Base de dados : MEDLINE
Pesquisa : C26.404.124 [Categoria DeCS]
Referências encontradas : 3050 [refinar]
Mostrando: 1 .. 10   no formato [Detalhado]

página 1 de 305 ir para página                         

  1 / 3050 MEDLINE  
              next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29305459
[Au] Autor:Talbot C; Davis N; Majid I; Young M; Bouamra O; Lecky FE; Jones S
[Ad] Endereço:Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.
[Ti] Título:Fractures of the femoral shaft in children: national epidemiology and treatment trends in England following activation of major trauma networks.
[So] Source:Bone Joint J;100-B(1):109-118, 2018 Jan.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: The aim of this study was to describe the epidemiology of closed isolated fractures of the femoral shaft in children, and to compare the treatment and length of stay (LOS) between major trauma centres (MTCs) and trauma units (TUs) in England. PATIENTS AND METHODS: National data were obtained from the Trauma and Audit Research Network for all isolated, closed fractures of the femoral shaft in children from birth to 15 years of age, between 2012 and 2015. Age, gender, the season in which the fracture occurred, non-accidental injury, the mechanism of injury, hospital trauma status, LOS and type of treatment were recorded. RESULTS: A total of 1852 fractures were identified. The mean annual incidence was 5.82 per 100 000 children (95% confidence interval (CI) 5.20 to 6.44). The age of peak incidence was two years for both boys and girls; this decreased with increasing age. Children aged four to six years treated in MTCs were more likely to be managed with open reduction and internal fixation compared with those treated in TUs (odds ratio 3.20; 95% CI 1.12 to 9.14; p = 0.03). The median LOS was significantly less in MTCs than in TUs for children aged between 18 months and three years treated in both a spica (p = 0.005) and traction (p = 0.0004). CONCLUSION: This study highlights the current national trends in the management of closed isolated fractures of the femoral shaft in children following activation of major trauma networks in 2012. Future studies focusing on the reasons for the differences which have been identified may help to achieve more consistency in the management of these injuries across the trauma networks. Cite this article: 2018;100-B:109-18.
[Mh] Termos MeSH primário: Fraturas do Fêmur/epidemiologia
Fraturas Fechadas/epidemiologia
Procedimentos Ortopédicos/tendências
Centros de Traumatologia/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Distribuição por Idade
Moldes Cirúrgicos/utilização
Criança
Pré-Escolar
Inglaterra/epidemiologia
Feminino
Fraturas do Fêmur/etiologia
Fraturas do Fêmur/cirurgia
Fixação Interna de Fraturas/utilização
Fraturas Fechadas/etiologia
Fraturas Fechadas/cirurgia
Seres Humanos
Incidência
Lactente
Recém-Nascido
Tempo de Internação/estatística & dados numéricos
Masculino
Procedimentos Ortopédicos/métodos
Prática Profissional/estatística & dados numéricos
Prática Profissional/tendências
Estações do Ano
Distribuição por Sexo
Tração/utilização
[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-2016-1315.R3


  2 / 3050 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:27770336
[Au] Autor:Obremskey WT; Cutrera N; Kidd CM; Southeastern Fracture Consortium
[Ad] Endereço:Vanderbilt University Medical Center, 1215 21st Avenue South, MCE South Tower, Suite 4200, Nashville, TN, 37232, USA. william.obremskey@vanderbilt.edu.
[Ti] Título:A prospective multi-center study of intramedullary nailing vs casting of stable tibial shaft fractures.
[So] Source:J Orthop Traumatol;18(1):69-76, 2017 Mar.
[Is] ISSN:1590-9999
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The purpose of this study was to determine optimal treatment of stable tibial shaft fractures using intramedullary nailing (IMN) or casting. MATERIALS AND METHODS: We performed a multi-center prospective study cohort. Patients with stable tibia shaft fractures meeting Sarmiento's criteria (isolated closed fractures with less than 12 mm of shortening and 10° of angulation) were enrolled prospectively and treated with either a reamed IMN with static interlocking screws or closed reduction followed by long-leg casting. Both groups were weight bearing following surgery. Radiographs were taken until union, and range of motion of knee and ankle joints was assessed. Malalignment (>5°) and malunion (>10°) were determined. Functional outcome measures using short musculoskeletal assessment scores (SMFA) and a knee pain score were scheduled at 6 weeks, 3 months and 6 months. RESULTS: At 3 months, differences between the casting and IMN groups were noted in return to work (6/15 vs 3/17, P < 0.05); ankle dorsiflexion (7° vs 12°, P < 0.05); plantar flexion (28° vs 39°, P < 0.05); and SMFA domains of Dysfunction Index, Bother Index, daily activities, emotional status, and arm/hand function (P < 0.05). The SMFA mobility function demonstrated a significant trend (P = 0.065). At 6 months, malalignment was present in 3/15 in the casting group and in 1/17 in the IMN group (P = 0.02). Malunion was present in 1/15 in the cast group. One fracture in the casting group went on to nonunion and required late IMN placement at 7 months and eventually healed. There were no differences in ankle motion, SMFA scores, or return to work. There was no difference in knee pain between the groups as measured by VAS and Court-Brown pain scale at 6 months. CONCLUSIONS: Patients with stable tibia fractures treated with intramedullary nailing have improved clinical and functional outcomes at 3 months compared with those treated with casting, but there are no differences in any other outcome measure. Patients treated in a cast may have a higher incidence of malalignment or malunion. LEVEL OF EVIDENCE: Level-II prognostic.
[Mh] Termos MeSH primário: Moldes Cirúrgicos
Fixação Intramedular de Fraturas
Fraturas Fechadas/terapia
Fraturas da Tíbia/terapia
[Mh] Termos MeSH secundário: Adulto
Pinos Ortopédicos
Feminino
Seguimentos
Consolidação da Fratura
Fraturas Fechadas/fisiopatologia
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Amplitude de Movimento Articular
Recuperação de Função Fisiológica
Fraturas da Tíbia/fisiopatologia
Resultado do Tratamento
Suporte de Carga
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161023
[St] Status:MEDLINE
[do] DOI:10.1007/s10195-016-0429-4


  3 / 3050 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28428189
[Au] Autor:Zhou YH; Wang W; Zheng MH
[Ad] Endereço:Department of paediatrics, Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
[Ti] Título:A painful wrist after a fall.
[So] Source:BMJ;357:j1642, 2017 04 20.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Acidentes por Quedas
Fraturas Fechadas/etiologia
Fraturas do Rádio/etiologia
Fraturas da Ulna/etiologia
Traumatismos do Punho/etiologia
[Mh] Termos MeSH secundário: Criança
Diagnóstico Diferencial
Fraturas Fechadas/diagnóstico por imagem
Seres Humanos
Masculino
Fraturas do Rádio/diagnóstico por imagem
Fraturas da Ulna/diagnóstico por imagem
Traumatismos do Punho/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170721
[Lr] Data última revisão:
170721
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170422
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j1642


  4 / 3050 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28410572
[Au] Autor:Doshi P; Gopalan H; Sprague S; Pradhan C; Kulkarni S; Bhandari M
[Ad] Endereço:Division of Orthopaedic Surgery, McMaster University, Well-Health Building, 293 Wellington Street North, Suite 110, Hamilton, ON, L8L 8E7, Canada.
[Ti] Título:Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study.
[So] Source:BMC Musculoskelet Disord;18(1):156, 2017 Apr 14.
[Is] ISSN:1471-2474
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Trauma is a major public health problem, particularly in India due to the country's rapid urbanization. Tibia fractures are a common and often complicated injury that is at risk of infection following surgical fixation. The primary objectives of this cohort study were to determine the incidence of infection within one year of surgery and to describe the distribution of infections by location and time of diagnosis for tibia fractures in India. METHODS: We conducted a multi-center, prospective cohort study. Patients who presented with an open or closed tibia fracture treated with internal fixation to one of the participating hospitals in India were invited to participate in the study. Participants attended follow-up visits at 3, 6, and 12 months post-surgery, where they were assessed for infections, fracture healing, and health-related quality of life as measured by the EurQol-5 Dimensions (EQ-5D). RESULTS: Seven hundred eighty-seven participants were included in the study and 768 participants completed the 12 month follow-up. The overall incidence of infection was 2.9% (23 infections). The incidence of infection was 1.6% (10 infections) in closed and 8.0% (13 infections) in open fractures. There were 7 deep and 16 superficial infections, with 5 being early, 7 being delayed, and 11 being late infections. Intra-operative antibiotics were given to 92.1% of participants and post-operative antibiotics were given to 96.8% of participants. Antibiotics were prescribed for an average of 8.3 days for closed fractures and 9.1 days for open fractures. Infected fractures took significantly longer to heal, and participants who had an infection had significantly lower EQ-5D scores. CONCLUSIONS: The incidence of infection within this cohort is similar to those seen in developed countries. The duration of prophylactic antibiotic use was longer than standard practice in North America, raising concern for the potential development of antibiotic resistant microbes within Indian orthopaedic settings. Future research should aim to identify the best practice for antibiotic use in India to ensure that antibiotic usage patterns do not lead to unnecessary overuse, while maintaining a low incidence of infection. TRIAL REGISTRATION: NCT01691599 , September 17, 2012.
[Mh] Termos MeSH primário: Fixação Interna de Fraturas/efeitos adversos
Consolidação da Fratura
Fraturas Fechadas/cirurgia
Fraturas Expostas/cirurgia
Infecção da Ferida Cirúrgica/epidemiologia
Fraturas da Tíbia/cirurgia
[Mh] Termos MeSH secundário: Adulto
Antibacterianos/administração & dosagem
Antibacterianos/uso terapêutico
Diagnóstico Tardio
Feminino
Seguimentos
Fraturas Fechadas/diagnóstico
Fraturas Expostas/diagnóstico
Seres Humanos
Incidência
Índia/epidemiologia
Masculino
Meia-Idade
Estudos Prospectivos
Qualidade de Vida
Infecção da Ferida Cirúrgica/tratamento farmacológico
Infecção da Ferida Cirúrgica/prevenção & controle
Fraturas da Tíbia/diagnóstico
Fatores de Tempo
Tempo para o Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170416
[St] Status:MEDLINE
[do] DOI:10.1186/s12891-017-1506-4


  5 / 3050 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
[PMID]:28386056
[Au] Autor:Sun ZY; Li XF; Zhao H; Lin J; Qian ZL; Zhang ZM; Yang HL
[Ad] Endereço:Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).
[Ti] Título:Percutaneous Balloon Kyphoplasty in Treatment of Painful Osteoporotic Occult Vertebral Fracture: A Retrospective Study of 89 Cases.
[So] Source:Med Sci Monit;23:1682-1690, 2017 Apr 07.
[Is] ISSN:1643-3750
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND The definition of a vertebral fracture is usually based on the presence of a deformation of the vertebral body and this can be misleading in the presence of a fracture without radiologic collapse with the definition of occult osteoporotic vertebral fractures (OOVFs). STIR sequence of MRI images showing hyperintensity signal was the most confirmative screening examination used to determine the presence of painful OOVFs. To date, clinical management of OOVFs has been rarely discussed. MATERIAL AND METHODS Between 2011 and 2013, 89 patients suffering from painful OOVFs underwent 142 percutaneous balloon kyphoplasty (PKP) procedures. Outcome data (mean variation of anterior and middle vertebral body height, visual analog scale [VAS] scores, Oswestry Disability Index [ODI] scores, and SF-36 scores) were recorded preoperatively, postoperatively, and at 1 month, 6 months, and 2 year after treatment, to evaluate the results. RESULTS We successfully treated 89 patients (142 vertebral bodies) with PKP. Cement leakages were observed in 12 (8.45%) treated vertebral bodies and there were 5 new adjacent vertebral fractures during the follow-up period. The mean variation of anterior and middle vertebral body height changed from 96.5±3.4% preoperatively to 97.2±2.5% postoperatively (p>0.05) and from 96.3±2.8% preoperatively to 97.9±3.1% postoperatively (p>0.05), respectively. The mean VAS scores were reduced significantly from pre-surgery to post-surgery (8.3±1.2 to 2.9±0.7; p<0.05), as was the ODI score (76.4±12.5 to 26.7±5.6; p<0.05). The SF-36 scores, including Bodily Pain (BF), Vitality (VT), Physical Function (PF), and Social Functioning (SF), all showed notable improvement (P<0.05). These variations were maintained during the 2-year follow-up period. CONCLUSIONS PKP is a safe and effective method in the treatment of painful OOVFs.
[Mh] Termos MeSH primário: Fraturas Fechadas/cirurgia
Cifoplastia/métodos
Fraturas por Osteoporose/cirurgia
[Mh] Termos MeSH secundário: Idoso
Cimentos para Ossos/uso terapêutico
Feminino
Fraturas Fechadas/diagnóstico por imagem
Fraturas por Compressão/diagnóstico por imagem
Fraturas por Compressão/cirurgia
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Osteoporose/tratamento farmacológico
Fraturas por Osteoporose/diagnóstico por imagem
Estudos Retrospectivos
Fraturas da Coluna Vertebral/cirurgia
Traumatismos da Coluna Vertebral/cirurgia
Coluna Vertebral/cirurgia
Resultado do Tratamento
Vertebroplastia/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Bone Cements)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170630
[Lr] Data última revisão:
170630
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170408
[St] Status:MEDLINE


  6 / 3050 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28159582
[Au] Autor:Tang Y; Wang X; Zhu Y; Sun H; Zhu M
[Ad] Endereço:Resident, Department of Oral & Craniomaxillofacial Science, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, Shanghai, China.
[Ti] Título:A Comparative evaluation of CBCT outcomes of two closed treatment methods in intracapsular condylar fractures.
[So] Source:Oral Surg Oral Med Oral Pathol Oral Radiol;123(5):e141-e147, 2017 May.
[Is] ISSN:2212-4411
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The cone beam computed tomography (CBCT) images of 2 closed treatments are compared for intracapsular condylar fractures (ICFs) to learn whether splint treatment could promote better radiologic outcomes. PATIENTS AND METHODS: Fifty-four patients with 60 sides of ICF were divided into 2 groups. In the control group (C-group), patients had a liquid diet for 1 month. In the trial group (T-group), patients wore splints with anterior elastic traction. Local CBCT images of the temporomandibular joint were obtained at T0 (mean 8.8 days), T1 (mean 37.4 days), and T3 (mean 3.3 months) after trauma. Six parameters, including 2 horizontal, 1 sagittal, and 3 vertical distances, were calculated using the coordinates of 10 points marked on CBCT sections. Statistical analysis included intragroup comparison at T0, T1, and T3, and intergroup comparison among subgroups classified by age and ICF types. RESULTS: Compared to C-group, vertical distances were significantly changed in T-group, specifically in adults and patients with ICF type B. Significant changes at stage T1 were also observed in T-group. CONCLUSION: During the natural healing process, ICF healed in the displaced position and the stump tended to move closer to the joint fossa in the vertical dimension. Splint treatment with elastic traction was helpful to increase joint space and promote better radiologic healing shape.
[Mh] Termos MeSH primário: Tomografia Computadorizada de Feixe Cônico
Fixação de Fratura/métodos
Fraturas Fechadas/diagnóstico por imagem
Fraturas Fechadas/terapia
Côndilo Mandibular
Fraturas Mandibulares/diagnóstico por imagem
Fraturas Mandibulares/terapia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Criança
Pré-Escolar
Feminino
Consolidação da Fratura
Seres Humanos
Masculino
Côndilo Mandibular/diagnóstico por imagem
Côndilo Mandibular/lesões
Meia-Idade
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:D; IM
[Da] Data de entrada para processamento:170205
[St] Status:MEDLINE


  7 / 3050 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28126324
[Au] Autor:Greenhill DA; Poorman M; Pinkowski C; Ramsey FV; Haydel C
[Ad] Endereço:Department of orthopaedic surgery and sports medicine, Temple university hospital, 3401N, Broad street, 19140 Philadelphia, USA. Electronic address: dustin.greenhill2@tuhs.temple.edu.
[Ti] Título:Does weight-bearing assignment after intramedullary nail placement alter healing of tibial shaft fractures?
[So] Source:Orthop Traumatol Surg Res;103(1):111-114, 2017 Feb.
[Is] ISSN:1877-0568
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: There is no consensus regarding postoperative weight-bearing (WB) assignment after treatment of tibial shaft fractures with an intramedullary nail. This study aims to determine if the postoperative WB assignment after tibia intramedullary nail placement alters healing. METHODS: Closed AO type 42A fractures treated with a reamed statically-locked intramedullary nail over a 10-year period were retrospectively reviewed from injury at 2, 3, 6, 9 and 12 month intervals until union or revision. Patients were categorized according to postoperative weight-bearing assignment: weight-bearing-as-tolerated (WBAT) or non-weight-bearing (NWB). Patients with additional diagnoses that confound routine fracture healing were excluded. Postoperative radiographic union scores for tibial fractures (RUST), coronal/sagittal angulations, and length were compared between different weight-bearing groups. Union was defined as a RUST≥10 at a painless fracture site. RESULTS: A total of 83 patients achieved union (32 WBAT, 51 NWB). Both WB groups had similar preoperative demographics. Average age was 37±13 years and follow-up averaged 1.3±0.2 years. There were no significant differences in average time to radiographic union between NWB versus WBAT groups (5.5 vs. 6.1 months, respectively; P=0.208) nor radiographic healing at 2, 3, and 6-month intervals (P=0.631). There were two nonunions and one fracture shortened in the NWB group. There were no reoperations for symptomatic or broken hardware in either cohort. CONCLUSION: Immediate WBAT after statically-locked intramedullary nail placement in simple tibial shaft fractures does not alter the time until or course of radiographic union. LEVEL OF EVIDENCE: IV.
[Mh] Termos MeSH primário: Fixação Intramedular de Fraturas
Consolidação da Fratura
Fraturas da Tíbia/cirurgia
Suporte de Carga
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seguimentos
Fraturas Fechadas/diagnóstico por imagem
Fraturas Fechadas/cirurgia
Seres Humanos
Masculino
Meia-Idade
Período Pós-Operatório
Estudos Retrospectivos
Fraturas da Tíbia/diagnóstico por imagem
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170128
[St] Status:MEDLINE


  8 / 3050 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28004292
[Au] Autor:Gomez-Barrena E
[Ad] Endereço:Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Madrid, Hospital La Paz, Pº Castellana 261, 28046, Madrid, Spain. egomezb@salud.madrid.org.
[Ti] Título:CORR Insights : Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA.
[So] Source:Clin Orthop Relat Res;475(2):495-497, 2017 02.
[Is] ISSN:1528-1132
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Acetábulo/cirurgia
Fraturas Fechadas
[Mh] Termos MeSH secundário: Artroplastia de Quadril
Prótese de Quadril
Seres Humanos
Fraturas Periprotéticas
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161223
[St] Status:MEDLINE
[do] DOI:10.1007/s11999-016-5208-2


  9 / 3050 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:27800574
[Au] Autor:Hasegawa K; Kabata T; Kajino Y; Inoue D; Tsuchiya H
[Ad] Endereço:Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
[Ti] Título:Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA.
[So] Source:Clin Orthop Relat Res;475(2):484-494, 2017 Feb.
[Is] ISSN:1528-1132
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Periprosthetic fractures of the acetabulum occurring during primary THA are rare. Periprosthetic occult fractures are defined as those not identified by the surgeon during the procedure which might be missed on a routine postoperative radiograph. However, it is unclear how frequently these fractures occur and whether their presence affects functional recovery. QUESTIONS/PURPOSES: In this study, using routine CT scans that were obtained as part of another primary hip arthroplasty study protocol, we retrospectively assessed (1) the prevalence of occult fractures of the acetabulum occurring during primary THA, (2) the location of occult fractures of the acetabulum during THA, and (3) risk factors contributing to such occult fractures. METHODS: Between 2004 and 2013, our institute performed 585 primary THAs (cementless or hybrid) in 494 patients with DICOM pre- and postoperative CT; during the period in question, all patients undergoing THA underwent CT before and after surgery. Preoperative CT images were taken as part of a CT-based three-dimensional templating software and navigation system. Postoperative CT images were taken an average of 1 week after surgery as part of a different protocol to evaluate cup position, restoration of leg length and offset, volume of postoperative hematoma to assess anticoagulation effects after THA, and fractures that were not found on routine postoperative radiographs (which we defined as occult fractures). Patients with a history of prior pelvic osteotomy, trauma, and infection were excluded (88 patients/99 hips); 406 patients (102 males and 304 females; 486 hips) form the basis of this report. The mean age of the patients was 60 ± 11 years, with a mean BMI of 23 ± 4 kg/m . The mean followup of the patients with periprosthetic fracture of the acetabulum was 58 ± 28 months (range, 12-131 months). Potential risk factors for occult acetabular fracture including age, sex, BMI, preoperative diagnosis, additional dome screw fixation, composition and size of each cup, and acetabular design were examined in multivariate analysis. Acetabular component designs were categorized as true hemispheric, peripheral self-locking, and elliptical; during the period in question the indications for each cup design were based on the brand of stem used. Comparison between preoperative and postoperative CT images was done to detect the fractures. Patients with fractures identified during surgery were treated with additional dome screw fixation and a 3-week period of nonweightbearing. Patients with occult fractures in this series did not receive additional treatment as we had confirmed secure fixation of the cup during surgery. RESULTS: Occult fractures occurred in 41 hips (8.4%); periprosthetic fractures of the acetabulum were seen during surgery in an additional two hips (0.4%). The superolateral wall was the most frequent location for occult fractures of the acetabulum. After controlling for relevant confounding variables, only the use of peripheral self-locking cups was associated with an increased risk of occult fracture (odds ratio [OR], 2.6 compared with hemispheric cups; 95% CI, 1.2-5.6; p < 0.05). All patients with occult fractures showed bone ingrowth fixation at the final followup, without any additional surgical intervention. CONCLUSIONS: Periprosthetic occult fractures of the acetabulum may occur relatively frequently during press-fit impaction. We observed a higher rate of fractures associated with the use of peripheral self-locking components. Occult acetabular fractures not detected on routine postoperative plain films may be ignored if secure fixation of the cup has been confirmed during the operation. LEVEL OF EVIDENCE: Level III, therapeutic study.
[Mh] Termos MeSH primário: Acetábulo/lesões
Artroplastia de Quadril/efeitos adversos
Fraturas Fechadas/etiologia
Articulação do Quadril/cirurgia
Fraturas Periprotéticas/etiologia
[Mh] Termos MeSH secundário: Acetábulo/diagnóstico por imagem
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Fraturas Fechadas/diagnóstico por imagem
Articulação do Quadril/diagnóstico por imagem
Prótese de Quadril
Seres Humanos
Masculino
Meia-Idade
Fraturas Periprotéticas/diagnóstico por imagem
Estudos Retrospectivos
Fatores de Risco
Tomografia Computadorizada por Raios X
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161102
[St] Status:MEDLINE
[do] DOI:10.1007/s11999-016-5138-z


  10 / 3050 MEDLINE  
              first record previous record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:27658550
[Au] Autor:Snoap T; Jaykel M; Williams C; Roberts J
[Ad] Endereço:Department of Orthopaedics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan.
[Ti] Título:Calcaneus Fractures: A Possible Musculoskeletal Emergency.
[So] Source:J Emerg Med;52(1):28-33, 2017 Jan.
[Is] ISSN:0736-4679
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Calcaneal fractures are commonly seen and treated in the emergency department. There are subsets of calcaneal fractures that pose a high risk to the adjacent soft tissue of the heel and can result in full-thickness tissue necrosis. OBJECTIVE: To identify which calcaneal fractures need to be managed within hours and triaged to the orthopedic team and which can be temporized in a neutral or plantarflexed ankle splint and seen in an outpatient setting. DISCUSSION: Tongue-type calcaneal fractures and tuberosity fractures must be triaged appropriately within the first few hours of presentation to prevent skin compromise. This requires the emergency physician to understand the radiographic morphology of the fracture as well as the clinical signs of skin compromise. Communication with the orthopedic surgery service is essential and splinting in a specific manner is important to stabilize the soft tissue envelope. CONCLUSION: Recognizing the calcaneal injury pattern and implementing the correct treatment strategy is paramount to having successful patient outcomes. A delay or error in treatment can turn a closed fracture into an open fracture.
[Mh] Termos MeSH primário: Calcâneo/lesões
Fraturas Ósseas/classificação
Fraturas Ósseas/complicações
[Mh] Termos MeSH secundário: Adulto
Calcâneo/diagnóstico por imagem
Serviço Hospitalar de Emergência/organização & administração
Feminino
Fraturas Ósseas/reabilitação
Fraturas Fechadas/reabilitação
Fraturas Fechadas/cirurgia
Fraturas Fechadas/terapia
Seres Humanos
Masculino
Doenças Musculoesqueléticas
Radiografia/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160924
[St] Status:MEDLINE



página 1 de 305 ir para página                         
   


Refinar a pesquisa
  Base de dados : MEDLINE Formulário avançado   

    Pesquisar no campo  
1  
2
3
 
           



Search engine: iAH v2.6 powered by WWWISIS

BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde