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1.
Cuad. Hosp. Clín ; 62(1): 25-32, jun. 2021. ilus.
Article in Spanish | LILACS | ID: biblio-1284248

ABSTRACT

INTRODUCCIÓN: las fracturas de humero corresponden del 1% al 2% de todas las fracturas en todo el cuerpo. La fractura de la diáfisis plantea problemas radicalmente distintos de los derivados de una fractura epifisaria. El hueso esponjoso diafisario es compacto, cuya consolidación se produce a través de mecanismos que contribuyen a la formación de callo de origen a la vez perióstica y endóstica. La reducción de una fractura epifisaria requiere gran precisión, mientras que el tratamiento de una fractura diafisaria debe tratar de respetar la longitud y los ejes del hueso y evitar cualquier desviación rotacional. OBJETIVO: el objetivo de la investigación es determinar cuál es la vía de acceso en el enclavado endomedular de las fracturas diafisiarias que presente una mejor recuperación funcional y vuelta a los rangos de movimientos normales de la articulación comprometida en el acceso quirúrgico intraoperatorio. MÉTODOS: se realizó un estudio en 20 pacientes que cumplieron con los criterios de inclusión, siendo un estudio de tipo transversal, descriptivo, observacional, no experimental. Que tiene como delimitación temporal marzo 2018 hasta diciembre de 2019.Se usó la escala DASH para realizar la valoración funcional post quirúrgica comparando los resultados de los pacientes tratados por el acceso anterógrado o retrogrado. RESULTADOS: comparando ambas técnicas en el postoperatorio una vez consolidada la fractura mediante la escala DASH, la encuestada realizada a los pacientes mostro mayor discapacidad en el grupo anterógrado con puntuación de 38, el grupo retrogrado presento una puntuación de 15,2. Significancia asintótica 0,350 > 0,005.


INTRODUCTION: humeral fractures correspond to 1% to 2% of all fractures in the body. Diaphysis fracture poses radically different problems from epiphyseal fracture. The diaphyseal cancellous bone is compact, the consolidation of which occurs through mechanisms that contribute to the formation of callus of both periosteal and endosteal origin. The reduction of an epiphyseal fracture requires great precision, while the treatment of a diaphyseal fracture should try to respect the length and axes of the bone and avoid any rotational deviation. The main objective of the research is to determine which is the access route in the endomedullary nailing of diaphyseal fractures that presents a better functional recovery and return to the normal ranges of movements of the compromised joint in intraoperative surgical access. METHODS: a study was conducted in 20 patients who met the inclusion criteria, being a cross-sectional, descriptive, observational, non-experimental study. The time limit was March 2018 to December 2019. The DASH scale was used to perform the post-surgical functional assessment comparing the results of patients treated by antegrade or retrograde access. RESULTS: comparing both techniques in the postoperative period, once the fracture was consolidated using the DASH scale, the survey applied to the patients showed greater disability in the antegrade group with a score of 38, the retrograde group presented a score of 15.2. Asymptotic significance 0.350> 0.005.


Subject(s)
Postoperative Period , Humerus , Diaphyses , Humeral Fractures
2.
Cuad. Hosp. Clín ; 62(1): 57-62, jun. 2021. ilus.
Article in Spanish | LILACS | ID: biblio-1284349

ABSTRACT

La rehabilitación de un paciente con fractura es progresivos y secuenciales para la mejora del foco de fractura, en especial en este tipo de fracturas con pérdida de sustancia ósea ya que suelen ser agresivas y de difícil resolución, por tanto, el tratamiento ortopédico es cuidadoso y complejo como la recuperación es prolongada sujeta a varios pasos según la progresión del paciente. El objetivo de este artículo es la de describir la secuencia de pasos en la rehabilitación de este tipo de fracturas, ya que no hay un manual claro para el manejo en rehabilitación de casos similares. El seguimiento y recuperación de este caso dura 8 meses dividida en 3 etapas de rehabilitación en un total de 122 sesiones, teniendo 4 evaluaciones en base a los tres parámetros de evaluación de ingreso: dolor, movimiento, postura y fuerza muscular, mejorando progresivamente estos aspectos.


The rehabilitation of a fractured patient is progressive and sequential for the improvement of the fracture focus, especially in this type of fractures with loss of bone substance since they are usually aggressive and difficult to resolve, so orthopedic treatment is careful and complex. as the recovery is prolonged subject to several steps depending on the patient's progression. The objective of this article is to describe the sequence of steps in the rehabilitation of this type of fractures, since there is no clear manual for the management in rehabilitation of similar cases. The follow-up and recovery of this case lasts 8 months divided into 3 stages of rehabilitation in a total of 122 sessions, having 4 evaluations based on the three parameters of admission assessment: pain, movement, posture and muscular strength, progressively improving these aspects.


Subject(s)
Humans , Male , Adult , Treatment Outcome , Fractures, Bone , Exercise Therapy , Diaphyses , Kinesiology, Applied , Femoral Fractures , Femur
3.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 568-574, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353962

ABSTRACT

Introducción: La fractura diafisaria de húmero es frecuente y, en la actualidad, se privilegia el tratamiento quirúrgico. La consolidación en mala rotación puede causar un deterioro de la función y artrosis a largo plazo. Con las técnicas mínimamente invasivas, es difícil manejar la rotación intraoperatoria al no tener una visión directa de la reducción fracturaria. Objetivo: Describir criterios radiográficos para la reducción rotatoria en las fracturas diafisarias de húmero. Materiales y métodos: Estudio retrospectivo de radiografías de húmero comparando criterios radiográficos del húmero distal entre radiografías con rotación interna (sin retroversión proximal) y rotación externa (con retroversión fisiológica). Criterios estudiados: sobreproyección del epicóndilo lateral por sobre el capitellum >50%, esclerosis del borde inferior de la fosa olecraneana, esclerosis del borde lateral de la fosa olecraneana y asimetría de la fosa olecraneana. Resultados: El 97% de las 200 radiografías estudiadas cumplió con los criterios de inclusión y exclusión. Sobreproyección del epicóndilo por sobre el capitellum: 83,3% de los casos; esclerosis del borde inferior de la fosa olecraneana: 30%, esclerosis del borde lateral de la fosa olecraneana: 86,6% y asimetría: 80% de ellas. Todos los criterios con significancia estadística (p <0,001). Al analizar los tres signos positivos en conjunto, la sensibilidad fue del 70% y la especificidad, del 98%; valor predictivo positivo 95,5% y valor predictivo negativo 84,5%. Conclusiones: La rotación humeral correcta es difícil de reproducir en las cirugías mínimamente invasivas, en pacientes con una fractura diafisaria. Describimos cuatro criterios radiográficos que permiten inferir una correcta rotación humeral. Nivel de Evidencia: III


Introduction: Humeral shaft fractures are frequent and surgical treatment is currently favored. Consolidation in malrotation is a complication that can lead to impaired function and long-term osteoarthritis. In minimally invasive techniques, it is difficult to manage intraoperative rotation as there is no direct view of the fracture reduction. Objective: To describe radiological criteria for rotational reduction in humeral shaft fractures. Materials and methods: Retrospective study of humerus radiographs comparing radiological criteria of the distal humerus between radiographs with internal rotation (without proximal retroversion) and radiographs with external rotation (with physiological retroversion). Criteria studied: Overprojection of the lateral epicondyle over the capitellum of more than 50%; sclerosis of the lower border of the olecranon fossa (OF); sclerosis of the lateral border of the OF and asymmetry of the OF. Results: 200 radiographs were studied; 97% met the inclusion and exclusion criteria. Overprojection of the epicondyle over the capitellum was found in 83.3% of the cases. Sclerosis of the inferior border of the OF in 30%, sclerosis of the lateral border of the OF in 86.6%, and asymmetry of OF in 80%. All criteria with statistically significant (p<0.001). When analyzing the 3 positive signs, we found a sensitivity of 70% and a specificity of 98%. The positive predictive value was 95.5% and the negative predictive value was 84.5%. Conclusions: Correct humeral rotation is difficult to reproduce when performing minimally invasive surgeries in patients with a diaphyseal fracture. We describe 4 radiological criteria that allow inferring a correct humeral rotation. Level of Evidence: III


Subject(s)
Radiography , Diaphyses , Fracture Fixation, Intramedullary , Humeral Fractures/surgery
4.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 575-580, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353963

ABSTRACT

Objetivo: Evaluar la satisfacción con el uso del brace termoplástico y el resultado funcional del tratamiento conservador en pacientes con fracturas de la diáfisis del húmero. Materiales y métodos: Estudio retrospectivo de pacientes con fracturas de húmero cerradas, tratados con brace termoplástico hasta su consolidación y un seguimiento mínimo de 12 meses. Se registraron los siguientes datos: tipo de fractura y localización, mecanismo de lesión, miembro lesionado, tiempo de inmovilización con yeso y uso del brace, complicaciones y tiempo de consolidación. Se evaluaron el dolor mediante la escala analógica visual, la satisfacción con la escala de Likert, el balance articular con la escala de Constant y la funcionalidad según el puntaje QuickDASH. Resultados: Se incluyó a 17 pacientes (16 mujeres, 1 hombre; edad promedio 67 años). La inmovilización inicial con yeso fue de 13 días (rango 0-32). Los pacientes usaron el brace por 8.6 semanas (rango 3-16) hasta la consolidación radiográfica en la décima semana. El seguimiento promedio fue de 24 meses (rango 12-60) y el puntaje de dolor, de 0,5 (rango 1-3). El 59% estuvo muy satisfecho con los resultados y el 41%, satisfecho. El 59% logró una flexión del hombro >150°, el 47%, una abducción >150°, el 41%, una rotación interna con pulgar entre escápulas y el 47%, una rotación externa de 70°. El puntaje QuickDASH promedio fue de 9. Conclusiones: Los pacientes se mostraron muy satisfechos con el uso del brace termoplástico para el tratamiento incruento de las fracturas de húmero y los resultados funcionales fueron aceptables. Nivel de Evidencia: IV


Purpose: To evaluate the satisfaction with the use of a thermoplastic brace and the functional outcomes in the conservative treatment of patients with humeral shaft fractures. Materials and methods: Retrospective study of patients with closed humerus fractures, treated with a thermoplastic brace until union and with a minimum follow-up of 12 months. We recorded the type and location of the fracture, mechanism of injury, injured limb, time of immobilization with plaster and use of brace, complications, and time of consolidation. The evaluation was performed using the visual analog scale (VAS) for pain, the Likert scale for patient satisfaction, the Constant scale for joint balance, and the QuickDash score for functionality. Results: 17 patients were included (16 female, 1 male), with an average age of 67 years. The initial plaster immobilization lasted 13 days (range 0-32). The patients wore the brace for 8.6 weeks (range 3-16) until radiographic consolidation in the 10th week. The average follow-up was 24 months (range 12-60) and the pain score was 0.5 (range 1-3). 59% were very satisfied with the results and 41% were satisfied. 59% achieved a shoulder flexion >150°; 47%, an abduction >150°; 41%, an internal rotation with thumb between scapulae; and 47%, an external rotation of 70°. The average QuickDASH score was 9. Conclusion: The use of a thermoplastic brace in the conservative treatment of humerus fractures presented high patient satisfaction and acceptable functional outcomes for the affected limb.Keywords: Humerus; fractures; thermoplastic brace; conservative treatment. Level of Evidence:IV


Subject(s)
Adult , Middle Aged , Braces , Treatment Outcome , Diaphyses , Humeral Fractures/therapy
5.
Autops. Case Rep ; 11: e2021276, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249019

ABSTRACT

Adamantinoma of the long bones is an exceedingly rare and slow-growing tumor that affects the diaphysis of long bones, particularly the tibia. Based on the pattern of the epithelial cell component and the presence or absence of the osteofibrous dysplasia-like element, several histological variants have been described, such as (i) tubular (the most frequent), (ii) basaloid, (iii) squamous, (iv) spindle variant, (v) osteofibrous dysplasia -like variant, and (vi) Ewing's sarcoma - like adamantinoma (the least frequent). The diagnosis may be challenging since this tumor may be mistakenly interpreted as carcinoma, myoepithelial tumor, osteofibrous dysplasia, and vascular tumor. We report the case of a 41-year-old male who presented with swelling over the right leg associated with pain. The X-ray showed a lytic lesion of the right-sided tibia. The diagnosis of adamantinoma was made based on the clinico-radiological, histomorphology, and immunohistochemical findings. Histologically, classic adamantinoma is a biphasic tumor characterized by epithelial and osteofibrous components in varying proportions and differentiating patterns. The diagnosis can be confirmed by immunohistochemistry for demonstrating sparse epithelial cell nests when the radiological features are strongly consistent with adamantinoma. This case is highlighted because the epithelial component can lead to a misdiagnosis, particularly when the clinico-radiological features are overlooked. Adamantinoma of long bones has the potential for local recurrence and may metastasize to the lungs, lymph nodes, or other bones. The prognosis is good if early intervention is taken.


Subject(s)
Humans , Male , Adult , Tibia/pathology , Adamantinoma/pathology , Diaphyses
6.
Article in Chinese | WPRIM | ID: wpr-879461

ABSTRACT

OBJECTIVE@#To explore clinical effects of intramedullary nailing through suprapatellar approach with semiextended position in treating tibial fractures.@*METHODS@#From January 2018 to June 2019, 23 patients with tibia fractures were treated with suprapatellar approach intramedullary nailing on knee semiextended position, including 18 males and 5 females, aged from 26 to 67 years old with an average age of (38.5±9.6) years old. Eight patients were tibial proximal fractures, 7 patients were tibial shaft fractures, 6 patients were tibial distal fractures and 2 patients were tibial segmental fractures. Operation time, intraoperative blood loss, complications and fracture healing time were recorded. Range of motivation of knee joint between 3 days and 3 months after operation were compared, Hospital for Special Surgery (HSS) score and visual analogue scale (VAS) were used to evaluate clinical effects.@*RESULTS@#All patients were followed up from 8 to 19 months with an average of (12.3±7.6) months. Operation time was (55.3±5.1) min, intraoperative blood loss was (84.0±8.7) ml. No obvious complications occurred. All patients were achieved bony union at stageⅠ, fracture healing time ranged from 3 to 8 months with an average of (4.6±1.5) months. Flexion extension range of knee motion at 3 days after operation was (110.4±15.3)°, and increased to (123.7±16.5)° at 3 months after operation (@*CONCLUSION@#Intramedullary nailing through suprapatellar approach with semiextended position in treating tibia fractureshas advantages of simple operation, less trauma for soft tissue, less pain, rapid recovery of function and less complication. It is especially suitable for patients with tibial multi-segment fracture and multiple fractures of ipsilateral lower limb for safety and simple.


Subject(s)
Adult , Aged , Bone Nails , Diaphyses , Female , Fracture Fixation, Intramedullary , Humans , Male , Middle Aged , Tibia , Tibial Fractures/surgery , Treatment Outcome
7.
Article in Chinese | WPRIM | ID: wpr-879452

ABSTRACT

OBJECTIVE@#To compare clinical effect of intramedullary nailing through suprapatellar, infrapatellar and paracpatellar approach in treating tibial shaft fracture.@*METHODS@#From June 2012 to June 2018, 36 patients with tibial shaft fracture were treated with intramedullary nails, and were divided into three groups according to surgical approach. Twleve patients were through suprapatellar approach, including 7 males and 5 females aged from 25 to 53 years old with an average of (37.8±11.4) years old;and 4 patients were type A, 4 patients were type B, and 4 patients were type C according to AO classification. Ten patients were through infrapatellar approach, including 6 males and 4 females aged from 19 to 56 years old with an average of (35.6±10.0) years old;and 3 patients were type A, 4 patients were type B, and 3 patients were type C according to AO classification. Forteen patients were through paracpatellar approach, including 8 males and 6 females aged from 21 to 58 years old with an average of (36.6±10.0) years old;and 4 patients were type A, 6 patients were type B, and 4 patients were type C according to AO classification. Operation time, intraoperative blood loss, fluoroscopy times, fracture healing time and complications among three groups were observed, and knee joint functions were evaluated by Lysholm score.@*RESULTS@#All patients were followed up from 12 to 18 months with an average of (15.0±3.0) months. There were no difference in intraoperative blood loss and fracture healing time among three groups (@*CONCLUSION@#intramedullary nailing through suprapatellar for the treatment of tibial shaft fracture is benefit for fracture healing and recovery of knee joint function, while infrapatellar and paracpatellar approach have advantages in exposure of insertion point. We should select approach reasonably according to our experience.


Subject(s)
Adult , Bone Nails , Diaphyses , Female , Fracture Fixation, Intramedullary , Humans , Male , Middle Aged , Tibia , Tibial Fractures/surgery , Treatment Outcome , Young Adult
8.
Int. j. morphol ; 38(5): 1311-1316, oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134441

ABSTRACT

SUMMARY: Blood supply to the diaphysis of long bones is majorly through nutrient artery, which enters the bone via nutrient foramen. The present study aims to identify morphological and morphometric variations of nutrient foramina of the femur, which is the largest long bone of the body extending from the pelvis to knee. A sample of 81 Sri Lankan adult femur were analyzed. The mean length of the femur analyzed was 436.93 mm and mean foramen index was 43.52. The majority of the bones had a single nutrient foramen. The predominant location of the nutrient foramen was on the posterior aspect of the bone in the middle third of the shaft according to the study. Majority of foramina were directed distally. The indices on nutrient foramen are important for procedures such as bone grafts and tumor resections, in managing trauma, orthopedic procedures and radiological interpretations.


RESUMEN: El suministro de sangre a la diáfisis de los huesos largos se realiza principalmente a través de la arteria nutricia, que ingresa al hueso a través del foramen nutricio diafisario. El presente estudio tiene como objetivo identificar las variaciones morfológicas y morfométricas del foramen nutricio del fémur, el hueso largo más grande del cuerpo que se extiende desde la pelvis hasta la rodilla. Se analizó una muestra de 81 fémures adultos de individuos de Sri Lanka. La longitud media de los fémures analizados fue de 436,93 mm y el índice de foramen medio fue de 43,52. La mayoría de los huesos tenían un solo foramen nutricio. Según el estudio, la ubicación predominante del foramen nutricio estaba en la cara posterior del hueso en el tercio medio del eje. La mayoría de los forámenes estaban dirigidos distalmente. Los índices sobre el foramen nutricio son importantes para procedimientos tales como injertos óseos y resecciones tumorales, en el manejo de traumatismos, procedimientos ortopédicos e interpretaciones radiológicas.


Subject(s)
Humans , Femur/anatomy & histology , Anatomic Variation , Sri Lanka , Diaphyses , Femur/blood supply
9.
Acta ortop. mex ; 33(1): 50-57, ene.-feb. 2019. graf
Article in Spanish | LILACS | ID: biblio-1248634

ABSTRACT

Resumen: Se presenta una guía terapéutica de la seudoartrosis diafisaria con los diferentes grados de dificultad a que se enfrenta el cirujano ortopédico, mencionando los principios que deben seguirse para obtener óptimos resultados.


Abstract: We present a therapeutic guide of diaphyseal pseudoarthrosis with the different degrees of difficulty faced by the orthopedic surgeon, mentioning the principles that must be followed to obtain optimal results.


Subject(s)
Humans , Pseudarthrosis/therapy , Algorithms , Bone Transplantation , Diaphyses
10.
Health sci. dis ; 20(5): 35-38, 2019. ilus
Article in French | AIM, AIM | ID: biblio-1262823

ABSTRACT

Introduction. Le traitement des fractures de la diaphyse humérale bénéficie d'un arsenal thérapeutique et varié. À Libreville, il n'est pas consensuel du fait des nombreuses écoles dont sont issus les praticiens. Le but de notre travail était d'évaluer les résultats du traitement de ces fractures dans notre service dans ce contexte particulier. Matériels et méthodes. Il s'agit d'une étude rétrospective sur un an allant du 1er mars 2017 au 1er mars 2018. Il a porté sur 33 patients traités dans le service et régulièrement suivis jusqu'à consolidation. Pour chaque patient, les paramètres analysés ont été : l'âge et le sexe, le mécanisme et les circonstances de survenue, le membre concerné et les délais de prise en charge, le type anatomopathologique, les complications immédiates et lésions associés, les méthodes thérapeutiques utilisées et les résultats anatomiques et fonctionnels. Résultats. Il y avait 20 hommes et 13 femmes ; leur âge moyen était de 33 ans. Dans 27 cas (83%), il s'agissait d'accidents de la voie publique. Treize patients (39 %) ont bénéficié d'un traitement orthopédique par plâtre et 20 patients (61 %) ont bénéficié d'un traitement chirurgical. 10 patients (84%) ayant eu un traitement orthopédique ont des bons / très bons résultats. 16 patients (80%) des patients ayant bénéficié d'un traitement chirurgical ont eu des bons et très bons résultats. Conclusion. Nos résultats (anatomiques ou fonctionnels) sont superposables entre le traitement chirurgical et le traitement orthopédique


Subject(s)
Academic Medical Centers , Diaphyses , Gabon , Humeral Fractures/radiotherapy , Outcome Assessment, Health Care
11.
Article in Chinese | WPRIM | ID: wpr-781671

ABSTRACT

OBJECTIVE@#To investigate the clinical results of locking compression plate combined with autologous iliac bone graft in the treatment of aseptic ulnar nonunion.@*METHODS@#From March 2009 to July 2017, 22 patients with aseptic ulnar diaphyseal nonunion with complete follow-up data were treated with surgery, including 12 males and 10 females, aged from 16 to 58 (39.7±9.9) years old and ranging in course of disease from 10 to 192 (39.4±55.7) months. There were 15 atrophic nonunions, 5 hypertrophic nonunions and 2 synovial pseudo-articular nonunions. After debridement of the nonunion, locking compression plate was used to fix the nonunion and autogenous iliac bone graft was given. Bone healing rate, surgical complications and clinical results were evaluated.@*RESULTS@#All the patients were followed up, and the duration ranged from 13 to 42 months, with a mean of (22.5±8.2) months, and 1 patient did not heal. Visual analogue pain scores ranged from 0 to 3 (0.9±0.9). Pronation of forearm was 47 to 86 (69.0±14.7) degrees, supination was 35 to 85 (63.0±9.4) degrees, wrist flexion was 20 to 80 (51.0±10.2) degrees, wrist flexion was 32 to 88 (71.0±11.7) degrees, elbow flexion contracture was 0 to 25 (9.0±5.6) degrees, further flexion was 105 to 150 (134.0±13.9) degrees, and grip strength was 87% on the opposite side. According to the Anderson scoring system, 8 cases were excellent, 11 were satisfied, 2 were not satisfied, and 1 was failed.@*CONCLUSIONS@#LCP combined with autologous iliac bone graft can effectively treat aseptic ulna diaphyseal nonunion.


Subject(s)
Adolescent , Adult , Bone Plates , Bone Transplantation , Diaphyses , Female , Fracture Fixation, Internal , Fractures, Ununited , General Surgery , Humans , Ilium , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Ulna , Young Adult
12.
Article in Korean | WPRIM | ID: wpr-750277

ABSTRACT

The aim of this study was to examine the bioactivity and osseointegration of Ti-6Al-4V alloy implant which was modified by an anodic oxidation and a cyclic precalcification treatments. After blasting treatment using HAp (Hydroxyapatitie; HAp) powder which is resorbable blasting media (RBM) on the surface of Ti-6Al-4V alloy implants, the anodic oxidation treatment and the cyclic precalcification treatment were conducted to form nanotube TiO2 layer and HAp precipitation respectively. The surface morphology of the surface-treated Ti-6Al-4V alloy implant was investigated after immersion in the simulated body fluid(SBF) for 3 days to investigate the bioactivity. To investigate the effect of surface treatment on bonding between the implant and bone, RBM treated implant and RBM-anodization-cyclic precalcification(RACP) treated implant were placed on the distal side of both tibia diaphysis of rats, and then the removal torque of the implant was measured after 4 weeks. On the surface of RACP treated group, bone-like apatite precipitation was observed after immersion in SBF for 3 days. The removal torque was significantly higher in the RACP treated group than in the RBM treated group. The interfacial fracture between the implant and the new bone was observed in the RBM treated group, but both the cohesive fracture at the new bone and the interfacial fractures between the implant and the new bone were observed in the RACP treated group.


Subject(s)
Alloys , Animals , Diaphyses , Immersion , Nanotubes , Osseointegration , Rats , Tibia , Torque
13.
Rev. Asoc. Argent. Ortop. Traumatol ; 83(4): 242-247, dic. 2018. []
Article in Spanish | LILACS, BINACIS | ID: biblio-984990

ABSTRACT

Introducción: La diáfisis del antebrazo es el sitio más frecuente de refracturas en niños. Estas lesiones suelen ocurrir en el tercio medio o proximal antes del año de la fractura inicial. Hay poca información sobre el tratamiento de este tipo de lesiones. El objetivo de este estudio fue evaluar los resultados y las complicaciones en pacientes con refracturas de antebrazo que requirieron fijación interna con clavos elásticos endomedulares. Materiales y Métodos: Se registró la siguiente información: datos demográficos, mecanismo de lesión, clasificación, tiempo desde la consolidación de la fractura original hasta la refractura, tipo de reducción y tiempo de consolidación. Los resultados fueron evaluados según la escala propuesta por Martus y las complicaciones, con una adaptación de la clasificación de Clavien-Dindo. Resultados: Se evaluaron 17 pacientes (14 varones) con 17 refracturas de antebrazo (15 cerradas y 2 expuestas). La edad era de 11 años (RIC 7, mín.-máx. 5-15). La lesión ocurrió a las 12 semanas de la fractura inicial (RIC 4.7, mín.-máx. 4-28). El 47% requirió reducción abierta. El tiempo de consolidación fue de 8 semanas (RIC 4, mín.-máx. 6-28). El seguimiento fue de 43 meses (RIC 47, mín.-máx. 12-103). Fue posible evaluar clínicamente a 16 pacientes (1 pérdida en el seguimiento). El resultado fue excelente en 15 casos y regular en uno. Un paciente tuvo pérdida del rango de movilidad (15º); uno, retraso de la consolidación (cúbito) y 3 sufrieron una segunda refractura. Conclusiones: La fijación interna con clavos elásticos endomedulares fue una técnica eficaz para tratar las refracturas de antebrazo en niños. Si bien un alto porcentaje necesita reducción abierta, el tiempo de consolidación y la tasa de complicaciones serían similares a los de las fracturas primarias tratadas con la misma técnica. Nivel de Evidencia: IV


Introduction: Forearm diaphysis is the most frequent site of re-fractures in children. These lesions usually occur in the middle or proximal third within a year of the initial fracture. There is little information on the treatment of this type of lesions. The aim of this study was to evaluate outcomes and complications in patients with forearm re-fractures requiring internal fixation with elastic stable intramedullary nails. Methods: Demographic data, mechanism of injury, classification, time from consolidation of the original fracture to refracture, type of reduction and time of consolidation were documented. Outcomes were evaluated according to Martus scale, and complications were evaluated with an adaptation of Clavien-Dindo classification. Results: Seventeen patients (14 men) with 17 forearm re-fractures (15 closed and 2 open) were identified. Median age was 11 years (IQR 7, min-max 5-15). Lesion occurred 12 weeks after the initial fracture (RIC 4.7, min-max 4-28). Fortyseven percent required open reduction. Union was achieved at 8 weeks (IQR 4, min-max 6-28). Follow-up was 43 months (IQR 47, min-max 12-103). Sixteen patients were clinically evaluated (1 lost at follow-up). Fifteen patients presented excellent results and one had a fair result. One had 15º loss of motion, one had delayed union (ulna) and three patients had a second re-fracture. Conclusions: In this series, elastic stable intramedullary nails represented an effective technique for the treatment of forearm re-fractures in children. Although many require open reduction, time to union and complication rate seem to be similar to primary fractures treated with the same technique. Level of Evidence: IV


Subject(s)
Child , Adolescent , Bone Nails , Diaphyses/surgery , Diaphyses/injuries , Forearm Injuries/surgery , Fracture Fixation, Intramedullary/methods , Recurrence , Treatment Outcome
14.
Article in French | AIM, AIM | ID: biblio-1263825

ABSTRACT

Introduction - Les méthodes thérapeutiques des fractures diaphysaires déplacées de l'avant bras chez l'adulte sont variées. Le but de cette étude était d'évaluer les résultats de l'embrochage centromédullaire. Patients et méthodes - Cette étude rétrospective a concerné 45 patients opérés pour une fracture diaphysaire d'un ou des deux os de l'avant bras chez l'adulte. Les fractures étaient fermées (n=25), ou ouvertes (n=20 ). Le siège de la fracture était le 1/3 supérieur (n=5), le 1/3 moyen (n=35), et le 1/3 inférieur (n=5 ). L'ostéosynthèse a été réalisée à foyer ouvert avec des broches de Kirschner de 2,5 mm de diamètre (n=37) ou de 2 mm ( n= 8 ). Un plâtre de 8 semaines était posé après l'intervention. Nous avons étudié la réduction de la fracture, la cicatrisation cutanée, la consolidation, la fonction selon les critères d'Anderson, et les complications. Résultats - La réduction postopératoire était satisfaisante chez 43 patients. La cicatrisation a été obtenue chez tous les patients dans un délai moyen de deux semaines. La consolidation osseuse a été obtenue chez 43 (95%) patients dans un délai moyen de 90 jours. Au recul moyen de 24 mois, 32 patients ont été revus. Les résultats finaux étaient excellents (n=18) bons (n=5), moyens (n=5), et mauvais (n= 3). Un seul cas d'infection (2%) a été noté. Conclusion - Cette méthode donne de bons résultats. Elle est simple, rapide, et peu onéreuse. Cette étude suggère que l'embrochage centromédullaire peut constituer une alternative dans le traitement des fractures diaphysaires des os de l'avant bras chez l'adulte


Subject(s)
Arm Bones , Cote d'Ivoire , Diaphyses , Fracture Dislocation/therapy , Patients
15.
Article in English | WPRIM | ID: wpr-759336

ABSTRACT

Although stems improve initial mechanical stability in revision total knee arthroplasty (TKA), ideal indications, proper lengths and diameters, and appropriate fixation methods remain controversial. The topics of the present article include the indications, selection of lengths and diameters, and fixation methods of stems in revision TKA. The use of a stem in revision TKA can protect the juxta-articular bone. A stem cannot be a substitute for optimal component fixation; it plays an adjunctive role in transferring the loads from the compromised metaphysis to the stronger diaphysis. Proper bone surface preparation and appropriate use of the stem based on a great store of knowledge are required to support the stemmed components effectively in revision TKA. The balance between overshielding and overloading the juxta-articular bone would provide excellent structural protection. The stem length and diameter should be tailored according to patients’ anatomical characteristics and determined fixation strategy. There are two traditional methods of stem fixation including the total cementation technique and the hybrid technique with a cementless press-fit stem. Selection of a cementation technique should be based on thorough consideration of advantages and disadvantages of each technique.


Subject(s)
Arthroplasty , Arthroplasty, Replacement, Knee , Cementation , Diaphyses , Knee , Methods
16.
Article in English | WPRIM | ID: wpr-786973

ABSTRACT

We present images of an 83-year-old female with a history of osteoporosis and bilateral total knee replacement arthroplasty, referred for bone scintigraphy and single-photon emission computed tomography (SPECT)/computed tomography (CT), owing to left knee pain. No trauma to, or intense exercise of, the kneewas reported. The bone scan and SPECT/CT revealed a focally increased Tc-99m methylene diphosphonate (MDP) uptake in the medial cortex of the left femoral diaphysis with matched linear radiolucency on CT images. This was misinterpreted as atypical femoral stress fracture; however, focal stress reaction injury to the nutrient foramen was confirmed on contrast-enhanced magnetic resonance imaging.


Subject(s)
Aged, 80 and over , Arthroplasty , Arthroplasty, Replacement, Knee , Diaphyses , Female , Fractures, Stress , Humans , Knee , Magnetic Resonance Imaging , Osteoporosis , Radionuclide Imaging , Technetium Tc 99m Medronate , Tomography, Emission-Computed , Tomography, Emission-Computed, Single-Photon
17.
Int. j. morphol ; 35(3): 919-924, Sept. 2017. ilus
Article in Spanish | LILACS | ID: biblio-893074

ABSTRACT

Múltiples palabras habituales utilizan raíces grecolatinas, como el caso de las estructuras mencionadas en Terminologia Anatomica. Un grupo de términos anatómicos originados en la Antigua Grecia emplean el lexema griego phy-sis o su homólogo ­fisis en español, es por ello que este trabajo tiene por objetivo analizar su significado y etimología en el diccionario de la Universidad de Salamanca, Diccionario de Términos Médicos de la Real Academia Nacional de Medicina y en el Diccionario Etimológico griego-latín del español, para contribuir a la comprensión y aprendizaje de Terminologia Anatomica en el estudio de la Anatomía Humana. Se propone que los estudiantes que cursan la asignatura de Anatomía Humana posean conocimientos básicos de latín y griego, para facilitar su aprendizaje y correcta aplicación de los términos.


Multiple common words use Greek and Latin roots, as is the case of structures mentioned in Terminologia Anatomica. For instance, a number of anatomical terms originating in ancient Greece, use the Greek lexeme ph-sis or its homologue -fisis in Spanish. Therefore, this work aims to analyze meaning and etymology of this term in the Universidad de Salamanca dictionary, the Royal National Academy of Medicine Dictionary of Medical Terms, and in the Spanish etymological Greek-Latin dictionary, to contribute to the understanding and learning of Terminologia Anatomica in the study of Human Anatomy. To facilitate learning and the correct use of Terminologia Anatomica, we propose that students in Human Anatomy course assignments acquire a basic knowledge of Latin and Greek.


Subject(s)
Humans , Anatomy/standards , Diaphyses/anatomy & histology , Epiphyses/anatomy & histology , Terminology as Topic
18.
Article in English | WPRIM | ID: wpr-759250

ABSTRACT

Fibrous dysplasia is a common benign skeletal lesion that may involve a single bone or multiple bones. Although fibrous dysplasia can affect any bone, monostotic fibrous dysplasia of the long bone typically occurs in the diaphysis or metaphysis. We report a very rare case of monostotic fibrous dysplasia involving the epiphysis of the distal femur in a young man.


Subject(s)
Diaphyses , Epiphyses , Femur , Fibrous Dysplasia, Monostotic
19.
Article in English | WPRIM | ID: wpr-71093

ABSTRACT

BACKGROUND: The purpose of this study was to analyze the radiographic and functional outcomes of flexible intramedullary (IM) nailing in adolescent patients with forearm fractures at the diaphysis or at the metadiaphyseal junction (MDJ). METHODS: We retrospectively reviewed the results of 40 patients who underwent IM nailing for pediatric forearm fractures. Thirty males and 10 females were followed for an average of 16 months (range, 12 to 20 months). Their average age was 11 years (range, 10 to 16 years). The average duration from the onset of trauma to surgery was 3.8 days (range, 1 to 36 days). Fracture sites were located at the MDJ of the radius in 8 patients (MDJ group) while 32 patients had middle-third fractures (D group). We assessed the magnitude and location of the maximum radial bow and range of movements. Functional outcomes were evaluated using Daruwalla criteria. RESULTS: Open reduction was carried out in 8 cases. Union was achieved at an average of 8.3 weeks postoperatively. The results were classified as good in 38 and excellent in 2 according to Daruwalla criteria with restoration of forearm rotation. The mean angulation at the last follow-up was 1.8° on the anteroposterior radiograph and 3.3° on the lateral radiograph (MDJ group: 1.8° and 2.1°, respectively; D group: 1.9° and 2.8°, respectively). There was no significant difference in the mean angulation between the groups. The mean magnitude of maximal radial bow was 5.7% ± 1.8% (MDJ group, 5.2% ± 0.8%; D group, 5.9% ± 1.9%). The mean location of maximal radial bow was 58.0% ± 8.8% (MDJ group, 56.4% ± 8.9%; D group, 58.6% ± 8.9%). The differences in the mean magnitude and location of maximal radial bow with the normal contralateral arms (7.0% ± 1.2% and 50.9% ± 6.0%, respectively) were not significantly different between the groups. Complications included superficial infection (2), delayed union (1), and refracture (1). CONCLUSIONS: IM nail fixation provided satisfactory results and maintained adequate stability for both forearm bone fractures in adolescents, even though the fracture was located at the MDJ of the radius.


Subject(s)
Adolescent , Arm , Diaphyses , Female , Follow-Up Studies , Forearm , Fracture Fixation, Intramedullary , Fractures, Bone , Humans , Male , Radius , Retrospective Studies
20.
Article in English | WPRIM | ID: wpr-71092

ABSTRACT

BACKGROUND: Camurati-Engelmann disease (CED) is a rare genetic skeletal disorder characterized by limb pain, muscle emaciation and weakness, and cortical thickening of the diaphysis of long bones. It is caused by mutations in the transforming growth factor beta 1 (TGFB1) (type I) or other unknown gene(s) (type II). We present 8 consecutive patients with type I CED. METHODS: We retrospectively reviewed medical records and radiographs of type I CED patients with special reference to the mode of presentation, process of diagnostic work-up, and disease course. They were 4 sporadic patients, and two pairs of mother and son. RESULTS: We categorized the mode of presentation into three groups. Group I had 4 patients who mainly presented with motor disturbances in young age. They drew medical attention for waddling gait, awkward ambulation or running, difficulty in going upstairs, or a positive Gower's sign at age 4 to 6 years. Subsequent development of limb pain and radiographic abnormality led to the diagnosis of CED at age 6 to 29 years. Group II had 3 patients who mainly presented with limb pain at age 15, 20, and 54 years, respectively. Radiographic evaluation and molecular genetic test led to the diagnosis of CED. The remaining 1 patient (group III) was asymptomatic until age 9 years when bony lesions at the tibiae were found incidentally. For the last 10 years, he intermittently complained of leg pain in the morning or after sports activities, which did not interfere with daily life. All the patients in group I showed a body mass index in the underweight range (< 18.4 kg/m²). At the latest follow-up, 4 patients in groups I and II required medication for the limb pain. CONCLUSIONS: CED presents with a wide range of severity. Awareness of this rare disease entity may be the key to timely correct diagnosis. This disease entity should be considered in the differential diagnosis of limb pain or motor disturbance in children to avoid unnecessary diagnostic work-up.


Subject(s)
Body Mass Index , Camurati-Engelmann Syndrome , Child , Diagnosis , Diagnosis, Differential , Diaphyses , Emaciation , Extremities , Follow-Up Studies , Gait , Humans , Leg , Medical Records , Molecular Biology , Mothers , Myalgia , Orthopedics , Phenotype , Rare Diseases , Retrospective Studies , Running , Sports , Thinness , Tibia , Transforming Growth Factor beta , Walking
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