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[PMID]:28467588
[Au] Autor:Ertürk C; Altay MA; Altay N; Öztürk IA; Baykara I; Sert C; Isikan UE
[Ad] Endereço:Department of Orthopedics and Traumatology, Istanbul Health Sciences University Kanuni Sultan Süleyman Training and Research Hospital, Küçükçekmece, Istanbul, Turkey. erturkc@yahoo.com.
[Ti] Título:The effect of 2 different surgical methods on intracompartmental pressure value in tibial shaft fracture: An experimental study in a rabbit model.
[So] Source:Ulus Travma Acil Cerrahi Derg;23(2):85-90, 2017 Mar.
[Is] ISSN:1306-696X
[Cp] País de publicação:Turkey
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Intracompartmental pressure (ICP) monitoring is a widely used modality, particularly after intramedullary nailing of tibial shaft fractures. It was hypothesized that ICP value in fracture fixed with Ilizarov circular fixator (ICF) might be lower than in fracture fixed with intramedullary pin (IMP). The present study is a comparison of ICP value in tibial fractures in a rabbit model fixed with ICF and IMP. METHODS: Twenty male New Zealand White rabbits were randomly divided into 2 groups of equal size: ICF group (Group 1) and IMP group (Group 2). Under anesthesia, half of proximal part of the right tibia of all rabbits was fractured. Tibial fractures were fixed with ICF in Group 1 and IMP in Group 2. ICP values were monitored at 6-hour intervals for 48 hours. RESULTS: There was statistically significant difference in ICP value between groups (p<0.001). While there was statistically significant increase in ICP values 24 hours post surgery, there was statistically significant decrease during second 24 hours following surgery. Most importantly, ICP values of ICF group were significantly lower than those of IMP group at 30, 36, and 42 hours post surgery (p<0.05). CONCLUSION: At 24th hour after fixation, ICP values measured in ICF group were lower compared with those of IMP group. These results indicate that use of ICF in tibial fractures provides additional decompression in the anterior compartment. In light of these findings, ICF may be preferable for treatment of tibial fractures with high risk for compartment syndrome.
[Mh] Termos MeSH primário: Fixação de Fratura
Fraturas da Tíbia
[Mh] Termos MeSH secundário: Animais
Modelos Animais de Doenças
Fixação de Fratura/efeitos adversos
Fixação de Fratura/métodos
Fixação de Fratura/estatística & dados numéricos
Masculino
Pressão
Coelhos
Fraturas da Tíbia/fisiopatologia
Fraturas da Tíbia/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.5505/tjtes.2016.82177


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[PMID]:28467582
[Au] Autor:Sönmez MM; Gülabi D; Ugurlar M; Uzun M; Sarban S; Seker A
[Ti] Título:Minimal invasive fixation of distal tibial fractures does not result in rotational malalignment: A report of 24 cases with CT imaging.
[So] Source:Ulus Travma Acil Cerrahi Derg;23(2):144-149, 2017 Mar.
[Is] ISSN:1306-696X
[Cp] País de publicação:Turkey
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Tibial torsion is rotation of the proximal versus the distal articular axis in the transverse plane. This study used computed tomography (CT) to examine rotational malalignment in the crus following use of minimally invasive plate osteosynthesis (MIPO) technique in distal tibial fractures and evaluated effect of rotational difference on clinical outcomes and VAS scores. METHODS: Analysis of 24 patients who were operated on for closed distal tibial fracture with MIPO technique between 2010 and 2012 was conducted. Malrotation was defined as rotational difference >10°. Operated knees were evaluated with 0.5-mm, fine-cut, 3-dimensional CT scan performed in cooperation with radiology department. Side-to-side difference in tibial torsion angle >10° was considered significant degree of malrotation. All patients were assessed clinically (visual analogue scale [VAS] and American Orthopaedic Foot and Ankle Society [AOFAS] scores) and radiologically at final visit. RESULTS: Mean follow-up period was 20.00±9.46 months (range: 18-51 months). Mean VAS score was 2.58±0.83 (range: 1-4) and mean AOFAS score was 87.50±4.05 (range: 78-93). Mean tibial rotation angle was 31.54±6.00° (range: 18-45°) on healthy side and 32.00±6.24° (range: 10-43°) on the operated side. No statistically significant difference was determined (p>0.05). CONCLUSION: Use of intraoperative fluoroscopy, cable technique, and uninjured extremity as reference, can reduce incidence of rotational malalignment of distal tibial fractures treated with MIPO.
[Mh] Termos MeSH primário: Fixação de Fratura
Procedimentos Cirúrgicos Minimamente Invasivos
Fraturas da Tíbia
[Mh] Termos MeSH secundário: Fixação de Fratura/métodos
Fixação de Fratura/estatística & dados numéricos
Seres Humanos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos
Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos
Amplitude de Movimento Articular
Fraturas da Tíbia/diagnóstico por imagem
Fraturas da Tíbia/fisiopatologia
Fraturas da Tíbia/cirurgia
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.5505/tjtes.2016.59153


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[PMID]:29248623
[Au] Autor:Kendall MC; Gorgone M
[Ad] Endereço:Department of Anesthesiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, United States. Electronic address: mark.kendall@lifespan.org.
[Ti] Título:Surgical site infection following open reduction and internal fixation of a closed ankle fractures: A retrospective multicenter cohort study.
[So] Source:Int J Surg;49:60-61, 2018 01.
[Is] ISSN:1743-9159
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Fraturas do Tornozelo
Infecção da Ferida Cirúrgica
[Mh] Termos MeSH secundário: Fixação Interna de Fraturas
Fraturas Expostas/cirurgia
Seres Humanos
Redução Aberta
Estudos Retrospectivos
Fraturas da Tíbia/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171218
[St] Status:MEDLINE


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[PMID]:29310377
[Au] Autor:Lin YN; Chuang CH; Huang SH; Huang SH; Lin TM; Lin IW; Lin SD; Kuo YR
[Ad] Endereço:Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University.
[Ti] Título:Fat grafting for resurfacing an exposed implant in lower extremity: A case report.
[So] Source:Medicine (Baltimore);96(48):e8901, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Although numerous reconstruction protocols have been reported for lower leg trauma, those for distal leg trauma remain few. We present the case of a woman with an implant exposure wound, who was successfully treated through fat grafting, without major flap surgery. PATIENT CONCERNS: An 83-year-old woman with an exposed implant in lower extremity received reconstruction surgery once and the surgery failed. She refused additional major surgery and negative pressure wound therapy. DIAGNOSES: The diagnosis of a tibia and fibula shaft open fracture (type IIIA) complicated with an exposed implant was made. INTERVENTIONS: The procedure was performed by deploying purified and emulsified fat with a Micro-Autologous Fat Transplantation gun. The required lipoaspirate amount was grossly estimated using a standard formula: 0.5 cc of a lipoaspirate per square centimeter of wound. We prepared the lipoaspirate simply through centrifugation followed by physical emulsification. The endpoint of fat grafting was when lipoaspirate began to flow out of the wound. The initial dressing after the procedure included the topical usage of biomycin ointment with AQUACEL Foam (ConvaTec Inc., NC, USA) coverage, which was later changed to INTRASITE gel (Smith & Nephew, London, UK) with a gauze dressing for 4 weeks. After 4 weeks, dressing components were changed to Mepilex (Mölnlycke Health Care, Gothenburg, Sweden) alone. OUTCOMES: The wound healed completely without requiring major flap surgery by 18 weeks after surgery. LESSONS: Fat grafting is one kind of cell therapy and potentially has regenerative effects during wound healing. Fat grafting is critical in the healing processes of complicated wounds and might be considered a step in reconstruction surgery.
[Mh] Termos MeSH primário: Tecido Adiposo/transplante
Fíbula/lesões
Fíbula/cirurgia
Fixação Interna de Fraturas/instrumentação
Fixadores Internos
Traumatismos da Perna/cirurgia
Procedimentos Cirúrgicos Reconstrutivos
Fraturas da Tíbia/cirurgia
[Mh] Termos MeSH secundário: Acidentes de Trânsito
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Traumatismos da Perna/etiologia
Retalhos Cirúrgicos
Cicatrização
[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.0000000000008901


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[PMID]:29245327
[Au] Autor:Luo P; Xu D; Wu J; Chen YH
[Ad] Endereço:aDepartment of Trauma Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversitybZhejiang provincial key lab of orthopaedics, WenzhoucDepartment of Trauma Orthopedics, Shangyu People's Hospital of Shaoxing City, ShaoxingdKey Laboratory for Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang, China.
[Ti] Título:Locked plating as an external fixator in treating tibial fractures: A PRISMA-compliant systematic review.
[So] Source:Medicine (Baltimore);96(49):e9083, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: This article is a systematic review of the published literature about the biomechanics, functional outcomes, and complications of a locked plate as an external fixator in treating tibial fractures. METHODS: We searched the PubMed, Ovid Medline, Embase, ScienceDirect, and Cochrane Library databases to retrieve the relevant studies. Studies published in English and Chinese which assessed adult patients and more than 4 cases who had sustained any type of fresh tibial fracture treated with the external locking plate, provided that they reported functional outcomes, range of motion (ROM), union or complication rates, and the biomechanical studies of external locked plating are also included. RESULTS: The electronic search strategy revealed 248 studies, and 2 studies were identified as relevant through manual search of references. Finally, 12 studies were included in this systematic review. These consist of 3 pure biomechanical studies, 8 case series, and 1 study including both of biomechanics and case series. Due to the heterogeneity of biomechanical studies, we can only conclude that external locked plate shows inferior structural stiffness than internal locked plate. The clinical studies reported that external locked plating gave a satisfactory ROM of the knee and ankle, functional outcomes, union rate, and low complication rate. CONCLUSIONS: We can only conclude that external locked plate shows inferior structural stiffness than internal locked plate because of the heterogeneity of biomechanical studies. The clinical studies showed locked plating as an external fixator in treating tibial fractures can be considered as a safe and successful procedure. However, as yet, there is unconvincing evidence that it is superior to standard techniques with regards to clinical and functional outcomes. More and well-designed studies about this technique should be carried out.
[Mh] Termos MeSH primário: Placas Ósseas
Fixação de Fratura/instrumentação
Fraturas da Tíbia/terapia
[Mh] Termos MeSH secundário: Fenômenos Biomecânicos
Seres Humanos
Amplitude de Movimento Articular
Fraturas da Tíbia/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009083


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[PMID]:27773721
[Au] Autor:Tajerian M; Hung V; Khan H; Lahey LJ; Sun Y; Birklein F; Krämer HH; Robinson WH; Kingery WS; Clark JD
[Ad] Endereço:Veterans Affairs Palo Alto Health Care System Palo Alto, CA, USA; Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA; Palo Alto Veterans Institute for Research, Palo Alto, CA, USA. Electronic address: maral@stanford.edu.
[Ti] Título:Identification of KRT16 as a target of an autoantibody response in complex regional pain syndrome.
[So] Source:Exp Neurol;287(Pt 1):14-20, 2017 Jan.
[Is] ISSN:1090-2430
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Using a mouse model of complex regional pain syndrome (CRPS), our goal was to identify autoantigens in the skin of the affected limb. METHODS: A CRPS-like state was induced using the tibia fracture/cast immobilization model. Three weeks after fracture, hindpaw skin was homogenized, run on 2-d gels, and probed by sera from fracture and control mice. Spots of interest were analyzed by liquid chromatography-mass spectroscopy (LC-MS) and the list of targets validated by examining their abundance and subcellular localization. In order to measure the autoantigenicity of selected protein targets, we quantified the binding of IgM in control and fracture mice sera, as well as in control and CRPS human sera, to the recombinant protein. RESULTS: We show unique binding between fracture skin extracts and fracture sera, suggesting the presence of auto-antigens. LC-MS analysis provided us a list of potential targets, some of which were upregulated after fracture (KRT16, eEF1a1, and PRPH), while others showed subcellular-redistribution and increased membrane localization (ANXA2 and ENO3). No changes in protein citrullination or carbamylation were observed. In addition to increased abundance, KRT16 demonstrated autoantigenicity, since sera from both fracture mice and CRPS patients showed increased autoantibody binding to recombinant kRT16 protein. CONCLUSIONS: Pursuing autoimmune contributions to CRPS provides a novel approach to understanding the condition and may allow the development of mechanism-based therapies. The identification of autoantibodies against KRT16 as a biomarker in mice and in humans is a critical step towards these goals, and towards redefining CRPS as having an autoimmune etiology.
[Mh] Termos MeSH primário: Autoantígenos/metabolismo
Síndromes da Dor Regional Complexa/sangue
Síndromes da Dor Regional Complexa/patologia
Queratina-6/imunologia
Queratina-6/metabolismo
Pele/metabolismo
Pele/ultraestrutura
Regulação para Cima/fisiologia
[Mh] Termos MeSH secundário: Adulto
Animais
Anexina A2/metabolismo
Autoantígenos/genética
Modelos Animais de Doenças
Membro Posterior/inervação
Seres Humanos
Masculino
Camundongos
Camundongos Endogâmicos C57BL
Meia-Idade
Fator 1 de Elongação de Peptídeos/metabolismo
Periferinas/metabolismo
Fosfopiruvato Hidratase/metabolismo
Frações Subcelulares/metabolismo
Fraturas da Tíbia/sangue
Fraturas da Tíbia/patologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (ANXA2 protein, human); 0 (Annexin A2); 0 (Autoantigens); 0 (EEF1A1 protein, human); 0 (KRT6A protein, human); 0 (Keratin-6); 0 (PRPH protein, human); 0 (Peptide Elongation Factor 1); 0 (Peripherins); EC 4.2.1.11 (Phosphopyruvate Hydratase)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:180101
[Lr] Data última revisão:
180101
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161028
[St] Status:MEDLINE


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[PMID]:29182140
[Au] Autor:Alshammari D; Alhefzi A; Bund L; Schneider L; Gicquel P
[Ti] Título:Popliteal artery dissection presented 12 hours after admission for a Salter III fracture of proximal tibia.
[So] Source:Acta Orthop Belg;82(4):918-922, 2016 Dec.
[Is] ISSN:0001-6462
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:A 16-year-old boy sustained a salter III fracture of the upper tibia following a motorcycle accident. Except for well localized knee pain, the patient did not have any other symptom. Repeated clinical examination did not reveal any absent peripheral pulse. Given the state of the fracture, anatomical reduction and screw fixation was planned in the operating room.  Twelve hours after admission the patient was taken to the operating room. During the period preceding surgery he continued to have normal vascular clinical examinations. Further clinical assessment was performed in the operating room and remained to be normal. However after induction and upon extension of the lower limb, peripheral pulses in the affected side were abruptly lost. Urgent vascular exploration of the area showed a popliteal artery dissection necessitating a bypass graft to restore blood flow.  We present a review of the literature alongside a case report showing how popliteal artery pathology in a similar context can present late and be for a period of time clinically undetectable.
[Mh] Termos MeSH primário: Aneurisma Dissecante/cirurgia
Parafusos Ósseos
Fixação Interna de Fraturas
Traumatismos do Joelho/cirurgia
Período Perioperatório
Artéria Poplítea/cirurgia
Fraturas da Tíbia/cirurgia
Procedimentos Cirúrgicos Vasculares
[Mh] Termos MeSH secundário: Acidentes de Trânsito
Adolescente
Aneurisma Dissecante/complicações
Seres Humanos
Traumatismos do Joelho/complicações
Lacerações/complicações
Lacerações/cirurgia
Masculino
Motocicletas
Artéria Poplítea/lesões
Veia Poplítea/lesões
Veia Poplítea/cirurgia
Fraturas da Tíbia/complicações
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[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]:29182123
[Au] Autor:Özkul B; Saygili MS; Çetinkaya E; Arslanoglu F; Bayhan IA; Demir B; Tekin AC
[Ti] Título:Angular deformity development after the distal tibial physeal fractures.
[So] Source:Acta Orthop Belg;82(4):814-820, 2016 Dec.
[Is] ISSN:0001-6462
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:Several clinical and radiological factors can be prognostic in the development of angular deformity following physeal injuries of the distal tibia. One of the radiological parameters, premature physeal closure (PPC), can be detected during postoperative follow-ups. Aim of our study was to identify the prognostic factors in development of angular deformity and its relationship with PPC. One hundred and four patients treated due to physeal injuries of the distal tibia were included in our study. Patients were divided into three groups based on Salter-Harris (SH) classification. The intergroup relationships between sex, age, the amount of energy sustained during injury, premature physeal closure, the amount of residual gap, and deformity were analyzed. Angular deformity developed in 25% (3/12) of SH Type 2, in 60% (9/15) of Type 3 and 30% (3/10) of Type 4 patients with PPC. A residual displacement of more than 2 mm, age and premature physeal closure were specified as significant risk factors for development of angular deformity. 2 mm limit for residual displacement and findings of premature physeal closure in the radiological evaluations during follow-ups are prognostic factors in avoiding malalignment of the distal tibia. LEVEL OF EVIDENCE: Level 3.
[Mh] Termos MeSH primário: Redução Fechada/métodos
Fixação Interna de Fraturas/métodos
Complicações Pós-Operatórias/epidemiologia
Fraturas Salter-Harris/cirurgia
Fraturas da Tíbia/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Criança
Feminino
Seguimentos
Consolidação da Fratura
Seres Humanos
Masculino
Complicações Pós-Operatórias/diagnóstico por imagem
Radiografia
Estudos Retrospectivos
Fraturas Salter-Harris/diagnóstico por imagem
Fraturas da Tíbia/diagnóstico por imagem
[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]:29193926
[Au] Autor:Zierenberg García C; Beaton Comulada D; Pérez López JC; Lamela Domenech A; Rivera Ortiz G; González Montalvo HM; Reyes-Martínez PJ
[Ti] Título:Acute Shortening and re-lengthening in the management of open tibia fractures with severe bone of 14 CMS or more and extensive soft tissue loss.
[So] Source:Bol Asoc Med P R;108(1):89-92, 2016.
[Is] ISSN:0004-4849
[Cp] País de publicação:Puerto Rico
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: A traumatic event to the tibia with more than 14 cm of bone and soft tissue loss represents a challenge to most orthopedic surgeons and is considered a limb-threatening condition. Few solutions are available in such clinical situations and among them is the acute shortening and re-lengthening of bone and soft tissue. MATERIALS AND METHODS: Our study presents the management of 7 patients with grade III B open fractures (according to the Gustillo-Anderson classification) of the tibia who underwent resection of all the devitalized tissues, acute limb shortening to close the defect, application of an external fixator, and metaphyseal osteotomy for re-lengthening. The patient outcomes were based on different parameters using the evaluation system established by Paley et al. RESULTS: Results acquired during the study show an average bone loss of 19cm (with a minimum of 14 cm and a maximum of 31.50cm). The average time to full recovery of all patients was 19 months with a minimum of 14 months and a max of 34 months. Patient presented with excellent bony union and none existent or small refractory leg length discrepancy and did not require bone grafts or free flaps. Complications that the patients had were contractures, which required secondary procedures such as Achilles tendon re-lengthening and recurrent infections. DISCUSSION: Overall patients had excellent bone union and were able to perform activities of their daily living. The Ilizarov technique of compression-dis- traction osteogenesis is an elegant treatment option that should be considered in patients suffering such traumatic events providing excellent bony union and good functional outcomes for the patient.
[Mh] Termos MeSH primário: Fraturas Expostas/cirurgia
Desigualdade de Membros Inferiores/cirurgia
Lesões dos Tecidos Moles/etiologia
Fraturas da Tíbia/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fixadores Externos
Fixação de Fratura/métodos
Consolidação da Fratura/fisiologia
Seres Humanos
Técnica de Ilizarov
Desigualdade de Membros Inferiores/etiologia
Osteotomia/métodos
Recuperação de Função Fisiológica
Lesões dos Tecidos Moles/patologia
Fraturas da Tíbia/complicações
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171214
[Lr] Data última revisão:
171214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE


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[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



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