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1.
J Occup Health ; 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38629674

RESUMO

OBJECTIVES: Surgeons are exposed to high levels of physical stress while working in the operating room. In industry, so-called exoskeletons are used to support the back and shoulder area. The aim of this study was to investigate the feasibility and effects of an upper body exoskeleton on postoperative physical complaints of surgeons. METHODS: Surgeons from a university hospital in the fields of orthopaedics, trauma- and visceral surgery performed two operations of the same type and planned length on two different days. The first operation was performed without an exoskeleton, the second with an exoskeleton. The participants completed questionnaires on shoulder pain (SPADI), neck pain (VAS and NDI) and back pain (VAS and ODI) before and after the procedure. RESULTS: A total of 25 participants were included and performed 50 surgeries with a mean surgery duration of 144 min without and 138 min with exoskeleton. Without the exoskeleton, the activity of the operation resulted in a significant increase of the VAS neck by 1.0 points (SD 1.2, p < 0.001), NDI by 4.8 (SD 8.6; p = 0.010), VAS back by 0.7 (SD 1.0, p = 0.002), and ODI by 2.7 (SD 4.1, p = 0.003). With the exoskeleton the the participants reported about significant less complaints after the surgery (VAS neck: p = 0.001, NDI: p = 0.003, VAS back: p = 0.036, ODI: p = 0.036, SPADI: p = 0.016) Conclusion: An upper body exoskeleton can significantly reduce the discomfort in the neck, shoulder and back caused to surgeons by surgery.

2.
Orthopadie (Heidelb) ; 53(5): 369-378, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575780

RESUMO

BACKGROUND: Virtual reality (VR) simulators have been introduced for skills training in various medical disciplines to create an approximately realistic environment without the risk of patient harm and have improved to more immersive VR (iVR) simulators at affordable costs. There is evidence that training on VR simulators improves technical skills but its use in orthopedic training programs and especially in curricular teaching sessions for medical students are currently not well established. The aim of this study was to describe the implementation of a VR operating theater as an elective course for undergraduate medical students and to evaluate its effect on student learning. METHODS: An elective course for 12 students was implemented during the summer semester of 2023. Using Oculus Quest 2 headsets (Reality Labs, Meta Platforms, USA) and controllers and the PrecisionOS platform, they were able to train five different surgical procedures. The courses were accompanied by weekly topic discussions and instructional videos. Students were assigned to two groups: group VR vs. group non-VR. The groups were switched after 5 weeks. User feedback and performance development (theoretical and procedural surgical knowledge) after VR training were assessed using three questionnaires. RESULTS: The students highly appreciated the implementation of VR training into their curriculum and 91% stated that they would opt for further VR training. All students stated that VR training improved their understanding of surgical procedures and that it should be obligatory in surgical training for undergraduate medical students. After 5 weeks of training, students in the VR group achieved significantly better results (100 out of maximum 180 points) than the non-VR group (70 points, p = 0.0495) in procedural surgical knowledge. After completion of the VR training the VR group achieved 106 points and the non-VR group 104 points (p = 0.8564). The procedural knowledge for non-VR group after 5 weeks significantly improved after VR training from 70 to 106 points (p = 0.0087). CONCLUSION: The iVR can be easily integrated into the curriculum of medical students and is highly appreciated by the participants. The iVR statistically improves the procedural knowledge of surgical steps compared to conventional teaching methods. Further implementation of iVR training in curricular teaching of medical students should be considered.


Assuntos
Currículo , Educação de Graduação em Medicina , Procedimentos Ortopédicos , Estudantes de Medicina , Realidade Virtual , Humanos , Educação de Graduação em Medicina/métodos , Estudantes de Medicina/estatística & dados numéricos , Estudantes de Medicina/psicologia , Procedimentos Ortopédicos/educação , Masculino , Feminino , Ortopedia/educação , Adulto Jovem , Competência Clínica , Avaliação Educacional , Adulto
3.
Clin Biomech (Bristol, Avon) ; 114: 106235, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38552372

RESUMO

BACKGROUND: Stability is regarded as an important factor for proper healing and avoiding secondary dislocation in osteoporotic fractures of the proximal humerus. Several surgical techniques have been proposed for treatment, including intramedullary nail osteosynthesis and locking plate fixation. This study introduces a novel approach that combines both techniques and compares its primary stability with conventional methods. METHODS: The study involved 25 osteoporotic humeri with two-part fracture models, which were randomly assigned to locking-plate fixation, intramedullary nailing, or a combination of both techniques. The specimens were subjected to sinusoidal loading at 250 N in 20° abduction for 5000 cycles and then to quasi-static loading until failure. Fracture movement, failure mode, and failure load were measured and compared among the groups. FINDINGS: The groups fixated with intramedullary nailing and the groups fixated with intramedullary nailing and locking plate fixation showed significantly lower fracture motion than the group using locking plate fixation only (p < 0.005) and significantly higher load to failure (p = 0.007 and p = 0.0062, respectively). There was no significant difference between the group using intramedullary nailing and the group using locking-plate fixation and intramedullary nailing in fracture movement or load-to-failure (p > 0.005). INTERPRETATION: The results indicate that locking plate fixation provides less primary stability than intramedullary nailing or the combined of both techniques. This combined approach may offer advantages as a treatment for complex proximal humeral fractures in osteoporotic bone, and specific implants should be developed to ensure optimal treatment.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Úmero , Fraturas por Osteoporose , Fraturas do Ombro , Humanos , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Fraturas por Osteoporose/cirurgia , Úmero/cirurgia , Fraturas do Ombro/cirurgia , Placas Ósseas , Fenômenos Biomecânicos , Pinos Ortopédicos , Fraturas do Úmero/cirurgia
4.
BMC Musculoskelet Disord ; 25(1): 212, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38475756

RESUMO

BACKGROUND: In terms of the optics used for Knee arthroscopy, a large number of different endoscopes are currently available. However, the use of the 30° optics in knee arthroscopy has been established as the standard procedure for many years. As early as the 1990s, needle arthroscopy was occasionally used as a diagnostic tool. In addition to the development of conventional optics technology in terms of camera and resolution, needle arthroscopes are now available with chip-on-tip image sensor technology. To date, no study has compared the performance of this kind of needle arthroscopy versus standard arthroscopy in the clinical setting in terms of the visibility of anatomical landmarks. In this monocentric prospective feasibility study, our aim was to evaluate predefined anatomical landmarks of the knee joint using needle arthroscopy (0° optics) and conventional knee arthroscopy (30° optics) and compare their performance during knee surgery. METHODS: Examinations were performed on eight cadavers and seven patients who required elective knee arthroscopy. Two surgeons independently performed the examinations on these 15 knee joints, so that we were able to compare a total of 30 examinations. The focus was on the anatomical landmarks that could be visualized during a conventional diagnostic knee arthroscopy procedure. The quality of visibility was evaluated using a questionnaire. RESULTS: In summary, the average visibility for all the anatomic landmarks was rated 4.98/ 5 for the arthroscopy using 30° optics. For needle arthroscopy, an average score of 4.89/ 5 was obtained. Comparatively, the needle arthroscope showed slightly limited visibility of the retropatellar gliding surface in eight (4.5/ 5 vs. 5/ 5), medial rim of the patella in four (4.85/ 5 vs. 5/ 5), and suprapatellar recess in four (4.83/ 5 vs. 5/ 5) cases. Needle arthroscopy was slightly better at visualizing the posterior horn of the medial meniscus in four knee joints (4.9/ 5 vs. 4.85/ 5). CONCLUSION: Needle arthroscopy is a promising technology with advantages in terms of minimally invasive access and good visibility of anatomical landmarks. However, it also highlights some limitations, particularly in cases with challenging anatomy or the need for a wide field of view.


Assuntos
Artroscopia , Articulação do Joelho , Humanos , Artroscopia/métodos , Estudos Prospectivos , Estudos de Viabilidade , Articulação do Joelho/cirurgia , Artroscópios
5.
BMC Health Serv Res ; 23(1): 1313, 2023 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-38017443

RESUMO

BACKGROUND: Due to the growing economic pressure, there is an increasing interest in the optimization of operational processes within surgical operating rooms (ORs). Surgical departments are frequently dealing with limited resources, complex processes with unexpected events as well as constantly changing conditions. In order to use available resources efficiently, existing workflows and processes have to be analyzed and optimized continuously. Structural and procedural changes without prior data-driven analyses may impair the performance of the OR team and the overall efficiency of the department. The aim of this study is to develop an adaptable software toolset for surgical workflow analysis and perioperative process optimization in arthroscopic surgery. METHODS: In this study, the perioperative processes of arthroscopic interventions have been recorded and analyzed subsequently. A total of 53 arthroscopic operations were recorded at a maximum care university hospital (UH) and 66 arthroscopic operations were acquired at a special outpatient clinic (OC). The recording includes regular perioperative processes (i.a. patient positioning, skin incision, application of wound dressing) and disruptive influences on these processes (e.g. telephone calls, missing or defective instruments, etc.). For this purpose, a software tool was developed ('s.w.an Suite Arthroscopic toolset'). Based on the data obtained, the processes of the maximum care provider and the special outpatient clinic have been analyzed in terms of performance measures (e.g. Closure-To-Incision-Time), efficiency (e.g. activity duration, OR resource utilization) as well as intra-process disturbances and then compared to one another. RESULTS: Despite many similar processes, the results revealed considerable differences in performance indices. The OC required significantly less time than UH for surgical preoperative (UH: 30:47 min, OC: 26:01 min) and postoperative phase (UH: 15:04 min, OC: 9:56 min) as well as changeover time (UH: 32:33 min, OC: 6:02 min). In addition, these phases result in the Closure-to-Incision-Time, which lasted longer at the UH (UH: 80:01 min, OC: 41:12 min). CONCLUSION: The perioperative process organization, team collaboration, and the avoidance of disruptive factors had a considerable influence on the progress of the surgeries. Furthermore, differences in terms of staffing and spatial capacities could be identified. Based on the acquired process data (such as the duration for different surgical steps or the number of interfering events) and the comparison of different arthroscopic departments, approaches for perioperative process optimization to decrease the time of work steps and reduce disruptive influences were identified.


Assuntos
Artroscopia , Salas Cirúrgicas , Humanos , Fluxo de Trabalho , Hospitais Universitários
6.
BMC Musculoskelet Disord ; 24(1): 790, 2023 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-37798626

RESUMO

BACKGROUND: Glenoid bone loss is among the most important risk factors for recurrent anterior shoulder instability, and a bony reconstruction is recommended in cases of critical bone loss (> 15%). The commonly used surgical techniques, including coracoid transfer, are associated with considerable complications. The aim of this study was to assess the motion at the glenoid-bone-block interface after coracoid and spina-scapula bone-block reconstruction of the anterior glenoid. METHODS: Twelve cadaveric shoulders were tested. A 20% bone defect of the anterior glenoid was created, and the specimens were randomly assigned for glenoid augmentation using a coracoid bone block (n = 6) or a scapular spine bone block (n = 6). The glenoid-bone interface was cyclically loaded for 5000 cycles with a force of 170 N. The micromotion was tracked using an optical measurement system (GOM ARMIS) and was evaluated with the GOM Correlate Pro software. RESULTS: The most dominant motion component was medial irreversible displacement for the spina-scapula (1.87 mm; SD: 1.11 mm) and coracoid bone blocks (0.91 mm; SD: 0.29 mm) (n.s.). The most medial irreversible displacement took place during the first nine cycles. The inferior reversible displacement was significantly greater for spina-scapula bone blocks (0.28 mm, SD: 0.16 mm) compared to coracoid bone blocks (0.06 mm, SD: 0.10 mm) (p = 0.02). CONCLUSIONS: The medial irreversible displacement is the dominant motion component in a bone-block reconstruction after a critical bone loss of the anterior glenoid. The spina-scapula and coracoid bone blocks are comparable in terms of primary stability and extent of motion. Thus, spina-scapula bone blocks may serve as alternatives in bony glenoid reconstruction from a biomechanical point of view.


Assuntos
Instabilidade Articular , Articulação do Ombro , Humanos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Transplante Ósseo/métodos , Escápula/diagnóstico por imagem , Escápula/cirurgia , Cadáver
7.
PLoS One ; 18(9): e0286280, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37733809

RESUMO

The ability of muscle to generate force depends on its architecture and health condition. MR-based diffusion tensor imaging of muscle (mDTI) is an innovative approach for showing the fiber arrangement for the whole muscle volume. For accurate calculations of fiber metrics, muscle segmentation prior to tractography is regarded as necessary. Since segmentation is known to be operator dependent, it is important to understand how segmentation affects tractography. The aim of this study was to compare the results of deterministic fiber tracking based on muscle models generated by two independent operators. In addition, this study compares the results with a segmentation-free approach. Fifteen subjects underwent mDTI of the right shoulder. The results showed that mDTI can be successfully applied to complex joints such as the human shoulder. Furthermore, operator segmentation did not influence the results of fiber tracking and fascicle length (FL), fiber volume (FV), fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) showed excellent intraclass correlation estimates (≥ 0.975). As an exploratory approach, the segmentation-free fiber tracking showed significant differences in terms of mean fascicle length. Based on these findings, we conclude that tractography is not sensitive to small deviations in muscle segmentation. Furthermore, it implies that mDTI and automatic segmentation approaches or even a segmentation-free analysis can be considered for evaluation of muscle architecture.


Assuntos
Imagem de Tensor de Difusão , Manguito Rotador , Humanos , Reprodutibilidade dos Testes , Anisotropia , Benchmarking
8.
Clin Biomech (Bristol, Avon) ; 105: 105984, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37156192

RESUMO

BACKGROUND: Complex proximal humerus fractures place high demands on osteosynthetic treatment. In some cases, double plating has already been used to increase primary stability of the osteosynthesis. This approach was advanced in the present study by developing an additive plate for the sulcus bicipitalis. To demonstrate the superior primary stability of the newly developed plate osteosynthesis, a biomechanical comparison against a conventional locking plate with an additional calcar screw was performed. METHODS: Ten pairs of cadaveric humeri were treated proximally with a locking plate (PENTA plate small fragment, INTERCUS). Each had a two-part fracture model with a fracture gap of 10 mm. All right humeri were treated with an additive novel plate that extends along the bicipital sulcus and encircles the lesser tuberosity proximally. First, the specimens were loaded sinusoidally at 250 N in 20° abduction for 5000 cycles. Afterwards quasi-static loading until failure was applied. FINDINGS: The movement at the fracture gap due to the cyclic loading occurred mainly as rotation around the z-axis, corresponding to a tilt medially and distally. The double plate osteosynthesis reduces the rotation by approximately 39%. For all load cycles observed, except 5000 cycles, medial and distal rotation of the head was significantly reduced by the double plate. The failure loads showed no significant differences between the groups. INTERPRETATION: In the tested scenario under cyclic loading, the novel double plate osteosynthesis showed a significant superiority of primary stability over the conventional treatment with one locking plate. Furthermore, the study showed the advantages of cyclic load application over quasi-static load application until failure.


Assuntos
Fraturas do Úmero , Fraturas do Ombro , Humanos , Fraturas do Ombro/cirurgia , Fixação Interna de Fraturas , Úmero , Parafusos Ósseos , Fraturas do Úmero/cirurgia , Placas Ósseas , Fenômenos Biomecânicos , Cadáver
9.
Medicina (Kaunas) ; 59(1)2023 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-36676737

RESUMO

Background and Objectives: Combined fractures of the humeral head and shaft (FHS) are rare but frequently involve an intermuscular fracture as its characteristic pattern. The aim of this retrospective study was to investigate intramedullary nailed and plated FHS in terms of outcomes and complications. Materials and Methods: The present study included patients with FHS, treated via either intramedullary nailing or plating within a period of 10 years, with a minimum follow-up of 12 months. Functional outcome was assessed using the age- and sex-adapted Constant-Murley Score (CMS-K). Rates of complications and revision surgeries were registered. Results: Twenty-five patients (18 females, 7 males, age 60.1 ± 14.2 years, range 23-76 years) were included in the study. Nailing was performed in 16 patients (12 females, 4 males, age 62.6 ± 12.4 years), whereas plating was executed in nine patients (6 females, 3 males, age 55.8 ± 17.0 years). Follow-up among all patients was 45.1 ± 26.3 months (range 12-97 months). CMS-K was 70.3 ± 32.3 in the nailing group, with reoperation in four cases, and 76.0 ± 31.0 in the plating group, with one reoperation (p = 0.42). Patients with no metaphyseal fragment displacement (n = 19; CMS-K 76.7 ± 17.3) demonstrated significantly better functional outcomes versus those with secondary displacement of the metaphyseal fragments (n = 6; CMS-K 60.0 ± 17.1), p = 0.046. Conclusions: Comparable acceptable clinical outcome is obtained when comparing nailing with additional open cerclage or lag-screw fixation techniques versus plating with open reduction. However, a higher revision rate was observed after nailing. The correct metaphyseal fragment fixation seems to be crucial to avoid loss of reduction and hence the need for revision surgery, as well as a worse outcome.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Úmero , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Fixação Intramedular de Fraturas/métodos , Cabeça do Úmero , Estudos Retrospectivos , Fraturas do Úmero/etiologia , Fraturas do Úmero/cirurgia , Placas Ósseas/efeitos adversos , Resultado do Tratamento
10.
Z Orthop Unfall ; 161(4): 439-446, 2023 Aug.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-35235973

RESUMO

The proximal humeral fracture is one of the most common fractures in the elderly. While epidemiological factors have been well studied, the influence of a proximal humeral fracture on morbidity, mortality and associated costs has not yet been adequately analysed.On a basis of 4.1 million insurance holders of the German public health insurance (GKV), patients with (study population, SP) and without (comparison group, VG) a proximal humeral fracture (pHF) were compared with regard to comorbidity, rehospitalisation, mortality, drug and aid needs as well as number of physician contacts. Study period was between 2012 and 2016.6068 patients of the SP met the inclusion and exclusion criteria (age 69.4 ± 14.3 years; male : female = 28.2% : 71.8%). 4781 patients (78.8%) received surgical, 1287 patients (21.2%) conservative treatment of the pHF. Rehospitalisations and visits to the general practitioner occurred more frequently in the SP vs. VG (p < 0.01). Contacts with specialists after pHF varied according to specialty, as did newly occurring diseases. Typical specialities for preventive examinations were significantly less common (gynaecology p < 0.01, pathology p < 0.01, dermatology p < 0.01). According to pHF, the costs of SP for drugs (2490.76 ± 1395.51 € vs. 2167.86 ± 1314.43 €; p = 0.04), medical therapies (867.01 ± 238.67 € vs. 393.26 ± 217.55 €; p < 0.01) and aids (821.02 ± 415.73 € vs. 513.52 ± 368.76 €; p < 0.01) were significantly above the VG. The two-year survival after pHF is lower in the SP than in the VG (p < 0.01).The results show increased morbidity and mortality as well as medical costs after a proximal humeral fracture. Preventive examinations and treatments are rarer. In the future, care concepts for patients with proximal humeral fractures should not only be optimised with regard to functional scores and reduced complication rates, but also with regard to quality of life and preservation of general health.


Assuntos
Qualidade de Vida , Fraturas do Ombro , Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Pacientes Internados , Fraturas do Ombro/epidemiologia , Fraturas do Ombro/terapia , Seguro Saúde , Atenção à Saúde , Fixação Interna de Fraturas/métodos , Estudos Retrospectivos
11.
Z Orthop Unfall ; 161(4): 422-428, 2023 Aug.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-35104902

RESUMO

BACKGROUND: Surgical treatment of proximal humerus fracture is an established procedure. Postoperative complications have been shown to have a significant impact on shoulder-specific outcome. Little is known to date about an influence on injury-independent quality of life. AIM OF THE WORK: The aim of this retrospective study is to analyse whether patients with a poor functional outcome after surgically treated proximal humerus fracture also show a reduced general quality of life in the medium term. Emphasis is placed on the analysis of patients with poor functional outcome due to postsurgical complications. MATERIAL AND METHODS: Evaluation of all patients operated at one level 1 trauma centre with a proximal humerus fracture in the period 01.01.2005 to 31.12.2015 and follow-up using validated scores (Constant-Murley Score [CMS], EQ-5D). Two groups, group A with good outcome (∆CMS ≤ 15P.) and group B with poor outcome (∆CMS ≥ 16P.), were defined. Furthermore, descriptive variables including definition of a complication were defined in advance. RESULTS: 138 patients were included in the study (group A: 91, group B: 47). The mean follow-up was 93.86 months ± 37.33 (36-167). Group B had significantly more complications. Furthermore, patients with poor outcome regarding the shoulder (group B) were also found to have significantly lower EQ-VAS (78.9 ± 19.2 [20.0-100] vs. 70.4 ± 19.5 [15.0-98.0]; p = 0.008) and EQ index (0.91 ± 0.14 [0.19-1.00] vs. 0.82 ± 0.17 [0.18-1.00]; p < 0.001). DISCUSSION: In conclusion, in the present study, the patients with poor outcome of shoulder function in CMS have significantly lower overall quality of life after a mean of more than 6 years of follow-up. The poor outcome was due to a significantly higher postoperative complication rate. This was independent of the fracture morphology present and the surgical procedure used.


Assuntos
Fraturas do Úmero , Fraturas do Ombro , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Ombro , Qualidade de Vida , Fixação Interna de Fraturas/métodos , Fraturas do Ombro/cirurgia , Complicações Pós-Operatórias/epidemiologia
12.
Unfallchirurgie (Heidelb) ; 126(7): 581-585, 2023 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-35833973

RESUMO

BACKGROUND: Lateral clavicle fractures can be treated both conservatively and surgically depending on the fracture classification. Different surgical techniques have been described for the operative treatment. The selection of the appropriate technique is decisive for the functional outcome and healing process without complications. CASE: We report on a patient with a secondary dislocation of two Kirschner wires after Kirschner wire osteosynthesis. The secondary dislocation caused one of the wires to migrate into the mediastinum and pulmonary tissue, directly under the aortic arch. To prevent further migration with potential damage to surrounding structures, a uniportal video-assisted thoracoscopy was performed to retrieve the wire. CONCLUSION: The treatment of lateral clavicle fractures should be performed with bent Kirschner wires as they can otherwise lead to severe complications including the occurrence of pseudarthrosis or secondary migration of the material. Safe and stable surgical techniques (plate osteosynthesis, hybrid treatment) should be preferred if they are available.


Assuntos
Fios Ortopédicos , Clavícula , Fixação Interna de Fraturas , Fraturas Ósseas , Humanos , Fios Ortopédicos/efeitos adversos , Clavícula/diagnóstico por imagem , Clavícula/lesões , Clavícula/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/normas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Feminino , Idoso de 80 Anos ou mais , Resultado do Tratamento
13.
Int Orthop ; 46(11): 2649-2657, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35982324

RESUMO

PURPOSE: Fibular mobility after suture button stabilization (SBS) of inferior tibiofibular joint (syndesmosis) injuries has been described. This effect is called the "flexible nature of fixation (FNF)." In this study, we aimed to quantify FNF in syndesmotic stabilization. METHODS: Postoperative bilateral computed tomography (CT) of ankle fractures with syndesmosis stabilization by SBS or syndesmotic screw (SYS) was retrospectively analyzed. The transverse offset (TO) and vertical offset (VO) were defined by evaluating the drill channels. The reduction outcome was evaluated by the side-to-side difference between the clear space and the anterior tibiofibular distance (antTFD). The calculated anterior tibiofibular distance (cal-antTFD) was calculated by subtracting the TO from the validated antTFD. Subsequently, a reevaluation of the reduction outcomes after SYS or SBS stabilization was performed using cal-antTFD. RESULTS: Sixty patients (44 with SBS and 16 with SYS stabilization) were analyzed. The intra-rater and inter-rater reliabilities for TO and VO were excellent (α > 0.92). SYS stabilization showed lower mean TO (- 0.02 mm; SD 0.14) and VO (0.11 mm; SD, 0.29 mm) than SBS stabilization (TO 1.16 mm, SD 1.4 mm; VO 0.2 mm, SD 0.8 mm; p = 0.001). The rate of malreduction according to cal-antTFD was higher than that of antFTD (p = 0.033). CONCLUSION: The presented method, which evaluates the position of the tibial to the fibular drill channel, allowed the quantification of the "FNF." The often described difference in the dynamic stabilization of SBS compared to the rigid stabilization by SYS could be objectified. Considering cal-antTFD illustrates that FNF potentially reduces the rate of malreduction in SBS stabilization.


Assuntos
Traumatismos do Tornozelo , Articulação do Tornozelo , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Parafusos Ósseos , Fíbula/diagnóstico por imagem , Fíbula/lesões , Fíbula/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Humanos , Estudos Retrospectivos
14.
Ann Anat ; 243: 151938, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35367623

RESUMO

Pain over the superior angle of the scapula is a common musculoskeletal symptom. It is often accompanied by radiating pain to the neck, head, and shoulder. The aetiologies can be varied but may also be idiopathic in nature. To explore the fascial connections of this region, we studied 26 unembalmed, -two Thiel and one alcohol body-donors of science, by dissection, histological probes, and plastinations. When removing the descending and transverse fibres of the trapezius, a large prominent triangular area of white connectives is revealed, varying in mass. A subdivision of these connectives can be further dissected to prove that the rhomboid minor and levator scapulae muscles are interconnected and enclosed by connectives. Between these two muscles a bridge of connective tissue, containing fat, is observed. These connectives end cranially at the surface of the splenius capitis, and at the midline, containing vessels and nerves, as supported by histology and plastinations. This unification is separate from the rhomboid major muscle but overlaps with the latter dorsally. It connects to the superior angle of scapula and its upper medial borders, respectively, and cranially to the root of the spine of the scapula. Beneath the united levator scapulae and rhomboid minor, described here, the serratus posterior superior and possibly serratus anterior form a hypomochlion or fulcrum at the superior angle of the scapula. Any tension on this unified entity can unbalance this fulcrum. Investigating the connections between these two unified muscles may help explain the often idiopathic nature of superior scapular pain, and the success or failure of surgery, and other treatments.


Assuntos
Músculos Superficiais do Dorso , Humanos , Músculos do Pescoço , Dor , Escápula , Ombro
15.
BMC Musculoskelet Disord ; 23(1): 196, 2022 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-35236325

RESUMO

BACKGROUND: In the context of the German contact restrictions due to the COVID-19 pandemic of March 2020, an online-based consultation system was established in our university orthopedic outpatient department to maintain patient care. As a basis for contact-minimizing communication, this was continued after the contact restrictions were lifted. The aim of this prospective pilot study was to assess the effectiveness, technical feasibility, and patient flow in this system under lockdown conditions and in the period afterwards. METHODS: The evaluation took place from the beginning of the first lockdown on March 13, 2020, until May 31, 2021. For each patient encounter, the quality of the sound and video connections was documented. The outcomes of the consultations were recorded. Four categories were distinguished: 1) no follow-up necessary, 2) follow-up via online consultation, 3) referral for surgical therapy, and 4) follow-up in the outpatient clinic for physical examination. A comparison was made between an early cohort right after implementation of the online consultation and and a late cohort after establishment of the consultation. RESULTS: There were 408 patient encounters via online consultation. A total of 360 (88%) consultations were uninterrupted. Initial presentations accounted for 124 (30%) consultations. In 75 (18%) patients, no further follow-up was necessary. Follow-up via online consultation was scheduled in 82 (20%) patients, direct referral for surgery was made in 86 (21%) patients, and a follow-up for physical examination was arranged in 165 (40%) patients. When comparing the early and late cohort, there was no difference in the duration of the conversation (p = 0.23). A significant difference was found in the type of further treatment. In the late cohort, conservative therapy was used more often (p < 0.01), resulting in a lower number of follow-up visits for clinical examination (p < 0.01). CONCLUSION: While a definite decision for further procedure was possible solely by online consultation in a large percentage of cases, 40% of patients still needed an additional in-person consultation for physical examination. A learning curve could be observed regarding the selection of patients suited for online consultation. Overall, online consultation is a useful measure to manage patient volume and to visibly support direct doctor-patient contact.


Assuntos
COVID-19 , Telemedicina , Instituições de Assistência Ambulatorial , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Humanos , Curva de Aprendizado , Pandemias , Projetos Piloto , Estudos Prospectivos , Encaminhamento e Consulta , SARS-CoV-2
16.
J Orthop Surg Res ; 17(1): 174, 2022 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-35313901

RESUMO

BACKGROUND: For biomechanical investigations on bone or bone implants, bone quality represents an important potential bias. Several techniques for assessing bone quality have been described in the literature. This study aims to systematically summarize the methods currently available for assessing bone quality in human bone tissue, and to discuss the advantages and limitations of these techniques. METHODS: A systematic review of the literature was carried out by searching the PubMed and Web of Science databases from January 2000 to April 2021. References will be screened and evaluated for eligibility by two independent reviewers as per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies must apply to bone quality assessment with imaging techniques, mechanical testing modalities, and compositional characterization. The terms used for the systematic search were: "(bone quality". Ti,ab.) AND "(human bone specimens)". RESULTS: The systematic review identified 502 relevant articles in total. Sixty-eight articles met the inclusion criteria. Among them, forty-seven articles investigated several imaging modalities, including radiography, dual-energy X-ray absorptiometry (DEXA), CT-based techniques, and MRI-based methods. Nineteen articles dealt with mechanical testing approaches, including traditional testing modalities and novel indentation techniques. Nine articles reported the correlation between bone quality and compositional characterization, such as degree of bone mineralization (DBM) and organic composition. A total of 2898 human cadaveric bone specimens were included. CONCLUSIONS: Advanced techniques are playing an increasingly important role due to their multiple advantages, focusing on the assessment of bone morphology and microarchitecture. Non-invasive imaging modalities and mechanical testing techniques, as well as the assessment of bone composition, need to complement each other to provide comprehensive and ideal information on the bone quality of human bone specimens.


Assuntos
Absorciometria de Fóton , Osso e Ossos/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Humanos , Projetos de Pesquisa/normas
17.
Sci Rep ; 12(1): 608, 2022 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-35022498

RESUMO

To investigate, whether hyperspectral imaging (HSI) is able to reliably differentiate between healthy and damaged cartilage tissue. A prospective diagnostic study was performed including 21 patients undergoing open knee surgery. HSI data were acquired during surgery, and the joint surface's cartilage was assessed according to the ICRS cartilage injury score. The HSI system records light spectra from 500 to 1000 nm and generates several parameters including tissue water index (TWI) and the absorbance at 960 nm and 540 nm. Receiver operating characteristic curves were calculated to assess test parameters for threshold values of HSI. Areas with a cartilage defect ICRS grade ≥ 3 showed a significantly lower TWI (p = 0.026) and higher values for 540 nm (p < 0.001). No difference was seen for 960 nm (p = 0.244). For a threshold of 540 nm > 0.74, a cartilage defect ICRS grade ≥ 3 could be detected with a sensitivity of 0.81 and a specificity of 0.81. TWI was not suitable for cartilage defect detection. HSI can provide reliable parameters to differentiate healthy and damaged cartilage. Our data clearly suggest that the difference in absorbance at 540 nm would be the best parameter to achieve accurate identification of damaged cartilage.


Assuntos
Cartilagem Articular/diagnóstico por imagem , Imageamento Hiperespectral , Osteoartrite do Joelho/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
18.
Arch Orthop Trauma Surg ; 142(10): 2701-2709, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34258658

RESUMO

INTRODUCTION: This study aimed to investigate the influence of epidemiologic parameters on complications that needed operative revision of operatively treated proximal humerus fractures. METHODS: We performed a retrospective single-center study in a level 1 trauma center. We included all patients with operatively treated proximal humerus fractures from January 1 2005 to December 31 2015. We characterized our cohort and subgroup using descriptive statistics. The primary outcome was postoperative complications. For this purpose, postoperative complications were defined in advance, an operative revision was necessary on a general rule. The secondary outcome was a model of the risk factors for complications created with multiple logistic regression. RESULTS: We included 1109 patients. The average age was 67.2 years (± 16.4), and 71.4% of the fractures occurred in women. A total of 644 patients (58.1%) had between one to three comorbidities, and 27.8% had four or more. The fracture morphology was as follows: 3 part 41.8%, 4 part 26.9%, 2 part 24.3%, and dislocation fracture 6.7%. Complications occurred in 150 patients (13.5%). The number of comorbidities [odds ratio (OR) 2.85, p < 0.01], body weight (OR 1.15, p = 0.02), and substance abuse (OR 1.82, p = 0.04) significantly correlated with the risk of complications. We achieved a sensitivity of 48% and a specificity of 74% for the variables body weight, substance abuse, age, and comorbidities CONCLUSION: The epidemiologic parameters, comorbidities, substance abuse, weight, and age are independent risk factors for complications. If these factors are present, one can predict a postoperative complication requiring surgical revision with low sensitivity and moderate specificity. Therefore, concerning the high number of multi-morbid patients with proximal humerus fractures, an increased postoperative complication rate can be expected. LEVEL OF EVIDENCE: Level of evidence IV.


Assuntos
Fraturas do Ombro , Transtornos Relacionados ao Uso de Substâncias , Idoso , Peso Corporal , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Úmero/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fraturas do Ombro/epidemiologia , Fraturas do Ombro/cirurgia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Resultado do Tratamento
19.
Arch Orthop Trauma Surg ; 142(7): 1385-1393, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33484306

RESUMO

INTRODUCTION: Inferior tendon quality, wide retraction, and tendon stumps that cannot be mobilized define the limits of what is technically feasible for open and arthroscopic rotator cuff reconstruction. The aim of this study was to develop a procedure that enables the open reconstruction of otherwise non-reconstructable rotator cuff tears. METHODS: From 2014 to 2018, 23 operations were performed on 21 patients (mean age 63) using open procedure involving separating the infraspinatus tendon from the point of insertion on the greater tubercle and mobilizing it proximally and ventrally into the defective area. Any remaining defects were augmented using an autologous biceps tendon interposition graft. This augmentation was performed to achieve complete closure of the defect. Furthermore, the augmentation of the rupture zone was intended to strengthen the tendon stumps of the SSP and ISP to better neutralize the initial tensile forces. After a postoperative period of 12 months-4 years, clinical examination and functional tests were carried out, the Constant score was determined, and radiological and magnetic resonance imaging check-up examinations were performed. RESULTS: The technique resulted in a low-tension closure of an otherwise "non-repairable" superior rotator cuff defect. All patients experienced a significant functional improvement, a reduction in pain, and an increase in muscle strength. An improvement in the Constant score from 48 points preoperatively to 87 points postoperatively (p < 0.05) was observed. In 19 patients (90%), the magnetic resonance image showed an intact reconstruction. Re-rupture was seen in three patients (14%). CONCLUSION: The surgical procedure using infraspinatus tendon shift and autologous biceps tendon interposition grafts resulted in the successful reconstruction of otherwise non-reconstructable massive rotator cuff lesions. The complete closure of the defect was observed.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroscopia/métodos , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Manguito Rotador/patologia , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/patologia , Lesões do Manguito Rotador/cirurgia , Ruptura , Tendões/cirurgia , Resultado do Tratamento
20.
Arch Orthop Trauma Surg ; 142(4): 641-648, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33884453

RESUMO

PURPOSE: Horizontal instability is a common problem after acromioclavicular joint injuries. The aim of this study was to evaluate if there is a difference regarding horizontal stability between an anatomical and a non-anatomical configuration of the double tunnel coraco-clavicular ligament reconstruction of the acromioclavicular joint. METHODS: Thirteen acromioclavicular joints of human cadaveric shoulders in ethanol-glycerin fixation were included in the study and underwent cyclic anterior and posterior translational testing at a load of 70 N using an electromechanical uniaxial testing machine. The shoulders were randomly assigned to the following groups: double coraco-clavicular tunnel technique in an anatomical configuration (DCTa) and double coraco-clavicular tunnel technique in an inverse configuration of the anatomical position (DCTb). The dislocation was recorded with a 3D optical measuring system. RESULTS: The total horizontal displacement (p10 = 0.0221; p5000 = 0.082) was significantly higher for the non-anatomical reconstruction (DCTb) compared to the anatomical reconstruction (DCTa) after every measured amount of cycles. The increase in displacement for DCTb group was overall higher than the increase in displacement for DCTa group but without significance. CONCLUSION: Reconstruction of the CC ligaments in an anatomical configuration with two suture devices results in a significantly higher stability of the AC joint in the horizontal plane than reconstruction of the CC ligaments in a non-anatomical configuration. Based on the results of this biomechanical in vitro study, the use of a double coraco-clavicular reconstruction should focus on an anatomically correct position of the suture devices.


Assuntos
Articulação Acromioclavicular , Artroplastia de Substituição , Luxações Articulares , Articulação Acromioclavicular/lesões , Articulação Acromioclavicular/cirurgia , Fenômenos Biomecânicos , Cadáver , Clavícula/lesões , Humanos , Luxações Articulares/cirurgia , Ligamentos Articulares/cirurgia
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