RESUMO
UNLABELLED: The purpose of the study was to assess and correlate the clinical and radiographic results of patients with distal radius fracture treated with a volar approach and plate osteosynthesis thus identifying the factors that determine or contribute to functional results in these patients. METHODS: All patients who underwent surgical treatment for distal radius fracture with a volar approach and plate osteosynthesis from May 2010 to May 2011 were identified. They were radiographically assessed with measurements of the volar and radial angle and clinically with the Mayo Wrist Score; the correlation coefficient was used to obtain the results. RESULTS: A total of 35 patients met the selection criteria; 23 females and 12 males; mean age was 40 years (18-62); the right extremity was predominant (25:10) and was the dominant limb in 57% of cases. The assessment using the MWS was done at postoperative year one; mean score was 81 (50-100): 37% were excellent, 31% good, 26% satisfactory, and 6% poor. The correlation showed that the MWS-radial angle and the MWS-volar angle had statistically significant values with p values of 0.0001 and 0.0008 respectively, both with a 95% confidence interval. CONCLUSION: The clinical and radiographic correlation showed that the radial and volar angles are determining factors for a satisfactory course. Age, sex, the dominant limb, the number of days elapsed and the AO classification did not show statistically significant values for patient course.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fraturas Fechadas/cirurgia , Fraturas do Rádio/cirurgia , Traumatismos do Punho/cirurgia , Adolescente , Adulto , Artrometria Articular , Feminino , Fraturas Fechadas/diagnóstico por imagem , Fraturas Fechadas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/fisiopatologia , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/fisiopatologia , Adulto JovemRESUMO
We conducted a prospective randomised study comparing the clinical, functional and radiographic results of 46 patients treated for scaphoid nonunion using a vascularised bone graft from the dorsal and distal aspect of the radius (group I), relative to 40 patients treated by means of a conventional non-vascularised bone graft from the distal radius (group II). Surgical findings included 30 sclerotic, poorly-vascularised scaphoids in group I versus 20 in group II. Bone fusion was achieved in 89.1% of group I and 72.5% of group II patients (p=0.024). Functional results were good to excellent in 72.0% of the patients in group I and 57.5% in group II. Considering only patients with sclerotic, poorly-vascularised scaphoids, the mean final outcome scores obtained were 7.5 and 6.0 for groups I and group II, respectively. We conclude that vascularised bone grafting yields superior results and is more efficient when there is a sclerotic, poorly-vascularised proximal pole in patients in scaphoid nonunion.
Assuntos
Transplante Ósseo/métodos , Fraturas não Consolidadas/cirurgia , Osso Escafoide/cirurgia , Traumatismos do Punho/cirurgia , Atividades Cotidianas , Consolidação da Fratura , Fraturas não Consolidadas/fisiopatologia , Força da Mão/fisiologia , Humanos , Satisfação do Paciente , Próteses e Implantes , Rádio (Anatomia)/irrigação sanguínea , Rádio (Anatomia)/cirurgia , Rádio (Anatomia)/transplante , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Osso Escafoide/lesões , Osso Escafoide/patologia , Resultado do Tratamento , Traumatismos do Punho/patologia , Traumatismos do Punho/fisiopatologiaRESUMO
As fraturas distais do rádio são as mais freqüentes do membro superior. São classificadas em estáveis e instáveis. As instáveis requerem tratamento cirúrgico. Não está definido na literatura qual o melhor método de fixação, mas existe atualmente uma tendência à utilização das placas com parafusos bloqueados. Um dos aspectos técnicos importantes é o posicionamento dos parafusos distais junto ao osso subcondral, proporcionando suporte mais adequado. A avaliação da localização desses parafusos é feita com radioscopia e radiografias, mas freqüentemente existem dúvidas quanto ao correto posicionamento. Os objetivos deste estudo são: avaliar se é possível determinar com precisão por meio de radiografias, a localização dos parafusos distais no rádio e se a experiência do avaliadorinfluencia nesta análise. Foram utilizados punhos de cadáveres. Cada rádio recebeu três parafusos junto à superfície articular distal. Por meio de incidências radiográficas clássicas e anguladas, médicos especialistas e não-especialistas em cirurgia da mão avaliaram a posição de cada parafuso, se intra ou extra-articular. Os índices de acerto foram submetidos à análise estatística.As radiografias provaram ainda ser um bom método de avaliação, não havendo melhora da precisão na localização dos parafusos com as incidências anguladas. A experiência profissional do avaliador não teve influência nos resultados.
The distal radius fractures are the most common fractures on upper limbs. They are classified as stable and unstable. The unstable ones require surgical treatment. However, literature does not define the best fixation method, but, today, a trend is seen towards using the locked screw plate. An important technical aspect is the distal screws positioning in the subchondral bone, with an adequate support. Fluoroscopy and radiographs are used to evaluate screws position, but there are usually doubts about the accurate positioning. The objectives of this study are to evaluate if it is possible to determine precisely the screw positioning by means of radiographs and if the previous experience of the investigator may improve the results. Cadavers' fists were used in this study. Three screws were introduced to each radius next to the distal joint surface. Specialized hand surgeons and not specialized physicians evaluated the X-ray images, at classic and angled planes, to provide the accurate positioning of each screw, intra or extra joint. The accuracy rate was submitted to statistical analysis. The X-ray images were proven to be a good evaluation method. The X-ray images captured at angled plane resulted in no improvements in the analysis of the screws positioning. Neither did the evaluator experience influence the results.
Assuntos
Humanos , Placas Ósseas , Fixação Interna de Fraturas , Fixação Interna de Fraturas/métodos , Fraturas do Rádio/cirurgia , Fraturas do Rádio , Parafusos Ósseos , Traumatismos do Punho/fisiopatologia , Traumatismos do Punho , Cadáver , Próteses e ImplantesRESUMO
The authors prospectively assess the results of surgically treated, unstable extra-articular distal radius fractures from 29 patients with good bone quality. Mean age was 49 years, ranging from 22 to 69 years; the female gender was the most frequently affected (58.6% of the cases). Surgical fixation was indicated for fractures presenting an angulation above 20 degrees , marked dorsal comminution, and radius shortening in excess of 10 mm on initial x-rays (anteroposterior and lateral views). The Kapandji technique, with intrafocal, nonthreaded Kirschner wires, was employed. Clinical data assessed anatomic aspects according to Scheck, functional aspect after Gartland and Werley, strength by Scheck's methods, and esthetic by Frykman's criteria. Functional assessment, according to Gartland and Werley, revealed 72.1% of excellent and good results at 3 months; 89.7% at 6 months; and 96.6% at 12 months. Immediate postoperative reduction was not maintained at the final follow-up at 12 months; however, that loss was not severe, and the anatomic outcome was good and excellent in 96.6% of the cases. Six patients presented complications. Four patients presented reflex sympathetic dystrophy; 1 patient had a superficial Kirschner wire infection, and another patient had radial nerve superficial branch paresthesia. The employed technique showed to be effective in the treatment of unstable, extra-articular fractures of the distal radius. It is easy to learn and to perform. The device employed has a low cost and is widely available in operation rooms.
Assuntos
Fixação Interna de Fraturas/métodos , Instabilidade Articular/cirurgia , Fraturas do Rádio/cirurgia , Traumatismos do Punho/cirurgia , Adulto , Fatores Etários , Idoso , Fios Ortopédicos , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pronação/fisiologia , Estudos Prospectivos , Rádio (Anatomia)/anatomia & histologia , Fraturas do Rádio/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Supinação/fisiologia , Resultado do Tratamento , Traumatismos do Punho/fisiopatologiaAssuntos
Humanos , Articulação do Punho/anormalidades , Articulação do Punho/fisiopatologia , Nervo Radial/anormalidades , Nervo Radial/fisiopatologia , Nervo Radial/lesões , Traumatismos do Punho/fisiopatologia , Traumatismos do Punho/reabilitação , Articulações dos Dedos/anormalidades , Articulações dos Dedos/fisiopatologia , Polegar/fisiopatologia , Polegar/lesõesRESUMO
Mini suture anchors are commonly used in hand surgery involving attachment of soft tissue to bone. There are few data on the biomechanical behavior of these implants under physiologic conditions. Commercially available mini anchors were inserted into the carpal bones of fresh-frozen cadaver wrists. Anchors were divided into threaded and pronged types according to design. The anchors were cyclically loaded. Pronged anchors (1.3 and 2.1 mm) failed at a range of 199 to 5,155 cycles. Threaded anchors (2.5 and 2.8 mm) consistently completed 40,000 cycles without failure. Before failure pronged anchors displaced on average 5.1 mm and threaded anchors displaced on average 0.01 mm. The pronged implants failed because of either prong fatigue or fracture; the threaded anchors remained structurally intact. The larger threaded suture anchors seem to have superior biomechanical properties than smaller pronged anchors.