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HUMERAL SHAFT FRACTURE WITH AN INTACT WEDGE FRAGMENT: MIPO VS CONVENTIONAL PLATING. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e268121. [PMID: 37720807 PMCID: PMC10502979 DOI: 10.1590/1413-785220233103e268121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/17/2023] [Indexed: 09/19/2023]
Abstract
Objectives Evaluate bone healing time, consolidation, and the complication rate between the minimally invasive plate osteosynthesis and open reduction with plate osteosynthesis in humeral diaphyseal fractures with an intact wedge (AO 12B2). Methods A retrospective study was carried out between 2016 and 2020. The medical records and radiographs of 18 patients were analyzed, and data were collected regarding the time of consolidation, age, sex, plate size, number of screws, complications such as iatrogenic injury damage to the radial nerve, material failure, and postoperative infection. Results No statistically significant differences were observed in the variables of age, sex, plate size, and number of screws used or in the RUSHU index (Radiographic Union Score for Humeral fractures). There were no postoperative infections, material failure, or need for reoperation, nor cases of secondary radial nerve injury. After one year, all patients had a consolidation index analyzed by RUSHU >11. Conclusion both techniques showed similar results, with a high consolidation rate and low rates of complications or iatrogenic damage to the radial nerve. Evidence level III; Retrospective comparative study .
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WEDGE FRAGMENT VARIATIONS OF TIBIAL SHAFT FRACTURES WITH INTRAMEDULLARY NAILING. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e268124. [PMID: 37720813 PMCID: PMC10502966 DOI: 10.1590/1413-785220233103e268124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/17/2023] [Indexed: 09/19/2023]
Abstract
Introduction Tibial shaft fracture is the most common long-bone fracture, and the standard treatment is intramedullary (IM) nail fixation. Regardless of the development of this technique pseudoarthrosis remains prevalent. Objectives Evaluate the correlation between wedge fragment size and displacement, displacement of the main fragments of the 42B2 type, and pseudoarthrosis incidence. Methods We retrospectively assessed all patients with 42B2 type fracture treated with IM nailing between January, 2015 and December, 2019. Six radiographic parameters were defined for preoperative radiographs in the anteroposterior (AP) and lateral views. Another six parameters were defined for postoperative radiographs at three, six, and 12 months. The Radiographic Union Score for Tibial Fractures score was used to assess bone healing. Results Of 355 patients with tibial shaft fractures, 51 were included in the study. There were 41 (82.0%) male patients, with a mean age of 36.7 years, 37 (72.5%) had open fractures, and 28 (54.9%) had associated injuries. After statistical analysis, the factors that correlated significantly with nonunion were wedge height > 18 mm, preoperative translational displacement of the fracture in the AP view > 18 mm, and final distance of the wedge in relation to its original anatomical position after IM nailing > 5 mm. Conclusion Risk factors for nonunion related to the wedge and42B2 fracture are wedge height > 18 mm, initial translation in the AP view of the fracture > 18 mm, and distance > 5 mm of the wedge from its anatomical position after IM nailing. Evidence level III; Retrospective comparative study .
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FUNCTIONAL OUTCOME OF TREATMENT OF DEVIATED OLECRANON FRACTURE (MAYO 2A) BY AN INTRAMEDULLARY SCREW WITH TENSION BAND COMPARED TO CLASSIC TENSION BAND - A PROSPECTIVE RANDOMIZED STUDY. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e256894. [PMID: 36506855 PMCID: PMC9721414 DOI: 10.1590/1413-785220223002e256894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/03/2021] [Indexed: 12/05/2022]
Abstract
Objective evaluate the functional treatment outcome of deviated transverse olecranon fractures (Mayo 2A) after treatment with tension-banded intramedullary screw (PIBT) compared to classical tension band (BTC). Methods Prospectively collect all deviated transverse olecranon fractures from 2012 to 2016 and randomize them into PIBT and BTC groups. Range of motion (ROM) was measured after 2 and 5 weeks, 3 and 6 months, and 1 and 2 years. Functional assessments (DASH, Oxford Elbow Score, and Mayo Elbow Performance Index) were performed after 3 and 6 months and 1 and 2 years. Complications were collected up to 2 years of follow-up. Results 22 patients were included, 11 in each group. The mean age was 47.9 years, and the left side was injured in 13 (59.0%) patients. All patients completed the 2-year follow-up. There was no ROM difference at any time between the two groups (p> 0.005). Flexion and extension gain was maximum at three months and remained unchanged until two years. Neither flexion nor extension returned to normal, missing around 10°. Pronation and supination returned to normal. All three functional scores showed almost complete recovery of elbow function after three months postoperatively, with no difference between the groups. No group had complications, no reoperation, and no implant removal. Conclusion PIBT had similar results in ROM and functional score compared to BTC. Both had low complication rates and no need for implant removal. Level of evidence I; Randomized Trial .
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DISTAL FEMORAL FRACTURES FROM HIGH-ENERGY TRAUMA: A RETROSPECTIVE REVIEW OF COMPLICATION RATE AND RISK FACTORS. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e256896. [PMID: 36506858 PMCID: PMC9721413 DOI: 10.1590/1413-785220223002e256896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/03/2021] [Indexed: 12/05/2022]
Abstract
Objective Determine complications' incidence and risk factors in high-energy distal femur fractures fixed with a lateral locked plate. Methods Forty-seven patients were included; 87.2% were male, and the average age was 38.9. The main radiographic parameters collected were distal lateral femoral angle (DFA), distal posterior femoral angle (DPLF), comminution length, plate length, screw working length, bone loss, and medial contact after reduction and plate-bone contact, location of callus formation, and implant failure. The complications recorded were nonunion, implant failure, and infection. Results Complex C2 and C3 fractures accounted for 85.1% of cases. Open fractures accounted for 63.8% of cases. The mean AFDL and AFDP were 79.8 4.0 and 79.3 6.0, respectively. The average total proximal and distal working lengths were 133.3 42.7, 60.4 33.4, and 29.5 21.8 mm, respectively. The infection rate was 29.8%, and the only risk factor was open fracture (p = 0.005). The nonunion rate was 19.1%, with longer working length (p = 0.035) and higher PDFA (p = 0.001) as risk factors. The site of callus formation also influenced pseudoarthrosis (p = 0.034). Conclusion High-energy distal femoral fractures have a higher incidence of pseudoarthrosis and infection. Nonunion has greater working length, greater AFDL, and absence of callus formation on the medial and posterior sides as risk factors. The risk factor for infection was an open fracture. Level of Evidence III; Retrospective Cohort Study .
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ETHICAL AND LEGAL ASPECTS OF TELEMEDICINE APPLIED IN ORTHOPEDICS. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e253719. [PMID: 36506863 PMCID: PMC9721437 DOI: 10.1590/1413-785220223002e253719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/07/2021] [Indexed: 12/15/2022]
Abstract
Due to the pandemic of COVID-19, many outpatient services were suspended, affecting hundreds of patients. As a result, several countries were forced to seek strategies to readapt their health systems, one of which was the expansion of telemedicine. Currently, telemedicine is used for several specialties, facilitating the treatment and follow-up of patients who have difficulty accessing it. Tele-orthopedics, telemedicine applied to the orthopedic specialty, allows orthopedic care to be offered to patients regardless of distance. By reducing travel time, waiting time, and costs, tele-orthopedics presents high patient satisfaction, allowing greater rehabilitation effectiveness after surgery and treatment compliance. There is much information in the current literature about telemedicine's legal and ethical aspects, but it is fragmented. This article aims to present a general explanation of these legal and ethical aspects, emphasizing tele-orthopedics. The ethical principles of autonomy, beneficence, non-maleficence and justice must be respected, as well the privacy and confidentiality during a teleconsultation. In this respect, orthopedic surgeons should be governed by traditional moral and ethical precepts. Still, they must also adapt to the new norms and laws regulating telemedicine use. Level of Evidence V: Expert Opinion.
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RADIOGRAPHIC EVALUATION OF IMMEDIATE LOADING SAFETY AFTER SURGICAL REDUCTION IN ACETABULAR FRACTURES: A COMPARATIVE-RETROSPECTIVE STUDY. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e256907. [PMID: 36506862 PMCID: PMC9721436 DOI: 10.1590/1413-785220223002e256907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 07/21/2021] [Indexed: 12/05/2022]
Abstract
Objective Radiographically evaluate the quality of reduction over six weeks of follow-up in patients with surgically treated deviated acetabular fractures who underwent rehabilitation with immediate loading as tolerated and compare this with the results of the unloaded protocol. Methods We retrospectively evaluated the records of 137 patients with deviated acetabular fractures treated with open reduction and internal fixation. Sixty-six (48.2%) patients underwent postoperative rehabilitation with immediate loading as tolerated, while 71 (51.8%) patients completed rehabilitation using a no-load protocol. The quality of the reduction was assessed radiographically by measuring the fracturing step and gap on radiographs taken immediately after surgery and three and six weeks after surgery. Results Comparing the joint step, group 1 had an average of 0.44 ± 1.4 mm, 0.47 ± 1.5 mm, and 0.51 ± 1.6 mm immediately, three and six weeks after surgery, respectively. Group 2 had a mean step of 0.24 ± 0.8 mm, 0.27 ± 0.9 mm, and 0.37 ± 1.2 mm immediately, three, and six weeks after surgery. No statistically significant differences were observed between the groups. With a joint gap, group 1 had a mean of 1.89 ± 1.7 mm, 2.12 ± 1.8 mm, and 2.36 ± 2.1 mm; and group 2 had a mean of 2.16 ± 2.4 mm, 2.47 ± 2.6 mm, and 2.67 ± 2.8 mm in the immediate postoperative period, three, and six weeks, respectively. There was also no statistical difference between groups in these measurements. Conclusion Immediate loading after surgical treatment of deviated acetabular fracture had no negative impact on radiographic reduction parameters and had similar results to the protocol without weight bearing. Level of evidence III; Therapeutic Retrospective Cohort Study .
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Toxic effects of thallium acetate by acute exposure to the nematode C. elegans. J Trace Elem Med Biol 2021; 68:126848. [PMID: 34479099 DOI: 10.1016/j.jtemb.2021.126848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Thallium (Tl) is a toxic metalloid and an emerging pollutant due to electronic devices and dispersal nearby base-metal mining. Therefore, Tl poses a threat to human health and especially the long-term impact on younger individuals exposed is still unknown. This study aimed to evaluate the toxic effects of thallium acetate in C. elegans in early larval stages, considering physiological and behavioral endpoints, as well as the Tl absorption and bioaccumulation. METHODS Caenorhabditis elegans (C. elegans) was exposed to Thallium acetate (50, 100, 150, 200, 250, 500, and 1000 μM) in the L1 larval stage, with the purpose to observe the toxic effects invoked until adulthood. Transgenic worms strains were transported GFP, reporters to DAF-16 and were used to verify the antioxidant response. ICP-MS quantified total Tl+ concentration to evidence Tl uptake and bioaccumulation. RESULTS Thallium acetate caused a significant reduction in the number of living worms (p < 0.0001 in 100-1000 μM), a delay in larval development (p < 0.01; p < 0.001 and p < 0.0001 in 100-1000 μM) through the larval stages, and egg production in the worm's uterus was reduced. Thallium acetate also induced behavioral changes. Additionally, thallium acetate activated antioxidant pathway responses in C. elegans by translocating the DAF-16 transcription factor and activation of SOD-3::GFP expression. The Tl+ quantification in worms showed its absorption in the L1 larval stage and bioaccumulation in the body after development. CONCLUSIONS Thallium acetate reduced survival, delayed development, caused behavioral changes, induced responses inherent to oxidative stress, and serious damage to the worm's reproduction. In addition, C. elegans absorbed and bioaccumulated Tl+. Together, our results highlight the impacts of Tl+ exposure in the early stages of life, even for a short period.
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VALIDITY AND RELIABILITY OF THE MANCHESTER SCALE USED IN THE ORTHOPEDIC EMERGENCY DEPARTMENT. ACTA ORTOPEDICA BRASILEIRA 2019; 27:50-54. [PMID: 30774531 PMCID: PMC6362691 DOI: 10.1590/1413-785220192701191577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives: To describe the clinical utility of the Manchester triage scale adapted for orthopedic emergency departments and to evaluate its validity in identifying patients with the need for hospital care and its reliability when reproduced by different professionals. Methods: Five triage flowcharts were developed based on the Manchester scale for the following orthopedic disorders: traumatic injuries, joint pain, vertebral pain, postoperative disorders, and musculoskeletal infections. A series of patients triaged by two orthopedists was analyzed to assess the concordance between the evaluators (reliability) and the validity of the Manchester scale as predictive of severity. Results: The reliability analysis included 231 patients, with an inter-observer agreement of 84% (Kappa = 0.77, p <0.001). The validity analysis included 138 patients. The risk category had a strong association with the need for hospital care in patients with trauma (OR = 6.57, p = 0.001) and was not significant for non-traumatic disorders (OR = 2.42; p = 0.208). The overall sensitivity and specificity were 64% and 76%, respectively. Conclusion: The evaluated system presented high reliability. Its validity was adequate, with good sensitivity for identifying patients requiring hospital care among those with traumatic lesions. However, the sensitivity was low for patients with non-traumatic lesions. Level of Evidence III, Retrospective Study.
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CLINICAL EVALUATION OF PATIENTS WITH VANCOMYCIN SPACER RETAINED FOR MORE THAN 12 MONTHS. ACTA ORTOPEDICA BRASILEIRA 2019; 27:55-58. [PMID: 30774532 PMCID: PMC6362697 DOI: 10.1590/1413-785220192701213649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: There is no consensus in the literature regarding the time taken to remove antibiotic spacers in the treatment of bone infections. The aim of this study is to evaluate the clinical results of patients with prolonged retention of the same. Methods: Patients selected were diagnosed with post-osteosynthesis infection and/or osteomyelitis and were submitted to treatment using an orthopedic cement spacer (polymethylmethacrylate) with vancomycin, retaining it for a period of more than 12 months. They were clinically evaluated to determine the presence of local or systemic infectious signs via hemogram, investigations of inflammatory markers, liver, renal and, with radiographic control. Results: Eighteen patients were included in the study. The mean retention time of the spacer was 30.4 months (15 – 61 months). No patient had clinical signs of local or systemic infectious relapse at the time of evaluation. Seven patients (39%) presented non-disabling pain in the operated limb. Seventeen patients (94%) presented a reduction in C-reactive protein values compared to the preoperative period. Radiographically, no migration, no spacer failure, or bone sequestration occurred. Conclusion: In this retrospective case series, cement spacer retention with vancomycin for more than 12 months was associated with good clinical results, without relapse of the infectious condition. Nível de Evidência IV. Estudos Terapêuticos - Investigação dos Resultados do Tratamento.
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COMPARATIVE STUDY BETWEEN OSTEOSYNTHESIS IN CONVENTIONAL AND BIOABSORBABLE IMPLANTS IN ANKLE FRACTURES. ACTA ORTOPEDICA BRASILEIRA 2015; 23:263-7. [PMID: 26981035 PMCID: PMC4775479 DOI: 10.1590/1413-785220152305121124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the functional results of ankle fractures treated with metallic and absorbable plates. Twenty patients were randomized into two groups (metallic and absorbable implant groups) and followed prospectively. In the immediate postoperative period, patients were immobilized with plaster casts for one week, which was replaced by a removable cast for another four weeks. Partial weight-bearing was allowed after three weeks, and full weight-bearing after six weeks. Functional recovery was similar in both groups. At six months, three patients in the metallic group complained of local pain, and had their implants removed. One patient in the absorbable group exhibited early dehiscence of the suture and underwent debridement and suturing with good evolution. The American Orthopaedic Foot and Ankle Society (AOFAS) score was similar between the two groups after six and nine months of follow-up. The absorbable implants showed clinical and functional results that were similar to those of metallic implants. Level of Evidence II, Prospective Comparative Study.
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Avaliação do resultado do tratamento cirúrgico das fraturas desviadas do terço proximal do úmero com placa pré-moldada com parafusos bloqueados. Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2012.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Estudo anatômico da via de acesso suprapatelar lateral para a haste intramedular bloqueada na fratura da tíbia. Rev Bras Ortop 2012. [DOI: 10.1590/s0102-36162012000200005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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ANATOMICAL STUDY ON THE LATERAL SUPRAPATELLAR ACCESS ROUTE FOR LOCKED INTRAMEDULLARY NAILS IN TIBIAL FRACTURES. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2012; 47:169-72. [PMID: 27042617 PMCID: PMC4799382 DOI: 10.1016/s2255-4971(15)30082-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 09/19/2011] [Indexed: 11/20/2022]
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Comparação entre o uso de placas e o de hastes flexíveis para a osteossíntese de fraturas do terço médio da clavícula: resultados preliminares. Rev Bras Ortop 2011. [DOI: 10.1590/s0102-36162011000700009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Paciente vítima de violência no trânsito: análise do perfil socioeconômico, características do acidente e intervenção do Serviço Social na emergência. ACTA ORTOPEDICA BRASILEIRA 2007. [DOI: 10.1590/s1413-78522007000500006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Identificar e analisar o perfil dos pacientes; o meio de transporte que causou o acidente; as normas do Código de Trânsito Brasileiro, se foram ou não seguidas; a rede de apoio e as intervenções do Serviço Social. MÉTODO: A pesquisa foi realizada com 100% dos pacientes internados nesta Instituição no período de 15/08/04 a 19/11/04, que foram vítimas de acidente no trânsito. Entrevistamos: 37 condutores de motocicletas, 26 pedestres, 15 condutores de veículo a motor e 06 passageiros, totalizando 84 pacientes. Foram utilizados formulários com questões abertas e fechadas de abordagem quantitativa e qualitativa. Resultado: A maior demanda foi de motociclistas, sendo que 83% são do sexo masculino, jovens com escolaridade até o ensino médio e renda mensal de dois salários mínimos. 62% residem em São Paulo e somente 36,5% possuem vínculo formal de trabalho. A maior parte das fraturas ocorreu nos membros inferiores (54%). Todos os pacientes necessitaram de cuidados após alta hospitalar, sendo que 98% contaram com o apoio familiar. CONCLUSÃO: Os elevados números de acidentes nos indicam que a violência no trânsito pode ser considerada um problema de saúde pública e estudos devem ser realizados para subsidiar as políticas públicas nesta área.
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Comparative multicenter study of treatment of multi-fragmented tibial diaphyseal fractures with nonreamed interlocking nails and with bridging plates. Clinics (Sao Paulo) 2006; 61:333-8. [PMID: 16924325 DOI: 10.1590/s1807-59322006000400010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2006] [Accepted: 05/10/2006] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE A prospective, randomized study to compare patients with closed, multi-fragmented tibial diaphyseal fractures treated using one of two fixation methods undertaken during minimally invasive surgery: nonreamed interlocking intramedullary nails or bridging plates. MATERIALS AND METHODS Forty-five patients were studied; 22 patients were treated with bridging plates, 23 with interlocking nails without reaming. All fractures were Type B and C (according to the AO classification). RESULTS Clinical and radiographic healing occurred in all cases. No cases of infection occurred. The healing time for patients who received nails was longer (4.32 weeks on average) than the healing time for those who received plates (P = 0.026). No significant differences were observed between the two methods regarding ankle mobility for patients in the two groups. CONCLUSIONS The healing time was shorter with the bridging plate technique, although no significant functional differences were found.
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Fatores preditivos de infecção em pacientes com fraturas expostas nos membros inferiores. ACTA ORTOPEDICA BRASILEIRA 2004. [DOI: 10.1590/s1413-78522004000100005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
134 pacientes com fraturas expostas dos membros inferiores dos tipos II, IIIA, IIIB e IIIC foram estudados prospectivamente entre fevereiro de 1998 e maio de 2000 no Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo para determinar os fatores de risco de infecção previsíveis Todos os pacientes foram registrados em um protocolo no qual eles tiveram amostras de fragmentos ósseos iniciais coletadas para cultura bacteriana, avaliação de condições clínica e administração precoce de antibiótico. Durante a abordagem inicial, as causas das fraturas, o tempo de exposição da fratura e o local onde os primeiros socorros foram recebidos foram observados. Durante o debridamento inicial, o volume de transfusão sangüínea, a classificação clinica ASA, o tempo cirúrgico, o ferimento cirurgico e o tipo de estabilização esquelética foram observados. Uma análise univariável foi realizada para identificar os riscos pervisíveis estatisticamente significantes para o desenvolvimento de infecções, com os seguintes resultados: tempo de exposição da fratura (p=0.0201), local dos primeiros socorros (p=0.400), tipo de fratura (p=0.0130), classificação ASA (p=0.0005), volume de transfusão de sangue (p=0.0002) tipo de osso fraturado (p=0.0052), tipo de acidente (p=0.0450), ferimento cirúrgico (p=0.0024), estabilização esquelética (p=0.0446), cultura bacteriana positiva na admissão (p=0.5290) e cirurgias concomitantes (p=0.1867). As variáveis com associação significante com a infecção foram introduzidas em uma equação de regresão multivariada (modelo logístico) para identificar as com efeitos independentes dos outros fatores. O modelo logístico final foi obtido e demonstrou as probabilidades de infecção nas fratruras expostas estudadas. Os riscos relativos revelados no modelo logístico final foram : volume de transfusão sangüínea (mais do que 1 unidade) - 6.4;classificação ASA nível III - 5.2; fixação interna do osso (imediata) - 3.9; osso fraturado (femur) - 3.5 and ferimento aberto - 3.0
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