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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


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[PMID]:28753234
[Au] Autor:Krul M; van der Wouden JC; Kruithof EJ; van Suijlekom-Smit LW; Koes BW
[Ad] Endereço:Department of General Practice, Erasmus Medical Center, PO Box 2040, Rotterdam, Netherlands, 3000 CA.
[Ti] Título:Manipulative interventions for reducing pulled elbow in young children.
[So] Source:Cochrane Database Syst Rev;7:CD007759, 2017 07 28.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pulled elbow (nursemaid's elbow) is a common injury in young children. It often results from a sudden pull on the arm, usually by an adult or taller person, which pulls the radius through the annular ligament, resulting in subluxation (partial dislocation) of the radial head. It can also be caused by a fall or twist. The child experiences sudden acute pain and loss of function in the affected arm. Pulled elbow is usually treated by manual reduction of the subluxed radial head. Various manoeuvres can be applied; most commonly, supination of the forearm, often combined with flexion, and (hyper-)pronation. It is unclear which is most successful. This is an update of a Cochrane review first published in 2009 and last updated in 2011. OBJECTIVES: To compare the effects (benefits and harms) of the different methods used to manipulate pulled elbow in young children. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, LILACS, PEDro, clinical trial registers and reference lists of articles. Date of last search: September 2016. SELECTION CRITERIA: Randomised or quasi-randomised controlled clinical trials evaluating manipulative interventions for pulled elbow were included. Our primary outcome was failure at the first attempt, necessitating further treatment. DATA COLLECTION AND ANALYSIS: Two review authors independently evaluated trials for inclusion, assessed risk of bias, and extracted data. We pooled data using a fixed-effect model. MAIN RESULTS: Overall, nine trials with 906 children (all younger than seven years old and 58% of whom were female) were included, of which five trials were newly identified in this update. Eight trials were performed in emergency departments or ambulatory care centres, and one was performed in a tertiary paediatric orthopaedic unit. Four trials were conducted in the USA, three in Turkey, one in Iran, and one in Spain. Five trials were at high risk of selection bias because allocation was not concealed and all trials were at high risk of detection bias due to the lack of assessor blinding. Eight trials compared hyperpronation with supination-flexion. We found low-quality evidence that hyperpronation resulted in less failure at first attempt than supination-flexion (9.2% versus 26.4%, risk ratio (RR) 0.35; 95% confidence interval (CI) 0.25 to 0.50; 811 participants, 8 studies). Based on an illustrative risk of 268 failures at first attempt per 1000 children treated using supination-flexion, this amounted to 174 fewer failures per 1000 children treated using hyperpronation (95% CI 134 to 201 fewer). Based on risk differences data, we also estimated a number needed to treat of 6 (95% CI 5 to 8); this means that six children would need to be treated with the hyperpronation method rather than the supination-flexion method to avoid one additional failure at the first attempt.The very low-quality evidence (from four studies) for pain during or after manipulation means that it is uncertain whether there is or is not a difference between pronation and supination-flexion. There was very low-quality evidence from six studies that repeat pronation may be more effective than repeat supination-flexion for the second attempt after initial failure. The remaining outcomes were either not reported (adverse effects, recurrence) or unsuitable for pooling (ultimate failure). Ultimate failure, reported for the overall population only because of the differences in the study protocols with respect to what to do after the first attempt failed, ranged from no ultimate failures in two studies to six failures (4.1% of 148 episodes) in one study.One trial compared supination-extension versus supination-flexion. It provided very low-quality evidence (downgraded three levels for very serious risk of bias and serious imprecision) of no clear difference in failure at first attempt between the two methods. AUTHORS' CONCLUSIONS: There was low-quality evidence from eight small trials that the pronation method may be more effective at first attempt than the supination method for manipulating pulled elbow in young children. For other outcomes, no conclusions could be drawn either because of very low-quality evidence or the outcomes not being reported. We suggest that a high-quality randomised clinical trial comparing hyperpronation and supination-flexion is required to provide definitive evidence. We recommend that this is preceded by a survey among clinicians to establish the extent of clinical equipoise and to optimise the study design and recruitment.
[Mh] Termos MeSH primário: Articulação do Cotovelo/lesões
Luxações Articulares/terapia
Manipulação Ortopédica/métodos
Rádio (Anatomia)/lesões
Entorses e Distensões/terapia
[Mh] Termos MeSH secundário: Pré-Escolar
Feminino
Seres Humanos
Lactente
Luxações Articulares/etiologia
Masculino
Manipulação Ortopédica/efeitos adversos
Manipulação Ortopédica/estatística & dados numéricos
Medição da Dor
Pronação
Ensaios Clínicos Controlados Aleatórios como Assunto
Entorses e Distensões/etiologia
Supinação
Falha de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170729
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD007759.pub4


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[PMID]:28663388
[Au] Autor:Gougoulias N; Sakellariou A
[Ad] Endereço:Frimley Health NHS Foundation Trust, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey, GU16 7UJ, UK.
[Ti] Título:When is a simple fracture of the lateral malleolus not so simple? how to assess stability, which ones to fix and the role of the deltoid ligament.
[So] Source:Bone Joint J;99-B(7):851-855, 2017 Jul.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Stable fractures of the ankle can be safely treated non-operatively. It is also gradually being recognised that the integrity of the 'medial column' is essential for the stability of the fracture. It is generally thought that bi- and tri-malleolar fractures are unstable, as are pronation external rotation injuries resulting in an isolated high fibular fracture (Weber type-C), where the deltoid ligament is damaged or the medial malleolus fractured. However, how best to identify unstable, isolated, trans-syndesmotic Weber type-B supination external rotation (SER) fractures of the lateral malleolus remains controversial. We provide a rationale as to how to classify SER distal fibular fractures using weight-bearing radiographs, and how this can help guide the management of these common injuries. Cite this article: 2017;99-B:851-5.
[Mh] Termos MeSH primário: Traumatismos do Tornozelo/diagnóstico por imagem
Instabilidade Articular/diagnóstico por imagem
Ligamentos Articulares/diagnóstico por imagem
Ligamentos Articulares/lesões
Fraturas da Tíbia/diagnóstico por imagem
[Mh] Termos MeSH secundário: Traumatismos do Tornozelo/classificação
Traumatismos do Tornozelo/terapia
Fixação de Fratura/métodos
Seres Humanos
Instabilidade Articular/classificação
Instabilidade Articular/terapia
Rotação
Supinação
Fraturas da Tíbia/classificação
Fraturas da Tíbia/terapia
Suporte de Carga
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[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-2016-1087.R1


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[PMID]:28511569
[Au] Autor:Seidel A; Krause F; Weber M
[Ad] Endereço:1 Department of Orthopaedic Surgery and Traumatology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland.
[Ti] Título:Weightbearing vs Gravity Stress Radiographs for Stability Evaluation of Supination-External Rotation Fractures of the Ankle.
[So] Source:Foot Ankle Int;38(7):736-744, 2017 Jul.
[Is] ISSN:1944-7876
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Isolated lateral malleolar fractures may result from a supination-external rotation (SER) injury of the ankle. Stable fractures maintain tibiotalar congruence due to competent medial restraints and can be treated nonoperatively with excellent functional results and long-term prognosis. Stability might be assessed with either stress radiographs or weightbearing radiographs. METHODS: A consecutive series of patients with closed SER fractures (presumed AO 44-B1) were prospectively enrolled from 2008 to 2015. Patients with clearly unstable fractures (medial clear space more than 7 mm) on the initial nonweightbearing radiograph were excluded and operated on. All other patients were examined with a gravity stress and a weightbearing anteroposterior radiograph. Borderline instability of the fracture was assumed when the medial clear space was 4 to 7 mm. Those were treated nonoperatively. RESULTS: Of 104 patients with isolated lateral malleolar fractures of the SER type, 14 patients were treated operatively because of clear instability (displacement) on the initial radiographs. Of the nonoperative patients, 44 patients demonstrated borderline instability on the gravity stress but stability on the weightbearing radiograph ("gravity borderline"); the remaining 46 were stable in both tests ("gravity stable"). At an average follow-up of 23 months, no significant differences were seen in the American Orthopaedic Foot & Ankle Society hindfoot score (92 points gravity-borderline group vs 93 points gravity-unstable group), the Foot Functional Index score (11 vs 10 points), the Short Form 36 (SF-36) physical component (86 vs 85 points), and SF-36 mental component (84 vs 81 points). Radiographically, all fractures had healed with anatomic congruity of the ankle. CONCLUSION: Weightbearing radiographs provided a reliable basis to decide about stability and nonoperative treatment in isolated lateral malleolar fractures of the SER type with excellent clinical and radiographic outcome at short-term follow-up. Gravity stress radiographs appear to overrate the need for operative treatment. LEVEL OF EVIDENCE: Level III, prospective comparative study.
[Mh] Termos MeSH primário: Fraturas do Tornozelo/fisiopatologia
Traumatismos do Tornozelo/fisiopatologia
Radiografia/métodos
Suporte de Carga/fisiologia
[Mh] Termos MeSH secundário: Gravitação
Seres Humanos
Prognóstico
Estudos Prospectivos
Rotação
Supinação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170518
[St] Status:MEDLINE
[do] DOI:10.1177/1071100717702589


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[PMID]:28296225
[Au] Autor:Wang X; Zhang C; Yin JW; Wang C; Huang JZ; Ma X; Wang CW; Wang X
[Ad] Endereço:Department of Orthopaedic Surgery, Huashan Hospital of Fudan University, Shanghai, China.
[Ti] Título:Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination-External Rotation Type IV Ankle Fractures.
[So] Source:Orthop Surg;9(1):42-48, 2017 Feb.
[Is] ISSN:1757-7861
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate the effect of internal fixation on postoperative ankle function in patients with supination-external rotation type IV ankle fractures, including medial malleolus fractures and deltoid ligament injury. METHODS: Between January 2012 and June 2014, patients with medial structure injuries were enrolled in this study and assigned to the medial malleolus fracture group or the deltoid ligament group. The surgical procedures for the two groups were documented. The follow-up endpoint was the time point when the steel plate or screw was removed from the lateral ankle. The Olerud-Molander ankle scoring system was used to assess ankle function. RESULTS: A total of 84 patients with supination-external rotation type IV ankle fractures had complete medical records and were included in this study. The average age of the patients was 44.16 years (range, 15-75). The patient sample included 39 males and 45 females. Overall, 49 patients (19 males and 30 females) suffered a medial malleolus fracture. The average age of these patients was 40.20 years (range, 15-75). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 81.6% (40 patients) of these patients. Overall, 35 patients (20 males and 15 females) experienced a deltoid ligament injury. The average age of these patients was 44.21 years (range, 17-73). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 11.5% (four patients) of these patients. Open reduction was performed in patients with medial malleolus fractures, and two 4.0-mm cannulated screws were used to fixate the posterior malleolus and the medial malleolus. The suture-anchor technique was used to repair the ligaments in patients with deltoid ligament injuries. The follow-up endpoint was the time point when the steel plate and screws were removed from the lateral ankle in patients. The average follow-up period was 13.4 months (range, 11-17). The Olerud-Molander ankle scoring system was used to assess postoperative ankle function. The average score for the patients in the medial malleolus fracture group was 90.3 points (range, 85-95). The average score for the patients in the deltoid ligament injury group was 87.7 points (range, 80-95). No significant differences were found in the scores between the two groups. CONCLUSION: Medial malleolus fracture and deltoid ligament injury are two different presentations of supination-external rotation type IV ankle fractures. Anatomic reduction of the articular surface concurrent with restoration of ankle stability can achieve favorable results for these two injuries.
[Mh] Termos MeSH primário: Fraturas do Tornozelo/cirurgia
Articulação do Tornozelo/cirurgia
Fixação Interna de Fraturas/métodos
Ligamentos Articulares/lesões
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Fraturas do Tornozelo/diagnóstico por imagem
Articulação do Tornozelo/diagnóstico por imagem
Articulação do Tornozelo/fisiopatologia
Feminino
Seguimentos
Seres Humanos
Ligamentos Articulares/diagnóstico por imagem
Ligamentos Articulares/cirurgia
Masculino
Meia-Idade
Cuidados Pós-Operatórios/métodos
Radiografia
Amplitude de Movimento Articular/fisiologia
Supinação/fisiologia
Tomografia Computadorizada por Raios X
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170316
[St] Status:MEDLINE
[do] DOI:10.1111/os.12318


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[PMID]:28236570
[Au] Autor:Kamrani RS; Moradi A; Sharafat Vaziri A; Nabian MH; Ghane B
[Ad] Endereço:Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
[Ti] Título:Arthroscopic ablation of an osteoid osteoma of the elbow: a case series with a minimum of 18 months' follow-up.
[So] Source:J Shoulder Elbow Surg;26(5):e122-e127, 2017 May.
[Is] ISSN:1532-6500
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Arthroscopic excision of an osteoid osteoma was first reported in the knee joint; since then, there have been several reports of arthroscopic excisions in the knee, shoulder, and elbow, with inconclusive outcomes because of a limited number of cases. The aim of this prospective study was to evaluate the medium-term functional effects of arthroscopic ablation in cases of an osteoid osteoma around the elbow. METHODS: We treated osteoid osteoma of the elbow through arthroscopic ablation in 10 patients. The arthroscopic resection procedure was performed 23 ± 9 months (range, 12-36 months) after initial symptoms. At the preoperative examination and last follow-up examination, the elbow flexion-extension and forearm supination-pronation ranges of motion were measured. The patients were assessed by the Mayo Elbow Performance Score, the visual analog scale for the elbow and wrist, and the Quick Disabilities of the Arm, Shoulder, and Hand score. Finally, the patients' general satisfaction was assessed. RESULTS: The postoperative elbow flexion-extension range of motion was significantly higher compared with range of motion before surgery (P = .001; r = 0.86). According to the Mayo Elbow Performance Score, the average score increased significantly at the final follow-up examination. The mean preoperative and final Quick Disabilities of the Arm, Shoulder, and Hand scores were 47 ± 14 and 1.6 ± 2.8, respectively (P < .001). All patients were satisfied with the operation result. CONCLUSION: According to the results of our study, arthroscopic ablation is a safe and efficient method of treatment for osteoid osteoma of the elbow, with a fast rehabilitation time.
[Mh] Termos MeSH primário: Técnicas de Ablação
Artroscopia
Neoplasias Ósseas/cirurgia
Articulação do Cotovelo
Osteoma Osteoide/cirurgia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Satisfação do Paciente
Pronação
Estudos Prospectivos
Amplitude de Movimento Articular
Recuperação de Função Fisiológica
Supinação
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170614
[Lr] Data última revisão:
170614
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170226
[St] Status:MEDLINE


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[PMID]:28166882
[Au] Autor:Balendra N; Langenderfer JE
[Ad] Endereço:Department of Physical Therapy, Central Michigan University, Mount Pleasant, MI 48859, USA.
[Ti] Título:Effect of hammer mass on upper extremity joint moments.
[So] Source:Appl Ergon;60:231-239, 2017 Apr.
[Is] ISSN:1872-9126
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:This study used an OpenSim inverse-dynamics musculoskeletal model scaled to subject-specific anthropometrics to calculate three-dimensional intersegmental moments at the shoulder, elbow and wrist while 10 subjects used 1 and 2 lb hammers to drive nails. Motion data were collected via an optoelectronic system and the interaction of the hammer with nails was recorded with a force plate. The larger hammer caused substantial increases (50-150%) in moments, although increases differed by joint, anatomical component, and significance of the effect. Moment increases were greater in cocking and strike/follow-through phases as opposed to swinging and may indicate greater potential for injury. Compared to shoulder, absolute increases in peak moments were smaller for elbow and wrist, but there was a trend toward larger relative increases for distal joints. Shoulder rotation, elbow varus-valgus and pronation-supination, and wrist radial-ulnar deviation and rotation demonstrated large relative moment increases. Trial and phase durations were greater for the larger hammer. Changes in moments and timing indicate greater loads on musculoskeletal tissues for an extended period with the larger hammer. Additionally, greater variability in timing with the larger hammer, particularly for cocking phase, suggests differences in control of the motion. Increased relative moments for distal joints may be particularly important for understanding disorders of the elbow and wrist associated with hammer use.
[Mh] Termos MeSH primário: Articulação do Cotovelo/fisiologia
Articulação do Ombro/fisiologia
Articulação do Punho/fisiologia
[Mh] Termos MeSH secundário: Adulto
Fenômenos Biomecânicos
Seres Humanos
Masculino
Modelos Biológicos
Movimento
Pronação
Rotação
Supinação
Análise e Desempenho de Tarefas
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170222
[Lr] Data última revisão:
170222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170208
[St] Status:MEDLINE


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[PMID]:28153481
[Au] Autor:Peyronnet A; Marc C; Lancigu R; Rony L; Cronier P; Hubert L
[Ad] Endereço:CHU d'Angers, 4, rue Larrey, 49100 Angers, France. Electronic address: apeyronnet@gmail.com.
[Ti] Título:Percutaneous reduction of proximal radius fracture in adults. A 12-case series.
[So] Source:Orthop Traumatol Surg Res;103(2):315-318, 2017 Apr.
[Is] ISSN:1877-0568
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:Fractures of the head or neck of the radius account for 5% of elbow fractures in adults. Treatment varies between authors. We report a retrospective series of 12 cases of percutaneous reduction of Mason II radial head fracture, without internal fixation. All fractures consolidated, without secondary displacement. There were no postoperative complications. Mean ranges of motion were 136° flexion-extension and 175° pronation-supination. Mean QuickDASH score was 11. Results in the present series were at least comparable to those for other techniques, validating percutaneous treatment as a solution for radial head fracture. TYPE OF STUDY: Case series. LEVEL OF EVIDENCE: IV.
[Mh] Termos MeSH primário: Articulação do Cotovelo/fisiopatologia
Redução Aberta/métodos
Fraturas do Rádio/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Articulação do Cotovelo/cirurgia
Feminino
Seres Humanos
Masculino
Meia-Idade
Pronação
Amplitude de Movimento Articular
Estudos Retrospectivos
Supinação
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170204
[St] Status:MEDLINE


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[PMID]:28119205
[Au] Autor:Wegner AM; Wolinsky PR; Cheng RZ; Robbins MA; Garcia TC; Amanatullah DF
[Ad] Endereço:University of California Davis Medical Center, Sacramento, CA, USA.
[Ti] Título:Sled fixation for horizontal medial malleolus fractures.
[So] Source:Clin Biomech (Bristol, Avon);42:92-96, 2017 Feb.
[Is] ISSN:1879-1271
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Horizontal fractures of the medial malleolus occur through exertion of various rotational forces on the ankle, including supination--external rotation, pronation--external rotation, and pronation-abduction. Many methods of fixation are employed for these fractures, but the optimal fixation construct remains unclear. METHODS: Horizontal medial malleolus osteotomies were performed in synthetic distal tibiae and randomized into two fixation groups: 1) two parallel unicortical cancellous screws or 2) medial malleolar sled fixation. Specimens were subjected to offset axial tension loading and tracked using high-resolution video. Clinical failure was defined as 2mm of articular displacement. FINDINGS: There were statistically significant increases in mean stiffness (127% higher, P=0.0007) and mean force to clinical failure (52% higher, P=0.0002) with the medial malleolar sled. The mean stiffness in offset tension loading was 232 (SD 83) N/mm for medial malleolar sled and 102 (SD 20) N/mm for parallel unicortical cancellous screws. The mean force to clinical failure was 595 (SD 112) N for medial malleolar sled and 392 (SD 34) N for unicortical screws. In addition, the medial malleolar sled demonstrated elastic recoil to pre-testing alignment while the unicortical screws did not. INTERPRETATION: Medial malleolar sled fixation was significantly stiffer and required more force to clinical failure than parallel unicortical cancellous screws. A medial malleolar sled requires more dissection to apply surgically, but provides significantly more initial fixation strength. Additionally, a medial malleolar sled acts like a tension band in its ability to capture comminuted fragments while being low profile enough to minimize soft tissue irritation.
[Mh] Termos MeSH primário: Fraturas do Tornozelo/cirurgia
Fixação Interna de Fraturas/métodos
Fraturas da Tíbia/cirurgia
[Mh] Termos MeSH secundário: Fraturas do Tornozelo/fisiopatologia
Articulação do Tornozelo/cirurgia
Fenômenos Biomecânicos
Parafusos Ósseos
Seres Humanos
Osteotomia
Pronação/fisiologia
Estresse Mecânico
Supinação/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170126
[St] Status:MEDLINE


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[PMID]:28095359
[Au] Autor:Phillips A; McClinton S
[Ad] Endereço:Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA. Electronic address: Adam.P.Phillips@dmu.edu.
[Ti] Título:Gait deviations associated with plantar heel pain: A systematic review.
[So] Source:Clin Biomech (Bristol, Avon);42:55-64, 2017 Feb.
[Is] ISSN:1879-1271
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Plantar heel pain is a common foot disorder associated with significant pain and gait-related disability. The aim of this systematic review was to identify gait deviations associated with plantar heel pain. METHODS: A systematic review of articles with quantitative gait variables in individuals with plantar heel pain was conducted using the CINAHL, MEDLINE, Scopus, and Embase databases. Methodological quality was assessed using the modified Downs and Black criteria and used along with the number of studies per gait variable to determine level of evidence. FINDINGS: Nineteen articles were included. There was strong evidence that stance phase duration is unchanged. There was moderate to strong evidence of decreased rearfoot center of pressure duration, impulse, and peak vertical ground reaction force at loading response. In compensation there was increased contact time of the midfoot and forefoot, increased midfoot and forefoot impulse, delayed time to the mid-stance vertical ground reaction force valley, and decreased peak force at terminal stance. The only quantitative measure of pronation/supination included limited evidence of increased medial forefoot and rearfoot inversion-eversion total mobility, and medial forefoot plantar flexion. INTERPRETATION: Studies included in this review identified specific foot and ankle gait deviations in individuals with plantar heel pain compared to asymptomatic cases or limbs. The variables identified in this review may be used to assist in identifying movement-related gait dysfunction for treatment decisions or as outcome measures of recovery. Additional research is needed to increase confidence and clinical relevance of gait variables used to assess and treat individuals with PHP.
[Mh] Termos MeSH primário: Doenças do Pé/fisiopatologia
Marcha/fisiologia
Calcanhar/fisiologia
Dor/fisiopatologia
Caminhada/fisiologia
[Mh] Termos MeSH secundário: Articulação do Tornozelo/fisiopatologia
Fenômenos Biomecânicos
/fisiopatologia
Seres Humanos
Pronação/fisiologia
Supinação/fisiologia
Suporte de Carga/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170118
[St] Status:MEDLINE



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