Navegando por Palavras-chave "Fracture fixation, internal"

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    Fatores de risco para recidiva de infecção de sítio cirúrgico em pós-operatório de osteossíntese após trauma
    (Universidade Federal de São Paulo (UNIFESP), 2011-03-30) Dell'Aquila, Adriana Macedo [UNIFESP]; Pereira, Carlos Alberto Pires [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To evaluate, in postoperative osteosynthesis patients after trauma, the clinical-epidemiological and microbiological aspects, and the risk factors for the relapse of surgical site infection (SSI) of the patients treated according to the protocol of the osteo-articular infections at São Paulo Hospital – Federal University of São Paulo. Methods: through the retrospective were evaluated all episodes of surgical site infection that occurred from December, 2004 to December, 2008 in post-trauma patients undergoing osteosynthesis, admitted at the orthopedics department of São Paulo Hospital. The procedures that progressed to deep infection or organ / space were treated with cycles of at least 4 to 6 weeks of antibiotic therapy and followed until one year after surgery. For the analysis of risk factors related to relapse of infection after treatment was used univariate and multivariate analysis model. Results: Of the 436 patients with osteoarticular infections, 117 (26.8%) had infections after osteosynthesis. Of these, 110 patients were included with osteoarticular infections after osteosynthesis, and the majority were male (84.5%) aged 18-89 years, average 39.8 years. Few were smokers (33.6%) and alcoholics (9.1%) and most (73.6%) had no underlying disease. Motorcycle accident was the most prevalent (44.5%), 90.0% had one or two fractures, 51.8% had joint involvement and 53.6% fractures were not exposed. There was a higher prevalence of infection in the tibia / fibula, especially for the proximal and the malleolar segment (44B3 and 42C2). Most underwent one surgery only (89.1%), without conversion (87.2%), and 54.5% of plate / screw or plate / screw / Kirshner wire, with duration of surgery more than two hours (81.8%). Antibiotic prophylaxis was inadequate in 76.4% and in 76.4% the surgical repair was performed in the first five days of admission. In 37 patients the causative agent was isolated, Staphylococcus (S. aureus and SCN) was the most frequent (38.8%). In 83 (75.4%) patients were able to start antimicrobial treatment of infection in less than five days of onset of symptoms and ciprofloxacin and clindamycin were the most common. Relapses of infection in 34 (30.9%) of 110 patients, of which 19 (17.3%) persisted with infection at the end of one year follow-up and only 10 (9.1%) did not consolidate the fracture. In univariate analysis was found as a risk factor for relapse of the SSI the performance of more than one surgery to stabilize the affected limb (OR 3,7 IC95=1,1-12,7 p=0,045), the presence of converting osteosynthesis (OR 3,6 IC95=1,1-11,3 p=0,023), the internal synthesis (OR 3,0 IC95=0,99-9,2 p=0,043) and longer duration of surgery (OR 0,4 IC95=0,1-1,6 p=0,029). In multivariate analysis, the only variable independently associated with SSI relapse was duration of surgery (OR 1,3 IC95=1,1-1,7 p=0,015). Conclusions: After one year of follow-up, using a protocol, the majority of patients showed cure of the infection and only 9.1% did not consolidate the fracture. Relapse of infection occurred in one third of patients. The only independent risk factor associated with relapse of infection was prolonged surgery.
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    Minimal invasive ostheosintesis for treatment of diaphiseal transverse humeral shaft fractures
    (Sociedade Brasileira de Ortopedia e Traumatologia, 2014-01-01) Zogaib, Rodrigo Kallás; Morgan, Steven; Belangero, Paulo Santoro; Fernandes, Hélio Jorge Alvachian; Belangero, William Dias; Livani, Bruno; Universidade Estadual de Campinas (UNICAMP); Swedish Medical Center; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE:To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique.METHODS:Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures.RESULTS:In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury.CONCLUSION:It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft.Level of Evidence III, Therapeutic Study.