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No. of bitstreams: 1 sembenelli_g_me_jabo.pdf: 2565740 bytes, checksum: d9b68e8304088478cada8ab56efa1c00 (MD5) Previous issue date: 2017-05-30 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo do presente estudo foi desenvolver placa de TPLO bloqueada modificada e avaliar a eficácia da estabilização óssea proporcionada pelo implante desenvolvido comparativamente a outros dois métodos convencionais de fixação óssea (placa bloqueada e placa bloqueada associada a pino intramedular). Por meio de estudos biomecânicos, avaliaram-se as construções às forças de torção, flexão craniocaudal, flexão mediolateral e compressão axial. Foram utilizadas sessenta tíbias sintéticas dividas em três grupos. O Grupo 1 (placa TPLO modificada), o Grupo 2 (placa bloqueada) e o Grupo 3 (placa bloqueada associada a pino intramedular) foram qsubdivididos em quatro grupos de cinco tíbias. Os ensaios foram realizados até a falha da montagem (implantes e/ou tíbia) e os resultados obtidos comparados entre os grupos. As variáveis estudadas foram analisadas sob delineamento inteiramente casualizado no esquema fatorial 3 por 4 com 5 repetições para cada combinação do esquema fatorial. Os resultados foram submetidos à análise de variância e as médias comparadas entre si pelo teste de Tukey a 5% de probabilidade. No ensaio de compressão axial houve diferença significativa em relação a variável força máxima em que o Grupo 3 obteve maior média, não havendo diferença significativa entre os Grupos 1 e 2. Todas as montagens falharam devido à flexão da placa na região de falha no corpo de prova. No ensaio de flexão em três pontos craniocaudal houve diferença significativa em relação às três variáveis estudas. Na variável força máxima G2>G3=G1, na variável deflexão G3>G1=G2 e na variável rigidez G3=G2, G2=G1 G3>G1. Todas as montagens falharam devido à quebra do corpo de prova. No ensaio de flexão mediolateral houve diferença significativa em relação a variável rigidez em que G3>G2=G1. Todas as montagens falharam devido à flexão da placa na região de falha no corpo de prova. No ensaio de torção houve diferença significativa em relação às variáveis ângulo no pico de torque e rigidez. Na variável ângulo no pico de torque G2>G1=G3. Na variável rigidez G1=G3>G2. Todas as montagens falharam devido à quebra do corpo de prova distal a placa. Conclui-se a placa de TPLO modificada apresentou semelhança biomecânica com a placa reta convencional na maioria das variáveis estudadas. O grupo, da associação placa e pino, obtive maiores índices de rigidez comparativamente aos outros dois grupos, exceto no teste de torção em que o grupo da placa de TPLO modificada apresentou o mesmo índice de rigidez que o da associação placa e pino. / The aim of this study was to develop modified TPLO locked plate and to evaluate the effectiveness of stabilization provided by the implant developed compared to two other conventional methods of stabilization (locked plate and plate-rod). Through biomechanical studies the constructions were evaluated to craniocaudal and mediolateral bending, axial compression and torsional forces. Sixty synthetic tibias were used divided into three groups. Group 1 (modified TPLO plate), Group 2 (locked plate) and Group 3 (plate-rod) were subdivided into four groups of five tibiae. The tests were perfomed until failure of the construction (implants / tibia) and the results compared between the groups. The variables studied were analyzed under a completely randomized design in the factorial scheme 3 by 4 with 5 replicates for each combination of the factorial scheme. The results were submitted to analysis of variance and the means compared to each other by the Tukey test at 5% probability. In the axial compression test there was a significant difference in relation to the variable maximum force in which Group 3 obtained higher mean, not having significant difference between Groups 1 and 2. All constructions failed due to plate bending in the gap region of the synthetic tibia. In the three-point craniocaudal flexion test there was a significant difference in relation to the three variables studied. In the variable force maximum G2> G3 = G1, in the variable deflection G3> G1 = G2 and in the variable stiffness G3 = G2, G2 = G1 G3> G1. All constructions failed because of the breaking of the synthetic tibia. In the three-point craniocaudal flexion test there was a significant difference in relation to the three variables studied. In the variable force maximum G2> G3 = G1, in the variable deflection G3> G1 = G2 and in the variable stiffness G3 = G2, G2 = G1 G3> G1. All constructions failed because of the breaking of the synthetic tibia. In the mediolateral flexion test there was a significant difference in relation to the stiffness variable in which G3> G2 = G1. All constructions failed due to plate bending in the gap region of the synthetic tibia. In the torsion test there was a significant difference in relation to the variables angle at peak torque and stiffness. In the variable angle at the torque peak G2> G1 = G3. In the stiffness variable G1 = G3> G2. All constructs failed due to the breaking of the synthetic tibia distally to the plate. It is concluded that the modified TPLO plate presented biomechanical similarity with the conventional plate in most of the studied variables. The groups of locking plate an plate-rod constructions obtained higher stiffness indices compared to the other two groups, except for the torsion test in which the modified TPLO plate group had the same stiffness index as the plate and plate-rod. / FAPESP: 2015/14602-8

Abstract The treatment of hip fractures in the elderly has been under debate for decades. There is a lack of standardisation of treatment and rehabilitation and also concerning the measurements and follow-up times in studies on treatment. Two patient series with cervical hip fractures treated with Austin Moore hemiarthroplasty in Finland and hook pin osteosynthesis in Sweden were compared using matched-pair analysis in view of different age groups. Hip fracture treatments in six hospitals in Finland and one in Great Britain were surveyed. The adequacy of a short four-month follow-up was studied by comparing outcomes at four months and one year. Standardised Audit of Hip Fractures in Europe data collection sets were tested and used in three studies. Osteosynthesis resulted in lower one-year mortality but a higher reoperation rate in patients aged 55–75 years and was associated with a lesser need for walking aids, less pain and lower four-month mortality in patients aged 76–80 years. There were some differences in the patient characteristics and the methods of treatment between Great Britain and Finland. In Great Britain, more patients returned to their own homes, but one-year mortality after trochanteric fractures was higher. Hip fracture treatments and outcomes were quite similar between the six Finnish hospitals. There was a slight difference in adjusted postoperative mobility and mortality in two hospitals compared to the others. Six of the ten functional domains and residential status remained unchanged, while walking ability and four functional domains improved between four months and one year. The standardised data set was a practical and reliable way to acquire a great variety of information on hip fracture patients, treatments and outcomes. Hook pin osteosynthesis can be recommended for patients with cervical hip fractures younger than 80 years, whereas older patients can also be safely treated with Austin Moore hemiarthroplasty. The characteristics and outcomes of hip fracture patients were rather similar between Finland and Great Britain and between the different Finnish hospitals irrespective of the variety of methods used in treatment. Standardised Audit for Hip Fractures in Europe is a reliable data collection set and suitable as a basis of hip fracture surveys, audits and registers. Four-month follow-up is justified as the shortest feasible alternative in studies on rehabilitation and residential status after hip fractures.

>Magister Scientiae - MSc / 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.

Tiek kasdieninėje veikloje, tiek profesionaliame sporte patiriamos traumos tiesiogiai įtakoja žmogaus gyvenimo kokybę. Dažniausiai pasitaikantys apatinių galūnių lūžiai – kulkšnies srityje (Jensen, 1998): nuo 107 iki 184 šimtui tūkstančių žmonių per metus (Lin, 2006). Juos dažniausiai patiria 25–35 metų vyrai ir vyresnės nei 50 metų moterys (Staa, 2001). Gydant abiejų kulkšnių kaulų lūžius – atstatomi kaulų lūžgaliai, stiprinami pažeisti raumenys, sausgyslės ir raiščiai, taip pat mokoma taisyklingos eisenos bei laikysenos. Tyrimo metodika. Tyrimas atliktas VšĮ Kauno Raudonojo Kryžiaus klinikinėje ligoninėje 2006–2008 metais. Ištirta 30 asmenų – n=22 moterys (73,3 proc.) ir n=8 vyrų (26,7 proc.), kurių amžiaus vidurkis 47±5 metai, – po abiejų kulkšnių osteosintezės. Pacientai buvo suskirstyti į dvi grupes: tiriamąją ir kontrolinę. Tiriamajai grupei buvo taikyta kineziterapija su kineziterapeuto priežiūra, fizioterapija ir masažas, jiems gulint fizinės medicinos ir reabilitacijos skyriuje (24 dienas), o kontrolinė grupė buvo apmokyta ir atlikinėjo pratimus savarankiškai, namuose. Abiejų grupių tiriamieji buvo testuojami prieš pradedant taikyti kineziterapiją, po 12 dienų, po 24 dienų ir po 8 mėnesių. Tyrimo metu buvo atlikti matavimai: pėdos tiesimas, lenkimas, sukimas į vidų, sukimas į išorę, blauzdos apimtys (sveikos ir operuotos kojos), šlaunies apimtys (sveikos ir operuotos kojos), atliktas testavimas pagal Lysholm skalę, funkcinį pėdos ir kulkšnies testą. Skausmas... [toliau žr. visą tekstą] / Injuries sustained both in daily activity or in professional sports make direct influence on the quality of life of human being. Most often fractures of the lower limbs occur in the area of the ankle (Jensen, 1998): ankle fractures are found from 107 to 184 per one hundred thousand people annually. These fractures are most frequent among men of 25–35 years old and women over 50 years old (Staa, 2001). During the treatment of bimalleolar fractures of the ankle not only injured muscles, tendons and ligaments are fortified, fractures of bones are reconstituted but also the patients are taught how to keep good pace and posture. Methods. The analysis was performed at PI Kaunas Red Cross clinical hospital in 2006–2008. 30 persons were examined after bimalleolar osteosynthesis: n=22 women (73,3 percent.) and n=8 men (26,7 percent.), the average age being 47±5 years old. The patients were divided into two groups: research and control. Physiotherapy under the supervision of physiotherapist was applied to the research group together with massages while they were in the department of physical medicine and rehabilitation (for 24 days) as well. The control group participations were trained and instructed to performe the excercises at home, on their own. Patients of both groups were tested before the physiotherapy was applied, after 12 days, after 24 days and after 8 months. During the analysis the following measurements were taken: plantarflexion, dorsiflexion, inversion, eversion, shin... [to full text]

Orientador: William Dias Belangero / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T12:25:06Z (GMT). No. of bitstreams: 1 Livani_Bruno_D.pdf: 17610036 bytes, checksum: 98624480cd2e00fcca5f2b8979f6df92 (MD5) Previous issue date: 2007 / Resumo: O tratamento das fraturas do terço distal da diáfise do úmero associadas a lesão do nervo radial ainda é assunto de controvérsia. Especialmente nesta região o nervo pode estar comprimido ou encarcerado por fragmentos ósseos. A osteossíntese com redução indireta da fratura e fixação interna, nesses casos, pode resultar em lesão nervosa permanente. O autor descreve uma técnica cirúrgica com a utilização da placa em ponte, introduzida percutaneamente nessas situações específicas. Seis pacientes foram operados evoluindo com a consolidação da fratura e a recuperação neurológica num tempo médio de 03 meses. Nessa casuística a única complicação foi um caso de infecção com fístula na cicatriz distal que resolveu completamente com a retirada do material de implante / Abstract: Fractures of the distal third of the humerus may be complicated by complete lesions of the radial nerve which may be entrapped or compressed by bone fragments. Indirect reduction and internal fixation may result in a permanent nerve lesion. The author describe the treatment of these lesions by insertion of a bridge plate using the minimally-invasive percutaneous technique. Six patients were operated on and showed complete functional recovery. Healing of the fractures occurred at a mean of 2.7 months (2 to 3) and complete neurological recovery by a mean of 2.3 months (1 to 5). In one patient infection occurred wich resolved after removal of the implante / Doutorado / Pesquisa Experimental / Doutor em Cirurgia

Abstract Hip fracture is a trauma with serious consequences, especially in the elderly. Etiological factors should be known better than nowadays to recognize the individuals at high risk. Also, the treatment of displaced femoral neck fractures has been controversial, and the factors leading to a functional outcome are not known well. The true impact of deep infection on the outcome after hip fracture surgery has also been insufficiently examined. The thesis is based on two etiological studies. In the first study, the geometrical parameters of the upper femur and pelvis in postmenopausal women with hip fracture were (n=70) compared to age-adjusted controls (n=40). Measurements were made from position-standardized and calibrated pelvic plain x-rays. The differences between the two different types of hip fracture, femoral neck fractures (n=46) and trochanteric fractures (n=24) were also defined. High femoral neck/shaft angle (NSA), thin femoral cortices, low femoral shaft diameter (FSD) and trochanter width and the pelvic dimensions associate strongly with the hip fracture risk in postmenopausal women. Greater NSA, smallest outer pelvic diameter and acetabular width, narrower FSD and smaller femoral neck/shaft cortex ratio were associated with femoral neck fracture rather than trochanteric fracture in postmenopausal women. In the second study, lifetime factors, some bone metabolism markers and bone mineral density were analyzed from postmenopausal women (n=74; 49 with femoral neck fracture, 25 with trochanteric fracture) and age-adjusted controls (n=40). Impaired functional ability, use of loop diuretics, antidiabetic, antidepressant and neuroleptic drugs, some concurrent diseases, such as stroke, diabetes, malignancy, cardiovascular diseases, low bone mineral density of the upper femur, low serum calcium, low serum 25-hydroxyvitamin D and high serum calcitonin, seem to be related to the risk of hip fracture, while low bone mineral density and low serum calcitonin are related to the trochanteric type of fracture in postmenopausal women. The treatment of displaced femoral fractures included two prospective case-control studies, and the first of these involved a comparison (357 matched pairs) of patients with osteosynthesis (OS) with two pins in Lund and patients with uncemented hemiarthroplasty (HA) in Oulu. The patients treated with OS had 4 months after fracture better ambulatory capacity, used walking aids less often and had less pain than the patients treated with HA. The other comparison (84 matched pairs) was made between OS with three screws and uncemented HA, and it revealed no significant differences between HA and OS in the short-term functional outcome. Both studies revealed a higher re-operation rate in OS patients than uncemented HA patients. The case-control study with 29 matched pairs showed that deep infection after a hip fracture operation impairs the short-term functional outcome and slightly increases mortality, with an attributable mortality rate of 10 %. In conclusion, this thesis suggests that the geometry of the upper femur and pelvis, the aforesaid lifetime factors, the aforesaid metabolism markers and bone mineral density are associated with the etiopathology and type of hip fracture in postmenopausal women. The short-term functional outcome was better in OS patients treated with two pins compared to uncemented HA, but the higher re-operation rate should be considered among the OS patients. Deep infection is a serious complication of hip fracture surgery, which impairs function and increases mortality.

In the field of orthopaedics and traumatology, a whole series of problems appear related to fracture fixation by means of various types of plates. Appropriate application of the plate is the difficult task that a doctor needs to deal with in the operating room. Regarding mechanics, the number of screws and their spacing have a major impact on the healing process. If there are too many screws or lack of them, the fracture does not heal properly. This can lead to implant failure. This work deals with stress-strain analysis of screws and bone tissue with a fracture fixed by LCP. It deals with the influence of different geometrical configurations of the screws on the stress, deformation and strain of the system. For this purpose, the computational modelling was used by means of the finite element method. Two computational models have been created, on which different screw arrangement was analysed. The first computational model represents diaphysis of the femur that is at the beginning of the healing process. For the four load models and eleven geometric configurations and number of the screws, a total of 44 computations were performed. The second computational model represents the distal part of the femur. Femoral geometry model was created based on CT (computed tomography) examination, geometric model of the plate was created by 3D scanning. Deformations and stresses were compared in the three geometric configurations of the screws during the healing process.

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.

The purpose of this study was to compare the stiffness of a Type II external skeletal fixator (ESF) to a 3.5 mm locking compression plate (LCP) in axial compression, mediolateral, and craniocaudal bending in a fracture gap model. The hypothesis was that the Type II ESF would demonstrate comparable stiffness to the LCP. A bone simulant consisting of short fiber reinforced epoxy cylinders and a 40 mm fracture gap was used. The LCP construct consisted of a 12 hole 3.5 mm plate with three 3.5 mm bicortical locking screws per fragment. The Type II ESF construct consisted of 3 proximal full fixation pins (Centerface®) per fragment in the mediolateral plane, and 2 carbon fiber connecting rods. Five constructs of each were tested in non-destructive mediolateral and craniocaudal bending, and axial compression. Stiffness was determined from the slope of the elastic portion of force-displacement curves. A one-way ANOVA and a Tukey-Kramer multiple comparisons test were performed, with significance defined as p < 0.05. In mediolateral bending, the stiffness of the Type II ESF (mean ± standard deviation; 1584.2 N/mm ± 202.8 N/mm) was significantly greater than that of the LCP (110.0 N/mm ± 13.4 N/mm). In axial compression, the stiffness of the Type II ESF (679.1 N/mm ± 20.1 N/mm) was significantly greater than that of the LCP (221.2 N/mm ± 19.1 N/mm). There was no significant difference between the constructs in craniocaudal bending. This information can aid in decision-making for fracture fixation, although ideal stiffness for healing remains unknown. / Master of Science / Optimum fracture stabilization requires a balance between providing a stable mechanical environment and preserving the blood supply to healing tissues. When the complexity of a fracture precludes reconstruction of the bony column, the fixation method chosen for repair must counteract the forces of weight bearing, including compression and bending. Knowledge of the relative construct stiffness is important for a clinician to determine the ability of a fixation technique to withstand all forces acting on a fracture, while supporting bone healing. The purpose of this study was to compare the stiffness of a Type II external skeletal fixator (ESF) and a locking compression plate (LCP) when non-destructive physiologic loads are applied in axial compression, mediolateral bending, and craniocaudal bending. Five constructs of each were tested in non-destructive mediolateral and craniocaudal bending, and axial compression. Stiffness was determined from the slope of the elastic portion of force-displacement curves. There was a significant difference between the stiffnesses of the Type II ESF and the LCP in all modes of loading except craniocaudal bending. The Type II ESF was significantly stiffer in mediolateral bending than the LCP, and the Type II ESF was significantly stiffer in axial compression compared to the LCP. There was no statistically significant difference in stiffness in craniocaudal bending. This information will aid a clinician in selecting an appropriate fixation method for a non-reconstructable fracture, but further studies are required to assess the importance of increased stiffness in a clinical setting.

Ziel der Studie war die Evaluation des biomechanischen Effekts einer medialen Unterstützung bei proximalen Humerusfrakturen. An 32 unfixierten humanen Humeri, aufgeteilt in vier Plattenosteosynthesegruppen, wurde der Einfluss von inferomedialen Schrauben, dynamischen Verriegelungsschrauben und medialer Knochenspanaugmentation vom Femurkopf, im Vergleich zu einer Gruppe ohne mediale Unterstützung, getestet. Die Steifigkeit der Proben wurde bei Torsion, axialer Ausrichtung, 20° Abduktion und 20° Adduktion geprüft. Anschließend wurde über 5000 Zyklen und bis zum Versagen belastet. Verglichen wurden Steifigkeiten, interfragmentäre Bewegungen, Maximalbelastungen und Versagensursachen. Ausschließlich für die Gruppe mit Knochenspanaugmentation konnten signifikante Unterschiede, im Vergleich zu den anderen Gruppen, nachgewiesen werden. Eine Knochenspanaugmentation, mittels kortikospongiösem Span vom Hüpftkopf, bot biomechanisch eine signifikante Unterstützung der medialen Säule. Klinisch könnte das Auftreten von sekundären Repositionsverlusten möglicherweise reduziert werden. Für die Verwendung von inferomedialen oder dynamischen Schrauben ließen sich bei 2-Segmentfrakturen im biomechanischen Modell keine signifikanten Vorteile nachweisen.