Raquis/Spine: Tras la compresion vertebral el resultado no depende de la ortesis

Comparative Study of the Treatment Outcomes of Osteoporotic Compression Fractures without Neurologic Injury Using a Rigid Brace, a Soft Brace, and No Brace

A Prospective Randomized Controlled Non-Inferiority Trial

Ho-Joong Kim, MD; Je-Min Yi, MD; Hyeon-Guk Cho, MD; Bong-Soon Chang, MD; Choon-Ki Lee, MD; Jee Hyoung Kim, MD; Jin S. Yeom, MD

J Bone Joint Surg Am, 2014 Dec 03; 96 (23): 1959 -1966

Abstract

Background:
The efficacy of brace application for the treatment of osteoporotic compression fractures remains unclear. The purpose of this study was to compare the treatment outcomes in patients with osteoporotic compression fractures with regard to whether the patients had no braces, rigid braces, or soft braces.

Methods:
We randomly assigned sixty patients with acute one-level osteoporotic compression fractures within three days of injury to the no-brace, soft-brace, and rigid-brace groups through 1:1:1 allocation. The primary outcome was the baseline adjusted Oswestry Disability Index score at twelve weeks after compression fracture. The non-inferior margin of the Oswestry Disability Index was set at an average of 10 points.

Results:
The baseline adjusted Oswestry Disability Index score at twelve weeks after compression fracture in the no-brace group was not inferior to that in the soft-brace or rigid-brace groups. The mean adjusted Oswestry Disability Index score was 35.95 points (95% confidence interval, 25.42 to 46.47 points) in the no-brace group and 37.83 points (95% confidence interval, 26.77 to 48.90 points) in the soft-brace group, with a difference of −1.88 points (95% confidence interval, −7.02 to 9.38 points) between the groups. Similarly, the mean adjusted Oswestry Disability Index score was 35.95 points (95% confidence interval, 25.42 to 46.47 points) in the no-brace group and 33.54 points (95% confidence interval, 23.79 to 43.29 points) in the rigid-brace group, with a difference of 2.41 points (95% confidence interval, −7.86 to 9.27 points) between the groups. During the follow-up assessment period, there was no significant difference among the groups for the overall Oswestry Disability Index scores (p = 0.260), visual analog scale for pain scores for back pain (p = 0.292), and anterior body compression ratios (p = 0.237). However, the Oswestry Disability Index scores and the visual analog scale scores for back pain significantly improved with time after the fractures (p < 0.001), and the body compression ratios significantly decreased with time in all three groups (p < 0.001).

Conclusions:
The Oswestry Disability Index scores for the treatment of compression fractures without a brace were not inferior to those with soft or rigid braces. Moreover, the improvement in back pain and progression of anterior body compression were similar among the three groups.

Level of Evidence: Therapeutic Level I

Trauma: menos "sensibilidad" quirúrgica en las fracturas de húmero

Nonoperative treatment of humeral shaft fractures revisited.

Ali E, Griffiths D, Obi N, Tytherleigh-Strong G, Van Rensburg L

J Shoulder Elbow Surg 2014 Jul 31.

PURPOSE

The purpose of this study was to examine the union rate of humeral shaft fractures treated nonoperatively and to establish whether a particular fracture type is more likely to go on to nonunion.

METHODS

Radiographs and patient records of 207 humeral shaft fractures occurring during 5 years were retrospectively reviewed. All patients were initially managed nonoperatively and placed in a U-slab on diagnosis in the emergency department; this was converted to a functional humeral brace at 7 to 10 days after injury. Fracture location, morphology and comminution were assessed radiologically. Union was defined as the absence of pain and movement at the fracture site in the presence of radiographic callus formation. Nonunion was defined as no evidence of bone union by 1 year after injury or fractures requiring delayed fixation, defined as operative fixation undertaken more than 6 weeks after injury.

RESULTS

The study included 138 humeral shaft fracture patients; 18 patients (11%) were lost to follow-up, and 24 went on to nonunion, giving an overall union rate of 83%. Of the 24 nonunions, 15 underwent delayed operative fixation at an average of 8.3 months after injury. The union rate for proximal-third fractures was 76% compared with 88% for middle-third fractures and 85% for distal-third fractures. Comminuted fractures (defined as 3+ parts) had a 89% union rate regardless of position.

CONCLUSION

A lower threshold for surgical intervention may be considered in proximal-third, two-part spiral-oblique humeral shaft fractures. Brace therapy can be the optimal treatment regimen, but it is not the only option.

Rodilla/Knee/Knie/Genou: Una buena rodillera para la artrosis

Strength and Functional improvement using Pneumatic Brace with Extension Assist for End-Stage Knee Osteoarthritis: A Prospective, Randomized trial
Jeffrey J. Cherian, Anil Bhave, Bhaveen H. Kapadia, Roland Starr, Mark J. McElroy, Michael A.
The Journal of Arthroplasty
Published Online: November 28, 2014
DOI: http://dx.doi.org/10.1016/j.arth.2014.11.036
Publication stage: In Press Accepted Manuscript

Abstract

Pneumatic unloader bracing with extension assists have been proposed as a non-operative modality that may delay the need for knee surgery by reducing pain and improving function.

This prospective, randomized, single blinded trial evaluated 52 patients who had knee osteoarthritis for changes in: (1) muscle strength; (2) objective functional improvements; (3); subjective functional improvements; (4) pain; (5) quality of life; and (6) conversion to total knee arthroplasty (TKA) compared to standard of care.

Patient outcomes were evaluated at a minimum 3 months. Braced patient’s demonstrated significant improvements in muscle strength, several functional tests, and patient reported outcomes when compared to the matched cohort.

These results are encouraging and suggest that this device may represent a promising alternative to standard treatment methods for knee osteoarthritis.