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  1 / 19453 MEDLINE  
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[PMID]:29411033
[Au] Autor:Baiu I; Melendez E
[Ti] Título:Nursemaid's Elbow (Elbow Subluxation).
[So] Source:JAMA;319(5):515, 2018 02 06.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Articulação do Cotovelo/lesões
Luxações Articulares
[Mh] Termos MeSH secundário: Pré-Escolar
Seres Humanos
Lactente
Luxações Articulares/etiologia
Luxações Articulares/prevenção & controle
Luxações Articulares/terapia
[Pt] Tipo de publicação:PATIENT EDUCATION HANDOUT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180208
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.22031


  2 / 19453 MEDLINE  
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[PMID]:29369191
[Au] Autor:Tang G; Zhang Y; Liu Y; Qin X; Hu J; Li X
[Ad] Endereço:Department of Orthopedics.
[Ti] Título:Comparison of surgical and conservative treatment of Rockwood type-III acromioclavicular dislocation: A meta-analysis.
[So] Source:Medicine (Baltimore);97(4):e9690, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There is no consensus on the effects of surgical versus conservative treatment on Rockwood type-III dislocation of the acromioclavicular joint in general orthopedic practice. The objective of this meta-analysis was to compare the clinical outcomes of patients managed surgically and conservatively following type-III acromioclavicular (AC) dislocation. METHODS: The Cochrane Library, EMBASE, MEDLINE via Ovid SP, and PubMed databases were searched for randomized controlled trials and observational studies. Patient data were pooled using standard meta-analytic approaches. For continuous variables, the weighted mean difference was used. For dichotomous data, the odds ratio was calculated. RESULTS: The current analysis included 10 trials on this topic, and the results demonstrated that there were no significant differences between surgical and conservative treatment in terms of pain, weakness, tenderness, post-traumatic arthritis, restriction of strength, unsatisfactory function, and scores (Constant, UCLA, Imatani, SST, DASH, Larsen). Analyses of ossification of the coracoclavicular ligament (OR = 1.62, 95% CI = 1.01-2.61) and osteolysis of the lateral clavicle (OR = 2.87, 95% CI = 1.27-6.52) suggested better function with conservative treatment versus surgical treatment, but the latter was superior to conservative treatment with regard to loss of anatomic reduction. Only 1 study showed a higher acromioclavicular joint instability score for surgical management compared with conservative management (P < .00001). CONCLUSION: In the management of Rockwood type-III AC dislocation, conservative treatment is superior to surgical treatment. Nonoperative treatment results in a lower incidence of ossification of the coracoclavicular ligament and osteolysis of the lateral clavicle compared with operative treatment. However, there was no statistical difference between operative and nonoperative treatment in terms of clinical outcomes.
[Mh] Termos MeSH primário: Articulação Acromioclavicular/lesões
Tratamento Conservador/métodos
Luxações Articulares/terapia
Procedimentos Ortopédicos/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Feminino
Seres Humanos
Masculino
Meia-Idade
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; 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.0000000000009690


  3 / 19453 MEDLINE  
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[PMID]:29201306
[Au] Autor:Kim HT; Can LV; Ahn TY; Kim IH
[Ad] Endereço:Department of Orthopaedic Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
[Ti] Título:Analysis of Radiographic Parameters of the Forearm in Traumatic Radial Head Dislocation.
[So] Source:Clin Orthop Surg;9(4):521-528, 2017 Dec.
[Is] ISSN:2005-4408
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:Background: Various deformities can occur in the forearm bones when the traumatically dislocated radial head is untreated for a long period. Without correction of all deformities, reduction of the dislocated radial head is difficult to maintain, and forearm and elbow motion will deteriorate after reduction. We evaluated radiographic parameters of forearms with traumatically dislocated radial heads (and of the normal sides) to understand the resulting deformities and the effectiveness of surgical treatment. Methods: We analyzed pre- and postoperative anteroposterior and lateral radiographs of 22 forearms (22 patients) with traumatic radial head dislocation. We divided the forearm into three equal parts and measured various morphological parameters. All patients underwent surgical treatment and evaluation of radial head reduction and range of motion pre- and postoperatively. Results: Before treatment, the middle of the ulna was significantly different from the unaffected side in both anteroposterior and lateral views. After surgery, the proximal ulna was significantly different from the unaffected side and the abnormal proximal radial neck angle persisted. The radial head was successfully reduced in 20 of 22 cases. Overall, the mean range of motion decreased after surgery, except for increased flexion-extension. Conclusions: Complicated deformities developing during long-term remodeling after injury indicate that stable reduction is difficult to achieve with conventional one-bone osteotomy. Even after successful reduction, secondary deformity in the proximal ulna and/or remaining deformity in the proximal radius can hinder forearm rotation.
[Mh] Termos MeSH primário: Articulação do Cotovelo/diagnóstico por imagem
Articulação do Cotovelo/lesões
Deformidades Articulares Adquiridas/diagnóstico por imagem
Luxações Articulares/diagnóstico por imagem
Rádio (Anatomia)/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Articulação do Cotovelo/fisiopatologia
Feminino
Antebraço/fisiopatologia
Seres Humanos
Deformidades Articulares Adquiridas/etiologia
Deformidades Articulares Adquiridas/fisiopatologia
Deformidades Articulares Adquiridas/cirurgia
Luxações Articulares/complicações
Luxações Articulares/cirurgia
Masculino
Período Pós-Operatório
Período Pré-Operatório
Pronação
Radiografia
Rádio (Anatomia)/cirurgia
Amplitude de Movimento Articular
Estudos Retrospectivos
Supinação
Ulna/diagnóstico por imagem
[Pt] Tipo de publicação: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.2017.9.4.521


  4 / 19453 MEDLINE  
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[PMID]:29305449
[Au] Autor:Walker T; Zahn N; Bruckner T; Streit MR; Mohr G; Aldinger PR; Clarius M; Gotterbarm T
[Ad] Endereço:University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
[Ti] Título:Mid-term results of lateral unicondylar mobile bearing knee arthroplasty: a multicentre study of 363 cases.
[So] Source:Bone Joint J;100-B(1):42-49, 2018 Jan.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: The aim of this independent multicentre study was to assess the mid-term results of mobile bearing unicondylar knee arthroplasty (UKA) for isolated lateral osteoarthritis of the knee joint. PATIENTS AND METHODS: We retrospectively evaluated 363 consecutive, lateral UKAs (346 patients) performed using the Oxford domed lateral prosthesis undertaken in three high-volume knee arthroplasty centres between 2006 and 2014. Mean age of the patients at surgery was 65 years (36 to 88) with a mean final follow-up of 37 months (12 to 93) RESULTS: A total of 36 (10.5%) patients underwent revision surgery, giving a survival rate of 90.1% at three years (95% confidence intervals (CI) 86.1 to 93.1; number at risk: 155) and 85.0% at five years (95% CI 77.9 to 89.9; number at risk: 43). Dislocation of the mobile bearing occurred in 18 patients (5.6%) at three years (95% CI 1.0 to 16.4; number at risk: 154) and in 20 patients (8.5%) at five years (95% CI 1.0 to 27.0; number at risk: 42). There were no significant differences in the dislocation rate between the participating centres or the surgeons. We were not able to identify an effect of each surgeon's learning curve on the dislocation rate of the mobile bearing. The clinical outcome in patients without revision surgery at final follow-up was good to excellent, with a mean Oxford knee score of 40.3 (95% CI 39.4 to 41.2), a mean Tegner activity score of 3.2 (95% CI 3.1 to 3.3) and a mean University of California, Los Angeles score of 5.7 (95% CI 5.5 to 5.9). CONCLUSION: Our data, which consists of a high number of patients treated with mobile bearing UKA in the lateral compartment, indicates a high revision rate of 15% at five years with dislocation of the mobile bearing being the main reason for implant failure. Despite the good functional and clinical results and the high patient satisfaction in our study group, we therefore discontinued using mobile-bearing lateral UKA in favour of a fixed-bearing component. Cite this article: 2018;100-B:42-9.
[Mh] Termos MeSH primário: Artroplastia do Joelho/instrumentação
Prótese do Joelho
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Artroplastia do Joelho/efeitos adversos
Artroplastia do Joelho/métodos
Feminino
Seguimentos
Seres Humanos
Luxações Articulares/etiologia
Luxações Articulares/cirurgia
Estimativa de Kaplan-Meier
Articulação do Joelho
Masculino
Meia-Idade
Osteoartrite do Joelho/cirurgia
Desenho de Prótese
Falha de Prótese/etiologia
Reoperação/estatística & dados numéricos
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180107
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B1.BJJ-2017-0600.R1


  5 / 19453 MEDLINE  
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[PMID]:29310380
[Au] Autor:Park JB; Kang SS; Yeom JS
[Ad] Endereço:Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu.
[Ti] Título:Traumatic C1-2 posterolateral dislocation with dens fracture, injury of the transverse atlantal ligament, and unilateral facet fracture with subluxation of C6-7: A case report.
[So] Source:Medicine (Baltimore);96(48):e8913, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Traumatic C1-2 dislocation associated with contiguous or noncontiguous cervical spine injury is rare. Moreover, there have been no reports describing traumatic C1-2 dislocation associated with multiple contiguous and noncontiguous cervical injuries. PATIENT CONCERNS: The authors present a case of a 20-year-old male with painful limitation of motion of the neck. This complex cervical injury occurred due to hyperextension of the head in a rotated position. The patient complained of neck pain that radiated to the left shoulder and arm, but he did not exhibit any neurological abnormalities. DIAGNOSES: The diagnosis of the patients was traumatic C1-2 posterolateral dislocation associated with type II dens fracture (Anderson and D'Alonzo classification), type II injury of the transverse atlantal ligament (Dickman classification), and unilateral facet fracture with subluxation of C6-7. INTERVENTIONS: The C1-2 posterolateral dislocation with type II dens fracture was successfully reduced by skull traction. The patient underwent anterior discectomy, open reduction, and fusion with plate fixation of C6-7 followed by posterior segmental fixation and fusion of C1-2. OUTCOMES: At his postoperative 1-year follow-up, solid fusion was noted with improvement of clinical symptoms. This is the first report of traumatic C1-2 posterolateral dislocation associated with multiple C2 injuries and noncontiguous subaxial cervical injury. LESSONS: A high index of suspicion and careful evaluation of entire cervical spine should be considered as the key to the proper diagnosis and treatment of traumatic C1-2 dislocation associated with contiguous and noncontiguous cervical injuries.
[Mh] Termos MeSH primário: Articulação Atlantoaxial/lesões
Vértebras Cervicais/lesões
Luxações Articulares/diagnóstico
Luxações Articulares/terapia
Ligamentos Articulares/lesões
Fraturas da Coluna Vertebral/diagnóstico
Fraturas da Coluna Vertebral/terapia
[Mh] Termos MeSH secundário: Seres Humanos
Masculino
Fusão Vertebral/métodos
Tração
Adulto Jovem
[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.0000000000008913


  6 / 19453 MEDLINE  
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[PMID]:29310333
[Au] Autor:Lu X; Yan G; Lu M; Guo Y
[Ti] Título:Epidemiologic features and management of elbow dislocation with associated fracture in pediatric population.
[So] Source:Medicine (Baltimore);96(48):e8595, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study was conducted to explore epidemiologic features of traumatic elbow dislocation with associated fractures in pediatric population following appropriate treatment options.Incidence of elbow dislocation with associated fractures was analyzed in 67 children using elbow radiographs. Treatment for the displaced elbow joint was performed by closed reduction and proper immobilization. Surgical intervention was applied to restore the correct alignment of the fracture. Mayo Elbow Performance Score (MEPS) was used to measure elbow joint function.Incidence of pure dislocation was observed in 7 of 67 children (10.45%). Elbow dislocation was typically accompanied by a single or multiple fractures in 39 (58.21%) and 21 (31.34%) of 67 children, respectively. In contrast, lateral humeral condyle fracture and medial humeral epicondyle fracture accounted for 35.90% and 30.77% of pediatric elbow fractures. All children with elbow fracture-dislocations received surgical intervention by open reduction and internal fixation. During follow-up, 56% to 92% of children displayed significant recovery of elbow function with improving MEPS after the displaced elbow and fractured fragments were reduced and held in place for weeks. There were statistical differences in MEPS between the types of fractures (P < .05 or P < .01).Incidence of isolated elbow dislocation without fracture is low; rather, it is frequently associated with fractures. Early surgical intervention achieves stable fixation and bony union with utility in improving elbow function in the pediatric population.
[Mh] Termos MeSH primário: Articulação do Cotovelo/cirurgia
Fixação Interna de Fraturas/métodos
Fraturas do Úmero/cirurgia
Luxações Articulares/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
China/epidemiologia
Articulação do Cotovelo/diagnóstico por imagem
Feminino
Seres Humanos
Fraturas do Úmero/diagnóstico por imagem
Fraturas do Úmero/epidemiologia
Luxações Articulares/diagnóstico por imagem
Luxações Articulares/epidemiologia
Masculino
Amplitude de Movimento Articular
Resultado do Tratamento
[Pt] Tipo de publicação: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.0000000000008595


  7 / 19453 MEDLINE  
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[PMID]:29182141
[Au] Autor:Kovari VZ; Vajda J; Veres R
[Ti] Título:360° fixation with modern instrumentations of segment separation cervical spine injury in a 23-month-old.
[So] Source:Acta Orthop Belg;82(4):923-929, 2016 Dec.
[Is] ISSN:0001-6462
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:In this case report clinical and technical lessons including seven years follow up learned from a flexion-distraction, highly unstable cervical spine injury causing a complete separation of C6-7 cervical segment with tetraparesis in a 23-month-old boy, are presented. To our knowledge this is the only documented case in medical literature where adult size implants (cage, plate and lateral mass screw-rod system) were utilized for cervical combined anterior and posterior internal fixation in a child under the age of two years without implant-size related problems. Seven years after the injury the child attends elementary school, can operate a wheelchair manually, and can eat and write. Computed tomography control showed no failure of the hardware and fusion was later observed in the intervertebral space of the stabilized cervical segment, however adjacent segment syndrome occurred without deterioration of the patient's status. The decision on the mode of realignment and fixation to be made in such a case was difficult because there is no standard procedure for infants.
[Mh] Termos MeSH primário: Vértebras Cervicais/cirurgia
Fixação Interna de Fraturas/métodos
Luxações Articulares/cirurgia
Quadriplegia/etiologia
Traumatismos da Medula Espinal/complicações
[Mh] Termos MeSH secundário: Acidentes de Trânsito
Vértebras Cervicais/diagnóstico por imagem
Vértebras Cervicais/lesões
Seguimentos
Seres Humanos
Lactente
Luxações Articulares/complicações
Luxações Articulares/diagnóstico por imagem
Masculino
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; 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


  8 / 19453 MEDLINE  
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[PMID]:28958361
[Au] Autor:Stinner DJ; Edwards D
[Ad] Endereço:Royal School of Mines, Centre for Blast Injury Studies, Imperial College London, Prince Consort Road, Kensington, London SW7 2BP, UK; US Army Institute of Surgical Research, San Antonio, TX, USA. Electronic address: Daniel.stinner@gmail.com.
[Ti] Título:Surgical Management of Musculoskeletal Trauma.
[So] Source:Surg Clin North Am;97(5):1119-1131, 2017 Oct.
[Is] ISSN:1558-3171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Musculoskeletal injuries cause a significant burden to society and can have a considerable impact on patient morbidity and mortality. It was initially thought that these patients were too sick to undergo surgery and later believed that they were too sick not to undergo surgery. The pendulum has subsequently swung back and forth between damage control orthopedics and early total care for polytrauma patients with extremity injuries and has settled on providing early appropriate care (EAC). The decision-making process in providing EAC is reviewed in an effort to optimize patient outcomes following severe extremity trauma.
[Mh] Termos MeSH primário: Sistema Musculoesquelético/lesões
Procedimentos Ortopédicos
Ferimentos e Lesões/terapia
[Mh] Termos MeSH secundário: Cuidados de Suporte Avançado de Vida no Trauma
Fraturas Ósseas/cirurgia
Custos de Cuidados de Saúde
Seres Humanos
Luxações Articulares/terapia
Lesões do Sistema Vascular/cirurgia
Ferimentos e Lesões/economia
Ferimentos e Lesões/mortalidade
Ferimentos e Lesões/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170930
[St] Status:MEDLINE


  9 / 19453 MEDLINE  
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[PMID]:28957380
[Au] Autor:Nagaoka T; Uzawa K; Seki Y; Morales Chocano D
[Ad] Endereço:Department of Anatomy, St. Marianna University School of Medicine, Kawasaki, Japan.
[Ti] Título:Pacopampa: Early evidence of violence at a ceremonial site in the northern Peruvian highlands.
[So] Source:PLoS One;12(9):e0185421, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Pacopampa, a ceremonial complex in Peru's northern highlands, reveals early evidence of trauma in the Middle to Late Formative Period coinciding with the emergence of social stratification in the area. We examine the prevalence of trauma in human remains found at the site and present evidence of the circumstances surrounding the deaths of individuals who lived during the early stages of Andean civilization. MATERIALS AND METHODS: The materials are the remains of 104 individuals (38 non-adult and 66 adult) from the Middle to Late Formative Periods. We explored trauma macroscopically and recorded patterns based on skeletons' locations, age at death, sex, social class, and chronology. RESULTS: We detected trauma in remains over the Middle to Late Formative Periods. While the prevalence of trauma was minimal in the Middle Formative Period, skeletons from the subsequent era exhibit more severe disturbances. However, all the skeletons show signs of healing and affected individuals experienced a low degree of trauma. DISCUSSION: Given the archaeological context (the remains were recovered from sites of ceremonial practices), as well as the equal distribution of trauma among both sexes and a lack of defensive architecture, it is plausible that rituals, rather than organized warfare or raids, caused most of the exhibited trauma. Pacopampa was home to a complex society founded on ritual activity in a ceremonial center: this is indicated by the presence of ritual violence in a society that built impressively large, ceremonial architecture and developed social stratification without any political control of surplus agricultural goods.
[Mh] Termos MeSH primário: Comportamento Ritualístico
Ecossistema
Violência
[Mh] Termos MeSH secundário: Adolescente
Adulto
Articulação do Cotovelo/patologia
Extremidades/patologia
Face/patologia
Feminino
Geografia
Seres Humanos
Luxações Articulares/patologia
Masculino
Meia-Idade
Peru
Fraturas Cranianas/patologia
Ferimentos e Lesões/patologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170929
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185421


  10 / 19453 MEDLINE  
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[PMID]:28904653
[Au] Autor:Nkaoui M; Boufettal M; Sasbou Y; Kharmaz M; El Ouadaghiri M; Lamrani MO; El Bardouni A; Mahfoud M; Berrada MS
[Ad] Endereço:Service de Chirurgie Orthopédique et de Traumatologie, CHU Ibn Sina, Université Mohammad V Souissi Rabat, Maroc.
[Ti] Título:[Pure internal subtalar dislocation: about a case].
[Ti] Título:Luxation sous-talienne interne pure: à propos d'un cas..
[So] Source:Pan Afr Med J;27:123, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:fre
[Ab] Resumo:Pure subtalar dislocation is a rare condition. We here report the case of a young patient presenting with pure internal subtalar dislocation as a result of a sport accident. He underwent orthopedic therapy achieving a good functional outcome.
[Mh] Termos MeSH primário: Traumatismos em Atletas/terapia
Luxações Articulares/terapia
Procedimentos Ortopédicos/métodos
Articulação Talocalcânea/lesões
[Mh] Termos MeSH secundário: Adulto
Seres Humanos
Luxações Articulares/etiologia
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.27.123.12173



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