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[PMID]:28457505
[Au] Autor:Uysal Ramadan S; Gurses MS; Inanir NT; Hacifazlioglu C; Fedakar R; Hizli S
[Ad] Endereço:Division of Radiology, Kecioren Training and Research Hospital, Ankara, Turkey.
[Ti] Título:Evaluation of the medial clavicular epiphysis according to the Schmeling and Kellinghaus method in living individuals: A retrospective CT study.
[So] Source:Leg Med (Tokyo);25:16-22, 2017 Mar.
[Is] ISSN:1873-4162
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:The evaluation of the medial clavicular epiphysis via CT plays an important role in the determination of age, particularly the 19th and 22nd ages. Several authors have recommended the use of the Schmeling and Kellinghaus methods in conjunction in the evaluation of the medial clavicular epiphysis. The aim of this retrospective study was to evaluate thin section CT scan images of the medial clavicular epiphysis according to the Schmeling and Kellinghaus method, and to discuss the obtained data in the light of the literature. The thoracic CT scan images (0.6mm section thickness) of 601 patients (202 female and 399 male) aged between 10 and 35years obtained by 16-detector CT were evaluated by two examiners. The stage 2 was seen between 13 and 23years of age; stage 3 was seen between 16 and 27years of age. However, 100% of the female cases with stage 3c were ⩾18years of age, and 100% of the male cases with stage 3c were ⩾19years of age. Stage 4 was first observed at 20years of age in both sexes, and stage 5 was first observed at 25years of age in both sexes. We believe that stage 3c may be used, particularly in the determination 18-year age limit for both sexes. The outcomes of our study are consistent with those of our previous study and other studies in the literature, which is important for the confirmation of the reliability of the method.
[Mh] Termos MeSH primário: Determinação da Idade pelo Esqueleto/métodos
Clavícula/anatomia & histologia
Epífises/anatomia & histologia
Tomografia Computadorizada por Raios X
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Antropologia Forense
Seres Humanos
Masculino
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:29188672
[Au] Autor:Fan F; Tu M; Luo YZ; Zhang K; Chen XG; Deng ZH
[Ad] Endereço:West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu 610041, China.
[Ti] Título:[Progress on the Rule of Clavicle Epiphyseal Closure Using Multi-Imaging Technology].
[So] Source:Fa Yi Xue Za Zhi;32(4):277-281, 2016 Aug.
[Is] ISSN:1004-5619
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:People aged 18 years could be punished lightly or diminished criminal responsibility, even be spared the death sentence, which has important meaning in Chinese judicatory adjudication. The epiphysis of long bones from human limbs and the secondary sexual characteristics almost have developed completely before 18 years old. Clavicle epiphysis is one of the articular metaphysis which has a late epiphyseal closure. The recent studies in exploring the rule of clavicle epiphyseal by multi-imaging technology shows that the development of clavicle epiphysis has some value in age estimation of 18 years old. CT, especially thin-section CT, is widely used at present. However, thin-section CT scanning has great net radiation, which is not ethically acceptable if it is not for diagnosis and treatment. MRI is nonradioactive tomographic imaging and easy to evaluate, which is one of the future research directions in forensic age estimation using the medial clavicle. This paper summarizes the progress on the rule of clavicle epiphyseal closure, and analyzes and summarizes the feasibility of rule of clavicle epiphyseal closure applies on age estimation.
[Mh] Termos MeSH primário: Clavícula/fisiologia
Epífises/fisiologia
Osteogênese
[Mh] Termos MeSH secundário: Adolescente
Determinação da Idade pelo Esqueleto
Grupo com Ancestrais do Continente Asiático
Morte
Antropologia Forense
Seres Humanos
Imagem por Ressonância Magnética
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.3969/j.issn.1004-5619.2016.04.011


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[PMID]:29369223
[Au] Autor:Xie L; Zhao Z; Zhang S; Hu Y
[Ad] Endereço:Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Wuhan.
[Ti] Título:Intramedullary fixation versus plate fixation for displaced mid-shaft clavicle fractures: A systematic review of overlapping meta-analyses.
[So] Source:Medicine (Baltimore);97(4):e9752, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Displaced mid-shaft clavicle fractures (DMCFs) are common injuries. Both intramedullary fixation (IMF) and plate fixation (PF) have been described and routinely used. Multiple trials have been conducted to compare these treatments. Multiple meta-analyses have been published to compare IMF and PF treatment for DMCFs; however, the results remain controversial. The purposes of this study were to perform a systematic review of overlapping meta-analyses comparing IMF and PF treatment for DMCFs, to help decision makers critically evaluate the current meta-analyses, and to propose a guide through the best available evidence. METHOD: We searched the Cochrane library, PubMed, and EMBASE data bases. Two authors independently scanned titles and abstracts to exclude irrelevant articles and identify meta-analyses that met the eligibility criteria. The methodological quality of the meta-analysis was independently assessed by the 2 authors using the Oxford Centre for Evidence-based Medicine Levels of Evidence and the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Heterogeneity information of each variable was extracted from the included studies. An I of <60% is accepted in this systematic review. The Jadad algorithm was then applied to determine which of the meta-analyses provided the best evidence. RESULTS: Eight meta-analysis met the inclusion criteria in this study. AMSTAR scores varied from 7 to 9. Heterogeneity of each outcome was acceptable. Four authors independently selected the same meta-analysis as providing the highest quality of evidence using the Jadad decision algorithm. CONCLUSION: This systematic review of overlapping meta-analyses suggests that compared with PF, major reintervention and refracture after implant removal occurred more frequently after PF of DMCFs. No differences in terms of function and non-union between PF and IMF were observed. Future research should focus on fracture selection for IMF and further improvement of plates and IM devices.
[Mh] Termos MeSH primário: Clavícula/lesões
Fratura-Luxação/cirurgia
Fixação Interna de Fraturas/métodos
Fixação Intramedular de Fraturas/métodos
Fraturas Ósseas/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Placas Ósseas
Clavícula/cirurgia
Feminino
Fixação Interna de Fraturas/instrumentação
Seres Humanos
Masculino
Metanálise como Assunto
Meia-Idade
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009752


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[PMID]:29221466
[Au] Autor:Benameur Y; Guerrouj H; Ghfir I; Ben Rais Aouad N
[Ad] Endereço:Department of Nuclear Medicine, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco. Benameur.yassir@gmail.com.
[Ti] Título:Unusual pathological fracture of the clavicle revealing primary hyperparathyroidism: a case report.
[So] Source:J Med Case Rep;11(1):342, 2017 Dec 09.
[Is] ISSN:1752-1947
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Primary hyperparathyroidism revealed by a pathological fracture is very uncommon; in the majority of cases the discovery of lytic bone lesions on imaging examinations evokes in the clinician first a neoplastic etiology and a metabolic origin is often omitted. This case report adds to the existing literature as it describes an unusual presentation of primary hyperparathyroidism. CASE PRESENTATION: We report a case of a 50-year-old Moroccan man, without any known tumor, who presented a fracture of his left clavicle with multiple osteolytic lesions on computed tomography suggesting bone metastases. However, bone scintigraphy oriented the diagnosis to a metabolic pathology by showing a metabolic bone "super scan" with increased tracer uptake in the left clavicle; parathyroid scintigraphy was able to localize pathological right parathyroid tissue. CONCLUSIONS: Whenever multiple osteolytic lesions are found in a patient without any known tumor, metabolic bone diseases including hyperparathyroidism should be highly considered.
[Mh] Termos MeSH primário: Adenoma/diagnóstico por imagem
Neoplasias Ósseas/diagnóstico
Clavícula/diagnóstico por imagem
Fraturas Espontâneas/diagnóstico por imagem
Hiperparatireoidismo Primário/diagnóstico
Neoplasias das Paratireoides/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adenoma/complicações
Neoplasias Ósseas/secundário
Clavícula/lesões
Diagnóstico Diferencial
Fraturas Espontâneas/etiologia
Seres Humanos
Hiperparatireoidismo Primário/etiologia
Masculino
Meia-Idade
Neoplasias das Paratireoides/complicações
Cintilografia
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180130
[Lr] Data última revisão:
180130
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171210
[St] Status:MEDLINE
[do] DOI:10.1186/s13256-017-1509-7


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[PMID]:29310373
[Au] Autor:Kim SH; Park AY; Cho HB; Yoo JH; Park SY; Chung JW; Kim MG
[Ad] Endereço:Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Hannam-dong, Yongsan-gu, Seoul, Korea.
[Ti] Título:A rare case of nonresterilized reinforced ETT obstruction caused by a structural defect: A case report.
[So] Source:Medicine (Baltimore);96(48):e8886, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Various factors can cause ventilatory failure after endotracheal tube (ETT) intubation, which is associated with increased patient morbidity and mortality. PATIENT CONCERNS: A 76-year-old woman who was diagnosed with a hemopericardium and suspicion of a major-vessel injury due to dislocation of the clavicular fracture fixation screw. DIAGNOSIS: Non-resterilized reinforced ETT obstruction caused by a structural defect. INTERVENTION: Endotracheal tube was exchanged. OUTCOMES: The ventilator profile showed rapid improvement. LESSONS: Anesthesiologists should consider that a non-resterilized reinforced ETT may be defective. An ETT defect can cause high PIP and ETT obstruction without kinking or foreign materials.
[Mh] Termos MeSH primário: Intubação Intratraqueal/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Tronco Braquiocefálico/lesões
Clavícula/lesões
Clavícula/cirurgia
Falha de Equipamento
Feminino
Seres Humanos
Derrame Pericárdico/etiologia
Derrame Pericárdico/cirurgia
Retratamento
Esternotomia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180115
[Lr] Data última revisão:
180115
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008886


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[PMID]:28458119
[Au] Autor:van Nijnatten TJA; Moossdorff M; de Munck L; Goorts B; Vane MLG; Keymeulen KBMI; Beets-Tan RGH; Lobbes MBI; Smidt ML
[Ad] Endereço:Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Ma
[Ti] Título:TNM classification and the need for revision of pN3a breast cancer.
[So] Source:Eur J Cancer;79:23-30, 2017 07.
[Is] ISSN:1879-0852
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: According to the seventh edition of tumour-node-metastasis (TNM) classification, pN3a status in breast cancer patients consists of presence of an infraclavicular lymph node metastasis (LNM) and/or presence of ≥10 axillary LNMs. The aim of this study was to determine whether prognosis of pN3a based on at least an infraclavicular LNM differs from ≥10 axillary LNMs. METHODS: Data were obtained from the Netherlands Cancer Registry. All patients were diagnosed between 2005 and 2008 with primary invasive epithelial breast cancer and pN2a or pN3a status as pathologic result. Patients with pN3a were subdivided in pN3a based on at least an infraclavicular LNM or ≥10 axillary LNMs. Disease-free survival (DFS) included any local, regional or contralateral recurrence, distant metastasis or death within 5 years. Kaplan-Meier curves provided information on 5-year DFS and 8-year overall survival (OS). In addition, Cox proportional hazards model was used to measure the effect of relevant clinicopathological variables on DFS and OS. RESULTS: A total of 3400 patients with pN2a and 1788 patients with pN3a were included. In 83 patients, pN3a was based on at least an infraclavicular LNM (4.6%) and in 1705 patients because of ≥10 axillary LNMs (95.4%). After multivariable analyses, DFS and OS were inferior in patients with pN3a based on ≥10 axillary LNMs compared to infraclavicular LNM (DFS 48.8% versus 63.8%, hazard ratio [HR] 1.59, p = 0.036; OS 46.6% versus 63.9%, HR 1.46, p = 0.042). Furthermore, pN2a and pN3a based on infraclavicular LNM had comparable DFS and OS. CONCLUSION: PN3a status based on an at least an infraclavicular LNM is rare, yet its prognosis is superior to ≥10 axillary LNMs. Reclassification of infraclavicular LNM in the next TNM should therefore be considered into pN2a.
[Mh] Termos MeSH primário: Neoplasias da Mama/patologia
Estadiamento de Neoplasias
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Axila
Neoplasias da Mama/mortalidade
Neoplasias da Mama/terapia
Clavícula
Terapia Combinada/métodos
Terapia Combinada/mortalidade
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Excisão de Linfonodo/métodos
Excisão de Linfonodo/mortalidade
Metástase Linfática
Meia-Idade
Países Baixos/epidemiologia
Radioterapia Adjuvante/métodos
Radioterapia Adjuvante/mortalidade
Carga Tumoral
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171230
[Lr] Data última revisão:
171230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:28819536
[Au] Autor:Bakkaly AE; Hanine MD; Amrani A; Dendane A; El Alami SZF; Madhi TE
[Ad] Endereço:Service de Chirurgie Orthopédique Pédiatrique, CHU Ibn Sina / Faculté de Médecine Mohammed V, Rabat, Maroc.
[Ti] Título:[Aneurysmal bone cyst of the clavicle: about a case].
[Ti] Título:Kyste anévrismal osseux de la clavicule: à propos d'un cas..
[So] Source:Pan Afr Med J;27:115, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:fre
[Ab] Resumo:Anevrysmal bone cyst is an aggressive, destructive but benign lesion in the long bones, spine or basin, affecting mainly children and young adults. However, it is a very rare tumor. We here report the case of a 8-year old boy with a very rare localization of anevrysmal cyst in the clavicle, initially presenting with pathologic bone fracture, that is a benign cystic lesion. The child underwent complete radical resection of the cyst located at the level of the right clavicle, followed by anatomopathological examination of surgical specimen which confirmed the diagnosis. Patient's evolution was marked by the absence of recurrences and by good radiologic bone remodeling. Radical cyst resection seems to avoid recidivism. This study aims to update the current understanding of this rare orthopaedic condition by comparing our results with those reported in the world literature.
[Mh] Termos MeSH primário: Cistos Ósseos Aneurismáticos/patologia
Remodelação Óssea
Clavícula/patologia
[Mh] Termos MeSH secundário: Cistos Ósseos Aneurismáticos/diagnóstico
Cistos Ósseos Aneurismáticos/cirurgia
Criança
Clavícula/cirurgia
Fraturas Ósseas/diagnóstico
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170819
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.27.115.11945


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[PMID]:28816894
[Au] Autor:Ahrens PM; Garlick NI; Barber J; Tims EM; Clavicle Trial Collaborative Group
[Ad] Endereço:1Department of Trauma and Orthopaedics, Royal Free Hampstead NHS Foundation Trust, London, United Kingdom 2Department of Statistical Science, University College London, London, United Kingdom.
[Ti] Título:The Clavicle Trial: A Multicenter Randomized Controlled Trial Comparing Operative with Nonoperative Treatment of Displaced Midshaft Clavicle Fractures.
[So] Source:J Bone Joint Surg Am;99(16):1345-1354, 2017 Aug 16.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The treatment of displaced midshaft clavicle fractures remains controversial. METHODS: We undertook a multicenter randomized controlled trial to compare effectiveness and safety between nonoperative management and ORIF (open reduction and internal fixation) for displaced midshaft clavicle fractures in adults. Three hundred and one eligible adult patients were randomized to 1 of the 2 treatment groups and followed at 6 weeks, 3 months, and 9 months after recruitment. The primary outcome was the rate of radiographically evident nonunion at 3 months following treatment. Secondary outcomes were the rate of radiographically evident nonunion at 9 months, limb function measured using the Constant-Murley Score and DASH (Disabilities of the Arm, Shoulder and Hand) score, and patient satisfaction. RESULTS: There was no difference in the proportion of patients with radiographic evidence of nonunion at 3 months between the operative (28%) and nonoperative (27%) groups, whereas at 9 months the proportion with nonunion was significantly lower (p < 0.001) in the operative group (0.8%) than in the nonoperative group (11%). The DASH and Constant-Murley scores and patient satisfaction were all significantly better in the operative group than in the nonoperative group at 6 weeks and 3 months. CONCLUSIONS: Although at 3 months there was no evidence that surgery had reduced the rate of nonunion of displaced midshaft clavicle fractures, at 9 months nonoperative treatment had led to a significantly higher nonunion rate (11% compared with <1%). The rate of secondary surgical intervention during the trial period was 12 (11%) of the 147 patients in the nonoperative group. ORIF is a safe and reliable intervention with superior early functional outcomes and should be considered for patients who sustain this common injury. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Clavícula/lesões
Fixação de Fratura/métodos
Fraturas Ósseas/terapia
[Mh] Termos MeSH secundário: Adulto
Feminino
Fixação Interna de Fraturas/métodos
Consolidação da Fratura
Fraturas Ósseas/cirurgia
Seres Humanos
Masculino
Meia-Idade
Redução Aberta/métodos
Satisfação do Paciente
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.01112


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[PMID]:28768788
[Au] Autor:Fuglesang HFS; Flugsrud GB; Randsborg PH; Oord P; Benth JS; Utvåg SE
[Ad] Endereço:University of Oslo, Oslo, Norway.
[Ti] Título:Plate fixation intramedullary nailing of completely displaced midshaft fractures of the clavicle: a prospective randomised controlled trial.
[So] Source:Bone Joint J;99-B(8):1095-1101, 2017 Aug.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: This is a prospective randomised controlled trial comparing the functional outcomes of plate fixation and elastic stable intramedullary nailing (ESIN) of completely displaced mid-shaft fractures of the clavicle in the active adult population. PATIENTS AND METHODS: We prospectively recruited 123 patients and randomised them to either plate fixation or ESIN. Patients completed the Quick Disabilities of the Arm, Shoulder and Hand (DASH) score at one to six weeks post-operatively. They were followed up at six weeks, three and six months and one year with radiographs, and their clinical outcome was assessed using both the DASH and the Constant Score. RESULTS: Plate fixation provided a faster functional recovery during the first six months compared with ESIN, but there was no difference after one year. The duration of surgery was shorter for ESIN (mean 53.4 minutes, 22 to 120) than for plate fixation (mean 69.7 minutes, 35 to 106, p < 0.001). The recovery after ESIN was slower with increasing fracture comminution and with open reduction (p < 0.05). CONCLUSION: Both methods return the patients to their pre-injury functional levels, but plate fixation has a faster recovery period in comminuted fractures than ESIN. ESIN has a shorter operative time and lower infection and implant rates of failure when using 2.5 mm nails or wider, suggesting that this is the preferred method in mid-shaft fractures with no comminution, whereas plate fixation is the superior method in comminuted fractures. Cite this article: 2017;99-B:1095-1101.
[Mh] Termos MeSH primário: Pinos Ortopédicos
Placas Ósseas
Clavícula/lesões
Fixação Intramedular de Fraturas/métodos
Fraturas Ósseas/cirurgia
Fraturas Cominutivas/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Clavícula/diagnóstico por imagem
Clavícula/cirurgia
Feminino
Seguimentos
Consolidação da Fratura
Fraturas Ósseas/diagnóstico
Fraturas Cominutivas/diagnóstico
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Radiografia
Fatores de Tempo
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170804
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.99B8.BJJ-2016-1318.R1


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[PMID]:28719555
[Au] Autor:Goudie EB; Clement ND; Murray IR; Lawrence CR; Wilson M; Brooksbank AJ; Robinson CM
[Ad] Endereço:1The Edinburgh Shoulder Clinic, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom 2Department of Trauma and Orthopaedics, The Glasgow Royal Infirmary, Glasgow, United Kingdom.
[Ti] Título:The Influence of Shortening on Clinical Outcome in Healed Displaced Midshaft Clavicular Fractures After Nonoperative Treatment.
[So] Source:J Bone Joint Surg Am;99(14):1166-1172, 2017 Jul 19.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We aimed to evaluate the effect of clavicular shortening, measured with 3-dimensional computed tomography (3DCT), on functional outcomes and satisfaction in patients with healed displaced midshaft clavicular fractures up to 1 year following injury. METHODS: The data used in this study were collected as part of a multicenter, prospective randomized controlled trial of open reduction and plate fixation compared with nonoperative treatment for acute, displaced midshaft clavicular factures. Patients who were randomized to nonoperative treatment and had healed by 1 year were included in the present study. Clavicular shortening relative to the uninjured, contralateral clavicle was measured on 3DCT. Outcome analysis was conducted at 6 weeks, 3 months, 6 months, and 1 year following injury and included the Disabilities of the Arm, Shoulder and Hand (DASH), Constant, and Short Form-12 (SF-12) scores and patient satisfaction. RESULTS: In the original trial, 105 patients were randomized to nonoperative treatment. Thirteen patients were lost to follow-up, leaving 92 patients, and an additional 16 (17%) developed nonunion and were excluded from the present study. Of the remaining 76 patients, 48 who had a 3DCT scan that included the whole length of both clavicles were included in the present study. The shortening of the injured clavicles, relative to the contralateral side, was a mean (and standard deviation) of 11.3 ± 7.6 mm, with a mean proportional shortening of 8%. Proportional shortening did not significantly correlate with the DASH (p ≥ 0.42), Constant (p ≥ 0.32), or SF-12 (p ≥ 0.08) scores at any point during follow-up. There was no significant difference in the mean DASH or Constant scores at any follow-up time point when the cutoff for shortening was defined as 1 cm (p ≥ 0.11) or as 2 cm (p ≥ 0.35). There was no significant difference in clavicular shortening between satisfied and unsatisfied patients (p ≥ 0.49). CONCLUSIONS: The present study demonstrated no association between shortening and functional outcome or satisfaction in patients with healed displaced midshaft clavicular fractures up to 1 year following injury. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Clavícula/lesões
Fraturas Ósseas/terapia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Placas Ósseas
Clavícula/patologia
Feminino
Fixação de Fratura/instrumentação
Fixação de Fratura/métodos
Fraturas Ósseas/diagnóstico por imagem
Fraturas Ósseas/patologia
Seres Humanos
Masculino
Meia-Idade
Medidas de Resultados Relatados pelo Paciente
Estudos Prospectivos
Tomografia Computadorizada por Raios X/métodos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170719
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.01010



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