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1.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367135

ABSTRACT

Introducción: El 10-30% de las fracturas de clavícula ocurren en el tercio distal. El diagnóstico se realiza con radiografías de hombro (de frente y de perfil, y proyección de Zanca). La mayoría de estas fracturas se tratan de forma conservadora, pero aquellas con gran desplazamiento, patrones transversos o conminutos pueden requerir tratamiento quirúrgico debido a la alta tasa de seudoartrosis. Se han descrito diversos tipos de fijación para este grupo de fracturas. Si bien la osteosíntesis con placas logra resultados clínico-funcionales y de consolidación satisfactorios, no está exenta de complicaciones y las más frecuentes son: intolerancia al material de osteosíntesis (hasta un 30%), infección, lesión neurovascular y seudoartrosis. Sin embargo, según nuestro conocimiento, no existen reportes sobre la osteólisis de la apófisis coracoides secundaria a la osteosíntesis con placa LCP en fracturas del tercio distal de la clavícula. Conclusión: La erosión de la apófisis coracoides debido a la fijación con placa y tornillos es una complicación que no ha sido publicada previamente. Debe tenerse extrema precaución al realizar el túnel óseo y al medir la longitud de los tornillos para evitar potenciales complicaciones. Nivel de Evidencia: IV


Background: Several surgical techniques have been developed to reduce the nonunion rate and improve functional outcomes after displaced distal clavicle fractures, including the use of a tension band, the modified Weaver-Dunn procedure, coracoclavicular screw fixation, or locking plates. None of these techniques have been universally accepted, and each one has its own complications. To our knowledge, there are no previous publications describing osteolysis of the coracoid process caused by the tip of a cortical screw of a distal LCP plate. Case summary: We present the case of a 29-year-old male patient who had been treated with an anatomic pre-contoured plate for a distal clavicle fracture. Six months later he presented to our institution with limiting shoulder pain and tenderness upon the right coracoid process. Standard radiographs of the shoulder showed that the tip of a cortical screw was eroding the coracoid process. A surgery with hardware removal was then performed. One month after the surgery the patient was painless and with a full active shoulder ROM. Conclusion: Erosion of the coracoid process with plate screw fixation has never been described before. We suggest that extreme precaution should be taken in drilling and measuring the length of screws to avoid potential complications. Level of Evidence: IV


Subject(s)
Adult , Postoperative Complications , Clavicle/surgery , Fractures, Bone , Shoulder Injuries , Fracture Fixation, Internal
2.
Article in Spanish | LILACS, BINACIS | ID: biblio-1358113

ABSTRACT

El acceso a la tecnología de planificación e impresión 3D está destinado a tener un impacto disruptivo en la práctica quirúrgica de la Ortopedia y Traumatología. Sus ventajas incluyen una mejor comprensión de las lesiones por tratar, mayor precisión técnica, acortamiento de los tiempos quirúrgicos, disminución de la pérdida sanguínea y menor exposición a los rayos. El objetivo de esta publicación es ofrecer una guía práctica paso a paso tomando como ejemplo el tratamiento de una fractura desplazada del tercio medio de la clavícula. Nivel de Evidencia: V


Access to 3D planning and printing technology is destined to have a disruptive impact on the surgical practice of Orthopedics. Its advantages include a better understanding of the injuries, greater technical precision, shortened surgical times, decreased blood loss, and less exposure to X-rays. The aim of this publication is to provide a practical step-by-step guide using the treatment of a displaced middle-third clavicle fracture as an example. Level of Evidence: V


Subject(s)
Orthopedics , Clavicle/injuries , Preoperative Period , Printing, Three-Dimensional
3.
Artrosc. (B. Aires) ; 29(1): 39-41, 2022.
Article in Spanish | LILACS, BINACIS | ID: biblio-1369639

ABSTRACT

La fijación de luxaciones acromioclaviculares de alto grado con métodos de cerclaje coracoclavicular exige una manipulación cuidadosa del instrumental y de los dispositivos de fijación como suturas o injertos a nivel subcoracoideo. La estrecha relación de la apófisis coracoides con el plexo braquial y la arteria axilar hace que esta sea una zona riesgosa y técnicamente demandante durante la cirugía. Para esta instancia, se han desarrollado dispositivos específicos, pero pueden ser costosos y poco disponibles. Se presenta una técnica manual, reproducible, segura y sencilla, que evita el uso de dispositivos adicionales para realizar cerclaje coracoclavicular en fijación o reconstrucción acromioclavicular.


Stabilization of high-grade acromioclavicular dislocations with coracoclavicular cerclage methods requires careful manipulation of instruments and fixation devices when approaching the coracoid process. This is risky and technically challenging surgical area due to the close relationship with the brachial plexus and the axillary artery. Specific devices have been developed for this instance, but they can be expensive and rarely available. A reproducible, safe and simple manual technique is presented, which avoids the use of additional devices to perform coracoclavicular cerclage in acromioclavicular fixation or reconstruction.


Subject(s)
Suture Techniques , Clavicle/injuries , Shoulder Injuries/surgery
4.
Rev. bras. ortop ; 56(6): 777-783, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1357133

ABSTRACT

Abstract Objective To study the anatomy of the medial coracoclavicular ligament and assess the contribution of the acromioclavicular, coracoclavicular and medial coracoclavicular ligaments to the stability of the acromioclavicular joint. Methods Twenty-six shoulders from 16 fresh cadavers were dissected after placement in dorsal recumbency with a 15-cm cushion between the shoulder blades. An extended deltopectoral approach was performed proximally and medially, followed by plane dissection and ligament identification. The acromioclavicular and coracoclavicular distances were measured using points previously marked with a millimeter caliper. Six of these specimens were submitted to a biomechanical study. The acromioclavicular ligament, the coracoclavicular ligament and the medial coracoclavicular ligament were sectioned sequentially, and a cephalic force of 20 N was applied to the lateral clavicle. The acromioclavicular and coracoclavicular distances were measured in each of the ligament section stages. Results The right medial coracoclavicular ligament presented, on average, 48.9 mm in length and 18.3 mm in width. On the left side, its mean length was 48.65 mm, with a mean width of 17.3 mm. Acromioclavicular, coracoclavicular and medial coracoclavicular ligament section resulted in a statistically significant increase in the coracoclavicular distance and posterior scapular displacement. Conclusion The medial coracoclavicular ligament is a true ligamentous structure found in all dissected shoulders. Our results showed that the scapular protraction relaxed the medial coracoclavicular ligament, while scapular retraction tensioned it; in addition, our findings demonstrate that this ligament contributes to the vertical and horizontal stability of the acromioclavicular joint.


Resumo Objetivo Estudar a anatomia do ligamento coracoclavicular medial e avaliar a contribuição do ligamento acromioclavicular, coracoclaviculares e coracoclavicular medial na estabilidade da articulação acromioclavicular. Métodos Foram dissecados 26 ombros de 16 cadáveres frescos, posicionados em decúbito dorso-horizontal, com um coxim de 15 cm de altura entre as escápulas. Realizou-se uma via deltopeitoral estendida proximal e medialmente. Realizou-se dissecção por planos e identificação dos ligamentos. Realizou a medida da distância acromio-clavicular e coracoclavicular usando pontos previamente demarcados com paquímetro milimetrado. Em seis dessas amostras foi realizado estudo biomecânico. Seccionando, nesta ordem, o ligamento acromioclavicular, os coracoclaviculares e o ligamento coracoclavicular medial com uma força cefálica de 20N foi aplicada na clavícula lateral. Foi medida a distância acromio-clavicular e coracoclavicular em cada uma das etapas de secção dos ligamentos. Resultados A média de comprimento do ligamento coracoclavicular medial foi de 48,9mm e a média de largura, de 18,3mm no lado direito. No esquerdo, a média de comprimento foi de 48,65mm e a média da largura, 17,3mm. Após a secção dos ligamentos acromioclaviculares, coracoclaviculares, com a secção do ligamento coracoclavicular medial houve aumento estatisticamente significativo da distância córaco-clavicular e um deslocamento posterior da escápula. Conclusão O ligamento coracoclavicular medial é uma estrutura ligamentar verdadeira, presente em todos os ombros dissecados. Nossos resultados demonstraram que o ligamento coracoclavicular medial encontra-se relaxado com a escápula em protração e tenso com a escápula em retração e segundo nossos resultados participa tanto da estabilidade vertical quanto da estabilidade horizontal da articulação acromioclavicular.


Subject(s)
Scapula , Shoulder , Acromioclavicular Joint/anatomy & histology , Cadaver , Clavicle , Joint Dislocations , Dissection
5.
Rev. bras. ortop ; 56(4): 490-496, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1341163

ABSTRACT

Abstract Objective Thepresentpaperaimedtoevaluatefunctionalandradiographicoutcomesfrom a group of patients with comminuted midshaft clavicle fracture who were surgically treated using a minimally invasive technique and followed-up for a minimum period of 12 months. Methods Longitudinal, observational study with 32 consecutive patients (31 males; mean age, 41 years old) with comminuted midshaft clavicle fracture who were surgically treated using the minimally invasive osteosynthesis technique with a 3.5mm reconstruction plate in the upper position. Patients were clinically and radiologically evaluated for a minimum follow-up period of 12 months. Results In 30 patients (93.72%), fracture consolidation occurred in an average time of 17 weeks (range, 12 to 24 weeks). The mean follow-up time was 21 months (range, 12 to 45 months). No implant break or pseudoarthrosis were recorded. There was no complaint of paresthesia around the surgical incisions. The surgically-treated shoulder presented lower passive elevation and longer clavicle length (p < 0.05) compared with the contralateral shoulder. Functional evaluation revealed an average Disability of Arm, Shoulder and Hand (DASH) score of 1.75, which is considered satisfactory. Age > 60 years old had a negative correlation with DASH score (p <0.05). Conclusion The minimally invasive osteosynthesis technique was satisfactory for the treatment of comminuted midshaft clavicle fracture, with a high consolidation rate and a low complication rate.


Resumo Objetivo Avaliar os resultados funcionais e radiográficos do tratamento cirúrgico realizado em um grupo de pacientes com fratura multifragmentada da diáfise de clavícula, pela técnica minimamente invasiva, em seguimento mínimo de 12 meses. Métodos Estudo observacional longitudinal de 32 pacientes consecutivos (31 do sexo masculino, idade média 41 anos) com fratura multifragmentada da diáfise da clavícula tratados cirurgicamente pela técnica minimamente invasiva de osteossíntese com placa de reconstrução de 3,5 mm na posição superior, avaliados clínica e radiologicamente, com seguimento mínimo de 1 ano Resultados Resultados Trinta pacientes (93,72%) evoluíram com consolidação da fratura em tempo médio de 17 semanas (entre 12 e 24 semanas). O tempo de seguimento médio foi de 21 meses (variando de 12 a 45 meses). Não houve quebra de implantes ou pseudoartroses. Não houve queixa de parestesia na região das incisões cirúrgicas. O ombro tratado cirurgicamente apresentou menor elevação passiva e maior comprimento da clavícula (p< 0,05) em relação ao contralateral. Na avaliação funcional, encontramos um valor médio de Disfunções do Braço, Ombro e Mão (DASH, na sigla em inglês) = 1,75, sendo o mesmo considerado satisfatório. Idade >60 anos apresentou correlação negativa com escore DASH (p< 0,05). Conclusão A técnica minimamente invasiva de osteossíntese mostrou-se satisfatória para o tratamento da fratura multifragmentada da diáfise da clavícula, com elevada taxa de consolidação e baixo índice de complicações.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Treatment Outcome , Clavicle , Minimally Invasive Surgical Procedures , Fractures, Bone
6.
Article in Chinese | WPRIM | ID: wpr-888338

ABSTRACT

OBJECTIVE@#To compare the clinical efficacy of distal radius T-plate combined with suture anchor and distal clavicle anatomical locking plate combined with suture anchor in the treatment of Neer Ⅱb distal clavicle fracture.@*METHODS@#From June 2014 to June 2018, 42 patients with Neer Ⅱb distal clavicle fractures were retrospectively analyzed. According to different surgical methods, they were divided into the observation group (T-shaped plate combined with suture anchor) and the control group (anatomical locking plate combined with suture anchor). There were 22 patients in the observation group and 20 patients in the control group. In the observation group, there were 13 males and 9 females, aged from 22 to 70 (45.78± 14.44) years old, 12 cases on the left side and 10 cases on the right side, 8 cases of traffic accident injury and 14 cases of fall. In the control group, there were 12 males and 8 females, aged from 24 to 66 (44.17±15.58) years, 13 cases on the left side and 7 cases on the right side, 6 cases of traffic accident injuryand 14 cases of fall. The operation time, intraoperative blood loss and fracture healing time were compared between the two groups, and Constant Murley score was used to evaluate shoulder joint function.@*RESULTS@#The patients in both groups were followed up for 18 to 24 (20.96±2.02) months. The incisions of both groups were healed at stageⅠ. The fracture ends of both groups were bony healed at the last follow up. There was no significant difference in operation time, intraoperative blood loss and fracture healing time between two groups (@*CONCLUSION@#The two methods can obtain satisfactory results in the treatment of Neer Ⅱb distal clavicle fractures, especially suitable for patients with comminuted distal clavicle fractures or osteoporosis; the clinical effect of the treatment of NeerⅡb distal clavicle fractures with T type distal radius plate combined with suture anchor is satisfactory, which provides another feasible treatment scheme for clinic.


Subject(s)
Aged , Aged, 80 and over , Bone Plates , Case-Control Studies , Clavicle/surgery , Female , Fracture Fixation, Internal , Fractures, Bone/surgery , Humans , Male , Middle Aged , Retrospective Studies , Suture Anchors , Treatment Outcome
7.
Article in Chinese | WPRIM | ID: wpr-888316

ABSTRACT

OBJECTIVE@#To explore the efficacy of a novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint.@*METHODS@#Retrospective analysis of 13 cases of proximal clavicle fracture with dislocation of sternoclavicular joint treated with sternoclavicular hook-plate from June 2011 to January 2019 in our department. There were 9 males and 4 females, aged 26 to 78 years old, with an average age of (54.08±13.91) years old. All the patients had closed injuries without damage of blood vessels and nerves. The patient's operation time, intraoperative blood loss, hospital stay time, and postoperative complications were recorded. Fracture healing and reduction were evaluated according to X-ray and CT after operation. Constant-Murley score and Rockwood sternoclavicular joint score were used to evaluate limb function at 12 months after operation.@*RESULTS@#All the patients were treated with sternoclavicular hook-plate. The operation time ranged from 50 to 76 min, with a mean of (54.08±13.91) min. The intraoperative blood loss ranged from 20 to 56 ml, with a mean of (46.08±11.15) ml. The hospital stay time ranged from 6 to 14 d, with a mean of (8.31±2.32) d. X-ray and CT examination on the second day after operation showed that all fractures and dislocations were anatomically reduced, and shoulder joint function exercise was performed early. All patients were followed up, and the duration ranged from 12 to 24 months, with a mean of (16.77±4.63) months. The healing time ranged from 9 to 13 d, with a mean of (11.00±1.75) d;and the bone healing time ranged from 3 to 4 months, with a mean of (3.65±0.46) months. There were no complications such as infection, internal fixation failure and nerve injury. At 12 months follow-up, the constant Murley score ranged from 78 to 100, with a mean of 87.83± 11.26; and Rockwood score ranged from 9 to 15, with a mean of 13.70±1.85. Among them, 11 cases were excellent, 1 case was good, and 1 case was general.@*CONCLUSION@#The use of the novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint is an effectively internal fixation with high safety, allowing early functional exercise for patients.


Subject(s)
Adult , Aged , Bone Plates , Clavicle , Female , Fracture Fixation, Internal , Fractures, Bone , Humans , Joint Dislocations , Male , Middle Aged , Retrospective Studies , Sternoclavicular Joint , Treatment Outcome
8.
Rev. ecuat. pediatr ; 21(3): 1-6, 31 Diciembre 2020.
Article in Spanish | LILACS | ID: biblio-1146534

ABSTRACT

Introducción:El quiste óseo aneurismático es una neoplasia benigna poco común de aparición en edad temprana. Tiene mayor incidencia en huesos largos y en la columna vertebral. Su etiología es incierta, aunquesuele asociarse a traumatismo, probablemente debido a obstrucción venosa o a la formación de fístulas que se producen tras la contusión. Caso:En este estudio se presenta el caso de un paciente de 15 años sin antecedentes de trauma que presenta un quiste óseo aneurismático en clavícula, localización poco habitual para esta patología. Evolución: Se le brindótratamiento con terapia esclerosante con Polidocanol al 3% por 8 ocasiones con respuesta favorable.No ha requerido cirugía hasta el momento. Conclusión:El tratamientoesclerosante fue exitoso en este informe de casos


Introduction: The aneurysmal bone cyst is a rare benign neoplasm that appears at an early age. It has a higher incidence in long bones and in the spine. Its etiology is uncertain, although it is usually associated with trauma, probably due to venous obstruction or the formation of fistulas that occur after contusion. Case: This study presents the case of a 15-year-old patient with no history of trauma who presents with an aneurysmal bone cyst in the clavicle, an unusual location for this pathology. Evolution: Treatment with sclerosing therapy with 3% Polidocanol was given 8 times with a favorable response. He has not required surgery so far. Conclusion: Sclerosing treatment was successful in this case report


Subject(s)
Humans , Bone Cysts , Clavicle , Bone Cysts, Aneurysmal , Case Reports , Child
9.
Int. j. morphol ; 38(5): 1229-1234, oct. 2020. graf
Article in Spanish | LILACS | ID: biblio-1134430

ABSTRACT

RESUMEN: Dentro de las disfunciones de los angioaccesos, la estenosis del arco de la vena cefálica (AVC) juega un papel significativo. Existen características anatómicas del AVC que explican, en parte, este fenómeno. Todo esto obliga a un conocimiento profundo del AVC y sus principales variantes. Se disecaron 43 (n=43) axilas de cadáveres adultos fijados en solución en base a formol. Se registró: longitud del AVC (LAC), angulación del AVC respecto a la vena cefálica (AAC), tipo de terminación (simple o múltiple), presencia de afluentes y su número. LAC promedio 31,6 mm (rango 17-46 mm); AAC promedio 128,95° (rango 65-165°). En cuanto al tipo de terminación 41 (95,3 %) fueron simples, mientras que 2 casos (4,7 %) fueron de forma múltiple. Respecto a los afluentes, se encontraron en 42 de los casos (90,5 %). Se encontraron válvulas en 27 (62,8 %) de los casos. La longitud promedio del AVC fue de 31,6 mm, se dispuso en la mayoría de los casos en ángulo obtuso, presentando en la mayoría de los casos terminación de tipo simple. Además, en el 90,5 % se encontró afluentes que se agotaban en el AVC y en más de la mitad de los casos se encontraron válvulas. Se discuten las implicancias de estos hallazgos en la génesis de la disfunción de angioaccesos.


SUMMARY: Within the angio access dysfunctions, the stenosis of the cephalic vein arch (AC) has a significant role. There are anatomical characteristics of AVC that partially explain this phenomenon. This requires a deep understanding of AVC and its main variants. 43 axillary regions of formalin-fixed adult cadavers were dissected. For this study, the following were registered: length of the AVC (LAC), angulation of the AVC with respect to the cephalic vein (AAC), type of termination (single or multiple), presence and number of tributaries. LAC average 31.6 mm (range 17-46 mm); AAC average 128,95° (range 65-165°). Regarding the type of termination, 41 (95.3 %) were simple, while 2 cases (4.7 %) were multiple. Tributaries were found in 42 of the cases (90.5 %). Valves were found in 27 (62.8 %) of the cases. The average length of the AVC was 31.6mm. Most cases presented an obtuse angle, and simple termination. In addition, in 90.5 % tributaries were found and in more than half of the cases valves were found. Implications of these findings in the genesis of angioaccess dysfunction are discussed.


Subject(s)
Humans , Male , Female , Adult , Shoulder/blood supply , Axilla/blood supply , Veins/anatomy & histology , Cadaver , Clavicle , Anatomic Variation
10.
Arch. argent. pediatr ; 118(2): e194-e198, abr. 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1100477

ABSTRACT

La pseudoartrosis congénita de la clavícula es una malformación rara y benigna, caracterizada por la ausencia del tercio medio de la clavícula. Suele ser unilateral y mayoritaria en el lado derecho. La etiología es desconocida y se postulan diversas teorías etiopatogénicas (vascular, embriológica y genética).Puede detectarse en el período neonatal o, más frecuentemente, durante la infancia. En ocasiones, puede ser sintomática. Puede requerir tratamiento mediante reconstrucción quirúrgica por injerto óseo.Se presentan 2 casos, uno de diagnóstico neonatal y otro de 3 años de edad realizados con 24 h de diferencia. Se destaca la consideración de este diagnóstico como diferencial de fractura obstétrica o postraumática, displasia cleidocraneal y neurofibromatosis de tipo 1.


The congenital pseudoarthrosis of the clavicle is a rare and benign malformation, characterized by the absence of the middle third of the clavicle. It is usually unilateral and the majority on the right side. The etiology is unknown, postulating diverse etiopathogenic theories (vascular, embryological and genetic).It can be detected in the neonatal period or, more frequently, during childhood. Occasionally it can be symptomatic. It may require treatment by surgical reconstruction by bone graft. Two cases are presented, one of neonatal diagnosis and another one of 3 years of age performed with 24 hours of difference. We emphasize on its consideration as a differential diagnosis of obstetric or post-traumatic fracture, cleidocranial dysplasia and neurofibromatosis type I.


Subject(s)
Humans , Female , Infant, Newborn , Child, Preschool , Pseudarthrosis/congenital , Clavicle/abnormalities , Pseudarthrosis/diagnostic imaging , Congenital Abnormalities , Diagnosis, Differential
11.
Rev. bras. anestesiol ; 70(1): 28-35, Jan.-Feb. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137137

ABSTRACT

Abstract Background and objectives: To evaluate the single-injection and triple-injection techniques in infraclavicular blocks with an ultrasound-guided medial approach in terms of block success and the need for supplementary blocks. Methods: This study comprised 139 patients who were scheduled for elective or emergency upper-limb surgery. Patients who received an infraclavicular blocks with a triple-injection technique were included in Group T (n = 68). Patients who received an infraclavicular blocks with a single-injection technique were included in Group S (n = 71). The number of patients who required supplementary blocks or had complete failure, the recovery time of sensory blocks and early and late complications were noted. Results: The block success rate was 84.5% in Group S, and 94.1% in Group T without any need for supplementary nerve blocks. The blocks were supplemented with distal peripheral nerve blocks in 8 patients in Group S and in 3 patients in Group T. Following supplementation, the block success rate was 95.8% in Group S and 98.5% in Group T. These results were not statistically significant. A septum preventing the proper distribution of local anesthetic was clearly visualized in 4 patients. The discomfort rate during the block was significantly higher in Group T (p < 0.05). Conclusion: In ultrasound-guided medial-approach infraclavicular blocks, single-injection and triple-injection techniques did not differ in terms of block success rates. The need for supplementary blocks was higher in single injections than with triple injections. The presence of a fascial layer could be the reason for improper distribution of local anesthetics around the cords.


Resumo Justificativa e objetivos: Avaliar as técnicas de injeção única e tripla no bloqueio infraclavicular, empregando-se acesso medial guiado por ultrassonografia, comparando-se o sucesso do bloqueio e a necessidade de bloqueios complementares. Método: O estudo incluiu 139 pacientes com indicação de cirurgia de membro superior eletiva ou de emergência. O Grupo T (n = 68 pacientes) recebeu bloqueio infraclavicular com técnica de injeção tripla e o Grupo S (n = 71), bloqueio infraclavicular com injeção única. Registrou-se o número de pacientes que necessitaram bloqueio complementar de nervo ou que apresentaram falha completa do bloqueio, o tempo de recuperação do bloqueio sensorial e as complicações precoces e tardias. Resultados: A taxa de sucesso do bloqueio infraclavicular, sem necessidade de bloqueio complementar de nervo, foi 84,5% e 94,1% para os Grupos S e T, respectivamente. No bloqueio infraclavicular foi necessário bloqueio de nervos periféricos distais em 8 e 3 pacientes dos Grupos S e T, respectivamente. Após a complementação, a taxa de sucesso do bloqueio foi 95,8% e 98,5% para os Grupos S e T, respectivamente. Os resultados não foram estatisticamente significantes. Imagem de septo impedindo a distribuição adequada do anestésico local foi claramente visualizada em quatro pacientes. A taxa de desconforto durante a realização do bloqueio foi estatatisticamente mais alta no Grupo T (p< 0,05). Conclusões: As técnicas de injeção única e tripla em bloqueio infraclavicular guiado por ultrasonografia com acesso medial não diferiram quanto à taxa de sucesso. A necessidade de bloqueio complementar foi maior com a técnica de injeção simples. A ocorrência de invólucro de fascia poderia justificar a distribuição inadequada do anestésico local ao redor dos fascículos do plexo.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Brachial Plexus Block/methods , Peripheral Nerves/anatomy & histology , Brachial Plexus/anatomy & histology , Clavicle , Ultrasonography, Interventional , Injections/methods , Middle Aged
12.
Rev. bras. ortop ; 55(1): 100-105, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092673

ABSTRACT

Abstract Objective To evaluate the results of the surgical treatment of fractures of the middle third of the clavicle. Methods A retrospective cross-sectional study, in which 36 patients who suffered fractures of the middle third of the clavicle and who were surgically treated from January 2012 to February 2017 were evaluated. They were evaluated for types of fracture, age, smoking, osteosynthesis material, and Constant-Murley and Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA-M) scores. Results The mean Constant-Murley and UCLA-M scores were 91.59 and 31.29 respectively. The mean age was 37.62 years, and it was statistically related to the type of osteosynthesis (p < 0.05), but the osteosynthesis material did not show significance with the improvement in the rates of the functional scores. Conclusion The surgical treatment provides good functional results after diaphyseal fractures of the clavicle, regardless of the line of the fracture, with a low rate of pseudarthrosis.


Resumo Objetivo Avaliar o resultado do tratamento cirúrgico de fraturas do terço médio da clavícula. Métodos Estudo transversal retrospectivo, em que foram avaliados 36 pacientes que sofreram fratura do terço médio da clavícula, que foram tratados cirurgicamente no período de janeiro de 2012 a fevereiro de 2017. Eles foram avaliados quanto aos tipos de fratura, idade, tabagismo, material de síntese, e escores de Constant-Murley e Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA-M). Resultados As médias dos escores de Constant-Murley e UCLA-M foram de 91,59 e 31,29, respectivamente. A idade média foi de 37,62 anos, e apresentou relação estatística com o tipo de síntese (p < 0,05), mas o material de síntese não apresentou significância com a melhora de pontuação dos escores funcionais. Conclusão O tratamento cirúrgico ocasiona bons resultados funcionais após a fratura diafisária de clavícula, independente do traço da fratura, com baixa taxa de pseudoartrose.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Incidence , Treatment Outcome , Clavicle/surgery , Fractures, Bone , Cross-Sectional Studies
13.
Article in English | WPRIM | ID: wpr-811284

ABSTRACT

We performed a revisionary open reduction and internal fixation for treating nonunion of the mid-shaft of the left clavicle with an autogenous cancellous bone graft. On postoperative day 4, the patient presented with neurologic deficits in the left upper extremity. We removed the implant and made a superior angulation to decompress the brachial plexus. At 6 months postoperatively, callus bridging and consolidation were visible and all hand and elbow functions were fully recovered. Our case suggests that brachial plexus neuropathy may be caused by stretching and compression after reduction and straightening of the nonunion site around adhesions or scar tissue. Therefore, care should be taken whether there are the risk factors that can cause brachial plexus neuropathy when revision surgery is performed for treating nonunion of a clavicle shaft fracture.


Subject(s)
Bony Callus , Brachial Plexus Neuropathies , Brachial Plexus , Cicatrix , Clavicle , Elbow , Hand , Humans , Neurologic Manifestations , Risk Factors , Transplants , Upper Extremity
14.
Article in Chinese | WPRIM | ID: wpr-828254

ABSTRACT

OBJECTIVE@#To explore the clinical effects of convolution method in treating displaced midshaft clavicle fracture.@*METHODS@#From January 2018 to July 2019, 32 patients (21 males and 11 females) with displaced midshaft clavicle fracture were treated, ranging in age from 18 to 65 years old, with a median age of 41.5 years old. Nineteen patients had fractures on the left side and 13 patients had fractures on the right side. The duration from injury to treatment ranged from 30 minutes to 5 days. The patients were treated with convolution method and repeated push and rotation of the affected upper limb, followed by external fixation of clavicle band. The reduction and healing of the fracture and the functional recovery of shoulder joint were observed.@*RESULTS@#After operation, fracture reduction was evaluated by X ray film. Seven patients had an excellent result, 20 good and 5 fair. All the patients were followed up, and the duration ranged from 14 to 18 weeks. The mean Neer score was 89.75±6.88, which included pain score of 32.66±2.54, functional score of 26.44±2.91, range of motion score of 22.38±2.06, and anatomy score of 8.43±0.84;17 patients receive an excellent result, 14 good and 1 fair.@*CONCLUSION@#The rotation method combined with the repeated pushing and rotating of the upper limb of the affected side can well reduce the displaced fracture of the middle clavicle. Bandage and clavicle band can be performed after reduction. Functional exercise runs through the whole course of treatment. Functional recovery of shoulder joint is good and satisfactory therapeutic effect is achieved.


Subject(s)
Adolescent , Adult , Aged , Bone Plates , Clavicle , Female , Fracture Fixation , Fracture Fixation, Internal , Fracture Healing , Fractures, Bone , Humans , Male , Middle Aged , Shoulder Joint , Treatment Outcome , Young Adult
15.
Article in Chinese | WPRIM | ID: wpr-828245

ABSTRACT

Clavicular fracture is a common upper limb fracture. Because of its special anatomical structure, it directly affects the function of the shoulder joint. The different injury mechanisms of clavicular fracture affect the mechanical effect of internal fixation, so the selection of internal fixation method has been puzzling orthopedists. As a modern computer based mechanical analysis, finite element analysis application in the internal fixation of clavicular fracture can not only clarify the pathogenesis of fractures, biomechanical properties of internal fixators and complications of fractures, but also provide guidance for preoperative planning. Therefore, it is beneficial to preoperative planning and individualized selection of surgical methods, and is expected to become an indispensable part in preoperative planning for clavicular fracture. In this paper, the pathogenesis, related influencing factors, selection of internal fixation and postoperative complications of clavicular fracture based on finite element analysis and problems during finite element analysis were reviewed.


Subject(s)
Bone Plates , Clavicle , Finite Element Analysis , Fracture Fixation, Internal , Fractures, Bone , General Surgery , Humans , Internal Fixators
16.
Article in Chinese | WPRIM | ID: wpr-828221

ABSTRACT

OBJECTIVE@#To explore the method and effect of small incision TightRope fixation in the treatment of fresh acromioclavicular joint dislocation.@*METHODS@#From January 2016 to May 2018, 28 cases of fresh acromioclavicular dislocation were treated, including 20 males and 8 females, aged 26 to 87 years with an average age of 51.3 years. The modified Rockwood classification included 1 case of typeⅡ, 22 cases of typeⅢand 4 cases of type V. The average time from injury to operation was 2.4 days. The operative time, shoulder function recovery time and postoperative complications were recorded, and the immediate reduction effect and Karlsson function of shoulder joint were evaluated.@*RESULTS@#In 28 patients, only one Rockwood typeⅡ was used to reconstruct the pyramidal ligament, and the other 27 were used to reconstruct the pyramidal ligament and the trapezoid ligament. The average operation time was (66.50±12.62) min (including intraoperative fluoroscopy time). Twenty-eight cases were followed up for 11 to 20 (16.7±4.6) months. The recovery time of shoulder function was 2 to 7 months with an average of 4 months. During the follow-up period, 1 case had osteolysis and loss of reduction at the clavicular plate site, and the rest had no complications such as re-dislocation and button plate prolapse. Immediate reduction effect after operation:6 cases with reduction insufficiency, 17 cases with complete reduction and 5 cases with excessive reduction;Karlsson function evaluation of shoulder joint in the last follow-up:excellent in 21 cases, good in 6 cases and poor in 1 case;Pearson analysis =0.060, suggesting that the immediate reduction effect of fresh acromioclavicular dislocation operation has no significant correlation with Karlsson function evaluationof shoulder joint in the last follow-up.@*CONCLUSION@#TightRope fixation through a small incision in the base of coracoid process is a simple and effective method for the treatment of dislocation of acromioclavicular joint. There was no significant correlation between the slight difference of immediate reduction effect within 5 mm and Karlsson function evaluation of shoulder joint in the last follow-up. It is suggested to pay attention to the loss of reduction and osteolysis of clavicular plate in clinical follow-up.


Subject(s)
Acromioclavicular Joint , Adult , Aged , Aged, 80 and over , Clavicle , Coracoid Process , Female , Humans , Joint Dislocations , Male , Middle Aged , Shoulder Dislocation , Treatment Outcome
17.
Rev Assoc Med Bras (1992) ; 66(5): 654-658, 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136269

ABSTRACT

SUMMARY OBJECTIVE To compare the effect of two internal fixation methods in the treatment of proximal clavicle fractures. METHODS Fifty patients with proximal clavicle fractures received surgical treatment. They were divided into a clavicular T-plate group and a double mini-plates group. The duration of the operation, blood loss during the operation, fracture healing time, and incision infection were evaluated between the two groups. RESULTS Operation time (t=2.063, P=0.058), intraoperative bleeding (t=1.979, P=0.062), and fracture healing time (t=1.082, P=0.066) were not statistically significant in the two groups. The patients were followed up for 12-18 months; one patient in the T-plate group had early removal of nails, but no clinical symptoms. At the 2-month follow-up, the ASES score in the double mini-plates group was significantly better than in the T-plate group (P<0.001); but at the 6-month follow-up, 1-week before removal of internal fixation and the final follow-up, the two groups had no significant differences (P>0.05). CONCLUSIONS Both internal fixations have similar clinical results in the duration of operation, blood loss during the operation, and fracture healing time. The double mini-plates fixation presents advantages by reducing complications and speeding fracture healing; thus it is a more effective method to treat proximal clavicle fractures.


RESUMO OBJETIVO Comparar o efeito de dois métodos de fixação interna no tratamento de fraturas da clavícula proximal. MÉTODOS Cinquenta pacientes com fraturas da clavícula proximal receberam tratamento cirúrgico. Eles foram divididos em um grupo de placa T clavicular e um grupo de miniplacas duplas. A duração da operação, perda de sangue durante a operação, tempo de cura da fratura e infecção na incisão foram avaliados nos dois grupos. RESULTADOS O tempo de operação (t=2,063, P=0,058), perda de sangue durante a operação (t=1,979, P=0,062) e tempo de cura das fraturas (t=1,082, P=0,066) não foram estatisticamente significativos nos dois grupos. Os pacientes foram acompanhados por 12-18 meses; um dos pacientes do grupo da placa T teve retirada antecipada dos parafusos, mas não apresentou sintomas clínicos. Aos dois meses de acompanhamento, a pontuação ASES no grupo de miniplacas duplas foi significativamente melhor do que a do grupo de placas T (P<0,001). Porém, no acompanhamento de seis meses, uma semana antes da remoção da fixação interna e do acompanhamento final, os dois grupos não apresentavem diferenças significativas (P>0,05). CONCLUSÃO Ambas técnicas de fixação interna têm resultados clínicos semelhantes quanto a duração da operação, perda de sangue durante a operação e tempo de cura da fratura. A fixação de miniplacas duplas apresenta vantagens quanto a redução das complicações e cura mais rápida da fratura, sendo, portanto, um método mais eficaz para tratar fraturas da clavícula proximal.


Subject(s)
Humans , Clavicle , Fractures, Bone , Bone Plates , Retrospective Studies , Treatment Outcome , Operative Time , Fracture Fixation, Internal
18.
Acta ortop. mex ; 33(6): 400-405, nov.-dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1345069

ABSTRACT

Resumen: La epifisiólisis esternoclavicular es una lesión rara, siendo la variante posterior aún menos frecuente. Su presentación clínica puede ser sutil o puede comprometer estructuras mediastinales, ya sea inicialmente o durante la evolución, lo que constituye un cuadro grave y potencialmente fatal. Este reporte de caso documenta una disociación esternoclavicular en un paciente con esqueleto inmaduro, dada por una lesión fisaria tipo Salter y Harris 1, la que se trató quirúrgicamente mediante reducción abierta y fijación interna con lazadas en ocho transóseas con sutura no reabsorbible. Con un seguimiento de 10 meses y resultados excelentes. Esta técnica parece ser una buena opción para el tratamiento de luxación esternoclavicular en el paciente esquemáticamente inmaduro, recuperando la función y evitando complicaciones.


Abstract: Sternoclavicular epiphysiolysis is a rare lesion, the posterior variant being even less common. Its clinical presentation may be subtle, or it may compromise mediastinal structures, either initially or during evolution, which is a serious and potentially fatal picture. This case report documents sternoclavicular dissociation in a patient with an immature skeleton, given by a Salter and Harris 1-type injury, which was surgically treated by open reduction and internal fixation with transosseous configuration with non-reabsorbable suture. With a 10-month follow-up and excellent results. This technique seems to be a good option for the treatment of sternoclavicular dislocation in the schematically immature patient, regaining function and avoiding complications.


Subject(s)
Humans , Joint Dislocations , Epiphyses, Slipped , Sternoclavicular Joint , Clavicle , Fracture Fixation, Internal
19.
Acta ortop. mex ; 33(6): 382-385, nov.-dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1345065

ABSTRACT

Resumen: Introducción: La clavícula es el único hueso que une al esqueleto axial con el esqueleto apendicular; durante la función de la extremidad torácica, un acortamiento clavicular implica que haya disminución de fuerza y de función, dado que ésta actúa como palanca, ya que a mayor acortamiento menor será la fuerza producida. Factores como la multifragmentación, la pérdida ósea y la reabsorción de los bordes de los fragmentos son algunas limitantes de la restitución de la longitud clavicular. ¿Cuánto podría afectar un acortamiento de la clavícula a la función de la extremidad torácica? Material y métodos: Se realizó un estudio retrospectivo y transversal no probabilístico en pacientes con fractura clavicular que fueron tratados quirúrgicamente. El acortamiento fue medido en milímetros en la radiografía postoperatoria; después se aplicó la escala de DASH (Disabilities of the Arm, Shoulder and Hand: Discapacidad de hombro, codo y mano) para determinar el grado de la función. Resultados: Se evaluaron 12 pacientes y la edad promedio de ellos fue 37 ± 17.7 años; dos mujeres y 10 hombres. Fueron evaluados cinco pacientes del lado derecho y siete del lado izquierdo. Se realizó un análisis estadístico con coeficiente de correlación de Pearson. El acortamiento promedio fue de 13.32 ± 9.9 mm. El promedio en la escala de DASH fue de 6.0 ± 3. Discusión: La correlación fue moderada junto con la limitación en la función, en acortamientos ≥ 1 cm, así como que también hubiese un significado clínico en la escala de DASH a partir de 6 puntos, 4 menos de lo que marca la literatura. Con esto se puede determinar que los pacientes manejados con o sin cirugía, con un acortamiento > 1 cm tendrán una limitación considerable en la función del hombro y la extremidad superior.


Abstract: Introduction: The collarbone is the only bone that joins the axial skeleton with the appendicular, during the function of the thoracic limb a shortening implies a decrease in strength and function since it acts as a lever, where the greater the shortening, the smaller will be the force produced. Factors such as multifragmentation, bone loss and reabsorption of the edges of the fragments are some limiting to the restitution of the clavicular length. How much might a shortening of the collarbone affect the function of the upper limb? Material and methods: A retrospective and non-probabilistic cross-sectional study was conducted in surgically treated clavicular fracture patients. Shortening was measured in millimeters on postoperative X-Ray, dash scale was subsequently applied to determine the degree of function. Results: 12 patients, average age 37 ± 17.7 years. 2 women and 10 men. 5 on the right side and 7 left side. Statistical analysis was performed with Pearson correlation coefficient. Average shortening 13.32 ± 9.9 mm. Average scale of DASH 6.0 ± 3. Discussion: Moderate correlation with limitation in function in shortenings ≥ 1 cm, as well as clinical significance on the DASH scale from 6 points, 4 less than what the literature marks. With this, it can be determined that patients managed with or without surgery, with a shortening > 1 cm will have a considerable limitation in the function of the shoulder and upper limb.


Subject(s)
Clavicle , Fractures, Bone , Shoulder , Cross-Sectional Studies , Retrospective Studies , Treatment Outcome , Middle Aged
20.
Rev. bras. ortop ; 54(6): 649-656, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057954

ABSTRACT

Abstract Objective To evaluate the clinical, radiological and functional results of the surgical treatment of acute acromioclavicular dislocation using a coracoclavicular fixation technique (syndesmopexy) with two metallic anchors, temporary clavicle and scapula fixation, and transfer of the coracoacromial ligament. Methods Longitudinal observational study of 30 patients with diagnoses of acute acromioclavicular dislocation, who were submitted to surgical treatment with a minimum follow-up of six months, and who were evaluated clinically, radiologically, and by the University of California at Los Angeles (UCLA), the Disabilities of the Arm, Shoulder and Hand (DASH) and the Constant-Murley functional scores. Results The mean values of the scores were: UCLA = 32; DASH = 11.21; and Constant-Murley = 86.93, with satisfactory results higher than 80%. The unsatisfactory results were associated with acromioclavicular pain on palpation, positive subacromial impingement tests, and older age group, presenting statistical significance (p < 0.05). Radiologically, higher values on account of the coracoclavicular distance ratio from the operated shoulder compared to the normal shoulder were related to worse outcomes, but with no statistically significant difference. No associations were found between the results of the functional scores and the variables degree of the injury, coracoacromial ligament transfer, clinical impression of loss of reduction and scapulothoracic dyskinesis. Conclusion The technique used provides an efficient fixation, with a high level of satisfaction according to the UCLA, Constant-Murley and DASH scores; moreover, it has a low complication rate, despite the high rate of residual radiological acromioclavicular subluxation.


Resumo Objetivo Avaliar os resultados clínicos, radiológicos, e funcionais do tratamento cirúrgico da luxação acromioclavicular aguda, utilizando a técnica de sindesmopexia coracoclavicular com duas âncoras metálicas, fixação temporária clavículo-escapular, e transferência do ligamento coracoacromial. Métodos Estudo observacional longitudinal com trinta pacientes com diagnóstico de luxação acromioclavicular aguda submetidos à cirurgia, com seguimento mínimo de seis meses, avaliados clínica, radiograficamente, e pelos escores de University of California at Los Angeles (UCLA), Disabilities of the Arm, Shoulder and Hand (DASH) e Constant-Murley. Resultados Os valores médios dos escores foram: UCLA = 32; DASH = 11,21; e Constant-Murley = 86,93, com resultados satisfatórios acima de 80%. Os resultados insatisfatórios foram relacionados à dor acromioclavicular, a testes de impacto subacromial positivos, e aos pacientes de faixa etária mais elevada (p < 0,05). Radiologicamente, valores maiores em razão da distância coracoclavicular do ombro operado, comparado com o ombro normal, foram relacionados a piores resultados, embora sem significância estatística. Não foi observada associação entre os resultados dos escores funcionais e as variáveis grau da lesão, transferência do ligamento coracoacromial, impressão clínica de perda de redução, e discinesia escapulo-torácica. Conclusão A técnica utilizada propicia uma fixação eficiente, com alto índice de satisfação segundo os escores de UCLA, Constant-Murley e DASH. Observou-se baixo índice de complicações apesar da frequência elevada de subluxação acromioclavicular radiológica residual.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Wounds and Injuries , Acromioclavicular Joint , Treatment Outcome , Clavicle , Joint Dislocations , Suture Anchors
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