possible embolization in patients with unstable pelvic trauma.


Subject(s)
Embolization, Therapeutic , Female , Fractures, Bone , Hematoma , Hemorrhage , Humans , Male , Mortality , Resuscitation , Retrospective Studies , Shock , Tomography, X-Ray Computed
20.
Article in English | WPRIM | ID: wpr-810956

ABSTRACT

BACKGROUND: The big data provided by Health Insurance Review and Assessment (HIRA) contains data from nearly all Korean populations enrolled in the National Health Insurance Service. We aimed to identify the incidence of facial fractures and its trends in Korea using this big data from HIRA.METHODS: We used the Korean Standard Classification of Disease and Cause of Death 6, 7 for diagnosis codes. A total of 582,318 patients were included in the final analysis. All statistical analyses were performed using SAS software and SPSS software.RESULTS: The incidence of facial fractures consistently declined, from 107,695 cases in 2011 to 87,306 cases in 2016. The incidence of facial fractures was the highest in June 2011 (n = 26,423) and lowest in January 2014 (n = 10,282). Nasal bone fractures were the most common, followed by orbit and frontal sinus fractures. The percentage of nasal bone fractures declined, whereas those of orbital fractures increased from 2011 to 2016 (P < 0.001). Among orbital fractures, inferior wall fractures were the most common, followed by medial wall fractures. Among mandibular fractures, angle fractures were the most common, followed by condylar process and symphysis fractures. Although it was difficult to predict the most common type of zygomatic and maxilla fractures, their incidence consistently declined since 2011.CONCLUSION: We observed trends in facial fractures in Korea using big data including information for nearly all nations in Korea. Therefore, it is possible to predict the incidence of facial fractures. This study is meaningful in that it is the first study that investigated the incidence of facial fractures by specific type.


Subject(s)
Cause of Death , Classification , Diagnosis , Facial Bones , Fractures, Bone , Frontal Sinus , Humans , Incidence , Insurance, Health , Korea , Mandibular Fractures , Maxilla , Nasal Bone , National Health Programs , Orbit , Orbital Fractures
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