RESUMO
Background: This review aims to identify what angulation may be accepted for the conservative treatment of pediatric radial neck fractures and how the range of motion (ROM) at follow-up is influenced by the type of fracture treatment. Patients and Methods: A PRISMA-guided systematic search was performed for studies that reported on fracture angulation, treatment details, and ROM on a minimum of five children with radial neck fractures that were followed for at least one year. Data on fracture classification, treatment, and ROM were analyzed. Results: In total, 52 studies (2420 children) were included. Sufficient patient data could be extracted from 26 publications (551 children), of which 352 children had at least one year of follow-up. ROM following the closed reduction (CR) of fractures with <30 degrees angulation was impaired in only one case. In fractures angulated over 60 degrees, K-wire fixation (Kw) resulted in a significantly better ROM than intramedullary fixation (CIMP; Kw 9.7% impaired vs. CIMP 32.6% impaired, p = 0.01). In more than 50% of cases that required open reduction (OR), a loss of motion occurred. Conclusions: CR is effective in fractures angulated up to 30 degrees. There may be an advantage of Kw compared to CIMP fixation in fractures angulated over 60 degrees. OR should only be attempted if CR and CRIF have failed.
RESUMO
An 85-year-old man came to the emergency room because of vomiting a black fluid and melaena. He was hypotensive and had severe anaemia. We suspected an upper digestive tract bleeding and an gastroscopy was performed, which showed necrosis of the entire oesophagus. Within 24 hours of admission the patient died of hypovolemic shock.
Assuntos
Esôfago/patologia , Idoso de 80 Anos ou mais , Anemia/etiologia , Evolução Fatal , Gastroscopia , Humanos , Masculino , Melena/etiologia , Necrose/complicações , Necrose/diagnóstico por imagem , Vômito/etiologiaRESUMO
An 85-year-old man came to the emergency room because of vomiting a black fluid and melaena. He was hypotensive and had severe anaemia. We suspected an upper digestive tract bleeding and a gastroscopy was performed, which showed necrosis of the entire oesophagus. Within 24 hours of admission the patient died of hypovolemic shock.