Navegando por Palavras-chave "Fracture fixation"
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- ItemSomente MetadadadosThe correct implant choice for transtrochanteric fracture in Brazil(Atha Comunicacao & Editora, 2016) Torquato, Diogo Fernandes [UNIFESP]; Bordini, Andre Figueiredo [UNIFESP]; Ferreira, Gustavo [UNIFESP]; Takata, Edmilson Takehiro [UNIFESP]; Trigueiro, Gustavo [UNIFESP]; Basile, Ricardo [UNIFESP]Objective: To assess the adequacy to the Brazilian population of orthopedic implants used for treatment of proximal femoral fractures. Methods: The neck-shaft angle of the femur of 101 patients was measured in anteroposterior pelvis radiographs and these measurements were correlated to gender, age, height, weight and ethnicity. In addition, we compared the values of the neck-shaft angle with the angulation of the main implants available in the Brazilian market for the treatment of transtrochanteric fractures. Results: Of the 101 measurements, an average of 130.9 +/- 6.7 degrees was obtained, ranging from 112 degrees to 150 degrees. Correlating these measurements with epidemiological variables, only age was statistically significant. Conclusion: Most of the analyzed population presented anatomical characteristics that allow the proper use of these implants to treat transtrochanteric fractures, as indicated from the analysis of neck-shaft angles. Nonetheless, 4% of individuals did not fit this pattern and would have required alternative implants.
- ItemAcesso aberto (Open Access)Estudo da relação anatômica do nervo sensitivo radial após fixação percutânea com fios de Kirschner(Sociedade Brasileira de Ortopedia e Traumatologia, 2008-03-01) Labronici, Pedro José; Franco, José Sergio; Hoffmann, Rolix; Silva, Anselmo Fernandes Da; Passos, Marco Aurélio Rodrigues Da Fonseca; Lourenço, Paulo Roberto Barbosa De Toledo; Fernandes, Hélio Jorge Alvachian [UNIFESP]; Reis, Fernando Baldy dos [UNIFESP]; Hospital Santa Teresa Clínica do Serviço de Ortopedia e Traumatologia Prof. Dr. Donato D'Ângelo; Universidade Federal do Rio de Janeiro Faculdade de Medicina Departamento de Ortopedia e Traumatologia; Faculdade de Medicina de Petrópolis; Universidade do Estado do Rio de Janeiro; Hospital de Ipanema Grupo de Trauma; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To establish the risk of lesion to the radial sensory nerve after percutaneous fixation in the distal radius region of cadavers. METHODS: The authors used 24 upper limbs of 12 skeletally mature cadavers, 10 male, and 2 female, mean age estimated as 50 years. A Kirschner wire was introduced in the styloid process of the radius to make the following determinations: distance between the wire and the radial sensory nerve, between the wire and the closest dorsal nerve branch, between the wire and the tendons of the first osteofibrous tunnel, and, finally, the number of branches of the radial sensory nerve. RESULTS: The site were the nerve appeared, between the two tendons and the Kirschner wire in the radial styloid process was a mean 5.09 cm, with a standard deviation of 0.75 cm. The distance between the Kirschner wire and the first dorsal branch was a mean 4.33 cm, ranging from zero to 10 cm. The number of nervous branches was a mean of four, ranging from two to eight branches. CONCLUSION: Results of this experimental study showed that when the wire is introduced in the styloid process of the radius, the risk of lesioning the radial sensory nerve is not a big risk. This risk is directly related to the number of nervous branches and to the angles of the wires while they are being introduced in the distal end of the radius.
- ItemAcesso aberto (Open Access)Intervenções para o tratamento de fratura e pseudartrose da clavícula em adultos e adolescentes: revisão sistemática(Universidade Federal de São Paulo (UNIFESP), 2010-11-25) Lenza, Mário [UNIFESP]; Faloppa, Flávio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: To evaluate the effectiveness of different methods of treatment for acute fracture or non-union of the middle third of the clavicle in adults and adolescents. Methods: Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, trial registries and reference lists of articles. No language or publication restrictions were applied. Selection criteria: Randomised and quasi-randomised controlled trials evaluating any intervention for treating fractures or non-union of the middle third of the clavicle were considered. The primary outcomes were pain, treatment failure and health-related quality of life or shoulder function. Data collection and analysis: Two authors independently selected eligible trials and three authors assessed methodological quality and cross-checked data extraction. Results: Conservative interventions: Three trials were included in this comparison. Two trials compared the figure-of-eight bandage with sling in a total of 234 participants. Both trials were underpowered and compromised by poor methodology. One trial found slightly higher pain levels in the bandage group at 15 days, and the other trial reported greater discomfort during bandage wear. There were no significant differences in functional or other outcomes reported for either trial. The third trial, which evaluated therapeutic ultrasound in 120 participants, was also underpowered but had a low risk of bias. The trial found no statistically significant difference between low-intensity pulsed ultrasound and placebo in the time to clinical fracture healing or in any of the other reported outcomes. Surgical versus conservative interventions: Four studies, two with moderate and two with high risk of bias were included. Two compared plate fixation versus sling; plate fixation showed better patient-based upper extremity outcome scores and less treatment failure. Other two trials comparing intramedullary fixation versus conservative interventions presented better upper limb function to the surgery treatment. Surgical interventions: Data from four small trials, each testing a different comparison, were included. Three trials had design features that carry a high risk of bias, limiting the strength of their findings. Low-contact dynamic compression plates appeared to be associated with significantly better upper-limb function throughout the year following surgery, earlier fracture union and return to work, and a reduced incidence of implant-associated symptoms when compared with a standard dynamic compression plate in 36 adults with symptomatic non-union of the middle third of the clavicle. One study (69 participants) compared the Knowles pin versus plate for treating middle third clavicle fractures or non-union. Knowles pins appeared to be associated with lower pain levels and use of post-operative analgesics, reduced incidence of implant-associated symptoms, and shorter operation time and hospital stay. One study (133 participants) found that a three-dimensional technique for fixation with a reconstruction plate was associated with a significantly lower incidence of symptomatic delayed union than a standard superior position surgical approach. One study (201 participants) assessed the intramedullary fixation for treating acute clavicle fractures comparing closed and opened reduction; there were statistical significant differences in favour of closed reduction with percutaneous fixation for the primary outcomes. Conclusion: There is limited evidence, from single trials only, regarding the effectiveness of different methods for treating fracture and non-union of the middle third of the clavicle. Further research is warranted.
- ItemAcesso aberto (Open Access)Osteossínteses com hastes intramedulares em crianças(Sociedade Brasileira de Ortopedia e Traumatologia, 2009-10-01) Fernandes, Helio Jorge Alvachian [UNIFESP]; Saad, Eduardo Abdalla [UNIFESP]; Reis, Fernando Baldy dos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The authors present a comprehensive review of the literature emphasizing the use of flexible intramedullary nails in the treatment of fractures in children, focusing the treatment of femoral shaft and forearm fractures and emphasizing the importance of the non-surgical approach. Children's age and weight threshold are not well defined for the use of the method. The removal of implants is a controversial matter in the literature, with a trend towards keeping the implants.
- ItemAcesso aberto (Open Access)Ponto de entrada para as hastes intramedulares anterógradas do fêmur: estudo em cadáver(Sociedade Brasileira de Ortopedia e Traumatologia, 2009-01-01) Labronici, Pedro José [UNIFESP]; Galeno, Luiz; Teixeira, Thiago Martins; Franco, José Sergio; Hoffmann, Rolix; Lourenço, Paulo Roberto Barbosa De Toledo; Giordano, Vincenzo; Pallottino, Alexandre; Amaral, Ney Pecegueiro Do; Universidade Federal de São Paulo (UNIFESP); Hospital Santa Teresa Serviço de Ortopedia e Traumatologia Prof. Dr. Donato D'Ângelo; Federal do Rio de Janeiro Departamento de Ortopedia e Traumatologia Faculdade de Medicina; Hospital de Ipanema Grupo de Trauma; Hospital Municipal Miguel Couto Programa de Residência Médica; Hospital Municipal Miguel Couto Serviço de Ortopedia e TraumatologiaOBJECTIVE: To analyze the natural exit of the wire guides in major trochanter through retrograde femoral approach, in cadaver specimens. Material and Method: 100 femurs had been perforated between the femoral condyles, at 1.2 cm of the intercondylar region. A 3-mm straight wire guide was introduced, through retrograde approach, until the proximal extremity of femur was reached. Femurs were assessed for posterosuperior and anterosuperior portions of major trochanter, pear-shaped cavity, and upper median line between the head-neck and the major trochanter. RESULTS: in 62%, the straight wire guides exited at the anterior surface of major trochanter. In the pear-shaped cavity, the median distance found was 1.0 cm and the interquartile range was 0.5 cm, initially expressing, in relation to pear-shaped cavity, better accuracy. CONCLUSION: the central axis of the medullar canal, at coronal plane, projected better accuracy in the region of the pear-shaped cavity.
- ItemAcesso aberto (Open Access)Treatment of the humeral shaft fractures - minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace: study protocol for a randomised controlled trial(Biomed Central Ltd, 2013-08-07) Matsunaga, Fabio T. [UNIFESP]; Tamaoki, Marcel J. S. [UNIFESP]; Matsumoto, Marcelo H. [UNIFESP]; Santos, Joao B. G. dos [UNIFESP]; Faloppa, Flavio [UNIFESP]; Belloti, Joao C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Non-operative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Surgical treatment is reserved for specific conditions. Modern concepts of internal fixation of long bone shaft fractures advocate relative stabilisation techniques with no harm to fracture zone. Recently described, minimally invasive bridge plate osteosynthesis has been shown to be a secure technique with good results for treating humeral shaft fractures. There is no good quality evidence advocating which method is more effective. This randomised controlled trial will be performed to investigate the effectiveness of surgical treatment of humeral shaft fractures with bridge plating in comparison with conservative treatment with functional brace.Methods/Design: This randomised clinical trial aims to include 110 patients with humeral shaft fractures who will be allocated after randomisation to one of the two groups: bridge plate or functional brace. Surgical treatment will be performed according to technique described by Livani and Belangero using a narrow DCP plate. Non-operative management will consist of a functional brace for 6 weeks or until fracture consolidation. All patients will be included in the same rehabilitation program and will be followed up for 1 year after intervention. the primary outcome will be the DASH score after 6 months of intervention. As secondary outcomes, we will assess SF-36 questionnaire, treatment complications, Constant score, pain (Visual Analogue Scale) and radiographs.Discussion: According to current evidence shown in a recent systematic review, this study is one of the first randomised controlled trials designed to compare two methods to treat humeral shaft fractures (functional brace and bridge plate surgery).
- ItemAcesso aberto (Open Access)Visualização radiológica intraoperatória da região occipitocervical e coluna cervical superior: nota técnica(Sociedade Brasileira de Coluna, 2009-06-01) Mudo, Marcelo Luis [UNIFESP]; Amantéa, Andrea Vieira [UNIFESP]; Cavalheiro, Sergio [UNIFESP]; Joaquim, Andrei Fernandes; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)We report a technical note to obtain a better intraoperative radiological view in surgeries of the craniocervical junction and upper cervical spine.