scholarly journals Tratamiento artroscópico de las fracturas de tercio distal de clavícula tipo 2 de Neer con sistema ZipTight.

2019 ◽  
pp. 149-155
Keyword(s):  
External Rotation ◽  
Surgical Techniques ◽  
Functional Results ◽  
High Rate ◽  
Type Ii ◽  
Rotator Cuff Injuries ◽  
Technical Modifications ◽  
Clavicle Fractures ◽  
Clinical And Radiological Results ◽  
Coracoclavicular Fixation

PURPOSE. Neer type II fractures of the external third of the clavicle are fractures with a high rate of nonunion or malunion (up to 30%). Multiple surgical techniques have been describe their treatment. Also, several arthroscopic techniques. METHODS. We have retrospectively reviewed 29 cases with Neer type II distal third clavicle fractures treated with coracoclavicular fixation with a suspension system. RESULTS. All fractures except 1 have undergone complete consolidation in 3 months,without the disadvantages of other systems such as KW,screws or plates. The rate of consolidation has been 96.5% (all but 1 patient).The mobility obtained was very satisfactory: flexion of 176º, abduction of 145º, an external rotation of 80º, an internal rotation with the hand until T11 and horizontal adduction of 132º. The functional results obtained have been excellent in most patients: obtaining 96 points on the Constant scale and excellent UCLA in 26 cases. This is one of the studies with more patients treated with this type of technique. All patients have been followed until the clinical and radiographic consolidation of the fractures.We also contribute some technical modifications to the initial technique that we have been obtaining with the experience to improve the clinical and radiological result of the patients. CONCLUSION.The arthroscopic assisted treatment of Neer type II distal third clavicle fractures with a Ziptight system is a reproducible technique that allows us to reduce and stabilize the fracture and also to diagnose and treat possible glenohumeral o rotator cuff injuries, obtaining excellent clinical and radiological results.

Outcomes, Union Rate, and Complications After Operative and Nonoperative Treatments of Neer Type II Distal Clavicle Fractures: A Systematic Review and Meta-analysis of 2284 Patients

2021 ◽  
pp. 036354652110533
Author(s):  
Sophie J. Uittenbogaard ◽  
Laurian J.M. van Es ◽  
Chantal den Haan ◽  
Derek F.P. van Deurzen ◽  
Michel P.J. van den Bekerom
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Operative Treatment ◽  
Type Ii ◽  
Distal Clavicle ◽  
Union Rate ◽  
Significant Difference ◽  
Clavicle Fractures ◽  
Coracoclavicular Fixation ◽  
Distal Clavicle Fractures

Background: As nonoperative treatment of Neer type II distal clavicle fractures is associated with nonunion rates up to 33%, operative treatment is frequently advocated. However, evidence is lacking regarding which operative treatment to perform and whether this is superior to nonoperative treatment in terms of functional outcome and complication rate. Purpose: (1) To evaluate which surgical technique in the treatment of Neer type II distal clavicle fractures is optimal with regard to patient-reported outcomes and union and complication rates. (2) To review nonoperatively treated patients. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature and meta-analysis were performed on January 27, 2021, in PubMed, Embase, CENTRAL, CINAHL/EBSCO, Web of Science/Clarivate Analytics, and SPORTDiscus/EBSCO. The search included all studies regarding nonoperative and operative treatment of Neer type II distal clavicle fractures with a minimum of 20 patients and follow-up of 12 months. The primary and secondary outcomes were patient-reported outcome measures at 12 months and union, complication, and revision rates. Results: A total of 59 articles were included involving 2284 patients. Coracoclavicular fixation, hook plate, transacromial pins, alternative plate, tension band wire/K-wire, a combination of surgical techniques, and a nonoperative group were described. Hook plates showed lower Constant-Murley scores as compared with coracoclavicular fixation (standard mean difference, –0.77; 95% CI, –1.26 to –0.28; P = .002). However, no significant difference was seen when the hook plate was compared with the locking plate and tension band wire/K-wire groups, and no significant difference in union rate was seen among all operative treatment groups. Operatively treated patients had significantly higher union rates than patients treated nonoperatively (standard mean difference: 0.05; 95% CI, 0.01 to 0.37; P = .004). Conclusion: Patients treated with hook plates showed significantly lower Constant-Murley scores and higher complication and revision rates as compared with those treated with coracoclavicular fixation, without differences in union rate. Higher Constant-Murley scores were seen in those patients with supplemental coracoclavicular fixation when using locking. Nonoperatively treated patients showed good functional outcome despite the 31% nonunion rate, although future studies are necessary to substantiate this conclusion. When using a locking plate, additional craniocaudal fixation showed significant better functional outcome.

scholarly journals InSafeLOCK® humeral nailing for humeral nonunions: Clinical and radiological results

2021 ◽  
Vol 32 (2) ◽  
pp. 446-453
Author(s):  
Oktay Polat ◽  
Serdar Toy ◽  
Birkan Kibar
Keyword(s):  
External Rotation ◽  
Operation Time ◽  
Functional Results ◽  
Dash Score ◽  
Radiological Results ◽  
Iliac Bone Graft ◽  
Loss Of Reduction ◽  
The Mean ◽  
Clinical And Radiological Results

Objectives: This study aims to evaluate the clinical and functional results of patients treated with InSafeLOCK® humeral nail and iliac crest autograft for humeral nonunion. Patients and methods: A total of 15 patients (11 males, 4 females; mean age: 52.1±15.3 years; range, 31 to 78 years) who were followed conservatively for humeral fractures and operated with the InSafeLOCK® humeral nail and iliac bone graft in our center between June 2018 and January 2020 were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, operative data, and pre- and postoperative Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), and Constant-Murley Scores (CMS) were recorded. Results: The mean time from injury to nonunion treatment was 10.9±1.6 months. Five patients had atrophic, eight patients had oligotrophic, and two patients had hypertrophic nonunion. Preoperatively, the mean DASH was 37.7±9.1, the mean CMS was 69.7±6.3, and the mean VAS was 3.8±0.7. In all patients, union was achieved. The mean operation time was 59.0±16.2 min. The mean postoperative DASH score was 16.1±8.7, CMS 87.4±3.4, and VAS score 0.8±0.7. Regarding the shoulder joint, the mean abduction was 164.7±11.3 degrees, the mean internal rotation was 82.0±6.8 degrees, the mean external rotation was 81.3±8.3 degrees, and the mean flexion was 162.0±12.1 degrees. During follow-up, complications such as vascular-nerve injury, reflex sympathetic dystrophy, screw migration or loosening, implant failure, and loss of reduction did not occur in any of our patients. Conclusion: Considering the satisfactory functional and radiological results, the InSafeLOCK® humeral nail can be used safely in humeral nonunions.

Endovascular treatment of an ilio-iliac arteriovenous fistula accompanied by venous thromboembolism presenting with multiple organ failure – A case report and literature review

Vascular ◽  
2021 ◽  
pp. 170853812199657
Author(s):  
Tiehao Wang ◽  
Jichun Zhao ◽  
Ding Yuan
Keyword(s):  
Multiple Organ Failure ◽  
Arteriovenous Fistula ◽  
Organ Failure ◽  
Iliac Artery ◽  
Vena Cava ◽  
Artery Aneurysm ◽  
Multiple Organ ◽  
High Rate ◽  
Type Ii ◽  
Type Ii Endoleak

Objectives Multiple organ failure is a rare manifestation of ilio-iliac arteriovenous fistula which can lead to a high rate of misdiagnosis and death. Methods We reported a 61-year-old man presenting with multiple organ failure rapidly after right lower limb swelling. Computed tomography angiography showed an ilio-iliac arteriovenous fistula caused by right common iliac artery aneurysm, and venous thrombosis of bilateral common iliac veins. A bifurcated stent-graft with coil embolization of right internal iliac artery was used for repair. Results The patient recovered rapidly and was discharged without complications. Although arteriovenous fistula persisted due to type II endoleak, aneurysm sac and inferior vena cava significantly shrunk at six months follow-up. Conclusions This report demonstrated that multiple organ failure may appear when the distal outflow tracts of arteriovenous fistula are obstructed. Moreover, endovascular repair is effective for reversal of multiple organ failure caused by arteriovenous fistula, even if arteriovenous fistula persists due to type II endoleak.

scholarly journals Muscle Changes in Lambs with Surgically Created Scoliosis Produced in Utero

1978 ◽  
Vol 5 (3) ◽  
pp. 283-287 ◽  
Author(s):  
G.M. Kent ◽  
W. Zingg ◽  
D. Armstrong
Keyword(s):  
Musculoskeletal Diseases ◽  
Fiber Type ◽  
Surgical Techniques ◽  
Spinal Curvature ◽  
Surgical Trauma ◽  
Developmental Defect ◽  
Type I ◽  
Type Ii ◽  
Muscle Changes ◽  
Type Ii Fibers

SUMMARY:Spinal curves may be produced in fetal lambs with three surgical techniques. These procedures vary from mere exposure of the costo-vertebral junction of three ribs through a paravertebral incision, to resection of the head and part of the adjacent shaft of three ribs. The fetal age varies from forty-nine to seventy-three days. The degree of curvature present at birth seems to increase in severity with decreasing fetal age at the time of surgery, but the type of surgical procedure does not appear to influence the severity of the curve, suggesting that the mechanical presence of the ribs does not prevent the development of scoliosis in these animals.Histological studies of the m. longissimus dorsi at the apices of the curves reveal two main types of abnormality in the muscle fibers. Both Type I and Type II fibers were significantly reduced in size in the biopsies taken from the side on which the surgery was performed, and there was marked alteration in the proportion of one fiber type to the other in most biopsies taken from both operated sides when compared with biopsies from unoperated twin animals.The fetal age and amount of surgical trauma appeared to play no role in the degree of muscle alteration, suggesting that even minimal surgical trauma to the paraspinal region at any fetal age between 49–73 days is sufficient to produce significant muscle fiber abnormality and spinal curvature.A parallel is drawn between these muscle findings and those in a number of human musculoskeletal diseases, and suggests the possibility of a developmental defect in the pathogenesis of these diseases.

Functional results of braced humeral diaphyseal fractures; why do 38% lose external rotation of the shoulder?

2000 ◽  
Vol 120 (5-6) ◽  
pp. 281-285 ◽  
Author(s):  
T. Fjalestad ◽  
Knut Strømsøe ◽  
Petter Salvesen ◽  
Bjørg Rostad
Keyword(s):  
External Rotation ◽  
Functional Results ◽  
Diaphyseal Fractures

GIRD syndrome in male handball and volleyball players: Is the decrease of total range of motion the turning point to pathology?

2021 ◽  
pp. 1-8
Author(s):  
Jonas Schmalzl ◽  
Helen Walter ◽  
Wolfram Rothfischer ◽  
Sören Blaich ◽  
Christian Gerhardt ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Turning Point ◽  
External Rotation ◽  
Constant Score ◽  
High Rate ◽  
Overhead Athletes ◽  
Glenohumeral Internal Rotation Deficit ◽  
Total Range ◽  
Volleyball Players

BACKGROUND: Adaptations in glenohumeral range of motion may affect overhead athletes and lead to shoulder pathologies. OBJECTIVE: The purpose of this study was to evaluate glenohumeral internal rotation deficit (GIRD) and postero-superior impingement among male handball and volleyball players and the relationship between these pathologies and training level (amateur vs. professional), position (attack vs. no attack), experience (> 5 years vs. < 5 years) and sports. METHODS: Sixty-seven handball players and 67 volleyball players with a mean age of 25 [± 5] years were included. The range of motion including external and internal rotation in 90∘ abduction of the dominant and non-dominant shoulder was measured of each examined athlete. Visual analogue scale, disabilities of the shoulder and hand score, constant score and subjective shoulder value were recorded. The athletes were examined for postero-superior impingement and abduction force was measured with an isokinetic dynamometer. RESULTS: Internal rotation was significantly lower and external rotation was significantly greater in the dominant arm for both sports. 72% presented with GIRD. GIRD was more prevalent in athletes active for > 5 years (odds ratio (OR) 3), in those training > 3 times per week (OR 1.4) and in handball players (OR 2.7). 24% presented with postero-superior impingement. Players active for > 5 years (OR 1.22), professionals (OR 1.14), volleyball players (OR 1.19), offensive players (OR 2.2) and athletes with GIRD > 10∘ (OR 1.5) showed a higher prevalence of postero-superior impingement. CONCLUSION: GIRD is a common phenomenon in handball and volleyball players. Offensive players are frequently suffering from postero-superior impingement. GIRD > 10∘ leads in nearly 75% of the athletes to a decrease of total range of motion and a high rate of postero-superior impingement. Thus, a decreased range of motion seems to be the turning point from adaptation to pathology. Therefore, regular controls of range of motion and countermeasures by means of stretching the posterior shoulder joint should be integrated in the training content.

A PROSPECTIVE STUDY TO EVALUATE THE SURGICAL MANAGEMENT OF PROXIMAL HUMERUS FRACTURES BY LOCKING PLATES

2021 ◽  
pp. 10-12
Author(s):  
Anurag Rathore ◽  
Garvita Solanki
Keyword(s):  
External Rotation ◽  
Functional Results ◽  
Average Score ◽  
Prospective Clinical Study ◽  
Locking Plates ◽  
Statistical Parameters ◽  
Functional Scores ◽  
Minimum Score ◽  
Comminuted Fractures ◽  
A Prospective Study

BACKGROUND: This prospective clinical study was performed to evaluate the efcacy and functional outcome in proximal humeral fractures following surgery with locking plates. MATERIAL & METHODS: from August 2013 to April 2015, 32 patients were enrolled in this study following exclusion and inclusion criteria. The evaluation parameters included Time taken for fracture union, functional scores, radiographs of the shoulder and ROM (Range of motion- exion, abduction, internal and external rotation etc.). Patients were followed up regularly at 6 weeks, 12 weeks, 24 weeks and 12 months. Functional results were evaluated using Neer's score. All data were collected and analyzed with the help of suitable statistical parameters. RESULTS: The nal results were evaluated by using NEER'S Score. In our study, the minimum score was 65 and maximum was 94. The average score was 83.9 (Mean ± S.D. : 83.875 ± 6.73). We had excellent results in 6(18.75%) patients, 19(59.375%) had satisfactory results, 7(21.875%) patients had unsatisfactory results but none of the case is failure in our study. CONCLUSION: Open reduction and internal xation with Locking Compression Plates, has given good results and it is the implant of choice now-a-days particularly in comminuted fractures and in osteoporotic bones in elderly patients.

Glenohumeral Translations are Only Partially Restored after Repair of a Simulated Type II Superior Labral Lesion

2003 ◽  
Vol 31 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Andreas Burkart ◽  
Richard E. Debski ◽  
Volker Musahl ◽  
Patrick J. McMahon
Keyword(s):  
Clinical Relevance ◽  
Glenohumeral Joint ◽  
Surgical Techniques ◽  
Testing System ◽  
Type Ii ◽  
Joint Stability ◽  
Anterior Translation ◽  
Labral Lesion ◽  
Force Moment ◽  
Biceps Anchor

Background The effect on joint stability of repair of type II superior labrum and biceps anchor lesions is unknown. Hypothesis Increased translations of the glenohumeral joint after a simulated type II lesion will be reduced after the lesion is repaired. Study Design Controlled laboratory study. Methods A robotic/universal force-moment testing system was used to simulate load-and-shift and apprehension tests on eight cadaveric shoulders to determine joint kinematics of the shoulder after venting, creation of a type II lesion, and repair of the lesion. Results At 30° of abduction, anterior translation of the vented joint in response to an anterior load was 18.7 ± 8.5 mm and was significantly increased to 26.2 ± 6.5 mm after simulation of a type II lesion. Repair did not restore anterior translation (23.9 ± 8.6 mm) to that of the vented joint. The inferior translation that also occurred during application of an anterior load was 3.8 ± 4.0 mm in the vented joint and increased significantly to 8.5 ± 5.4 mm with a simulated type II lesion. After repair, the inferior translation decreased significantly to 6.7 ± 5.3 mm. Conclusions Repair of a type II lesion only partially restored glenohumeral translations to that of the vented joint. Clinical Relevance Surgical techniques including improved repair of passive stabilizers injured in the type II lesion should be considered.

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