Objective:Osteosynthesis with intramedullary nailing is considered the method of choice to treat diaphyseal femur fractures in adults. The objective of this retrospective study was to evaluate the bone healing time and incidence of infection in patients with diaphyseal femur fractures treated surgically with retrograde and antegrade intramedullary nailing.Methods:The medical records of 123 patients from two university hospitals dated 2011-2013 were evaluated, with 126 diaphyseal femur fractures having been found. The most frequent treatment was antegrade intramedullary nailing (51%), of which 38% involved reaming (n=25).Results:We found evidence of 92% healed fractures at 12 months postoperatively. Complications included chronic osteomyelitis in one patient and femoral neck fracture in another patient, both after reamed antegrade nailing. Pyoarthritis of the knee associated with osteomyelitis affected two patients after reamed retrograde nailing and one patient after unreamed retrograde nailing.Conclusion:We did not observe a significant difference in bone healing rates with the use of reamed or unreamed antegrade or retrograde nailing. Complications included the presence of infection with an incidence similar to that reported in the literature, and of particular significance, unrelated to the type of approach. Level of evidence III, Retrospective comparative study.
Introdução: Avanços nos protocolos de imunossupressão, diagnóstico precoce e manejo adequado da Rejeição Celular Aguda tornaram viável a realização do Transplante de Intestino Isolado, Multivisceral e Multivisceral Modificado. Objetivo: Analisar os protocolos de imunossupressão dos principais centros de transplante. Método: Revisão de artigos indexados ao PubMed, publicados no período de 2006 a 2012, com foco em receptores adultos. Um total de 211 adultos foi transplantado em sete centros. A imunossupressão foi realizada de três maneiras: Protocolo 1: Indução com Daclizumab e manutenção com Tacrolimus e corticosteróides. Protocolo 2: Indução com Alemtuzumab e manutenção com Tacrolimus. Protocolo 3: Indução com Timoglobulina e Rituximab e Tacrolimus. Resultados: Protocolo 2 teve a menor taxa de rejeição aguda (34%) e os Protocolos 1 e 3 tiveram 54% e 48%, respectivamente. A taxa de sobrevida de um ano foi de 70%, 79%, e 81% nos Protocolos 1,2 e 3, respectivamente. No Protocolo 3, a sobrevida de um ano para transplante de intestino e para transplante multi- visceral separadas foi 86% e 79%, respectivamente. Conclusão: Protocolo 2 utilizou imunossupressores mais potentes, capazes de reduzir a taxa de rejeição celular aguda, no entanto, apresentou menor taxa de sobrevida de um ano, possivelmente devido a um aumento de sepse grave devido à imunossupressão mais forte. O Protocolo 3 apresenta-se aparentemente como a melhor opção, com sobrevidas superiores.
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