Navegando por Palavras-chave "Bone fractures"

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    Intervenções para o tratamento de fratura e pseudartrose da clavícula em adultos e adolescentes: revisão sistemática
    (Universidade Federal de São Paulo (UNIFESP), 2010-11-25) Lenza, Mário [UNIFESP]; Faloppa, Flávio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To evaluate the effectiveness of different methods of treatment for acute fracture or non-union of the middle third of the clavicle in adults and adolescents. Methods: Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, trial registries and reference lists of articles. No language or publication restrictions were applied. Selection criteria: Randomised and quasi-randomised controlled trials evaluating any intervention for treating fractures or non-union of the middle third of the clavicle were considered. The primary outcomes were pain, treatment failure and health-related quality of life or shoulder function. Data collection and analysis: Two authors independently selected eligible trials and three authors assessed methodological quality and cross-checked data extraction. Results: Conservative interventions: Three trials were included in this comparison. Two trials compared the figure-of-eight bandage with sling in a total of 234 participants. Both trials were underpowered and compromised by poor methodology. One trial found slightly higher pain levels in the bandage group at 15 days, and the other trial reported greater discomfort during bandage wear. There were no significant differences in functional or other outcomes reported for either trial. The third trial, which evaluated therapeutic ultrasound in 120 participants, was also underpowered but had a low risk of bias. The trial found no statistically significant difference between low-intensity pulsed ultrasound and placebo in the time to clinical fracture healing or in any of the other reported outcomes. Surgical versus conservative interventions: Four studies, two with moderate and two with high risk of bias were included. Two compared plate fixation versus sling; plate fixation showed better patient-based upper extremity outcome scores and less treatment failure. Other two trials comparing intramedullary fixation versus conservative interventions presented better upper limb function to the surgery treatment. Surgical interventions: Data from four small trials, each testing a different comparison, were included. Three trials had design features that carry a high risk of bias, limiting the strength of their findings. Low-contact dynamic compression plates appeared to be associated with significantly better upper-limb function throughout the year following surgery, earlier fracture union and return to work, and a reduced incidence of implant-associated symptoms when compared with a standard dynamic compression plate in 36 adults with symptomatic non-union of the middle third of the clavicle. One study (69 participants) compared the Knowles pin versus plate for treating middle third clavicle fractures or non-union. Knowles pins appeared to be associated with lower pain levels and use of post-operative analgesics, reduced incidence of implant-associated symptoms, and shorter operation time and hospital stay. One study (133 participants) found that a three-dimensional technique for fixation with a reconstruction plate was associated with a significantly lower incidence of symptomatic delayed union than a standard superior position surgical approach. One study (201 participants) assessed the intramedullary fixation for treating acute clavicle fractures comparing closed and opened reduction; there were statistical significant differences in favour of closed reduction with percutaneous fixation for the primary outcomes. Conclusion: There is limited evidence, from single trials only, regarding the effectiveness of different methods for treating fracture and non-union of the middle third of the clavicle. Further research is warranted.
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    Trauma na infância e adolescência: epidemiologia, tratamento e aspectos econômicos em um hospital público
    (Sociedade Brasileira de Ortopedia e Traumatologia, 2008-01-01) Franciozi, Carlos Eduardo da Silveira [UNIFESP]; Tamaoki, Marcel Jun Sugawara [UNIFESP]; Araújo, Eduardo Fiorentino Alves de [UNIFESP]; Dobashi, Eiffel Tsuyoshi [UNIFESP]; Utumi, Carlos Eduardo [UNIFESP]; Pinto, Jose Antonio [UNIFESP]; Ishida, Akira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION: the motivation to conduct this study was the reduced number of articles in literature correlating multiple trauma in childhood and infancy. The objective here was to describe the epidemiological profile of traumatic injuries treated in a trauma center, evaluating the economic aspects associated with hospitalized patients' costs and the period of hospital stay according to the treatment provided. MATERIAL AND METHODS: we assessed all Pirajussara Hospital patients' files in the period of December of 2005 to December 2006. We selected 182 patients, 129 (71%) males and 53 (29%) females; 88 (48%) Caucasian and 94 (52%) non-Caucasian children. RESULTS: male patients were prevalent, with 129 (71%) cases. The most frequent trauma mechanism was fall (36%) and the primary diagnose was humeral supracondylar fracture (20,9%) and 47 (25,82%) associated lesions. The mean hospitalization time was 4.1 days with an estimated cost of R$ 649.50 for each patient. The most expensive and the longest periods of hospital therapy were associated to skull trauma and femoral fracture; the economic impact increased when associated lesions were present. The mortality rate was 2.74% with 5 deaths, with skull trauma being accounted for 80% of the deaths, while child abuse accounts for 40%. CONCLUSION: the pediatric population exhibits particular characteristics that make it unique concerning trauma injuries' epidemiology and handling.