Dissertations / Theses on the topic 'Fractures Surgery'
To see the other types of publications on this topic, follow the link: Fractures Surgery.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Fractures Surgery.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Mdlalose, Lindubuhle. "Immediate versus delayed surgical management of septic mandibular fractures." Thesis, University of the Western Cape, 2015. http://hdl.handle.net/11394/4611.
Full textAbstract:
Magister Scientiae Dentium - MSc(Dent)Aim: The aim of the study was to compare immediate and delayed surgical management of septic mandibular fractures. Introduction: Infected mandible fractures can be treated via diverse protocols. Two recognized protocols are the so-called delayed approached and the immediate approach. In the delayed approach, sepsis is resolved first, followed by surgery. With the immediate approach, the sepsis is first drained, followed by open reduction and internal fixation of the jaw fracture in one continuous surgical procedure. Material and methods: 20 clinical cases where included in the study. Patients were randomly selected and assigned to the two treatment protocol groups. Pain, vital signs, fracture union, fracture stability, surgical time, hospital time, follow-up visits and patients’ demographics were recorded. Results: No statistically significant findings were made in the analysis of the demographic data and clinical parameters relating to the sepsis. The only significant data were related to the surgical time and hospital time. It was found that the advantages of the immediate approach versus the delayed approach related only to shorter surgical time and less days spent in hospital for the immediate approach. Conclusion: Septic mandibular fractures can be managed either by an immediate or a delayed approach. The immediate surgical approach seems to have an advantage over the delayed approach regarding the surgical time and hospital admission days.
2
Nowak, Jan. "Clavicular Fractures, Epidemiology, Union, Malunion, Nonunion." Doctoral thesis, Uppsala University, Orthopaedics, 2002. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-2598.
Full textAbstract:
During a three-year period (1989-91), all patients living in the county of Uppsala, Sweden, with a radiographically verified fracture of the clavicle were prospectively, consecutively followed (n=245).
The epidemiological study (I) was restricted to the two first years with 187 fractures in185 patients. The short term study (II) with 6 months follow-up included 222 patients. The long term study (III) with 10 years follow-up included 208 patients. The malunion study (IV) included eight patients and the nonunion study (V) 24 patients all of whom were consecutively operated between 1988-2000.
Displacement, especially with no bony contact in the initial radiographs, was a statistically significant risk factor for sequelae.
Comminute fractures, especially if including transversally placed fragments, were associated with a significantly increased risk of remaining symptoms. An increasing number of fragments was also associated with an increased risk of sequelae.
Patients with remainig symptoms after 6 months were on average older at the time of injury as compared to patients without remaining symptoms. Advancing age was also a significant risk factor for sequelae – specifically pain at rest – still after 10 years.
There was no difference between gender with respect to the risk of sequelae, except for nonunion.
Fracture location did not predict outcome, except for more cosmetic defects (middle part).
Shortening defined as overlapping at the fracture site was a significant risk factor for cosmetic defects after 10 years.
Patients who experience pain at rest and/or cosmetic defects more than twelve weeks after the fracture have a higher risk for sequelae.
The radiographic examination should always consist of two projections: the AP (0°) view and the 45° tilted view. Transversally placed fragments are not seen in the 0° view.
Removal of excessive callus in patients with persistent symptoms even several years after the fracture showed a good outcome. One does not have to stabilize the clavicle when excising the hypertrophic callus.
Symptomatic clavicular nonunions should be treated with surgery. Reconstruction plate combined with cancellous bone gives a faster and more reliable healing rate than external fixation.
3
Roussot, Mark. "Amputation rate following tibia fractures with associated popliteal artery injuries." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25507.
Full textAbstract:
Objectives: 1. Determine the amputation rate; and 2. identify risk factors in patients with tibia fractures and associated popliteal artery injuries. Intervention: Amputation or limb salvage. Design: Retrospective case-control study. Setting: Level 1 trauma center. Patients: Thirty popliteal artery injuries with ipsilateral tibial fractures. Outcome measures: Primary and delayed amputation rates were determined. Risk factors tested for significance (Fischer's Exact) included: mechanism of injury, signs of threatened viability, compartment syndrome, fracture pattern, surgical sequence, and time delay from injury or presentation to revascularization. Results: The study group consisted of 22 males and 8 females, with a mean age of 31 years. Motor vehicle accidents and gunshot wounds constituted the mechanism in 17 and 11 patients respectively. Twenty-one were polytrauma victims. Intra/extra16 articular metaphyseal fractures (OTA 41 A-C) were recorded in 19 and diaphyseal (OTA 42 A-C) in 7 patients. Primary amputation was performed in 7 and delayed in 10 patients (overall rate 57%). No individual risk factors were predictive of amputation; however, the "miserable triad" of a proximal tibia fracture (OTA 41) with signs of threatened viability, and delay to revascularization ≥ 6 hours from injury or ≥ 2 hours from presentation was predictive of amputation (p = 0,036 and p = 0,018 respectively). Conclusions: We should aim to intervene within 6 hours following injury or 2 hours following presentation to reduce the risk of amputation. This provides a target for trauma teams even with uncertain time of injury. Level of Evidence: III.
4
Nussbaum, Marcy Lauren. "Meta-Analysis of Open vs Closed Surgery of Mandibular Condyle Fractures." VCU Scholars Compass, 2006. http://scholarscompass.vcu.edu/etd/1397.
Full textAbstract:
A review of the literature reveals a difference of opinion regarding whether open or closed reduction of condylar fractures produces the best results. It would be beneficial to critically analyze past studies that have directly compared the two methods in an attempt to answer this question. A Medline search for articles using the key words 'mandibular condyle fractures' and 'mandibular condyle fractures surgery' was performed. The articles chosen for the meta-analysis contained data on at least one of the following: postoperative maximum mouth opening, lateral excursion, protrusion, deviation on opening, asymmetry, and joint pain or muscle pain. Several common statistical methods were used to test for differences between open and closed surgery, including the weighted average method for fixed and random effects as well as the Mantel-Haenszel method for fixed effects. Some of the outcome variables were found to be statistically significant but were interpreted with caution because of the poor quality of the studies assessed. There is a need for more standardized data collection as well as patient randomization to treatment groups.
5
Kauta, Ntambue. "The management of fragility fractures of the hip: a quality assessment project." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25067.
Full textAbstract:
Introduction: Fragility fractures of the hip (FFH) constitute the most serious complication of osteoporosis carrying a mortality rate of up to 20 – 30% in the first year after injury and are associated with post injury decay in patient's level of activity in more than 50% of the cases. It is also a predictor of future osteoporosis related fractures. Surgical fixation of the hip fracture within 48 of admission, multimodal pain management, deep vein thrombo-prophylaxis, early physical therapy, appropriate assessment and management of osteoporosis and frailty in a multidisciplinary approach are the standard of care for FFH to keep the mortality and morbidity rate as low as possible and prevent future fragility fractures. Aim: To assess the standard of care of FFH at our institution and determine areas of care which need more attention and improvement. Methods: Retrospective review of clinical and radiographic records of all patients admitted at our level 1 trauma unit for fragility fracture of the hip from 1st January 2014 to 31st December 2014. The waiting time from admission to surgical fixation of the hip fracture, pain control and thrombo-prophylaxis strategies, the rate of geriatric referrals and the extent of osteoporosis management were assessed. Results: We admitted 113 fragility fractures of the hip from 1st January to 31st December 2014. Ninety- eight clinical records and 98 pelvis radiographs were included in the study. The other 15 clinical records were incomplete and were therefore excluded. The average waiting time from admission to surgery was 49 hours (range 9 -120). Low dose morphine, paracetamol and tramadol were the only perioperative pain control medication used for all patients. All patients had low molecular weight heparin and compression stockings prescribed for thrombo-prophylaxis. Only 2 (2, 04%) of patients had some osteoporosis investigations ordered. There were no geriatric referrals made and no formal osteoporosis management in all reviewed records. Conclusion: While the waiting time from admission to surgery was largely within the recommended time frame, there were no signs of a multidisciplinary approach to the management of fragility fractures of the hip at our institution leaving osteoporosis and frailty largely untreated.
6
Davis, Johan H. "Thoracolumbar injuries : short segment posterior instrumentation as standalone treatment - thoracolumbar fractures." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5351.
Full textAbstract:
Thesis (MMed (Surgical Sciences. Orthopaedic Surgery))--University of Stellenbosch, 2010.Objective: This research paper reports on the radiographic outcome of unstable thoracolumbar injuries with short segment posterior instrumentation as standalone treatment; in order to review rate of instrumentation failure and identify possible contributing factors. Background: Short segment posterior instrumentation is the treatment method of choice for unstable thoracolumbar injuries in the Acute Spinal Cord Injury Unit (Groote Schuur Hospital). It is considered adequate treatment in fracture cases with an intact posterior longitudinal ligament, and Gaines score below 7 (Parker JW 2000); as well as fracture dislocations, and seatbelt-type injuries (without loss of bone column - bearing integrity). The available body of literature often states instrumentation failure rates of up to 50% (Alanay A 2001, Tezeren G 2005). The same high level of catastrophic hardware failure is not evident in the unit researched. Methods: Sixty-five consecutive patients undergoing the aforementioned surgery were studied. Patients were divided into two main cohorts, namely the “Fracture group” (n=40) consisting of unstable burst fractures and unstable compression fractures; and the “Dislocation group” (n=25) consisting of fracture dislocations and seatbelt-type injuries. The groups reflect similar goals in surgical treatment for the grouped injuries, with reduction in loss of sagittal profile and maintenance thereof being the main aim in the fracture group, appropriately treated with Schantz pin constructs; and maintenance in position only, the goal in the dislocation group, managed with pedicle screw constructs. Data was reviewed in terms of complications, correction of deformity, and subsequent loss of correction with associated instrumentation failure. Secondly, factors influencing the aforementioned were sought, and stratified in terms of relevance. Results: Average follow up was 278 days for the fracture group and 177 days for the dislocation group (all patients included were deemed to have achieved radiological fusion – if fusion technique was employed). There was an average correction in kyphotic deformity of 10.25 degrees. Subsequent loss in sagittal profile averaged 2 degrees (injured level) and 5 degrees (thoracolumbar region) in the combined fracture and dislocation group. The only factor showing a superior trend in loss of reduction achieved was the absence of bone graft (when non-fusion technique was employed). Instrumentation complications occurred in two cases (bent connection rods in a Schantz pin construct with exaggerated loss in regional sagittal profile, and bent Schantz pins). These complications represent a 3.07% hardware failure in total. None of the failures were considered catastrophic. Conclusion: Short segment posterior instrumentation is a safe and effective option in the treatment of unstable thoracolumbar fractures as a standalone measure.
7
Boudissa, Mehdi. "Réduction virtuelle des fractures complexes du bassin à l'aide du premier simulateur biomécanique patient-spécifique Computer-assisted surgery in acetabular fractures: Virtual reduction of acetabular fracture using the first patient-specific biomechanical model simulator Computer Assisted Surgery in Preoperative Planning of Acetabular Fracture Surgery: State of the Art." Thesis, Université Grenoble Alpes (ComUE), 2019. http://www.theses.fr/2019GREAS038.
Full textAbstract:
The aim of this work was to develop and validate a new pre-operative planning in acetabular surgery based on a patient-specific biomechal model. During the first part of this work we brought enhancement in each step of the planning process for acetabular fracture surgery. The first step was to generate 3D models of several acetabular fracture patterns using semi-automatic segmentation methods. In the same time, we showed that the segmented fragments bone could be usefull to correctly classify acetabular fracture by unexperimented residents. The second step was to generate a patient-specific model, in a very simple way, that could be used in clinical practice by surgeons. A literature review of acetabular planning models was performed to identify that a new paradigm was required because of the limitations of the existing models. Once the objectives of patient-specific modelling was identified, a literature review of hips models was performed to record biomechanical properties of the elements that we had to modelize. A compromise between simplicity and realistic behaviour was found to generate patient-specifics biomechanical models, in a limited time, that could be used in clinical practice. Clinical studies on 14 operated cases, then 29 operated cases and finally 39 operated cases, were performed to validate retrospectively the simulations. The results were quite promising. Only open-source softwares with their own weaknesses were used because validity and feasability of the procedure was required before bigger investissment. The proof of concept was done. A prospective clinical study has shown the efficiency of the patient-specific biomechanical simulation and its feasibility in a daily clinical practice. This work opens a door for new approaches in surgical planning and patient-specific modellingL’objectif de cette thèse est de développer et valider une nouvelle méthode de planification pré-opératoire en chirurgie traumatique de l’acetabulum reposant sur un modèle biomécanique patient-spécifique. La première partie de ce travail a consisté en l’élaboration et l’amélioration progressive de ce nouvel outil de planification. La première étape était de générer des modèles tri-dimensionnels de plusieurs fractures acétabulaires à l’aide d’une méthode de segmentation semi-automatique. Dans le même temps, nous avons démontré que les fragments osseux segmentés pouvaient être utile pour classer correctement les fractures acétabulaires par des internes non expérimentés. La seconde étape était de générer un modèle biomécanique patient-spécifique, le plus simplement possible pour pouvoir être compatible avec une pratique clinique régulière. Une revue de la littérature à propos des différentes méthodes de planifications péri-opératoire en traumatologie de l’acetabulum a été réalisée afin d’identifier qu’un nouveau paradigme était nécessaire du fait des limites des méthodes existantes. Une fois les objectifs d’une modélisation biomécanique patient-spécifique définis, une revue de la littérature des différents modèles biomécanique de la hanche a été réalisée pour définir les propriétés biomécaniques des différents éléments à modéliser. Un compromis entre simplicité et comportement réaliste du modèle a été trouvé pour générer un modèle biomécanique patient-spécifique, dans un temps limité, compatible avec une utilisation courante en pratique clinique. Des études cliniques portant sur 14 cas de fractures acétabulaires opérées, puis 29 et finalement 39 cas ont été réalisées pour valider rétrospectivement les simulations biomécaniques. Les résultats montraient une parfaite adéquation avec la réalité. Seuls des logiciels en libre accès, avec leurs faiblesses, étaient utilisés car la fiabilité et la validité de la simulation étaient nécessaires avant d’envisager plus d’investissements. La preuve de concept était donnée. Enfin, une étude clinique prospective a démontré l’efficacité de la simulation biomécanique patient-spécifique et sa faisabilité en pratique clinique quotidienne. Ce travail ouvre la porte à de nouvelles approches en matière de planification chirurgicale et de modélisation patient-spécifique
8
Koller, Ian M. "Locking plates for distal femur fractures does an increased working length improve healing?" Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2844.
Full textAbstract:
Includes abstract.Includes bibliographical references.
Distal femur locking plates have become a very popular means of internal fixation because of their ability to provide stable distal periarticular fixation. In spite of this enthusiasm however several studies have reported significant problems with healing. In the distal femur it is recognized that locking plate fixation may be too rigid if used in certain configurations that limit the essential micro movement required for biological healing. Implant failure may arise from rigid configurations that cause excessive hardware stress concentrations. In an attempt to address these problems longer plates and an increased working length have been proposed to reduce construct rigidity. The purpose of our study is to investigate whether an increased working length translates into improved healing.
9
Plant, Caroline Elizabeth. "Outcome and management of acute dorsally displaced fractures of the distal radius." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/89823/.
Full textAbstract:
Fractures of the distal radius are a common injury, affecting younger patients typically through sporting and road traffic accidents, and older osteoporotic patients often due to falls from a standing height. The potential consequences of these fractures are rare but can be catastrophic, with risk of lasting impairment to the patient. This thesis aimed to examine (1) how surgeons decide which patients with a dorsally displaced distal radius fracture need an operation, (2) what is the evidence basis for the two most commonly performed operations for patients with this fracture in the UK, (3) Are electronic and manual goniometers and dynamometers able to reliably assess wrist function in patients and healthy volunteers, (4) Does the patients’ functional outcome correspond with their radiological outcome, and (5) what is the long-term outcome of these patients. A number of research methods were employed to achieve these objectives. A mixed methods approach was deployed, involving observations of nineteen patient/surgeon consultations followed by mini interviews with the consulting surgeons, to gain an insight into which patients with a dorsally displaced distal radius fracture receive an operation in practice. In-depth interviews were undertaken with 14 Orthopaedic surgeons to explore the patient/surgeon/context related factors that contribute to their decision-making.
10
Louw, Frederik Marthinus. "Neurovascular complications in displaced extension-type supracondylar fractures in children : outcome of conservative management." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/12517.
Full textAbstract:
Includes bibliographical referencesThe aim of our study was to review our conservative management of neurovascular complications in displaced extension-type supracond ylar fractures of the humerus in children. We critically analysed the outcomes. Our results shall aim to clarify the management of this contentious issue.
11
van, Essen Ellen. "The efficacy of arcuate dynamic traction splintage in the treatment of intra-articular fractures of the proximal interphalangeal joints of the hand a retrospective descriptive review : this dissertation [thesis] is submitted to Auckland University of Technology in partial fulfillment for the degree of Master of Health Science, October 2003 /." Full thesis. Abstract, 2003. http://puka2.aut.ac.nz/ait/theses/VanEssenE.pdf.
Full text
12
Dangor, Zain. "Outcomes of double miniplate osteosynthesis in the immediate management of infected mandible fractures." University of the Western Cape, 2020. http://hdl.handle.net/11394/7264.
Full textAbstract:
Magister Chirurgiae Dentium (MChD)Introduction: A common complication of poorly managed mandible fractures is infection. There is a consensus amongst clinicians in treating infected mandible fractures in an immediate setting. The approach includes drainage of the purulent discharge, debridement of the fracture, removal of teeth in the fracture line and immediate fixation. Fixation can be load bearing or load sharing in nature. Although clinicians advocate for the use of a reconstruction load bearing plate, a double miniplate fixation could be an alternative. Aim: The aim is to assess the outcomes of double miniplate osteosynthesis in the immediate management of infected mandible fractures Material and method: A prospective cohort study was conducted. The sample size was 20 (n =20). Infections were treated with an incision and drainage and the fractures fixated with a double miniplate fixation system. Pain scores, fracture union, fracture stability and surgical times were measured. Follow–up visits included one week, six weeks and three months respectively. Results: Mandibular angle fractures were most commonly infected. The most common cause of infection were teeth in the line of fracture. The buccal fascial space was the most commonly involved fascial space in regard to spread of infection. Nineteen of the twenty cases attained fracture stability. However, complications commonly encountered were persistent infection and wound dehiscence. Conclusion: Although a limited number of clinical cases were treated, the results correspond with the current literature when an immediate miniplate fixation protocol is used in infected mandible fractures. However, complications encountered in the study included the persistence of infection and wound dehiscence.
13
Mattsson, Per. "Resorbable Bone Cement for Augmentation of Hip Fracture." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5822.
Full text
14
Ekman, Anna. "Hips at risk osteoporosis and prevention of hip fractures." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2001. http://publications.uu.se/theses/91-554-4930-1/.
Full text
15
Delisle, Josée. "Predicting factors of contralateral hip fractures among patients above 55 years of age." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=101112.
Full textAbstract:
Background. The incidence of osteoporotic fractures increases by 1-3% per year of age. Nine to twelve percent of patients that have suffered a primary hip fracture will have a fracture of the contralateral hip within 5 years. Our objective is to identify predictive factors of contralateral hip fractures among men and women over 55 years of age.Methods. A case control study with matched pairs was conducted, through a retrospective chart review of patients admitted for hip fractures at the Jewish General Hospital (JGH) and the Montreal General Hospital (MGH) between 1992 and 2004.
Results. Contralateral hip fractures were most strongly associated with the use of mobility aid (OR= 5.69, CI 95% (3.20-10.14)). No other risk factors could be identified as predictors, probably due to missing data.
Conclusion. This study confirms the use of mobility aid as a predictor of contralateral hip fractures. Future prospective risk studies may further optimize the diagnostic accuracy for predicting contralateral hip fractures.
16
Chyfetz, Michael. "Geriatric hip fractures: do they necessitate admission to a Level 1 trauma center?" Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=114604.
Full textAbstract:
BACKGROUND: Hip fractures result in significant mortality, morbidity, and costs. Falls are the main mechanism of injury in the geriatric population with hip fractures associated with an annual cost of $9 billion dollars in the United States. Within the next decade, it is estimated that approximately 25% of the Canadian population will be 65 years and older. The cost of trauma center care is high, raising questions about the value of treating isolated hip fractures at Level 1 (tertiary) trauma centers. OBJECTIVES: To conduct a cost-effectiveness analysis of isolated geriatric hip fractures treated in Level 1 trauma centers compared with Level II and III centers. METHODS: A retrospective cohort study was comprised of patients over 65 years of age treated for isolated hip fractures in the Province of Quebec, Canada between January 1, 1998 and December 31, 2002. Data for the study was obtained from the Quebec Trauma Registry (QTR) and 3 patient cohorts were created according to treatment at 3 Level I, 29 Level II, and 21 Level III trauma centers. The primary outcome was total treatment cost defined as hospital costs for patient care from time of arrival at the hospital to discharge. All statistical analyses were carried out with SPSS version 19.0 (SPSS Inc., Chicago, Illinois). RESULTS: We identified 11,009 cases which met our inclusion criteria. The majority of patients were female (77%). Average age was 82 (Range: 65-105; SD: 7.5). The vast majority (96.9%) of admissions were as a result of falls. There were no significant differences with respect to mean age of patients, complication rate, and mortality amongst patient admitted to Level 1, 2 and 3 Trauma Centers. Average length of stay for all patients was 15.4 days (Confidence Interval 95%: 2-55). Our study finds a 20% and 60% savings of approximately $5 and $16 million dollars when patients are admitted to Level 2 and 3 Trauma Centers when compared to Level 1 Centers. CONCLUSIONS: Level 1 trauma centers do not improve the long term functional and rehabilitation outcomes of geriatric isolated hip fracture patient when compared to Level 2 and 3 centers. Our results suggest that treatment of Isolated Hip Fractures at Level 1 Trauma Centers is not cost-effective. A separate geriatric triage criteria for isolated hip fractures could lead to improved resource utilization, cost effectiveness and acute care outcomes.KEY WORDS: Elderly, Isolated hip fractures, Cost of trauma care, Trauma center performance, Level I.CONTEXTE: Fractures de la hanche suite à une importante mortalité, la morbidité et les coûts. Les chutes sont le principal mécanisme de blessure chez les personnes âgées avec des fractures de la hanche liées à un coût annuel de 9 milliards de dollars aux États-Unis. Dans la prochaine décennie, on estime qu'environ 25% de la population canadienne sera âgée de 65 ans et plus. Le coût des soins de traumatologie est élevé, ce qui soulève des questions sur la valeur du traitement des fractures de la hanche isolées au niveau 1 (tertiaire) des centres de traumatologie. OBJECTIFS: Pour effectuer une analyse coûts-efficacité analyse des fractures de la hanche isolés gériatriques traités dans les centres de traumatologie de niveau 1 par rapport aux niveaux II et III. Centres Méthodes: Une étude de cohorte rétrospective a été composé de patients de plus de 65 ans traités pour des fractures de la hanche isolées dans la province de Québec, au Canada entre Janvier 1, 1998 et Décembre 31, 2002. Les données de l'étude a été obtenue à partir du Registre des traumatismes du Québec (QTR) et 3 cohortes de patients ont été créés selon le traitement au niveau 3 I, 29 II niveau, et 21 centres de traumatologie de niveau III. Le critère principal était coût total du traitement définis comme les coûts hospitaliers pour les soins aux patients de l'heure d'arrivée à l'hôpital de se décharger. Toutes les analyses statistiques ont été réalisées avec SPSS version 19,0 (SPSS Inc, Chicago, Illinois). Résultats: Nous avons identifié 11.009 cas qui répondaient à nos critères d'inclusion. La majorité des patients étaient des femmes (77%). L'âge moyen était de 82 (intervalle: 65-105; SD: 7,5). La grande majorité (96,9%) des admissions étaient à la suite de chutes. Il n'y avait pas de différences significatives en ce qui concerne moyenne d'âge des patients, le taux de complications et de la mortalité parmi les patients admis au niveau 1, 2 et 3 centres de traumatologie. Durée moyenne de séjour pour tous les patients était de 15,4 jours (intervalle de confiance à 95%: 2-55). Notre étude a montré une réduction de 20% et 60% des économies de l'ordre de $ 5 et $ 16 millions de dollars lorsque les patients sont admis au niveau 2 et 3 centres de traumatologie par rapport au niveau 1 centres. CONCLUSIONS: Les centres de traumatologie de niveau 1 ne pas améliorer les résultats fonctionnels à long terme et de réadaptation gériatrique du patient de fracture de la hanche isolé par rapport aux niveaux 2 et 3 centres. Nos résultats suggèrent que le traitement des fractures de la hanche isolés dans les Centres de traumatologie de niveau 1 n'est pas rentable. Un des critères de triage séparées pour les fractures de la hanche gériatriques isolés pourrait conduire à une meilleure utilisation des ressources, la rentabilité et les résultats des soins aigus.MOTS CLÉS: Personnes âgées, isolées fractures de la hanche, coûts des soins de traumatologie, le rendement centre de traumatologie de niveau I.
17
Chow, Lop-keung Raymond. "Clinical morbidity of resorbable plates and screws for internal fixation in orthognathic surgery." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31954285.
Full text
18
Sin, Tak-nam, and 冼德藍. "Evidence-based clinical practice guidelines for care of skeletal pin sites in orthopaedic patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44626332.
Full text
19
Sia, Charles Pactol, and 謝漢明. "Internal versus intermaxillary fixation in vertical subsigmoid osteotomy for mandibular setback: arandomized controlled trial." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46600097.
Full text
20
Parekh, Jugal. "Minimally invasive approach for surgical treatment of proximal femur fractures." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3100/.
Full textAbstract:
Minimally invasive surgery (MIS) is fast becoming a preferred choice for patients and surgeons, due to its biological, aesthetic and commercial benefits. The dynamic hip screw (DHS) is the standard implant for the treatment of fractures of the proximal femur, which is considered to be the most frequent injury in the elderly. The aim of this research was to develop MIS for the treatment of these fractures utilising the principle and surgical technique of the DHS implant. During the research, a thorough medical device design process was conducted to develop three new medical devices 13 a new angle guide, a new ergonomic T-handle and a new implant. The design process for each of the new medical devices conformed to requirements of the relevant standards. The designs of the new medical devices were verified using methods such as risk analysis, finite element analysis and mechanical testing of manufactured prototype. Finally, an operative technique applying a minimally invasive approach with the new medical devices was developed to treat the fractures of the proximal femur.
21
Barouni, Elyas. "Soft tissue Reconstruction of Gustilo-Anderson Grade IIIB Open Extra-Articular Tibial Fractures at a Tertiary Hospital in Cape Town, South Africa: A Retrospective Case Series." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32588.
Full textAbstract:
Introduction: Management of Gustilo-Anderson grade 3b tibia fractures are challenging due to the high rate of complications which includes infection, nonunion and possible amputation. Due to limited soft tissue coverage of the tibia antero-medially, open fractures remain a treatment challenge. Despite many advances, the ideal time delay to definitive soft tissue cover remains controversial. Aim: We aimed to investigate the management strategy and the outcome of soft tissue reconstruction of Gustilo-Anderson grade 3b tibia fractures at a tertiary hospital in Cape Town, South Africa. Methods: A retrospective study was conducted on 22 patients who underwent soft tissue reconstruction for grade 3b tibia fractures from January 2014 to July 2017. Patient demographics, comorbidities, injury characteristics and management practices such as time to debridement, relook time, Negative Pressure Wound Therapy (NPWT), soft tissue coverage and complications were recorded. Results: Most patients were males (n=18; 81.8%) with an average age of 39.3 years. Pedestrian vehicle accidents accounted for 45.4%(n=10), motor-vehicle accidents (n=6; 27.3%) and gunshot wounds (n=2; 9.1%). The commonest site of injury was the middle third of the tibia (n=13; 59.1%), distal third (n=7; 31.8%) and proximal third (n=2; 9.1%). Most patients (n=18; 81.8%) were debrided within 24 hours. The mean times for NPWT prior to cover was 12.5 days and for soft tissue cover 13.7 days (range 2-35), respectively. Fasciocutaneous flaps (n=11; 50%) were predominantly used as cover, then pedicled muscle flaps (n=8; 36.4%), free flaps (n=2) and skin graft(n=1). Most patients (n=13; 59.1%) received satisfactory outcomes. Seven (31.8%) required soft tissue revisions. Three patients (13.6%) suffered complications namely, complete flap loss resulting in amputation, partial skin graft loss and soft tissue infection, respectively. Patients who underwent debridement after 24 hours reported the least complications and there appeared to be better outcomes in the relooks beyond 48 hours. Conclusion: Despite achieving outcomes which concur with other published studies, the BOAST 4 guidelines were not fully reflected in our management strategy. We will require larger numbers in future studies to formulate a standardized management protocol going forward.
22
Chow, Lop-keung Raymond, and 周立強. "Clinical morbidity of resorbable plates and screws for internal fixation in orthognathic surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31954285.
Full text
23
葉永玉 and Wing-yuk Ip. "Design and biomechanical study of internal fixation devices for difficult phalangeal fractures." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B3197966X.
Full text
24
Wasserman, Halley M. M. D. "Low bone mineral density and fractures are highly prevalent in pediatric patients with Spinal Muscular Atrophy regardless of disease severity." University of Cincinnati / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1458299334.
Full text
25
Chiarello, Eugenio <1981>. "Evaluation of the Effectiveness of Femoral Neck Prophylactic Surgery in Elderly Osteoporotic Patiens to Prevent Hip Fractures." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2016. http://amsdottorato.unibo.it/7302/.
Full textAbstract:
The aim of our RCT was to evaluate safety and efficacy of a new device called Prevention Nail System (PNS) developed for the prevention of femoral neck fractures (FNFs) in patients with severe osteoporosis. The PNS is a titanium screw with a hydroxyapatite coating implanted in the femoral neck in order to reinforce it. We enrolled patients with: FNF; age ≥65 years; DXA of the noninjured hip with a T-score ≤ −2.5 SD. In the fractured hip patients received standard treatment while the contralateral hip was randomized either to receive PNS (group A) or not: control group (B). During each follow-up (FU) at 3, 12 and 24 months, DXA, CT and X-rays of the reinforced hip were performed.
The mean age was 83 years and the preoperative DXA was −3.3 SD in both groups. The walking ability of patients with PNS were comparable to controls. The CT scan showed good integration of the PNS in the bone. At the longest available FU 23 patients reported one or more falls. 16 nonfemoral fractures were recorded: 10 (A) and 6 (B) and 6 contralateral hip fractures (CHFs): 3 in the PNS group and 3 in the control group. In A all CHFs occurred within 1 month after surgery and there was a difficult screw placement during surgery, in the control group the CHFs were consequence of a fall (6 months to 2 years after the first FNF). No statistical differences were reported between groups A and B.
In conclusion, the device was well tolerated; CHFs in the PNS group should be considered a technical error due to the surgical instruments. Safety of the device can be increased by improving the instruments to reduce the risk of iatrogenic fractures.
26
Shituleni, Sibasthiaan Gometomab. "Displaced intracapsular neck of femur fractures: dislocation rate after total hip arthroplasty." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16788.
Full textAbstract:
Includes bibliographical referencesBackground: Dislocation is one of the most common orthopaedic complications after primary total hip arthroplasty (THA). The reported dislocation rate in elective THR is 5 - 8%. This number increases up to 22% for THA done for neck of femur fractures. Larger femoral head sizes increase the head-neck ratio and range of motion before impingement, therefore reducing the dislocation rate. Due to the reported increase in dislocation for trauma, some surgeons prefer to do a hemi-arthroplasty or open reduction and internal fixation (ORIF). Methods: A retrospective review of all THA done for neck of femur fractures during 2006 - 2012 was undertaken at a large referral hospital. Records were reviewed for patient related and surgical risk factors. We excluded all pathological fractures, extra-capsular fractures and failed ORIF. Results: A total of 96 cases were identified as suitable for analysis. Average age at surgery was 73.2 years (range 30 - 81). Delay to surgery was 5.3 days (range 1 - 63). Average follow up period was 18.3 months (range 3 months - 4.3years). Four patients (4.3%) had a confirmed dislocation. The four patients who had confirmed dislocation had the following characteristics, 28 mm femoral head size, age over 60 years, 2 posterior approaches and 3 females, although not statistically significant. Conclusion: The outcomes of THR in patients with neck of femur fractures can be favourable and provide good long-term prosthesis survival. We report on low dislocation rate post total hip replacement for intra-capsular neck of femur fractures.
27
Schmaedecke, Alexandre. "Avaliação biomecânica de diferentes bloqueios transcorticais de interlocking nail em relação às forças de torção, encurvamento e axiais atuantes em fraturas diafisárias de fêmur de cães - estudo in vitro." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-06062007-154221/.
Full textAbstract:
O advento da osteossíntese biológica é importante avanço no desenvolvimento da ortopedia. As vantagens que as hastes de Interlocking Nail têm demonstrado clinicamente, como método de fixação interna que promove formação de calo ósseo adequado, respeitando as premissas básicas da ortopedia moderna, com paciente retomando suas atividades de forma ativa, precoce e indolor, transportam esta técnica à condição de principal em termos de tratamento de fraturas cominutivas de fêmur em pacientes humanos e animais de companhia. No entanto, face a pouca disponibilidade de dados biomecânicos disposta em bibliografia, buscou-se, através deste estudo biomecânico não destrutivo, disponibilizar o padrão de movimentação interfragmentária do foco da fratura, mediante osteossíntese com hastes bloqueadas. Foi realizado estudo contemplando cinco grupos diferentes, com seis elementos cada, em análise in vitro, em relação a quatro diferentes possibilidades de bloqueio transcortical. Avaliou-se também comportamento do sistema quando utilizada haste de comprimento menor ao ideal, submetidos aos ensaios de compressão excêntrica, encurvamento crânio-caudal e rotação, através de análise fotogramétrica e confrontamento de dados aos obtidos pela análise de rigidez disponibilizada pela máquina universal de ensaios mecânicos Kratos® modelo 5002 dotada de célula de carga de 981 N (100 kgf). A análise dos resultados obtidos não apresentou diferença significativa entre os grupos nos ensaios propostos, tanto para análise fotogramétrica quanto análise de rigidez, sendo menor que 1,0 mm a média da movimentação interfragmentária de todos os grupos estudados. Estes dados demonstram biomecanicamente a aplicabilidade da técnica em fraturas cominutivas de terço médio de diáfise femoral em cães, possibilitando, frente à necessidade do cirurgia, optar por qualquer das técnicas de bloqueio aqui estudadas.The advent of biological osteosynthesis is an important advance in the orthopedics development. The advantages that the rods of Interlocking Nail have clinically demonstrated, as method of internal fixation that promotes adequate bone callous formation, respecting the basic premises of the modern orthopedics, with patient retaking its activities of active, precocious and painless form, carry this technique to the first choice in terms of treatment of femoral comminutive fractures in human and small animal patients. However, face to few availability of biomechanical data disposed in bibliography, this non destructive biomechanical study had the aim to demonstrate the standard of interfragmentary motion, in Interlocking nails osteosynthesis. This research was developed contemplating five different groups, with six elements each group, in an in vitro analysis, in relation to four different possibilities of transcortical blockade. The behavior of the system when the osteosynthesis was made through one lesser length to the ideal interlocking rod was also evaluated. All groups were submitted to the assays of eccentric compression, bending and torsion, through photogrammetric analysis and comparison to the analysis of rigidity data, disposed for the Kratos® universal machine of mechanical assays, model 5002 endowed with 981 N (100 kgf) load cell. The analysis of disposed results did not present significant difference between the groups in the considered assays, neither for photogrammetric analysis nor for rigidity analysis, being the average of the interfragmentary motion lesser that one millimeter on all of the studied groups. These data biomecanically demonstrate the applicability of the interlocking nail technique in medial third cominnutive femoral fractures in dogs, including, front to the necessity of the surgeon, the possibility to opt to any of the techniques of blockade studied.
28
Machino, Masaaki, Yasutsugu Yukawa, Tetsuro Hida, Yoshiharu Oka, Teruo Terashima, Susumu Kinoshita, and Fumihiko Kato. "A Prospective Randomized Study for Postoperative Pain Relief of Lower Extremity Fractures: Efficacy of Intrathecal Morphine Administration." Nagoya University School of Medicine, 2010. http://hdl.handle.net/2237/14176.
Full text
29
Vinnars, Bertil. "Scaphoid fractures : Studies on diagnosis and treatment." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8845.
Full text
30
Nasomyont, Nat. "The Impact of Oral Bisphosphonate Therapy on Vertebral Morphometry in Patients with Duchenne Muscular Dystrophy and Glucocorticoid-Induced Osteoporosis." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1592168905130579.
Full text
31
Damas, Anny-France. "L’actualité des traités chirurgicaux dans la Collection Hippocratique." Thesis, Paris 4, 2012. http://www.theses.fr/2012PA040233.
Full textAbstract:
Cette étude se doit d’analyser ce que les textes de la Collection hippocratique, ainsi que l’apport des commentateurs d’Hippocrate, tels Celse, Galien, et jusqu’aux chirurgiens actuels permettent de connaître de l’art chirurgical des Vème et IVème siècles avant J.-C., en Grèce. Les textes dits « chirurgicaux » sont ceux qui mentionnent un acte technique sur le corps humain, le plus souvent à l’aide d’un instrument « chirurgical ». Ils nous donnent des indications sur les pathologies traitées. Quelques documents iconographiques et quelques rares vestiges sont un apport intéressant. En confrontant les textes hippocratiques et la technique chirurgicale actuelle, nous verrons dans quelle mesure il est possible de reconstituer les conditions de réalisation de l’acte chirurgical par les praticiens hippocratiquesThe present study focuses on surgery procedures in fifth and fourth century B.-C. Greece. The analysis of these procedures is based on information stemming from the text constituting the Hippocratic Corpus as well as from Hippocrates’ commentators such as Celsus and Galen- and modern surgeons. The texts analyzed particularly those named “surgical “are those describing a manual intervention on the human body, most frequently supported by an instrument considered as “surgical.” They offer indications on the pathologies treated. Certain iconographic documents are of particular interest. The confrontation between Hippocratic texts and modern surgical techniques will enable to estimate the possibility of restitution of the surgical procedures’ conditions by the Hippocratic surgeons
32
Johansson, Torsten. "Displaced Femoral Neck Fractures : A prospective randomized study of clinical outcome, nutrition and costs." Doctoral thesis, Linköping : Univ, 2002. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5233.
Full text
33
Skoglund, Björn. "Following the mevalonate pathway to bone heal alley." Doctoral thesis, Linköpings universitet, Ortopedi och idrottsmedicin, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-11282.
Full textAbstract:
The mevalonate pathway is an important biosynthetic pathway, found in all cells of virtually all known pro- as well as eukaryotic organisms. This thesis is an investigation into the use of two drugs, originally developed for different applications, but both affecting the mevalonate pathway, in to models of fracture repair. Using two different rodent models of fracture repair, a commonly used cholesterol lowering drug (statin) and two drugs used to treat osteoporosis (bisphosphonate) were applied both systemically as well as locally in order to enhance fracture repair. Papers I and II investigate the potential of simvastatin to improve the healing of femoral fractures in mice. Papers III and IV explore the use of two bisphosphonates to improve early fixation of stainless steel screws into rat bone. The statin simvastatin lead to an increased strength of the healing cellus. The application of bisphosphonates increased early screw fixation. It seems clear that both drugs have uses in orthopaedic applications. One interesting avenue of further research would be to combine the two classes of drugs and see if we can get the benefits while at the same time diminishing the drawbacks.
34
Aguiar, Leonardo Toledo de. "Avaliação do efeito do metotrexato na reparação tecidual em um defeito ósseo simulando fratura de mandíbula em ratos." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-24032009-163741/.
Full textAbstract:
Objetivo: O presente estudo teve como objetivo verificar os efeitos do tratamento com altas e baixas doses de metotrexato (MTX) na reparação de fraturas mandibulares, num modelo experimental com ratos. Métodos: O modelo experimental empregado consiste na criação de um defeito ósseo na mandíbula do rato, semelhante a uma fratura. Oitenta ratos foram distribuídos em 4 grupos de 20 animais que receberam, por via intraperitoneal: soro fisiológico (controle) (1 ml, após a cirurgia); dexametasona (DX) (0,15 mg / kg, dose única após a cirurgia); alta dose MTX (1,6 mg / kg, semanalmente); baixa dose MTX, (0,25 mg / kg, semanalmente). Os animais foram sacrificados no dia 1º, 7º, 15º e 30º dia após a cirurgia. As mandíbulas foram submetidas à análise radiográfica para medir a distância entre os cotos ósseos e a área de osteotomia. Avaliação histomorfométrica foi realizada usando um software analisador de imagens digitalizadas para verificar a formação de cartilagem e óssea. Resultados: Os resultados revelaram não haver alterações significantes entre os tratamentos nos parâmetros avaliados nos 10 e 70 dias após a cirurgia. Animais do grupo controle sacrificados no 15º dia após a cirurgia tiveram uma redução da distância entre as extremidades ósseas e na área da osteotomia, bem como um grande aumento na formação de cartilagem. O padrão desses parâmetros nos animais tratados com baixas doses de MTX e DX não foram significativamente diferentes do grupo controle neste período. No entanto, os animais tratados com alta dose de MTX tiveram aumento da distância entre os cotos ósseos e da área da osteotomia, bem como foi praticamente nulo o aumento da formação de cartilagem. Sobre o 30º dia após a cirurgia, os animais do grupo controle tinham praticamente recuperado a região da fratura, bem como aqueles tratados com doses baixas de MTX. Os grupos tratados com a alta dose de MTX e DX mantiveram abertos os defeitos ósseos. Conclusões: Este estudo mostra claramente que a baixa dose de MTX não afetou a reparação óssea de fraturas mandibulares em ratos, em contraste com a alta dose de MTX, que afeta desfavoravelmente a regeneração óssea.Purpose: The present study aims to verify the effect of high and low dose of methotrexate (MTX) treatment on bone repair of mandibular fractures in rats. Methods: The experimental model employed consists in creating a defect in rat mandible, similar to a fracture. Eighty rats were distributed in 4 groups of 20 animals that received, intraperitoneally: saline (1 ml, after surgery); dexametazone (DX, 0.15 mg/Kg, one dose at surgery); high dose MTX (1.6 mg/Kg, weekly); low dose MTX, (0.25 mg/Kg, weekly). Groups of five animals were sacrificed on the 1st, 7th, 15th and 30th day after surgery. Mandibles were submitted to radiographic analysis to measure the distance between bony edges and the area of osteotomy. Histopathological evaluation was performed in digitalized images using an analyzer software to examine cartilage and bone formation. Results: The treatments did not alter any evaluated parameters on days 1 and 7 after surgery. Control animals sacrificed on the 15th day after surgery had a reduction of the distance between bony ends and in the area of osteotomy, as well as a great increase in cartilage formation. The pattern of these parameters in animals treated with low dose MTX and DX did not differ from control group. However, animals treated with higher dose of MTX kept increasing the distance between bony ends and the area of osteotomy, and the increase in cartilage formation was practically inexistent. On the 30th day after surgery, control animals had pratically recovered the fracture region, as well as those treated with low dose MTX. The group treated with higher dose MTX and DX still had an open bone defect. Conclusions: This study clearly shows that low dose MTX did not affect bone healing of mandibular fractures in rats, in contrast to a higher dose, which promotes impairment of bone regeneration.
35
楊國泰 and Kwok-tai Cathay Yeung. "Finite element modeling of bone cement for vertebroplasty." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31228021.
Full text
36
Fillat, Gomà Ferran. "Influència de la impressió 3D en la categorització de les fractures d’húmer proximal." Doctoral thesis, Universitat Autònoma de Barcelona, 2021. http://hdl.handle.net/10803/671997.
Full textAbstract:
Els sistemes de classificació de les fractures d’húmer proximal han demostrat de manera reiterada una baixa concordança interobservador. Aquests sistemes són importants per estandarditzar el procés diagnòstic i facilitar la comunicació i les decisions terapèutiques. També ens permeten predir i comparar els resultats en funció del tractament realitzat (maneig quirúrgic o ortopèdic) i per a compartir-lo amb la comunitat medico-científica. Les raons d’aquest nivell baix de concordança interobservador són diverses: la tècnica d’imatge utilitzada, l’experiència de l’observador, els tipus de classificacions, etc.
La interpretació de les imatges mèdiques en dues dimensions ha suposat durant molts anys (i encara és al dia d’avui), el punt de partida en el procés diagnòstic i de tractament de les patologies de l’aparell locomotor. La seva correcta interpretació està condicionada per la capacitat d’abstracció de la imatge de cadascú.
La impressió 3D està revolucionant, no només el sector industrial, sinó també el món de la medicina. Davant de les múltiples aplicacions clíniques de la impressió 3D, els models anatòmics 3D es postulen principalment com una eina docent i diagnòstica en cirurgia ortopèdica i traumatologia. Com que es tracta d’una tecnologia relativament nova, en la literatura encara es troben poques evidències científiques dels seus beneficis.
Davant de l’emergent impacte de la impressió 3D en cirurgia ortopèdica i traumatologia, i atès a que la concordança interobservador en la classificació de les fractures d’húmer proximal segueix sent un problema sense resoldre, en aquest treball es pretenen aportar evidències de com influeix l’ús de models anatòmics impresos en 3D de fractures d’húmer proximal a l’hora de la seva classificació. Tanmateix, es proposa un nou tipus de classificació quantitativa basada en el 3D, que podria millorar el problema existent en la classificació de fractures d’húmer proximal.Los sistemas de clasificación de las fracturas de húmero proximal han demostrado de forma reiterada una baja concordancia interobservador. Estos sistemas son importantes para estandarizar el proceso diagnóstico y facilitar la comunicación y las decisiones terapéuticas. También nos permiten predecir y comparar los resultados en función del tratamiento realizado (manejo quirúrgico u ortopédico) y para compartirlo con la comunidad médico-científica. Las razones de este nivel bajo de concordancia interobservador son diversas: la técnica de imagen utilizada, la experiencia del observador, los tipos de clasificaciones, etc. La interpretación de las imágenes médicas en dos dimensiones ha supuesto durante muchos años (y todavía es el día de hoy), el punto de partida en el proceso diagnóstico y de tratamiento de las patologías del aparato locomotor. Su correcta interpretación está condicionada por la capacidad de abstracción de la imagen de cada uno. La impresión 3D está revolucionando, no sólo el sector industrial, sino también el mundo de la medicina. Ante las múltiples aplicaciones clínicas de la impresión 3D, los modelos anatómicos 3D se postulan principalmente como una herramienta docente y diagnóstica en cirugía ortopédica y traumatología. Como se trata de una tecnología relativamente nueva, en la literatura aún se encuentran pocas evidencias científicas de sus beneficios. Ante la emergente impacto de la impresión 3D en cirugía ortopédica y traumatología, y dado a que la concordancia interobservador en la clasificación de las fracturas de húmero proximal sigue siendo un problema sin resolver, en este trabajo se pretenden aportar evidencias de cómo influye el uso de modelos anatómicos impresos en 3D de fracturas de húmero proximal a la hora de su clasificación. Además, se propone un nuevo tipo de clasificación cuantitativa basada en el 3D, que podría mejorar el problema existente en la clasificación de fracturas de húmero proximal.
Classification systems for proximal humerus fractures have repeatedly demonstrated a low level of interobserver agreement. These systems are important for standardizing the diagnostic process and facilitating communication and therapeutic decisions. They also allow us to predict and compare results based on the treatment performed (surgical or orthopedic management) and to share it with the medical-scientific community. The reasons for this low level of inter-observer agreement are diverse: the imaging technique used, the experience of the observer, the types of classifications, etc. The interpretation of medical images in two dimensions has been for many years (and still is today), the starting point in the diagnostic and treatment process of pathologies of the locomotor system. Its correct interpretation is conditioned by the capacity of abstraction of the image of each one. 3D printing is revolutionizing not only the industrial sector, but also the world of medicine. In view of the multiple clinical applications of 3D printing, 3D anatomical models are mainly postulated as a teaching and diagnostic tool in orthopedic surgery and traumatology. As this is a relatively new technology, there is still little scientific evidence of its benefits in the literature. Given the emerging impact of 3D printing in orthopedic surgery and traumatology, and given that interobserver agreement in the classification of proximal humerus fractures remains an unresolved problem, this work aims to provide evidence of how the use of 3D printed anatomical models of proximal humerus fractures influences their classification. Furthermore, a new type of quantitative classification based on 3D is proposed, which could improve the existing problem in the classification of proximal humerus fractures.
Universitat Autònoma de Barcelona. Programa de Doctorat en Cirurgia i Ciències Morfològiques
37
Bastos, Endrigo Oliveira. "Avaliação do tratamento cirúrgico das fraturas de côndilo mandibular pelo acesso retromandibular transparotídeo." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5158/tde-21122010-120024/.
Full textAbstract:
INTRODUÇÃO: A redução cirúrgica e fixação rígida por meio do acesso retromandibular transparotídeo vem se difundindo como uma das opções para o controverso tratamento das fraturas de côndilo mandibular. OBJETIVOS: Avaliar o tratamento cirúrgico pela via retromandibular transparotídea das fraturas extracapsulares de côndilo mandibular em adultos. MÉTODOS: Foram avaliados retrospectivamente dez pacientes consecutivos operados pelo autor no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Todos eram adultos com fraturas extracapsulares de côndilo mandibular causando encurtamento maior que 2 mm ou desvio maior que 10 graus. Os pacientes foram operados por meio do acesso retromandibular transparotídeo e tiveram suas tomografias pré e pós-operatórias avaliadas por meio de reconstrução tridimensional. A qualidade da redução quanto ao posicionamento no foco de fratura foi classificada como ideal, satisfatória ou pobre. Em sete pacientes com fraturas unilaterais, os lados não fraturados serviram como controles em uma avaliação quantitativa do posicionamento da cabeça condilar. As variáveis altura condilar e inclinações sagital, coronal e axial foram medidas nas tomografias pré e pós-operatórias para os lados fraturados e não fraturados. As diferentes medidas foram comparadas entre si. Quanto à morbidade do acesso, foram avaliadas: assimetrias na mímica facial, incidência de fístulas salivares ou infecções e qualidade das cicatriz. Com pelo menos 18 meses após a cirurgia, os pacientes foram convocados para uma avaliação do pós-operatório tardio. Foram questionados quanto a presença de estalidos articulares, limitação da abertura oral, dor facial e mastigação insatisfatória. A situação referida no pós-operatório tardio foi comparada referida para o período anterior ao trauma. Os pacientes foram examinados em busca de estalidos ou dor à palpação facial, intercuspidação não corrigida, desvio à abertura oral, limitação à protrusão ou à lateralidade. A abertura oral máxima foi quantificada. RESULTADOS: No foco de fratura, a redução foi classificada como satisfatória ou ideal em nove pacientes. Quanto ao posicionamento da cabeça condilar, para as variáveis altura condilar e inclinação coronal, no pré-operatório, houve diferença estatística entre os lados fraturados e os lados normais. No pós-operatório, não houve diferença para nenhuma das variáveis na comparação entre os lados fraturados e os não fraturados. Não foram observadas assimetrias na motricidade da mímica, fístulas salivares ou infecção desde o pós-operatório imediato. Uma paciente apresentou cicatriz hipertrófica. No pós-operatório tardio, encontraram-se abertura oral máxima entre 39 e 55 mm, desvio à abertura oral em um paciente e surgimento de estalidos em dois, o que não se mostrou estatisticamente diferente do período anterior ao trauma. CONCLUSÕES: O tratamento aberto por via retromandibular com redução e fixação rígida de fraturas extracapsulares de côndilo mandibular com desvio ou encurtamento em adultos é capaz de prover correção da anatomia condilar com baixa morbidade relacionada ao acesso e com evolução funcional satisfatória.INTRODUCTION: Open reduction and rigid internal fixation through retromandibular transparotid approach has been increasingly accepted as one of the options for treatment of fractures of the mandibular condyle, which is still a controversial subject. OBJECTIVES: To evaluate surgical treatment through retromandibular transparotid approach for extracapsular fractures of mandibular condyle in adults. METHODS: Ten consecutive patients operated on by the author at University of São Paulo Medical School Hospital were retrospectively evaluated. All of them were adults with extracapsular fractures of mandibular condyle causing shortening greater than 2 mm or deviation greater than 10 degrees. Patients were operated through retromandibular transparotid approach and had their pre and postoperative CT scans assessed with tridimensional reconstruction. Quality of reduction at fracture site was classified as optimal, satisfactory or poor. In seven patients with unilateral fractures, non-fractured sides served as controls in quantitative assessment condylar head positioning. Variables condylar height and sagittal, axial and coronal inclinations were measured in preoperative and postoperative CT scans, on fractured and not fractured sides. The different measures were compared. On morbidity of the approach, were evaluated: facial animation asymmetry, incidence of salivary fistula or infection and quality of scar. At least 18 months after surgery, patients were called for an assessment of postoperative period. They were asked about the presence of clicking joints, limitation on mouth opening, facial pain and poor mastication. Situation at postoperative period was compared with the one previous to trauma. Patients were examined for clicking or pain on palpation, uncorrected intercuspation, chin deviation on mouth opening and limitation on protrusion or laterality. The maximum mouth opening was measured. RESULTS: At the fracture site, reduction was rated as satisfactory or ideal in nine patients. As for the positioning of the condylar head, for the variables height and coronal condylar inclination, preoperatively, there was statistical difference between fractured and normal sides. Postoperatively, there was no difference for any variable when comparing fractured and normal sides. There were no asymmetries in facial animation, salivary fistula or infection since immediate postoperative period. One patient had hypertrophic scar. In the late postoperative period, were found: maximum mouth opening between 39 and 55 mm, chin deviation at oral opening in one patient and the emergence of clicking in two, data that was not statistically different from the period before the trauma. CONCLUSIONS: Treatment of shortened or deviated extracapsular fractures of the mandibular condyle in adults by open reduction and rigid internal fixation through retromandibular transparotid approach can provide correction of condylar anatomy with low morbidity and satisfactory functional outcome
38
Baccarin, Daniel Castelo Branco. "Estudo mecânico "in vitro" da resistência a forças axiais do parafuso canulado de 3,5mm de diâmetro, em comparação ao parafuso convencional de mesmo diâmetro, em fraturas de cabeça e colo femoral." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-16042007-173138/.
Full textAbstract:
Em razão da complexidade da osteossíntese nas regiões de colo e cabeça femorais, aliado à dificuldade da boa redução e fixação da fratura, objetivou-se estudar comparativamente os efeitos das cargas com forças axiais nos conjuntos osso-parafuso convencional e osso-parafuso canulado. O parafuso canulado possui eficiente capacidade compressiva e por possuir uma cânula central é capaz de simplificar a técnica cirúrgica se comparado aos parafusos ósseos convencionais. Foram utilizados dois parafusos dispostos paralelamente, inseridos da porção lateral do fêmur, abaixo do trocânter maior, em direção à cabeça femoral em 14 fêmures de cães acima de 20 kilos de peso, subdivididos em 2 grupos de 7 fêmures com parafusos convencionais e 7 fêmures com parafusos canulados , sem sinais macroscópicos ou radiográficos de moléstias ósseas. Os resultados obtidos mostraram que não houve diferenças estatísticas na força máxima e na rigidez nos dois grupos, e em todos os ensaios, os implantes não sofreram deformação, portanto conclui-se que as resistências dos parafusos convencional e canulado, utilizados na osteossíntese de fraturas de cabeça e colo de fêmur, são semelhantes.Because of the complexity of osteosynthesis of femoral head and neck fractures and the difficulty of good reduction and fixation of the fractures, we studied comparatively the effects of load and axial forces of bone-conventional screws and bone-cannulated screws. The cannulated screw presents efficient compressive capacity and it presents a central cannula capable of simplifying the surgical technique if compared to conventional bone screws. We used two screws placed parallel, inserted in the lateral aspect of the femur, beneath the greater trocanter, directed to the femoral head, in fourteen femurs of dogs over 20Kg, subdivided in two groups of seven femurs each, the first with conventional screws and the second with cannulated screws, with no macroscopic or radiographic signs of bone diseases. The results didn´t show any statistical differences in maximum strength and rigidity of both groups and the implants didn´t suffer deformities in any essays, therefore we conclude that the resistances of conventional and cannulated screws, used in of femoral heads and necks fracture repairs, are similar.
39
Ljunggren, Ribom Eva. "Muscles, Estrogen, and Bone." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3779.
Full text
40
Cavalcanti, Samantha Cristine Santos Xisto Braga. "Avaliação da reparação da fratura de côndilo mandibular e da simetria facial em ratos tratados com metotrexato." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/23/23149/tde-04102011-121140/.
Full textAbstract:
O Metotrexato (MTX) é utilizado em altas doses no tratamento de neoplasias e em baixas doses como antiinflamatório. O objetivo deste estudo foi avaliar a reparação da fratura de côndilo mandibular e a simetria facial em ratos tratados com MTX. Foram utilizados 100 ratos, Wistar, machos que foram submetidos a procedimento cirúrgico utilizando modelo experimental de fratura de côndilo do lado direito. Os ratos foram distribuídos em quatro grupos e receberam os seguintes tratamentos: Controle - soro (um mL/semana); Dexametasona - dexametasona (0,15 mg/Kg); MTX Baixa dose - MTX (três mg/kg/semana); MTX Alta dose - MTX (30 mg/Kg). Os períodos de sacrifício foram de um dia, sete, 15, 30 e 90 dias de pós-operatório (n=cinco). O peso dos animais foi documentado. Foi realizada coleta de sangue para análise bioquímica de proteínas totais e fosfatase alcalina. Foi realizado exame radiográfico das cabeças em norma axial para análise cefalométrica. Foram realizadas mensurações lineares da maxila e mandíbula, bem como angulares do desvio mandibular. As amostras foram processadas histologicamente sendo obtidas lâminas com cortes no sentido coronal. Os dados quantitativos foram submetidos a análises estatísticas (=0,05). Os animais recuperaram peso ao longo do tempo, exceto no grupo MTX Alta dose. Os níveis séricos de proteínas totais mostraram aumento nos períodos iniciais e os de fosfatase alcalina queda nos períodos de formação do calo ósseo no tratamento com MTX. Houve redução no comprimento mandibular com alterações também na maxila e desvio progressivo da mandíbula em relação à base do crânio no grupo MTX Alta dose. A análise histológica revelou que houve reparo da fratura, pela formação de calo ósseo, e das estruturas da articulação sendo que no grupo MTX Alta dose ocorreu um retardo neste processo, havendo desvio do côndilo e em um espécime houve anquilose fibrosa. A histomorfometria revelou que a área de neoformação óssea foi menor no grupo MTX Alta dose. Foi concluído que o tratamento com MTX em alta dose teve efeito deletério na simetria facial de ratos submetidos à fratura do processo condilar e prejudicou a formação do calo ósseo e o reparo da articulação temporomandibular, com possível indução de anquilose fibrosa.low doses as an antiinflammatory. The aim of this study was to evaluate the healing of the mandibular condyle fracture and facial symmetry in rats treated with MTX. 100 Wistar male rats undergone surgery using an experimental model of mandibular condyle fracture of the right side. The rats were distributed in four groups and received the following treatments: Control Saline (1 ml/week); Dexamethasone dexamethasone (0,15mg/kg); MTX Low dose MTX (3 mg/kg/week); MTX High dose MTX (30 mg/kg). Animals were sacrificed at one, seven, 15, 30 and 90 days postoperatively (n=5). Animals body weight were recorded. Blood has been taken to provide the biochemical analysis of total proteins and alkaline phosphatase. Radiographic axial exams from the heads were provided to cephalometric analysis. Linear measures of jaw and mandible, as well as angular measures of the mandibular deviation were done. The samples were histologically processed and coronal sections were obtained. Quantitative data were submitted to statistical analysis (=0,05). The animals regained body weight over the time, except in MTX High dose group. Total protein serum levels demonstrated the increase in initial periods and the alkaline phosphatase levels showed decrease in the periods of bone callus formation. There was reduction in the mandibular length and also changes in the jaw and progressive deviation in the mandible in relation to the skull basis in the MTX High dose group. The histological analysis revealed that there were repair of the bone and temporomandibular joint although in the MTX High dose group there was a delay in this process, in wich there was deviation of the condyle and one specimen was fibrous ankylosis. Histomorphometry revealed that the new bone formation area was lower in MTX High dose group. It was concluded that treatment with high dose MTX had a deleterious effect on facial symmetry of rats submitted to fracture of the condylar process and damaged the bone callus formation and repair of the temporomandibular joint, with possible induction of fibrous ankylosis.
41
Muñante, Cardenas Jose Luis. "Traumatismos faciais em pacientes pediatricos e adolescentes = analise epidemiologica." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289449.
Full textAbstract:
Orientador: Jose Ricardo de Albuquerque BarbosaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologika
Made available in DSpace on 2018-08-15T11:26:22Z (GMT). No. of bitstreams: 1 MunanteCardenas_JoseLuis_M.pdf: 1001514 bytes, checksum: 4dea799fe4c80806263615b573dd2c89 (MD5) Previous issue date: 2010
Resumo: Realizamos um estudo retrospectivo para analisar as diferentes características das fraturas faciais na população pediátrica atendida pela Área de Cirurgia Buco-Maxilo-facial da Faculdade de Odontologia de Piracicaba -UNICAMP entre 1999 e 2008. Foram analisados os prontuários de 2986 pacientes, dos quais 757 foram menores que 18 anos. Os seguintes parâmetros foram avaliados: idade, sexo, etiologia, localização e tipo de fratura, lesões associadas, tratamento e complicações. Resultados: Foram atendidos 530 crianças e adolescentes de gênero masculino (70,01%) e 227 do gênero feminino (29,99%), sendo os adolescentes o grupo etário mais afetado. As causas mais comuns das lesões foram os acidentes de bicicleta (220, 29,06%) e as quedas (215, 28,40%). O osso facial mais afetado por fraturas foi a mandíbula (112, 44,8%) e as lesões associadas mais freqüentes foram as lacerações e o trauma dentoalveolar. O tratamento foi cirúrgico em 75 casos (30%) e as principais complicações foram deiscência, hemorragia pósoperatória e infecção de material de fixação interna. Conclusões: Os acidentes de bicicleta e as quedas foram consideradas as principais causas de injurias maxilo-faciais. A mandíbula foi a mais afetada por fraturas. Estudos epidemiológicos de lesões faciais permitem o desenho das circunstâncias de risco e a identificação dos indivíduos mais sucetiveis. A avaliação da eficácia do tratamento instituído e a compreensão de suas complicações permite uma interpretação realista e coerente da melhor forma como estes doentes devem ser conduzidos.
Abstract: We performed a retrospective study to analyse the different characteristics of such fractures in the pediatric population of Piracicaba Region, Sao Paulo, Brazil. We reviewed the clinical records of 2986 patients. A total of 757 patients under 18 years were treated by the Oral and Maxillofacial Surgery Division of Piracicaba Dental School between 1999 and 2008.The following parameters were evaluated: age, sex, etiology, location and type of fracture, associated injury, treatment and complications. Results: There were 530 boys (70.01%) and 227 girls (29.99%), treated for injuries, with the main prevalence in teenage. The most common injury causes were bicycle accidents (220, 29.06%) followed by falls (215, 28.40%).The facial bone most affected by fractures was the mandible (112, 44.8%) and the associated injuries were lacerations, dentoalveolar trauma and craniofacial trauma. The treatment was surgical in 75 cases (30%) of cases and the main complications were dehiscence, post-operative infection and loosed of internal fixation material and facial paraesthesia. Conclusions: Bicycle accidents and falls were found to be the principal causes of maxillofacial injuries. The facial bone most affected by fractures was the mandible. Epidemiological studies of facial injuries enable the design of the risk circumstances and the identification of the most vulnerable individuals. The evaluation of the effectiveness of treatment instituted and understanding its complications allow a realistic and consistent interpretation about which is the best way for treating these patients.
Mestrado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Mestre em Clínica Odontológica
42
Mota, Carlos Windson Cavalcante. "Efeito da chalcona (Myracroduon Urundeuva Fr. All.) nas fraturas expostas induzidas em ratos." reponame:Repositório Institucional da UFC, 2006. http://www.repositorio.ufc.br/handle/riufc/7294.
Full textAbstract:
MOTA, Carlos Windson Cavalcante. Efeito da Chalcona (Myracroduon Urundeuva Fr. All.) nas fraturas expostas induzidas em ratos. 2006. 65 f. Dissertação (Mestrado em Cirurgia) - Universidade Federal do Ceará. Faculdade de Medicina, Fortaleza, 2006.Submitted by denise santos (denise.santos@ufc.br) on 2014-02-18T12:41:18Z No. of bitstreams: 1 2006_dis_cwcmota.pdf: 642116 bytes, checksum: 6ab81fa88af4da3624ec8d5fe3464344 (MD5)
Approved for entry into archive by denise santos(denise.santos@ufc.br) on 2014-02-18T12:41:40Z (GMT) No. of bitstreams: 1 2006_dis_cwcmota.pdf: 642116 bytes, checksum: 6ab81fa88af4da3624ec8d5fe3464344 (MD5)
Made available in DSpace on 2014-02-18T12:41:40Z (GMT). No. of bitstreams: 1 2006_dis_cwcmota.pdf: 642116 bytes, checksum: 6ab81fa88af4da3624ec8d5fe3464344 (MD5) Previous issue date: 2006
A chalcona é um complexo fitoterápico derivado da aroeira-do-sertão (Myracrodruon urundeuva Fr. All.), planta usada popularmente como antiinflamatório e cicatrizante. Avaliaram-se os efeitos anti-sépticos e cicatrizantes das chalconas nas feridas e o seu efeito sobre a consolidação óssea nas fraturas expostas induzidas em ratos. Utilizaram-se ratos Wistar machos adultos, com peso médio de 300g. A fratura foi realizada no fêmur esquerdo dos animais e exposta por 3h antes de iniciar o tratamento. Os animais foram distribuídos ao acaso em dois grupos: o grupo 1 o foco da fratura foi limpo com 100 mL de soro fisiológico 0,9% e o grupo 2, o foco da fratura foi limpo com 100 mL de soro fisiológico 0,9% e 40 mL de chalconas, na concentração de 10 mg de chalcona por 1 mL de solução salina a 0,9%. Em todos os animais foram realizadas culturas dos focos de fraturas antes de iniciar o tratamento que consistiu na osteosíntese intramedular com fio de Kirschener de 1 mm de diâmetro. Foi realizada a avaliação clínica e radiológica no pós-operatório imediato, no 7º, 14º, 21º e 28º dias do tratamento. Na avaliação clínica verificava-se o aspecto da ferida: sinais flogísticos, deiscência da ferida, fístula e ferida cicatrizada. No primeiro grupo, a cicatrização ocorreu após a 3º semana em 78,9 % dos animais; no segundo grupo, a cicatrização ocorreu a partir da 2º semana em 50 % dos ratos. Em todos os animais ocorreram contaminações, sendo o Staphylococcus aureus o microorganismo isolado mais comumente. No primeiro grupo, 80% dos animais perderam a redução na segunda semana, e no segundo grupo, 50% dos animais perderam a redução na terceira semana. Conclui-se que a chalcona na concentração testada não tem efeito na consolidação da fratura exposta induzida em rato, porém é benéfica na cicatrização da ferida operatória.
43
Ohrt, Gary Thomas. "Surgical simulation training models for orthopaedic fracture surgery." Thesis, University of Iowa, 2013. https://ir.uiowa.edu/etd/4888.
Full textAbstract:
Articular fracture reduction is a complex surgical task that requires surgeons to be competent at multiple surgical skills to successfully complete. The list of skills needed includes the ability to use fluoroscopic images to build a 3D mental model of the fracture during reconstruction, the proper handling and use of surgical instruments, how to manipulate the fracture fragment into a reduced configuration with minimal hand motion, proper k-wire placement, and the preservation of surrounding soft tissues. Current training methodology is based on an apprenticeship model. The resident learns by watching a senior surgeon, and then preforms the procedure on live patients under the guidance of the senior surgeon to gain competence. This endangers the patient and does not provide the best outcome for either patient or resident.
The work presented in this thesis is the early development of an articular fracture reduction simulator, the subsequent use of the simulator in the training of orthopaedic residents, and assessment of the improvement of residents after practice on the simulator. To date, the simulator has been tested on four different groups of residents,3 different groups from the University of Iowa and one group from the University of Minnesota. Considerable effort has been made to validate the improvement seen in resident performance through objective means. The Objective Structured Assessment of Technical Skills (OSATS) is a global rating score and procedural checklist that has been previously validated to objectively measure surgical skill. Other assessment metrics include hand motion capture to count the number of discrete actions and measure distance traveled during the surgical procedure, fluoroscopic usage and radiation exposure, articular `step-off', the surface deviation from an intact or ideal reconstruction, and contact stress exposure.
The results indicate that the goals for the simulator have been met, that the simulator provides a means of training orthopaedic residents, assessing improvement, decreased the cost of training, and improved patient safety. The simulator is not without limitations including sample size, and radiation exposure. The task being trained is complex and can be broken down into basic subtasks that could be trained individually. Even with flaws, the simulator is an improvement over current training methods and is an excellent first step toward creating a surgical skills curriculum to comply with new mandates from orthopaedic surgery's governing bodies.
44
Sasaki, Sandra Umeda. "Estudo comparativo entre dois métodos de tratamento da lesão do ligamento cruzado posterior por avulsão óssea na tíbia : amarrilho artroscópico e fixação com parafuso por via posterior aberta." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-19042007-115606/.
Full textAbstract:
Atualmente, os bons resultados na lesão do ligamento cruzado posterior por avulsão óssea na tíbia associam-se ao tratamento cirúrgico e precoce. A técnica convencional é a fixação com parafuso pela via de acesso posterior do joelho, com abordagem direta das estruturas vasculares e nervosas da região. Neste estudo experimental em 20 joelhos de cadáveres, buscamos apresentar uma alternativa com amarrilho por via artroscópica, comparando-o com a técnica convencional, através da inspeção direta e de testes biomecânicos. Houve falha na fixação de apenas um exemplar de cada método e medidas de deslocamento tibial posterior (p=0,23) e rigidez média (p=0,28) sem diferenças significativas entre as duas técnicas. Concluímos ser o amarrilho artroscópico viável e uma alternativa no tratamento desta lesão.Nowadays, good results on the management of posterior cruciate ligament bony avulsion of the tibia are associated with early surgical repair. The usual method of treatment is the open posterior approach with screw fixation, wich requires popliteal neurovascular bundle direct manipulation. This study presents a new arthroscopic suture and compares it with the conventional technique, using biomechanical tests and direct inspection in cadaveric specimens (20 knees). On both methods there was a fixation fail in one knee. The analisys of tibial posterior displacement (p=0,23) and stiffness (p=0,20) were similar for the two methods. The Arthroscopic suture presented is an effective reattachment method for this fracture pattern.
45
McLean, Gavin W. "An investigation into the balance of pro- and anti-inflammatory cytokines in cardiac surgery and hip fracture surgery." Thesis, Queen's University Belfast, 2017. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.727756.
Full textAbstract:
The aim of this study was to investigate the balance of pro- and anti-inflammatory cytokines in patients undergoing cardiac and hip fracture surgery in relation to the development of postoperative acute kidney injury (AKI). 400 patients undergoing elective cardiac surgery and 237 patients undergoing emergency hip fracture surgery were recruited. For each patient blood and urine samples were analysed preoperatively and postoperatively to determine how cytokine balance alters in those patients who develop postoperative AKI. In both patients groups, the balance of pro- and anti-inflammatory cytokines in the blood was maintained, regardless of whether or not the patient developed postoperative AKI. This demonstrates that the underlying process responsible for AKI in these patients was not located within the systemic circulation. In the cardiac surgery patients who developed postoperative AKI, it was found that there was a local imbalance of pro- and anti-inflammatory cytokines in the urine, indicating that the pathological cause of AKI is located within the kidney. What was observed was an inadequate anti-inflammatory response to the pro-inflammatory insult of surgery, thus, leaving the kidney vulnerable to the pro- inflammatory onslaught and, subsequently renal injury. A different picture was seen in the hip fracture patients, where elevated pro- and anti-inflammatory mediators were observed preoperatively due to the trauma that occurred in sustaining the hip fracture. This showed an important finding that the hip fracture patients had been undergone cytokine preconditioning as a result of trauma, prior to surgery. In this group the cytokines behaved quite differently to the cardiac surgery group. In the absence of preconditioning, postoperative AKI is associated with an inadequate anti- inflammatory cytokine response to the pro-inflammatory rise associated with surgery. However, when preconditioning is present, the cytokine levels must be analysed more carefully with the clinical context in mind.
46
Benegas, Eduardo. "Estudo comparativo entre a haste intramedular bloqueada e a placa em ponte no tratamento cirúrgico das fraturas da diáfise do úmero." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-12022009-130247/.
Full textAbstract:
O objetivo deste estudo é o de comparar os resultados clínicos e radiográficos do tratamento cirúrgico das fraturas da diáfise do úmero com haste intramedular bloqueada ou placa em ponte. Quarenta fraturas da diáfise do úmero, em 39 pacientes, dos tipos A, B ou C da classificação do grupo A.O., foram tratadas no período compreendido entre junho de 2003 e dezembro de 2007. Destas, após seleção por sorteio, 21 fraturas foram submetidas à osteossíntese com placas em ponte de 4,5 mm e parafusos (grupo PP) e 19 com hastes intramedulares bloqueadas não fresadas (grupo HIB). Duas eram fraturas expostas, uma do tipo II e outra do tipo III-a de Gustilo. Vinte e cinco pacientes eram do sexo masculino (64%) e a idade variou de 19 a 75 anos (idade média de 41 anos e 10 meses). O lado direito foi acometido em 22 pacientes (55%) e a queda, o mecanismo de trauma mais freqüente (46%). O tempo mínimo de seguimento foi de seis meses e o máximo de 60 meses para o grupo PP (M=34,5 meses) e de oito e 58 meses (M=27meses) para o grupo HIB. Em apenas um caso, operado com haste intramedular bloqueada, não houve a consolidação. Houve um caso de infecção profunda no grupo PP e um de infecção superficial no grupo HIB. Dois casos do grupo PP evoluíram com capsulite adesiva e, em apenas um dos casos do grupo HIB, o parafuso distal ficou saliente. Ocorreu neuropraxia do nervo cutâneo lateral do antebraço em um dos casos do grupo HIB que regrediu em três dias. Não houve diferença entre os grupos com relação ao tempo total da cirurgia. O tempo de utilização da radioscopia no ato operatório foi maior no grupo HIB. Houve semelhança entre os dois métodos de fixação nos resultados referentes à dor, à função, à flexão ativa e à força de flexão na articulação do ombro e também com relação à dor, mobilidade, força muscular e estabilidade na articulação do cotovelo. Segundo os critérios da UCLA para o ombro, obtivemos resultados excelentes e bons em 85,7% no grupo operado com placa em ponte e 79% no grupo com haste intramedular bloqueada e de acordo com os critérios de Broberg e Morrey para o cotovelo, obtivemos resultados excelentes e bons em 85,7% no grupo operado com placa em ponte e 90,5% no grupo com haste intramedular bloqueada. Na avaliação subjetiva, duas pacientes, uma do grupo HIB e outra do PP, não ficaram satisfeitas. Conclusão: Não houve diferença no resultado clínico e radiográfico entre os dois métodosThe purpose of the study is to compare clinical and radiographic outcomes between nonreamed locked intramedullary nail and bridging plate for the treatment of humeral shaft fracture. Forty humeral shaft fractures in 39 patients, A, B or C AO types were treated between June 2003 and December 2007. The cases were randomly assigned into two groups being 21 fractures fixed by a 4.5 mm bridging plate, and 19 by nonreamed intramedullary locking nail. Two cases had open fractures, one Gustilo type II, the other type IIIa. Twenty five patients were male (64%), ages ranging from 19 to 75 years old (mean age 41 years and 10 months). The right side was treated in 22 patients (55%) and fall was the most frequent cause of fracture (46%). The minimal period of follow-up was six months and the maximum was 60 months for the bridging plate group (mean=34.5 months) and ranged from eight to 58 months (mean=27months) for the nail group. Only one case from the nail group presented a nonunion. One case, in the plate group, developed a deep infection, and another one, in the nail group, had a superficial infection. Two cases of the bridging plate group had adhesive capsulites and in one case of the nail group the distal screw became prominent. A transient neuropraxis of the antebrachial lateral cutaneous nerve was found in one case of the nail group, but it recovered in three days. There were no differences between the groups concerning pain, function, active flexion and strength of flexion of the shoulder, as well as pain, range of motion, muscle strength, and stability of the elbow. According to the UCLA score, we had 85.7% excellent and good results in the plate group and 79% in the nail group. According to Broberg and Morrey score for the elbow, we had 85.7% excellent and good results in the plate group and 90.5% in the nail group. Just one patient, from the nail group, was not satisfied with the final result, according to subjective criteria. In conclusion, there were no differences in the final clinical and radiographic results between the two methods of fixation
47
Charilaou, Johan. "Quantitative fit analysis of acromion fracture plating systems using three-dimensional anatomical modelling." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31486.
Full textAbstract:
Background
Displaced acromial fractures are challenging to treat. Complex bony anatomy, variable fracture morphology and limitations of available implants present challenges in achieving favourable surgical outcomes. We determined to what extent currently available scapular and clavicular plating systems are able to provide adequate fixation options.
Methods
Patients presenting to an urban trauma centre with acromial fractures sustained from blunt trauma between 2012 and 2016 were identified (n = 15, 14M / 1F). The fracture patterns were categorized according to location (Type I = 13%, Type II = 27%, Type III = 60%). Computed Tomography (CT) scans were reconstructed to produce three-dimensional (3D) printed anatomical models on which a quantitative fit analysis was performed. Measurements were performed twice, by five separate observers, with fit graded as anatomical fit (< 2mm), intermediate fit (> 2mm) or no-fit.
Results
The anterior clavicle 6 hole plate fitted best in 45.7% of cases. Acromial plates only achieved 27.3%. The acromion short plate together with the lateral clavicle short plates performed the best in Type II fractures. An inter-observer intraclass correlation coefficient (ICC) agreement of 0.974 was obtained.
Conclusion
The available commercial acromial plating system fails to provide adequate congruency and fit for fixation. Clavicular plates were superior alternative implants. 3D printed anatomical models can be used effectively to assist in templating implants preoperatively.
48
KATO, FUMIHIKO, NAOKI ISHIGURO, MASAAKI MACHINO, KEIGO ITO, YASUTSUGU YUKAWA, and HIROAKI NAKASHIMA. "COMBINED POSTERIOR-ANTERIOR SURGERY FOR OSTEOPOROTIC DELAYED VERTEBRAL FRACTURE WITH NEUROLOGIC DEFICIT." Nagoya University School of Medicine, 2014. http://hdl.handle.net/2237/20549.
Full text
49
Segevall, Cecilia. "Recovery following hip fracture surgery for older people living in rural areas." Licentiate thesis, Mittuniversitetet, Avdelningen för omvårdnad, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-34770.
Full textAbstract:
Vid tidpunkten för framläggningen av avhandlingen var följande delarbete opublicerat: delarbete 1 inskickat.
At the time of the defence the following paper was unpublished: paper 1 submitted.
50
Barrera, Betanzos Fernando. "Development of innovative techniques for the manufacture of bioresorbable composites intended as fracture fixation devices." Thesis, University of Nottingham, 2018. http://eprints.nottingham.ac.uk/49087/.
Full textAbstract:
In this project innovative manufacturing processes have been developed and characterised for the efficient and effective fabrication of PGF-PLA composites which have adequate properties for the fixation of fractured bones in flat and curved geometries. Fully bioresorbable composite plates where produced by compression moulding of unidirectional phosphate glass fibre mats and PLA films alternatively stacked inside the mould cavity. The implementation of cyclic pressure during the compression moulding consolidation stage resulted in the production the strongest PGF-PLA composites hitherto reported. The strength of the composites consolidated via cyclic pressure was at least 30% higher with respect to the control samples fabricated using the conventional static pressure profile, reaching values of 480 MPa for plates reinforced with 0.45 fibre volume fraction. The increases in composite strength were attributed to the influence of pressure cycling on the fibre network permeability, melt viscosity and capillary pressure, leading to improved fibre impregnation with respect to statically applied pressure, obviating the need for elevated processing temperatures to reduce the melt viscosity. Pressure cycling seemed to promote the formation of transcrystalline layer around the fibres which could have also contributed to the superior properties of composites consolidated under cyclic pressure. PGF-PLA composite rods with cylindrical cross sections were manufactured via uniaxial compression and plane strain forging of preconsolidated composite blanks obtained from compression moulded composite plates. Forging under uniaxial conditions reduced both the flexural strength and the elastic modulus of all the composite rods in comparison to the compression moulded composite plates by as much as 85% and 47%, respectively, for the 0.35vf samples consolidated under cyclic pressure, as a result of the fracture of the fibres consequent to the extensional flow. Fibre fracture was prevented through confinement of the deformation to the x-y plane during plane strain forging. The mechanical properties of the compression moulded composite plates were preserved in the forged composite rods with 0.15 and 0.25 fibre volume fractions, but the high segregation of fibres in the 0.35vf and 0.45vf compression moulded composite plates fabricated with thick glass fibre mats led to the reduction of both the flexural strength and modulus of the forged composite rods with respect to the compression moulded composite plates by as much as 74% and 29%, respectively, for the 0.45vf consolidated under cyclic pressure, as a result of the nucleation of intra-ply cracks during plane strain forging. The deleterious effect of intra-ply cracks in the plane strain forged composite rods was significantly reduced by stacking a larger number of thinner phosphate glass fibre mats prior to compression moulding of the 0.35vf and 0.45vf composite plates. The properties of the forged composite rods decreased in aqueous media. The initial loss of strength and modulus was attributed to the water-mediated lubrication of the fibre-matrix interface. Further decreases in mechanical properties were related to the fibre diameter reduction as a result of quick glass dissolution, which impaired the frictional stress transfer. Complete loss of the reinforcing effect of glass fibres was observed after 15 days of immersion in aqueous media. Cylindrical PGF-PLA composite rods were also produced via a new and leaner manufacturing method consisting in compression moulding of thermoplastic hybrid preforms. Hybrid preforms were produced by depositing a sheath of PLA on phosphate glass fibre bundles continuously fed into a cross head extrusion die. Due to the characteristics of the technique, composites could be reinforced with both as-drawn and annealed phosphate glass fibres which were embrittled as a result of anisotropy relaxation and the formation of a surface tensile layer following heat treatment. On account of the effect of annealing on the phosphate glass fibres mechanical properties, the flexural strength of as-drawn fibre reinforced compression moulded composite rods was higher with respect to annealed fibre reinforced ones, the former reaching maximum strength values of 371 MPa for the 0.45vf samples in comparison to 278 MPa for the latter. The flexural moduli of the composites rods manufactured through consolidation of PLA-sheathed fibre bundles were the highest hitherto reported for bioresorbable composites reaching values in excess of 30 GPa for the samples with 0.45vf. The higher modulus values of this type of rods with respect to conventional laminated composites were associated with their unique reinforcement distribution achievable by compression moulding of PLA-sheathed fibre bundles. Annealed fibre reinforced composites showed a better retention of mechanical properties in wet conditions with respect to as-drawn fibre reinforced ones, as a result of the slow degradation of annealed fibres, managing to present values even exceeding the human cortical bone range during the 30 day in vitro degradation study.