Publications by authors named "Jorge Dos Santos Silva"

17 Publications

  • Page 1 of 1

THE MISSING LINK IN THE HISTORY OF THE LOCKED INTRAMEDULLARY NAIL.

Acta Ortop Bras 2021 Jul-Aug;29(4):228-231

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Grupo de Trauma, São Paulo, SP, Brazil.

Femoral Shaft intramedullary nails were first described by the Aztecs in 16th century, but the modern use of intramedullary nails as the gold standard treatment for femoral shaft fractures began with Gerald Kuntcher in 1939. From the first Kuntcher's study in 1939, to the creation of interlocking nail, a long and some minor developments were described around the world. However, a major development is missing: the first nail to have a rotational and vertical stability locking system was described by Flavio Godoy Moreira, but was never published on an indexed journal for the correct historical reference.
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http://dx.doi.org/10.1590/1413-785220212904246573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443011PMC
December 2020

Bioactive glass S53P4 to fill-up large cavitary bone defect after acute and chronic osteomyelitis treated with antibiotic-loaded cement beads: A prospective case series with a minimum 2-year follow-up.

Injury 2021 Jul 1;52 Suppl 3:S23-S28. Epub 2021 Jun 1.

Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.

Introduction: Bioactive glass S53P4 (BAG-S53P4) has been used in the treatment of osteomyelitis with excellent results. The aim of this study was to evaluate the clinical and radiographic results of patients treated with use of antibiotic-loaded cement beads, followed by bone defects filling using bioglass.

Methods: We treated a prospective series of patients presenting with acute or chronic osteomyelitis of a long bone of the upper or lower limb. The first-stage procedure involved debridement and filling of cavitary defects with antibiotic-loaded polymethylmethacrylate (PMMA) beads. When signs of infection subsided, the defects were filled with BAG-S53P4. The main outcomes assessed were the reinfection rate, need for reoperation, radiographic and functional evaluations (DASH and Lysholm scores).

Results: Ten patients were included, aged between 4 and 66 years (mean 25.4 years). The source of infection was hematogenic in five cases and post-traumatic in the other five. Hematogenic infections required two debridements before filling with bioglass, whereas post-traumatic cases required only one. The time between the first debridement and the application of bioglass varied from 1 to 63 weeks (average of 17 weeks). All patients showed a favorable evolution after bioglass procedure, with no need for reoperation or relevant wound problems. The radiographic evaluation showed partial incorporation of the material and adequate bone formation, and functional scores were satisfactory in all cases.

Conclusion: The treatment of osteomyelitis with surgical debridement and PMMA beads, followed by filling of bone defect with BAG-S53P4, was effective in all patients evaluated, with adequate infectious control and bone regeneration. No cases required reoperation after bioglass implantation. Patients with hematogenous osteomyelitis required a greater number of debridements before filling with bioglass.
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http://dx.doi.org/10.1016/j.injury.2021.05.030DOI Listing
July 2021

Factors associated with one year mortality in ill patients with proximal femoral fractures treated non operatively.

Injury 2021 Jul 1;52 Suppl 3:S60-S64. Epub 2021 Jun 1.

Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil. Electronic address:

Introduction: Non-operative treatment is an exceptional indication for the treatment of proximal femur fracture. The aim of the study was to analyze the mortality rate in one year and associated factors in severely ill patients submitted to non-operative treatment.

Methods: It was included 28 patients treated from August 2014 to September 2019. Eighteen (64.3%) patients were female and 10 (35.7%) were male. The mean age was 78.7 ± 11.9 years old. The main outcome evaluated was the mortality rate in one year. It was also evaluated the correlation with gender, age, personal habits, number of comorbidities and Charlson Comorbidity Index (CCI).

Results: The functional result was assessed with WOMAC score via telephone call. The mortality rate in one year was 42.8% without statistical positive correlation with any of the studied parameters. Patients with three or more comorbidities didn't have a higher mortality rate comparing to survived patients (83.3% vs 81.3%). The CCI also didn't show any correlation with high mortality (6.9 vs 7.1). The functional result of the survived patients was poor (78.2 points WOMAC).

Conclusion: The conclusion is that the mortality rate in one year of ill patients with hip fractures treated non-operatively is 42.8% without correlation with age, gender of number of comorbidities, and the functional result of the survived patients is poor.
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http://dx.doi.org/10.1016/j.injury.2021.04.059DOI Listing
July 2021

Intramedullary Steinmann pin nailing of the ulna: an option for the damage control orthopedics treatment of forearm fractures in open injuries in polytraumatized patients - A description of the technique and presentation of a case series.

Injury 2021 Jul 1;52 Suppl 3:S33-S37. Epub 2021 Jun 1.

Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil. Electronic address:

Introduction: Forearm shaft fracture is common in young adult patients and associated with soft tissue and organ injuries. In open fractures in polytrauma patients, damage control orthopaedics (DCO) is well indicated. The aim of this study is to describe intramedullary Steinmann pin fixation of the ulna as a DCO procedure for the forearm and present a case series.

Description Of The Technique: A 3.0 mm Steinmann pin is inserted retrograde in the ulna proximal fragment through the fracture site using the open wound as the approach. With direct visualization of the reduction, the pin is advanced into the distal fragment. The reduction of the longitudinal axis and shortening is thus achieved.

Patients And Methods: This method was used for all open fractures of forearm both-bone fractures in polytrauma patients undergoing DCO from 2014 to 2019. The alignment and length of the ulna were evaluated radiographically after pin fixation and before and after definitive fixation. Differences in the need for secondary procedures and infection rate between DCO and definitive fixation were also evaluated.

Results: There were 30 males (85.7%) with an average age of 32.9 ± 12.0 years and a mean ISS (Injury Severity Score) of 29.4 (range, 18.0-41.0). The most common associated injuries were thoracic trauma (62.8%) and head trauma (45.7%). In the radius and ulna, 51.4% and 60.0% of fractures, respectively, were multifragmentary (types B and C). Gustilo type IIIA represented 77.1% of the injuries. Pin fixation achieved good alignment and length in all cases. The mean time between DCO and definitive fixation was 12.0 days, and no secondary procedure was needed, nor any case developed either superficial or deep infection. The conversion from DCO to definitive fixation was considered easy in all cases.

Conclusion: Intramedullary Steinmann pin fixation of the ulna is a viable option for DCO for forearm both-bone fractures in open fractures in polytrauma patients.
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http://dx.doi.org/10.1016/j.injury.2021.05.033DOI Listing
July 2021

COMPARISON OF BICONDYLAR TIBIAL PLATEAU FRACTURES WITH DOUBLE OR SINGLE LATERAL LOCKED PLATE.

Acta Ortop Bras 2020 Jul-Aug;28(4):182-185

Universidade de São Paulo, Medical School, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil.

Objective: To compare postoperative radiographic outcomes of Schatzker type V and VI tibial plateau fractures treated with double-plate or single lateral locked plate.

Methods: Sixty-three patients operated from December 2011 to February 2016 were selected, 47 from the double-plate group and 16 from the single lateral locked plate group. Minimum follow-up for all patients was 6 months. Fracture reduction evaluation was based on radiographic parameters: joint reduction, sagittal alignment, coronal alignment, and condylar width.

Results: Radiographic evaluation showed no statistical difference in the immediate or late postoperative periods.

Conclusion: Despite the reduced sample, this study is aligned with current results published in the medical literature. The severity of Schatzker type V and VI tibial plateau fractures can be minimized by the correct indication for the implant regarding fracture morphology.
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http://dx.doi.org/10.1590/1413-785220202804233122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405846PMC
August 2020

EVALUATION OF PREDICTIVE FACTORS OF IN HOSPITAL MORTALITY IN PATIENTS WITH PROXIMAL FEMORAL FRACTURE.

Acta Ortop Bras 2020 Jan-Feb;28(1):40-43

Universidade de São Paulo, Medical School, Institute of Orthopedics and Traumatology, Geriatrics Group, São Paulo, SP, Brazil.

Objective: To investigate the existence of a causal association between orthopedic treatment and the occurrence of in hospital death.

Methods: 338 patients with proximal femoral fracture were evaluated, of whom 27 faced in hospital death. Patients who faced in hospital death (case group) were compared to patients who did not (control group) regarding exposure to risk factors prior to injury and factors related to orthopedic treatment.

Results: The factors related to higher in hospital mortality rate were: male sex (case group: 52%, control: 26%; p = 0.005), lower Parker's score (case group: 5.0 points, control: 6.2; p = 0.048), delirium on admission (case group: 26%, control: 10%; p = 0.011); delirium developed during hospitalization (case group: 77%, control: 35%; p <0.001), and time until surgery (13.3 days, 9.1; p = 0.049).

Conclusion: The in hospital mortality rate of patients with proximal femoral fracture was 8%, and the main associated risk factors were male sex, reduced Parker's score, delirium diagnosed on hospital admission or developed during hospitalization, and time until surgery.
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http://dx.doi.org/10.1590/1413-785220202801215801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006536PMC
February 2020

CLINICAL EVALUATION OF PATIENTS WITH VANCOMYCIN SPACER RETAINED FOR MORE THAN 12 MONTHS.

Acta Ortop Bras 2019 Jan-Feb;27(1):55-58

Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, São Paulo, São Paulo, Brazil.

Objective: There is no consensus in the literature regarding the time taken to remove antibiotic spacers in the treatment of bone infections. The aim of this study is to evaluate the clinical results of patients with prolonged retention of the same.

Methods: Patients selected were diagnosed with post-osteosynthesis infection and/or osteomyelitis and were submitted to treatment using an orthopedic cement spacer (polymethylmethacrylate) with vancomycin, retaining it for a period of more than 12 months. They were clinically evaluated to determine the presence of local or systemic infectious signs via hemogram, investigations of inflammatory markers, liver, renal and, with radiographic control.

Results: Eighteen patients were included in the study. The mean retention time of the spacer was 30.4 months (15 - 61 months). No patient had clinical signs of local or systemic infectious relapse at the time of evaluation. Seven patients (39%) presented non-disabling pain in the operated limb. Seventeen patients (94%) presented a reduction in C-reactive protein values compared to the preoperative period. Radiographically, no migration, no spacer failure, or bone sequestration occurred.

Conclusion: In this retrospective case series, cement spacer retention with vancomycin for more than 12 months was associated with good clinical results, without relapse of the infectious condition. .
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http://dx.doi.org/10.1590/1413-785220192701213649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362697PMC
February 2019

VALIDITY AND RELIABILITY OF THE MANCHESTER SCALE USED IN THE ORTHOPEDIC EMERGENCY DEPARTMENT.

Acta Ortop Bras 2019 Jan-Feb;27(1):50-54

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (IOT-HCFMUSP), Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil.

Objectives: To describe the clinical utility of the Manchester triage scale adapted for orthopedic emergency departments and to evaluate its validity in identifying patients with the need for hospital care and its reliability when reproduced by different professionals.

Methods: Five triage flowcharts were developed based on the Manchester scale for the following orthopedic disorders: traumatic injuries, joint pain, vertebral pain, postoperative disorders, and musculoskeletal infections. A series of patients triaged by two orthopedists was analyzed to assess the concordance between the evaluators (reliability) and the validity of the Manchester scale as predictive of severity.

Results: The reliability analysis included 231 patients, with an inter-observer agreement of 84% (Kappa = 0.77, p <0.001). The validity analysis included 138 patients. The risk category had a strong association with the need for hospital care in patients with trauma (OR = 6.57, p = 0.001) and was not significant for non-traumatic disorders (OR = 2.42; p = 0.208). The overall sensitivity and specificity were 64% and 76%, respectively.

Conclusion: The evaluated system presented high reliability. Its validity was adequate, with good sensitivity for identifying patients requiring hospital care among those with traumatic lesions. However, the sensitivity was low for patients with non-traumatic lesions.
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http://dx.doi.org/10.1590/1413-785220192701191577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362691PMC
February 2019

Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil.

Braz J Infect Dis 2016 May-Jun;20(3):272-5. Epub 2016 Apr 18.

Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.

Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions of Brazil and Latin America.
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http://dx.doi.org/10.1016/j.bjid.2016.03.005DOI Listing
March 2017

COMPARATIVE STUDY BETWEEN OSTEOSYNTHESIS IN CONVENTIONAL AND BIOABSORBABLE IMPLANTS IN ANKLE FRACTURES.

Acta Ortop Bras 2015 Sep-Oct;23(5):263-7

Universidade de São Paulo, Faculdade de Medicina, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil.

Objective: To compare the functional results of ankle fractures treated with metallic and absorbable plates. Twenty patients were randomized into two groups (metallic and absorbable implant groups) and followed prospectively. In the immediate postoperative period, patients were immobilized with plaster casts for one week, which was replaced by a removable cast for another four weeks. Partial weight-bearing was allowed after three weeks, and full weight-bearing after six weeks. Functional recovery was similar in both groups. At six months, three patients in the metallic group complained of local pain, and had their implants removed. One patient in the absorbable group exhibited early dehiscence of the suture and underwent debridement and suturing with good evolution. The American Orthopaedic Foot and Ankle Society (AOFAS) score was similar between the two groups after six and nine months of follow-up. The absorbable implants showed clinical and functional results that were similar to those of metallic implants. Level of Evidence II, Prospective Comparative Study.
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http://dx.doi.org/10.1590/1413-785220152305121124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775479PMC
March 2016

Advances in treating exposed fractures.

Rev Bras Ortop 2015 Mar-Apr;50(2):125-30. Epub 2015 Feb 26.

Department of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.

The management of exposed fractures has been discussed since ancient times and remains of great interest to present-day orthopedics and traumatology. These injuries are still a challenge. Infection and nonunion are feared complications. Aspects of the diagnosis, classification and initial management are discussed here. Early administration of antibiotics, surgical cleaning and meticulous debridement are essential. The systemic conditions of patients with multiple trauma and the local conditions of the limb affected need to be taken into consideration. Early skeletal stabilization is necessary. Definitive fixation should be considered when possible and provisional fixation methods should be used when necessary. Early closure should be the aim, and flaps can be used for this purpose.
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http://dx.doi.org/10.1016/j.rboe.2015.02.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519576PMC
August 2015

Epidemiological study on talus fractures.

Rev Bras Ortop 2014 Jul-Aug;49(4):334-9. Epub 2014 Aug 5.

Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil.

Objective: to analyze the characteristics of patients with talus fractures and the injuries that they present.

Methods: retrospective analysis on patients hospitalized in the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine of the University of São Paulo, between 2006 and 2011, with talus fractures. Patient profile parameters, risk factors, fracture characteristics, treatment data and acute complications were analyzed.

Results: analysis on 23 cases showed that men were more affected than women, with a ratio of 4.8:1. The most frequent trauma mechanism was traffic accidents, followed by falls from a height. The most frequent type of fracture was at the neck of the talus, with 17 cases. Among the 23 cases, seven had peritalar dislocation at the time of presentation, four had exposed fractures and 11 presented other associated fractures. The mean length of time between the trauma and the definitive treatment was six days, while the mean length of hospital stay was 11 days. Three patients presented acute postoperative complications.

Conclusion: talus fractures occurred most commonly in the region of the talar neck and most frequently in young males who suffered high-energy trauma. In almost half of the cases, there were other associated fractures. The length of hospital stay was 11 days.
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http://dx.doi.org/10.1016/j.rboe.2013.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511570PMC
August 2015

Influence of time to surgery on the incidence of complications in femoral neck fracture treated with cannulated screws.

Injury 2014 Nov;45 Suppl 5:S36-9

Department of Orthopaedics and Traumatology, University of São Paulo, Brazil; Rua Ovidio Pires de Campos, São Paulo - SP, Brazil.

Background: Osteosynthesis of femoral neck fractures is particularly indicated in patients aged under 60 years. A prolonged interval between the fracture and surgical fixation has been associated with avascular necrosis (AVN) of the femoral head. The primary objective of this study was to evaluate the association between the time to surgery and the development of complications in patients with femoral neck fractures.

Methods: Patients with displaced fractures of the femoral neck (Garden III or IV) who underwent fixation with three cannulated screws in the inverted triangle configuration from January 2009 to December 2010 were evaluated retrospectively for the development of orthopaedic complications. Patients were divided into two groups according to the time to surgery (within 7 days or more than 7 days). Complication rates were compared between the two groups. Regression analyses were performed to assess the risk factors for complications.

Results: Thirty-one patients were included in the study; the duration of follow-up ranged from 24 to 50 months. The time from fracture to surgery ranged from 3 to 18 days. Fifteen patients underwent surgery within 7 days, and 16 patients underwent surgery after 7 days. There were four cases of femoral head necrosis. One patient had an associated infection; one patient experienced non-union, and another demonstrated osteosynthesis failure. There were no statistically significant differences in the overall rate of complications between the groups (p = 0.999). None of the preoperative parameters or fracture characteristics were predictive factors for complications. The only factor associated with the development of complications was inadequate fracture reduction in the anteroposterior (AP) view (odds ratio [OR] = 35.50, 95% confidence interval [CI] = 2.56 to 548.36, p = 0.008).

Conclusions: The interval between the occurrence of the injury and surgical fixation is not associated with the development of complications in fractures of the femoral neck. Inadequate fracture reduction in the AP view is a predictive factor for complications in these fractures.
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http://dx.doi.org/10.1016/S0020-1383(14)70019-1DOI Listing
November 2014

Prevalence of acute diseases in the elderly assisted in emergency department of orthopedics.

Acta Ortop Bras 2014 ;22(2):99-101

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Objective: To make an analysis of the care of elderly in an Emergency Department of Orthopedics with the primary objective to know the percentage of elderly treated, their conditions of origin and level of accidental conditions, and examine possible comorbidities, evolution and mortality rate.

Methods: Retrospective observational epidemiological study based on survey records of a tertiary hospital during one year (January to December 2006).

Results: In the year 2006 (January to December) 12,916 calls to patients older than 60 were performed.

Conclusion: Massive attendance of the elderly population was observed, however, the vast majority related to chronic problems that do not require urgent attention. Patients requiring urgent attention suffer from trauma related to falls and are between the seventh and ninth decades of life, mostly female and requiring hospitalization for longer periods. Level of Evidence VI, Cases Series.
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http://dx.doi.org/10.1590/1413-78522014220200854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031255PMC
May 2014

Outcomes evaluation of locking plate osteosynthesis in displaced fractures of the proximal humerus.

Rev Bras Ortop 2013 Nov-Dec;48(6):491-499. Epub 2013 Dec 25.

Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Objective: To evaluate functional outcomes, radiographic findings and complications of proximal humeral fractures treated with locking plates and to determine prognostic factors for successful clinical outcomes.

Methods: Forty patients undergoing internal fixation of fractures of the proximal humerus with the Philos plate were included in the study. The surgeries were performed between 2004 and 2011 and the patients underwent radiographic and clinical evaluation, by Constant-Murley and Dash score. Outcomes were analyzed by use of multivariate regression with several different variables.

Results: Patients were on average of 61.8 ± 16.28 years, and most were female (70%). The Constant-Murley score was 72.03 ± 14.01 and Dash score was 24.96 ± 19.99. The postoperative radiographs showed a head-shaft angle of 135.43° ± 11.82. Regression analysis showed that the patient's age and the Hertel classification influenced the Constant-Murley scale ( = 0.0049 and 0.012, respectively). Other prognostic criteria such as Neer and AO classification, head-shaft angle, the presence of metaphyseal comminution and extension of the humeral metaphyseal fragment showed no effect on prognosis. Complications occurred in four patients (10%).

Conclusion: The fixation with the Philos plate provided good clinical and radiographic results in fractures of the proximal humerus, with a low complication rate. Patient's age and Hertel classification were defined as prognostic factors that led to worse functional outcomes.
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http://dx.doi.org/10.1016/j.rboe.2013.12.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565971PMC
December 2013

ANATOMICAL STUDY ON THE LATERAL SUPRAPATELLAR ACCESS ROUTE FOR LOCKED INTRAMEDULLARY NAILS IN TIBIAL FRACTURES.

Rev Bras Ortop 2012 Mar-Apr;47(2):169-72. Epub 2015 Dec 6.

Head of the Trauma Service, Henry Ford Hospital, Detroit, USA.

Objective: Intramedullary nails are the gold standard for treating tibial shaft fractures. Knee pain is a frequent complication after the procedure. Alternative routes such as the suprapatellar approach for nail insertion are seen as an option for avoiding late postoperative knee pain. The question is whether this approach might give rise to any injury to intra-articular structures of the knee.

Methods: This study analyzed the suprapatellar approach and the risk to adjacent structures by reproducing it in 10 knees of five cadavers.

Results: This approach was seen to make it easy to locate the entry point, with lesions only occurring in the Hoffa fat. In three of our cases, there were lesions of the chondral surface, which is an obstacle that is difficult to overcome.

Conclusion: There is a need to develop specific material to minimize injury to intra-articular structures when using this route.
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http://dx.doi.org/10.1016/S2255-4971(15)30082-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4799382PMC
April 2016

Comparative multicenter study of treatment of multi-fragmented tibial diaphyseal fractures with nonreamed interlocking nails and with bridging plates.

Clinics (Sao Paulo) 2006 Aug;61(4):333-8

Department of Orthopedics and Traumatology, Clinics Hospital, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil.

Objective: A prospective, randomized study to compare patients with closed, multi-fragmented tibial diaphyseal fractures treated using one of two fixation methods undertaken during minimally invasive surgery: nonreamed interlocking intramedullary nails or bridging plates.

Materials And Methods: Forty-five patients were studied; 22 patients were treated with bridging plates, 23 with interlocking nails without reaming. All fractures were Type B and C (according to the AO classification).

Results: Clinical and radiographic healing occurred in all cases. No cases of infection occurred. The healing time for patients who received nails was longer (4.32 weeks on average) than the healing time for those who received plates (P = 0.026). No significant differences were observed between the two methods regarding ankle mobility for patients in the two groups.

Conclusions: The healing time was shorter with the bridging plate technique, although no significant functional differences were found.
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http://dx.doi.org/10.1590/s1807-59322006000400010DOI Listing
August 2006
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