RESUMO

AIM: to assess the small-scale 3D printing feasibility and cost estimation of a device for controlled dynamization. MATERIALS AND METHOD: The two-part device previously developed by our research group was printed with a carbon fiber-reinforced nylon filament (Gen3 CarbonX™ PA6+CF, 3DXTECH Additive Manufacturing) by a professional 3D printer (FUNMAT HT, Intamsys). Electricity, material, and labor costs for production in a Brazilian city in the Santa Catarina state were calculated. RESULTS: The devices for controlled dynamization were successfully printed in accordance with the planned design and dimensions. Six out of 38 printed devices presented defects in the bolt hole and were discarded. The average printing time per device was 1.9 h. The average electricity, material, and labor costs per printed device were respectively US$0.71, US$13.55, and US$3.04. The total production cost per device reaches approximately US$20 by adding the average cost of defective devices (15 %). CONCLUSION: 3D printing of the controlled dynamization device is feasible and its cost seems affordable to most healthcare services, which could optimize the consolidation of diaphyseal fractures and reduce treatment time for patients.

Assuntos

RESUMO

Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia. Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator. Result There were no statistically significant differences ( p > 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain. Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.

RESUMO

Introducción: Las fracturas supracondíleas del húmero en el niño son por lo general de tratamiento quirúrgico, mediante reducción cerrada o abierta asociada a la colocación de alambres. Por su parte, la fijación externa es una opción aceptada en ciertas circunstancias. Objetivo: Actualizar sobre el uso de la fijación externa en pacientes con fractura supracondílea del húmero en el niño. Métodos: Se realizó una búsqueda y análisis de la información en un periodo de 61 días (primero de junio al 31 de julio de 2023) y se emplearon las siguientes palabras: pediatric supracondylar humeral fractures AND external fixation, external fixation AND elbow, complex fractures AND pediatric supracondylar. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 177 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote. De ellos, se utilizaron 34 citas seleccionadas para realizar la revisión, 32 de los últimos cinco años. Resultados: Se hizo referencia a las indicaciones y contraindicaciones, además de las ventajas de la fijación externa. Se mencionaron las principales diferencias entre la fijación con alambres de Kirschner y la fijación externa. Se expuso la técnica en cinco pasos. Se plasmaron los cuidados posoperatorios, complicaciones y comentarios sobre los resultados. Conclusiones: La fijación externa constituye una modalidad de tratamiento efectiva para pacientes pediátricos con patrones de fractura complejos. Es una técnica factible de realizar y reproducir. Los resultados son iguales o superiores al ser comparados con las otras modalidades quirúrgicas.

Introduction: Supracondylar humerus fractures in children are generally treated surgically, through closed or open reduction associated with placement of the wires. For its part, external fixation is an accepted option in certain circumstances. Objective: To update on the use of external fixation in patients with supracondylar fracture of the humerus in children. Methods: The search and analysis of the information was carried out in a period of 61 days (June 1st to July 31st, 2023) and the following words were used: pediatric supracondylar humeral fractures AND external fixation, external fixation AND elbow, complex fractures AND pediatric supracondylar. Based on the information obtained, a bibliographic review of a total of 177 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search engine and reference administrator. Of these, 34 selected citations were used to carry out the review, 32 of the last five years. Results: References are made to the indications and contraindications, in addition to the advantages of external fixation. The main differences between Kirschner wire fixation and external fixation are mentioned. The technique is exposed in five steps. Postoperative care, complications and comments on the results are reflected. Conclusions: External fixation is an effective treatment modality for pediatric patients with complex fracture patterns. It is a feasible technique to perform and reproduce. The results are equal or superior when compared with other surgical modalities.

RESUMO

Abstract Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia. Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator. Result There were no statistically significant differences (p> 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain. Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.

Resumo Objetivo Comparar os resultados funcionais entre duas técnicas de fixação externa circular utilizadas no tratamento de fraturas complexas da extremidade proximal da tíbia. Materiais e Métodos Trata-se de um estudo de coorte retrospectivo, com 51 pacientes submetidos ao tratamento cirúrgico de fraturas complexas do planalto tibial com fixador externo circular. Os pacientes foram divididos em dois grupos: 12 pacientes tratados com a técnica clássica e 39 pacientes tratados com a técnica simplificada. As variáveis analisadas incluíram idade, sexo, mecanismo da lesão, energia do trauma, lesões associadas, tipo de fixador, tempo de uso do fixador e resultados clínico-radiográficos. A técnica clássica lança mão principalmente de fios de Kirschner transfixantes, e a simplificada substitui os fios de Kirschner por pinos de Schanz no bloco distal do fixador externo circular. Resultados A partir da comparação das montagens, não encontramos diferenças estatisticamente significativas (p> 00,5) entre os dois grupos em relação aos resultados clínico-radiográficos, incluindo a consolidação da fratura, a qualidade da redução da fratura articular, a amplitude de movimento, a discrepância residual na medida dos membros inferiores e a dor do paciente no pós-operatório. Conclusão Sugerimos que a técnica simplificada, utilizando pinos de Schanz no lugar dos fios de Kirschner, pode ser uma alternativa viável e eficaz no tratamento de fraturas complexas da extremidade proximal da tíbia com fixador externo circular. Essa abordagem simplificada pode oferecer benefícios, como menor taxa de infecção e maior conforto para o paciente, sem comprometer os resultados clínicos e radiográficos, o que justifica, o seu uso.

Assuntos

RESUMO

Abstract Chronic distal radioulnar joint (DRUJ) dislocation has been treated historically with complex osteotomies and reconstructive procedures, often resulting in intractable stiffness and loss of function. It is desirable to use a technique of fixation that will not only restore the wrist biomechanics but also be cosmetically appealing to the individual. We present a novel technique of reduction and fixation of a chronically dislocated DRUJ in a 26-year-old male using a minimally invasive approach, with successful restoration of DRUJ function and no postoperative complications.

Resumo Luxação crônica da articulação radioulnar distal (ARUD) foi tratada historicamente com osteotomias complexas e procedimentos reconstrutivos, geralmente resultando em rigidez intratável e perda de função. É desejável usar uma técnica de fixação que não apenas restaure a biomecânica do punho, mas também seja esteticamente atraente para o indivíduo. Apresentamos uma nova técnica de redução e fixação de uma ARUD deslocada cronicamente em um homem de 26 anos, usando uma abordagem minimamente invasiva, com restauração bem-sucedida da função da ARUD e sem complicações pós-operatórias.

Assuntos

RESUMO

La Impresión 3D es una tecnología emergente utilizada cada vez más en medicina. En los países en vías de desarrollo, donde las fracturas por motocicletas y automóviles se encuentran en aumento, la disponibilidad de fijadores externos para el manejo de fracturas abiertas es un problema frecuente. La impresión 3D puede ser una alternativa económica e igualmente confiable a los dispositivos tradicionales elaborados con acero o titanio. El objetivo de este trabajo es mostrar la experiencia con el uso de Impresión 3D y su aplicación en el manejo clínico de fracturas abiertas diafisiarias de tibia. Se realizó un estudio pre-experimental y prospectivo. Se incluyeron 14 pacientes con fracturas de tibia AO/ASIF 42A, 42B y 42C tratados con un fijador externo con rótulas elaboradas con Impresión 3D como medida de Control de Daños en Ortopedia desde su ingreso hasta su resolución definitiva. Todos los pacientes fueron de sexo masculino, con un promedio de edad 23,16 años con 50% entre 20-23 años. Las fracturas fueron 42,85% tipo 42A, 37,71% 42B y 21,42% 42C. El 78,57% de las fracturas fueron ocasionadas por motocicletas: 57,14% grado II según Gustilo y Anderson, un 28,57% grado III y 14,28% grado I. El 37,71% eran politraumatizados. Ninguno de los pacientes presentó complicaciones como pérdida de la reducción, aflojamiento de las rótulas, ruptura o fatiga de las rótulas ni fatiga de la barra. La impresión 3D demostró ser una herramienta y alternativa útil en el manejo agudo de fracturas abiertas diafisiarias de tibia(AU)

3D Printing is an emerging technology used more and more in medicine. In developing countries, where motorcycle and automobile fractures are on the rise, the availability of external fixators for the management of open fractures is a frequent problem. 3D printing can be a cheap and equally reliable alternative to traditional devices made of steel or titanium. The objective of this work is to show the experience with the use of 3D Printing and its application in the clinical management of open diaphyseal fractures of the tibia. A pre-experimental and prospective study was made. 14 patients with AO/ASIF tibia fractures 42A, 42B and 42C treated with an external fixator with 3D-printed ball-caps as a Damage Control measure in Orthopedics from admission to final resolution were included. All patients were male, with an average age of 23,16 years, 50% between 20-23 years. The fractures were 42,85% type 42A, 37,71% 42B and 21,42% 42C. 78,57% of the fractures were caused by motorcycles: 57,14% grade II according to Gustilo and Anderson, 28,57% grade III and 14.28% grade I. 37,71% were polytraumatized. None of the patients had complications such as loss of reduction, loosening of the patellas, rupture or fatigue of the patellas, or rod fatigue. 3D printing proved to be a useful tool and alternative in the acute management of open diaphyseal fractures of the tibia(AU)

Assuntos

RESUMO

Abstract Objective Over the last decades, volar locking plates (VLPs) have been the mainstay treatment for distal radius fractures (DRFs). With the growing body of evidence, we systematically reviewed studies on recent VLP modifications. Methods A systematic search was performed in the PubMed/MEDLINE database for studies published in English in the past five years. The inclusion criteria were randomized controlled trials (RCTs) on the operative treatment of DRFs. We excluded ongoing trials and studies not directly addressing DRF. The primary outcomes assessed were subjective (such as the scores on the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire, the Patient-rated Wrist Evaluation [PRWE], the European Quality of Life-5 Dimensions [EQ-5D], the 36-item Short Form Health Survey [SF-36], and the Visual Analog Scale [VAS]) and objective clinical outcomes (the complication rate). Results We identified 29 articles published from 2016 to 2020 with high quality of evidence, except for one, which had evidence of moderate quality. In total, 3,079 DRFs were analyzed in the present study. All studies except one had a greater proportion of female participants, and only in 1 study the mean age of the sample was < 40 years old. There were no significant differences between the VLP and external fixation (EF) in terms of the scores on the DASH (p= 0.18) and PRWE (p= 0.77). The VLP alone without pronator quadratus (PQ) repair yielded significantly better outcomes. Conclusion In unstable fractures, the VLP and EF yielded comparable long-term results. There is no clear benefit of adding PQ repair to current the VLP surgical technique. Level of EvidenceLevel I

Resumo Objetivo Nas últimas décadas, a placa volar bloqueada (PVB) tem sido o tratamento principal para fraturas do rádio distal (FRDs). Com o crescente conjunto de evidências, revisamos sistematicamente estudos sobre modificações recentes na PVB. Métodos Uma pesquisa sistemática foi realizada utilizando o banco de dados PubMed/MEDLINE por estudos publicados em inglês nos últimos cinco anos. Os critérios de inclusão foram ensaios clínicos controlados e randomizados (ECCRs) sobre o tratamento cirúrgico de FRDs. Excluímos ensaios e estudos em andamento que não abordavam diretamente a FRD. Os desfechos primários avaliados foram desfechos clínicos subjetivos (como as pontuações no questionário de Deficiências do Braço, Ombro e Mão [Disabilities of the Arm, Shoulder and Hand, DASH, em inglês], na Avaliação do Punho Classificada pelo Paciente [Patient-rated Wrist Evaluation, PRWE, em inglês], no questionário Qualidade de Vida Europeia - 5 Dimensões [European Quality of Life-5 Dimensions, EQ-5D, em inglês], na Pesquisa de Saúde por Formulário Curto de 36 Itens [36-item Short Form Health Survey, SF-36, em inglês], e na Escala Visual Analógica [EVA]) e objetivos (taxa de complicações). Resultados Identificamos 29 artigos publicados entre 2016 e 2020 com alta qualidade de evidência, exceto por um, de qualidade moderada. Ao todo, foram analisadas 3.079 FRDs neste estudo, Todos os estudos analisados, exceto por um, tinham maior proporção de participantes do gênero feminino, e somente em 1 estudo a idade média da amostra foi < 40 anos. Não houve diferença significativa entre a PVB e fixação externa (FE) em termos das pontuações no DASH (p= 0,18) e na PRWE (p= 0,77). Os resultados da PVB isolada, sem qualquer reparo do pronador quadrado (PQ), foram significativamente melhores. Conclusão Em fraturas instáveis, a PVB e a FE produziram resultados comparáveis no longo prazo. Não há um benefício claro em se adicionar reparo do PQ à técnica cirúrgica atual da PVB. Nível de EvidênciaNível I

Assuntos

RESUMO

Introduction: Indications for provisional external fixation prior to the definitive treatment of fractures are associated with the control of local and systemic damage and the impossibility of definitive osteosynthesis in the emergency. Objective: To identify complications associated with external fixation prior to definitive internal osteosynthesis. Methods: This is a comparative, prospective study (Level II). Inclusion criteria: patients treated as emergencies (November 2019 and March 2020) who underwent provisional external correction followed by definitive osteosynthesis. We look for signs of inadequacies in external correction and correlation with infections (erythema, hyperemia, fistulae in the path of the pins or surgical scars), systemic symptoms of infection, and radiographic parameters for treatment up to eight weeks after surgery. Results: The average time for conversion to definitive osteosynthesis was 15.9 days and 47 lower limbs and three upper limbs were fixed. Of the participants who had deep infections, three (6%) showed signs during initial treatment (external fixator) and nine (18%), after definitive internal osteosynthesis. We found no correlation between provisional external correction and complications in the definitive treatment with osteosynthesis. Conclusion: The use of temporary external fixation before definitive internal osteosynthesis in fractures of the appendicular skeleton failed to increase complication rates even if the path of the implants in both procedures overlapped. Level of Evidence II, Comparative Prospective Study.

Introdução: As indicações para a fixação externa provisória que antecedem o tratamento definitivo das fraturas está associado ao controle do dano local e sistêmico e à impossibilidade de osteossíntese definitiva na urgência. Objetivo: Identificar complicações associadas à fixação externa precedente à osteossíntese interna definitiva. Métodos: Estudo prospectivo comparativo realizado com pacientes atendidos em situação de urgência entre novembro de 2019 e março de 2020, que sofreram a fixação externa provisória seguida de osteossíntese definitiva. Buscamos indícios de inadequações na fixação externa e correlação com: infecção (eritema, hiperemia, fístula do trajeto dos pinos ou da cicatriz cirúrgica), sintomas sistêmicos de infecção e parâmetros radiográficos da evolução do tratamento até oito semanas do pós-operatório. Resultados: O tempo médio para conversão em osteossíntese definitiva foi de 15,9 dias, e foram fixados 47 membros inferiores e 3 membros superiores. Dos participantes que apresentaram quadros de infecções profundas, três (6%) apresentaram os sinais durante o tratamento inicial (fixador externo) e nove (18%) após a osteossíntese interna definitiva. Não foi encontrada correlação entre a fixação externa provisória e complicações no tratamento definitivo com osteossíntese. Conclusão: O emprego da fixação externa temporária antes da osteossíntese interna definitiva em fraturas do esqueleto apendicular não provocou aumento nas taxas de complicações, mesmo quando houve sobreposição no trajeto dos implantes usados nos dois procedimentos. Nível de Evidência II, Estudo Prospectivo Comparativo.

RESUMO

Objective To evaluate the quality of life of patients using an Ilizarov type external fixator for the treatment of complicated fractures and their sequelae. Method This is an observational and cross-sectional study, in which the 36-item short form survey (SF-36) questionnaire (translated into Portuguese) was applied during outpatient consultations in 2 periods, in the months of July 2018 and January 2019. The patients who participated in the study underwent their surgical procedures between January and June 2018. Results We evaluated 36 patients using an external Ilizarov fixator. We observed a predominance of male patients, with a mean age of 37.9 years. Fractures of leg bones and their complications represented half of the sample. Improvement in functional capacity and emotional aspects of the patients was observed throughout the treatment. Conclusion The use of the circular external fixator is an important and effective method for the surgical treatment of complex fractures and their sequelae. This study allowed us to conclude that, after treatment, patients achieved functional return to daily activities with adequate quality of life.

RESUMO

Abstract Objective To evaluate the quality of life of patients using an Ilizarov type external fixator for the treatment of complicated fractures and their sequelae. Method This is an observational and cross-sectional study, in which the 36-item short form survey (SF-36) questionnaire (translated into Portuguese) was applied during outpatient consultations in 2 periods, in the months of July 2018 and January 2019. The patients who participated in the study underwent their surgical procedures between January and June 2018. Results We evaluated 36 patients using an external Ilizarov fixator. We observed a predominance of male patients, with a mean age of 37.9 years. Fractures of leg bones and their complications represented half of the sample. Improvement in functional capacity and emotional aspects of the patients was observed throughout the treatment. Conclusion The use of the circular external fixator is an important and effective method for the surgical treatment of complex fractures and their sequelae. This study allowed us to conclude that, after treatment, patients achieved functional return to daily activities with adequate quality of life.

Resumo Objetivo Avaliar a qualidade de vida dos pacientes em uso do fixador externo do tipo Ilizarov para tratamento de fraturas complexas e de suas sequelas Método Trata-se de um estudo observacional e transversal, em que foi aplicado o questionário 36-item short form survey (SF-36) (traduzido para a língua portuguesa) durante as consultas ambulatoriais em 2 períodos, nos meses de julho de 2018 e janeiro de 2019. Os pacientes que participaram do estudo realizaram seus procedimentos cirúrgicos no período de janeiro a junho de 2018. Resultados Foram avaliados 36 pacientes em uso de fixador externo do tipo Ilizarov. Foi observado predomínio do sexo masculino e idade média de 37,9 anos. As fraturas de ossos da perna e suas complicações representaram metade da amostra. Foi observada melhora na capacidade funcional e nos aspectos emocionais dos pacientes ao longo do tratamento. Conclusão O uso do fixador externo circular constitui um método importante e eficaz para o tratamento cirúrgico de fraturas complexas e de suas sequelas. Este trabalho permitiu concluir que, após o tratamento, os pacientes alcançaram retorno funcional às atividades diárias com adequada qualidade de vida.

Assuntos