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[PMID]:29381950
[Au] Autor:Bai S; Zhang H; Li Z; Li D; Li H
[Ad] Endereço:Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China.
[Ti] Título:A 53-year-old man with a sclerosing rib lesion: A case report.
[So] Source:Medicine (Baltimore);96(47):e8692, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Sclerosing osteomyelitis of Garré is a rare condition that occurs most commonly in tubular bones and the mandible. Its nontypical symptoms, low morbidity, and insidious process make its diagnosis difficult at an early stage. In this article, we reported a case of chronic sclerosing osteomyelitis which occurred in flat bone. PATIENT CONCERNS: A 53-year-old man was diagnosed with rib sclerosing osteomyelitis of Garré who had an 8-year course of intermittent local pain and swelling, which radiated toward the left side of his chest wall. Chest computed tomography (CT) showed irregular sclerosis of the diaphysis of the 10th rib, with periosteal reaction and narrowing of the medullary cavity, and magnetic resonance imaging (MRI) showed T2 heterogeneous low-signal intensity over the 10th rib. DIAGNOSES: Based on the features of the clinical signs and radiography and biopsy of the lesion, diagnosis of rib sclerosing osteomyelitis of Garré was made. INTERVENTIONS: The patient was treated with surgical excision of a 10-cm-long lesion after failed conservative treatment. OUTCOMES: Postoperatively, the patient achieved good functional recovery at the 10-year follow-up. LESSONS: Rib sclerosing osteomyelitis of Garré is an unusual condition and represents a noninfective course in the rib with a low morbidity. The surgical management was successful in relieving the patient's symptom.
[Mh] Termos MeSH primário: Osteomielite/diagnóstico
Osteomielite/patologia
Costelas/patologia
[Mh] Termos MeSH secundário: Diáfises
Seres Humanos
Masculino
Meia-Idade
Osteomielite/cirurgia
Esclerose
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008692


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[PMID]:29201304
[Au] Autor:Ko SH; Cha JR; Lee CC; Joo YT; Eom KS
[Ad] Endereço:Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
[Ti] Título:Minimally Invasive Plate Osteosynthesis Using a Screw Compression Method for Treatment of Humeral Shaft Fractures.
[So] Source:Clin Orthop Surg;9(4):506-513, 2017 Dec.
[Is] ISSN:2005-4408
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:Background: This study aims to compare the surgical outcomes of open reduction and internal fixation (ORIF) and minimally invasive plate osteosynthesis (MIPO) using a screw compression method in simple humeral shaft fractures. Methods: This retrospective study was performed with 50 patients who had surgical interventions for the treatment of simple humeral shaft fractures and had follow-ups of at least 12 months in Ulsan University Hospital between August 2008 and June 2015. Group 1 included 23 patients treated with ORIF and group 2 included 27 patients treated with the MIPO technique using a locking screw plate. The time to clinical/radiographic union, the joint range of motion (ROM), and function were evaluated. Results: The average time to clinical/radiographic bone union was shorter in group 2 (12.0 ± 3.7 weeks/14.8 ± 2.0 weeks in group 1 and 9.4 ± 1.3 weeks/12.0 ± 3.3 weeks in group 2; = 0.022/ = 0.034). Shoulder and elbow joint function evaluated by joint ROM and visual analogue scale (VAS), Korean Shoulder Elbow Society (KSS), American Shoulder and Elbow Surgeons (ASES), and the University of California at Los Angeles (UCLA) scores was excellent in both groups. On the average shoulder ROM at 12 months after the operation, group 1 had forward elevation of 160°, external rotation of 30° in adduction and lumbar vertebra 10 level in internal rotation and group 2 had forward elevation of 170°, external rotation of 35° in adduction and lumbar vertebra 9 level in internal rotation. The mean VAS, KSS, ASES, and UCLA scores were 2.8, 87.0 ± 0.9, 89.4 ± 0.9, and 31.0 ± 1.4, respectively, in group 1 and 1.7, 89.1 ± 2.7, 91.0 ± 1.6, and 32.4 ± 3.2, respectively, in group 2. There were statistically significant intergroup differences in VAS score ( = 0.011). There were significantly less postoperative infections in group 2 (three cases, 10.7% in group 1 and 0 case in group 2; = 0.041) although all of them were superficial infections and well-treated by an average 4-week course of antibiotics (range, 2 to 6 weeks). Conclusions: MIPO using a screw compression method in simple humeral shaft fractures demonstrated superior efficacy to ORIF in terms of the time to clinical/radiographic union, pain score, and postoperative infection rate.
[Mh] Termos MeSH primário: Fixação Interna de Fraturas/métodos
Fraturas do Úmero/cirurgia
Procedimentos Cirúrgicos Minimamente Invasivos/métodos
Redução Aberta
[Mh] Termos MeSH secundário: Adulto
Idoso
Placas Ósseas
Parafusos Ósseos
Diáfises/lesões
Diáfises/cirurgia
Articulação do Cotovelo/fisiopatologia
Feminino
Fixação Interna de Fraturas/instrumentação
Consolidação da Fratura
Seres Humanos
Fraturas do Úmero/diagnóstico por imagem
Masculino
Meia-Idade
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos
Redução Aberta/efeitos adversos
Radiografia
Amplitude de Movimento Articular
Estudos Retrospectivos
Rotação
Articulação do Ombro/fisiopatologia
Infecção da Ferida Cirúrgica/etiologia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE
[do] DOI:10.4055/cios.2017.9.4.506


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[PMID]:29182134
[Au] Autor:Rajak MK; Thakur R; Choudhary A; Bhaduri I; Kumar S
[Ti] Título:Titanium elastic nailing in femoral diaphyseal fractures in children of 6-14 years age.
[So] Source:Acta Orthop Belg;82(4):883-888, 2016 Dec.
[Is] ISSN:0001-6462
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Traditionally conservative methods were used in managing paediatric femoral diaphyseal fractures. There has been a renewed interest for operative treatment with Titanium elastic nail system (TENS) in the age group of 6-14 years. MATERIALS AND METHODS: This prospective study was done on 20 patients. Two titanium nails were used for stabilization. We followed them for maximum of two years. The results were evaluated using Flynn's scoring criteria. RESULTS: In our study we had fifteen males and five females with average age 10.35 years. Average time for fracture union was 9.0 weeks, full weight bearing 9.2 weeks, hospital stay 8.6 days and return to school at 10 weeks. The results were excellent in 14, good in 5 and poor in 1 patient. Most common complication was irritation at nail entry site. No delayed union or nonunion seen. CONCLUSION: Treatment of diaphyseal femoral fracture in selected pediatric patients by TENS is reasonably effective.
[Mh] Termos MeSH primário: Pinos Ortopédicos
Fraturas do Fêmur/cirurgia
Fixação Interna de Fraturas/métodos
Titânio
[Mh] Termos MeSH secundário: Adolescente
Criança
Diáfises/lesões
Diáfises/cirurgia
Feminino
Fraturas do Fêmur/diagnóstico por imagem
Seguimentos
Consolidação da Fratura
Seres Humanos
Masculino
Estudos Prospectivos
Radiografia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
D1JT611TNE (Titanium)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171228
[Lr] Data última revisão:
171228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:29182132
[Au] Autor:Kailis V; Hariga H; Docquier PL
[Ti] Título:Prevention of re-fractures of both bones of the forearm in children.
[So] Source:Acta Orthop Belg;82(4):872-875, 2016 Dec.
[Is] ISSN:0001-6462
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The aim of this study was to observe if the re-fracture rate after forearm both bones was decreased by protecting the forearm with a preventive brace for 6 months following the fracture and by ceasing all physical activities. METHODS: We performed a retrospective study in 75 consecutive cases of diaphyseal fracture of both bone of forearms, in 52 boys and 23 girls aged from 6 months to 11 years. It concerned a first episode of fracture in 84% of cases and a re-fracture in 17%. RESULTS: Re-fracture rate was 0% in the group where a protective brace was worn while it was 20% in the group without brace. CONCLUSIONS: Both the wearing of a protective brace and absence of sport for 6 months may decrease the re-fracture rate to 0%, if the patient is compliant by wearing it and by ceasing all physical activities.
[Mh] Termos MeSH primário: Braquetes
Fraturas do Rádio/prevenção & controle
Volta ao Esporte
Prevenção Secundária/métodos
Fraturas da Ulna/prevenção & controle
[Mh] Termos MeSH secundário: Moldes Cirúrgicos
Criança
Pré-Escolar
Redução Fechada/métodos
Diáfises/lesões
Diáfises/cirurgia
Feminino
Traumatismos do Antebraço/diagnóstico por imagem
Traumatismos do Antebraço/prevenção & controle
Traumatismos do Antebraço/cirurgia
Seres Humanos
Imobilização/métodos
Lactente
Masculino
Fraturas do Rádio/complicações
Fraturas do Rádio/diagnóstico por imagem
Fraturas do Rádio/cirurgia
Recidiva
Estudos Retrospectivos
Fraturas da Ulna/complicações
Fraturas da Ulna/diagnóstico por imagem
Fraturas da Ulna/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171228
[Lr] Data última revisão:
171228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:29182129
[Au] Autor:Alhefzi A; Alshammari D; Bund L; Schneider L; Gicquel P
[Ti] Título:Anatomical and functional evaluation of diaphyseal femoral fractures in children under 6 years old.
[So] Source:Acta Orthop Belg;82(4):854-860, 2016 Dec.
[Is] ISSN:0001-6462
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:Objective : The aim of this study is to evaluate both the anatomical and functional consequences of our treatment protocol of diaphyseal femoral fractures in children under 6 years old Methods : We conducted a retrospective analysis of a series containing 50 children in Strasbourg University Hospital whom had traumatic diaphyseal femoral fractures and underwent conservative treatment by traction followed by casting with a mean follow-up period of 25 months. Results : All fractures healed without complications i.e. gait disorders, back pain and limitation of activity. Results showed a significant correlation between the initial varus angulation and shortening which could influence the final remodeling result within the first 24 months. Using the Receiver Operating Characteristic curve, we developed the Initial Displacement Index on Traction (IDIT) which is the sum of both the initial varus in degrees and the initial shortening in millimeters. Conclusion : The treatment by initial traction followed by a cast for childrens ≤ 6 years old gives clinical and radiological results comparable with those reported for immediate casting method. The hospitalization period is longer in the traction method but with less exposure to general anesthesia (GA) and risks of secondary displacements.
[Mh] Termos MeSH primário: Redução Fechada
Diáfises/lesões
Fraturas do Fêmur/cirurgia
Fraturas Ósseas/cirurgia
Fraturas Cominutivas/cirurgia
Tração
[Mh] Termos MeSH secundário: Acidentes por Quedas
Remodelação Óssea
Moldes Cirúrgicos
Pré-Escolar
Feminino
Consolidação da Fratura
Seres Humanos
Lactente
Masculino
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171228
[Lr] Data última revisão:
171228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:28793321
[Au] Autor:Allen MR; McNerny E; Aref M; Organ JM; Newman CL; McGowan B; Jang T; Burr DB; Brown DM; Hammond M; Territo PR; Lin C; Persohn S; Jiang L; Riley AA; McCarthy BP; Hutchins GD; Wallace JM
[Ad] Endereço:Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
[Ti] Título:Effects of combination treatment with alendronate and raloxifene on skeletal properties in a beagle dog model.
[So] Source:PLoS One;12(8):e0181750, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A growing number of studies have investigated combination treatment as an approach to treat bone disease. The goal of this study was to investigate the combination of alendronate and raloxifene with a particular focus on mechanical properties. To achieve this goal we utilized a large animal model, the beagle dog, used previously by our laboratory to study both alendronate and raloxifene monotherapies. Forty-eight skeletally mature female beagles (1-2 years old) received daily oral treatment: saline vehicle (VEH), alendronate (ALN), raloxifene (RAL) or both ALN and RAL. After 6 and 12 months of treatment, all animals underwent assessment of bone material properties using in vivo reference point indentation (RPI) and skeletal hydration using ultra-short echo magnetic resonance imaging (UTE-MRI). End point measures include imaging, histomorphometry, and mechanical properties. Bone formation rate was significantly lower in iliac crest trabecular bone of animals treated with ALN (-71%) and ALN+RAL (-81%) compared to VEH. In vivo assessment of properties by RPI yielded minimal differences between groups while UTE-MRI showed a RAL and RAL+ALN treatment regimens resulted in significantly higher bound water compared to VEH (+23 and +18%, respectively). There was no significant difference among groups for DXA- or CT-based measures lumbar vertebra, or femoral diaphysis. Ribs of RAL-treated animals were smaller and less dense compared to VEH and although mechanical properties were lower the material-level properties were equivalent to normal. In conclusion, we present a suite of data in a beagle dog model treated for one year with clinically-relevant doses of alendronate and raloxifene monotherapies or combination treatment with both agents. Despite the expected effects on bone remodeling, our study did not find the expected benefit of ALN to BMD or structural mechanical properties, and thus the viability of the combination therapy remains unclear.
[Mh] Termos MeSH primário: Alendronato/farmacologia
Conservadores da Densidade Óssea/farmacologia
Densidade Óssea/efeitos dos fármacos
Diáfises/fisiologia
Fêmur/fisiologia
Vértebras Lombares/fisiologia
Cloridrato de Raloxifeno/farmacologia
[Mh] Termos MeSH secundário: Alendronato/efeitos adversos
Animais
Remodelação Óssea/efeitos dos fármacos
Diáfises/efeitos dos fármacos
Cães
Quimioterapia Combinada/efeitos adversos
Feminino
Fêmur/efeitos dos fármacos
Vértebras Lombares/efeitos dos fármacos
Imagem por Ressonância Magnética
Modelos Animais
Osteoporose/tratamento farmacológico
Cloridrato de Raloxifeno/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Bone Density Conservation Agents); 4F86W47BR6 (Raloxifene Hydrochloride); X1J18R4W8P (Alendronate)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170810
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0181750


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[PMID]:28663406
[Au] Autor:Gupta S; Kafchinski LA; Gundle KR; Saidi K; Griffin AM; Wunder JS; Ferguson PC
[Ad] Endereço:Glasgow Royal Infirmary, 84 Castle St, Glasgow G4 0SF, UK.
[Ti] Título:Intercalary allograft augmented with intramedullary cement and plate fixation is a reliable solution after resection of a diaphyseal tumour.
[So] Source:Bone Joint J;99-B(7):973-978, 2017 Jul.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: Intercalary allografts following resection of a primary diaphyseal tumour have high rates of complications and failures. At our institution intercalary allografts are augmented with intramedullary cement and fixed using compression plating. Our aim was to evaluate their long-term outcomes. PATIENTS AND METHODS: A total of 46 patients underwent reconstruction with an intercalary allograft between 1989 and 2014. The patients had a mean age of 32.8 years (14 to 77). The most common diagnoses were osteosarcoma (n = 16) and chondrosarcoma (n = 9). The location of the tumours was in the femur in 21, the tibia in 16 and the humerus in nine. Function was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system and the Toronto Extremity Salvage Score (TESS). The survival of the graft and the overall survival were assessed using the Kaplan-Meier method. RESULTS: The median follow-up was 92 months (4 to 288). The mean MSTS 87 score was 29.1 (19 to 35), the mean MSTS 93 score was 82.2 (50 to 100) and the mean TESS score was 81.2 (43 to 100). Overall survival of the allograft was 84.8%. A total of 15 patients (33%) had a complication. Five allografts were revised for complications and one for local recurrence. CONCLUSION: Intercalary allografts augmented with intramedullary cement and compression plate fixation provide a reliable and durable method of reconstruction after the excision of a primary diaphyseal bone tumour, with high levels of function and satisfaction. Cite this article: 2017;99-B:973-8.
[Mh] Termos MeSH primário: Neoplasias Ósseas/cirurgia
Condrossarcoma/cirurgia
Neoplasias Femorais/cirurgia
Úmero/cirurgia
Osteossarcoma/cirurgia
Procedimentos Cirúrgicos Reconstrutivos/métodos
Tíbia/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Aloenxertos
Cimentos para Ossos
Neoplasias Ósseas/tratamento farmacológico
Placas Ósseas
Condrossarcoma/tratamento farmacológico
Terapia Combinada
Diáfises
Feminino
Neoplasias Femorais/tratamento farmacológico
Seres Humanos
Masculino
Meia-Idade
Osteossarcoma/tratamento farmacológico
Estudos Prospectivos
Taxa de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Bone Cements)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170701
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.99B7.BJJ-2016-0996


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[PMID]:28651860
[Au] Autor:Simcox LE; Myers JE; Cole TJ; Johnstone ED
[Ad] Endereço:Maternal and Fetal Health Research Center, Institute of Human Development, University of Manchester, Manchester, United Kingdom; St Mary's Hospital, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Center, Manchester, United Kingdom
[Ti] Título:Fractional fetal thigh volume in the prediction of normal and abnormal fetal growth during the third trimester of pregnancy.
[So] Source:Am J Obstet Gynecol;217(4):453.e1-453.e12, 2017 Oct.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Currently, 2-dimensional ultrasound estimation of fetal size rather than fetal growth is used to define fetal growth restriction, but single estimates in late pregnancy lack sensitivity and may identify small for gestational age rather than growth restriction. Single or longitudinal measures of 3-dimensional fractional thigh volume may address this problem. OBJECTIVE: We sought to derive normal values for 3-dimensional fractional thigh volume in the third trimester, determine if fractional thigh volume is superior to 2-dimensional ultrasound biometry alone for detecting fetal growth restriction, and determine whether individualized growth assessment parameters have the potential to identify fetal growth restriction remote from term delivery. STUDY DESIGN: This was a longitudinal prospective cohort study of 115 unselected pregnancies in a tertiary referral unit (St Mary's Hospital, Manchester, United Kingdom). Standard 2-dimensional ultrasound biometry measurements were obtained, along with fractional thigh volume measurements (based on 50% of the femoral diaphysis length). Measurements were used to calculate estimated fetal weight (Hadlock). Individualized growth assessment parameters and percentage deviations in longitudinally measured biometrics were determined using a Web-based system (iGAP; http://iGAP. RESEARCH: bcm.edu). Small for gestational age was defined <10th and fetal growth restriction <3rd customized birthweight centile. Logistic regression was used to compare estimated fetal weight (Hadlock), estimated fetal weight (biparietal diameter-abdominal circumference-fractional thigh volume), fractional thigh volume, and abdominal circumference for the prediction of small for gestational age or fetal growth restriction at birth. Screening performance was assessed using area under the receiver operating characteristic curve. RESULTS: There was a better correlation between fractional thigh volume and estimated fetal weight ((biparietal diameter-abdominal circumference-fractional thigh volume) obtained at 34-36 weeks with birthweight than between 2-dimensional biometry measures such as abdominal circumference and estimated fetal weight (Hadlock). There was also a modest improvement in the detection of both small for gestational age and fetal growth restriction using fractional thigh volume-derived measures compared to standard 2-dimensional measurements (area under receiver operating characteristic curve, 0.86; 95% confidence interval, 0.79-0.94, and area under receiver operating characteristic curve, 0.92; 95% confidence interval, 0.85-0.99, respectively). CONCLUSION: Fractional thigh volume measurements offer some improvement over 2-dimensional biometry for the detection of late-onset fetal growth restriction at 34-36 weeks.
[Mh] Termos MeSH primário: Diáfises/diagnóstico por imagem
Fêmur/diagnóstico por imagem
Retardo do Crescimento Fetal/diagnóstico
Imagem Tridimensional
Ultrassonografia Pré-Natal
[Mh] Termos MeSH secundário: Estudos de Coortes
Diáfises/crescimento & desenvolvimento
Feminino
Fêmur/crescimento & desenvolvimento
Peso Fetal
Idade Gestacional
Seres Humanos
Recém-Nascido
Recém-Nascido Pequeno para a Idade Gestacional
Modelos Logísticos
Estudos Longitudinais
Gravidez
Terceiro Trimestre da Gravidez
Circunferência da Cintura
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170628
[St] Status:MEDLINE


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[PMID]:28374715
[Au] Autor:Kozlov VK; Akhmedov BG; Chililov AM
[Ad] Endereço:Mechnikov Northwest State Medical University, Saint-Petersburg, Russia; Saint-Petersburg State University; Yaroslav Mudryi Novgorod State University, Velikiy Novgorod, Russia.
[Ti] Título:[Clinical experience with various techniques integrated treat the wounded with gunshot fractures of limbs].
[Ti] Título:Klinicheskii opyt primeneniya razlichnykh metodik kompleksnogo lecheniya ranenykh s ognestrel'nymi perelomami kostei konechnostei..
[So] Source:Khirurgiia (Mosk);(3):61-69, 2017.
[Is] ISSN:0023-1207
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:AIM: To increase an efficiency of complex treatment of patients with diaphyseal gunshot fractures of long bones by introduction of modern minimally invasive surgical techniques of internal osteosynthesis into clinical practice of civil health care and to improve the outcomes in victims. MATERIAL AND METHODS: Prospective comparative clinical trial included 104 victims from the Republic of Yemen with gunshot wounds of limbs of various severity for the period 2009-2011. There were diaphyseal fractures of long bones of limbs associated with soft tissue injuries. Men were predominant (80.7%). Age ranged from 15 to 80 years (mean 38,5 ± 5,7 years). Various surgical techniques of simultaneous and staged treatment were used for gunshot fractures of long bones of limbs. Additional immune therapy was prescribed to prevent infectious complications in the most severe cases. RESULTS AND DISCUSSION: Victims were comprehensively treated according to different staged treatment: conventional surgical treatment with external fixation devices or early primary minimally invasive functionally stable osteosynthesis with LCP/BIOS plates were applied for low-energy fractures; in case of high-energy fractures the first stage included external fixation devices deployment followed by their subsequent replacement during delayed minimally invasive osteosynthesis. The essence of improvement is pursuit to simultaneous minimally invasive surgery by using of current plates for osteosynthesis and preventive immunotherapy of immune dysfunction to eliminate infectious complications. As a result, we obtained 2-fold decrease of surgical invasiveness (r≤0,01) and hospital-stay (r≤0,01). Repeated osteosynthesis was not made. Also 4-fold and 40-fold reduction of infectious and noninfectious complications was observed. This management was accompanied by reduced rehabilitation tine and significantly improved quality of life. CONCLUSION: Improved technique and algorithm of complex treatment of diaphyseal gunshot fractures of long bones of limbs were described. Early minimally invasive functionally stable osteosynthesis with modern implants and non-specific immune prevention of infectious complications are more effective and economically justified compared with conventional treatment including external fixation devices without immunoactive therapy.
[Mh] Termos MeSH primário: Diáfises
Extremidades
Fixação Intramedular de Fraturas
Fraturas Ósseas
Imunomodulação/imunologia
Infecção da Ferida Cirúrgica
Ferimentos por Arma de Fogo/complicações
[Mh] Termos MeSH secundário: Adulto
Terapia Combinada/métodos
Diáfises/diagnóstico por imagem
Diáfises/lesões
Diáfises/cirurgia
Extremidades/diagnóstico por imagem
Extremidades/lesões
Extremidades/cirurgia
Feminino
Fixação Intramedular de Fraturas/efeitos adversos
Fixação Intramedular de Fraturas/instrumentação
Fixação Intramedular de Fraturas/métodos
Fraturas Ósseas/diagnóstico
Fraturas Ósseas/etiologia
Fraturas Ósseas/terapia
Seres Humanos
Masculino
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos
Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação
Procedimentos Cirúrgicos Minimamente Invasivos/métodos
Infecção da Ferida Cirúrgica/imunologia
Infecção da Ferida Cirúrgica/prevenção & controle
Resultado do Tratamento
Iêmen
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170724
[Lr] Data última revisão:
170724
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE
[do] DOI:10.17116/hirurgia2017361-69


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[PMID]:28291432
[Au] Autor:Baki ME; Aldemir C; Duygun F; Dogan A; Kerimoglu G
[Ad] Endereço:Department of Orthopedics and Traumatology, Medical Faculty of Karadeniz Technical University, 61080 Trabzon Turkey. bakiemre61@yahoo.com.
[Ti] Título:Comparison of non-compression and compression interlocking intramedullary nailing in rabbit femoral shaft osteotomy model.
[So] Source:Eklem Hastalik Cerrahisi;28(1):7-12, 2017 Apr.
[Is] ISSN:1309-0313
[Cp] País de publicação:Turkey
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: This study aims to compare non-compression and compression intramedullary nailing in an experimental femoral shaft osteotomy model in terms of radiological, histological, and biomechanical aspects. MATERIALS AND METHODS: Twenty-four white New Zealand rabbits (average weight 4.3 kg; range 4 to 4.8 kg) were divided into three groups. A right femoral osteotomy was performed in all rabbits and all femurs were fixed with titanium compression interlocking intramedullary nail. After locking of nails, no compression was performed in group 1 while 0.5 mm and 1 mm compressions were performed in group 2 and 3, respectively. All rabbits were sacrificed four weeks after operation. Fracture sites were examined histologically and radiologically. Finite element analyses were performed. RESULTS: Radiological scores of groups 2 and 3 were significantly higher than group 1. There was no significant difference between groups 2 and 3 radiologically. Best histological scores were achieved in group 2. According to finite element analyses, osteotomy site in group 2 was exposed to 1240 N of load and 34.5 MPa of mean stress. CONCLUSION: Compression interlocking intramedullary nailing provides faster fracture healing than non-compression interlocking intramedullary nailing. Best histological fracture healing scores were obtained with 0.5 mm compression performed at the fracture site.
[Mh] Termos MeSH primário: Pinos Ortopédicos
Fraturas do Fêmur/cirurgia
Fêmur/cirurgia
Fixação Intramedular de Fraturas/métodos
Consolidação da Fratura
[Mh] Termos MeSH secundário: Animais
Diáfises
Fraturas do Fêmur/diagnóstico por imagem
Fêmur/diagnóstico por imagem
Fêmur/lesões
Fixação Intramedular de Fraturas/instrumentação
Osteotomia
Coelhos
Radiografia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170315
[St] Status:MEDLINE



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