Use of the Kalnberz external fixator on comminuted open fractures of the upper tibia caused by war injuries

Gunshot wounds of the tibia with considerable overlying skin loss frequently need flap cover; external fixation possibly bone grafting. Treatment of such injuries requires time. Rigid fixation of bone can be achieved by the use of an external fixator. If fractures are located in the upper third of the tibia only a few types of the external fixator will not compromise joint function. One such fixator is the Kalnberz apparatus. The Kalnberz fixator is a simplified version of the Ilizarov fixator. Its use involves a cruciform introduction of two pins in the plane. External fixation was first suggested by R Wittimoser (1949); but it was C A Ilizarov who began to develop the method in 1954

The use of cutaneous turnover flaps to replace skin loss in the leg

Soft tissue loss is a frequent accompaniment to open fractures of the tibia and chronic osteomyelitis associated with pseudarthrosis. In Mozambique most of these problems follow war injuries. There are many methods of closing these soft tissue defects; but the best way is the use of a flap. This paper describes the use of a one stage de-epithelialised cutaneous turnover flap in three patients. It is applicable to many circumstances and is quick and easy to perform

Revascularizacao dos membros inferiores por ponte femoro-tibial com veia safena autologa. Tecnica cirurgica e resultados a longo prazo. / Revascularization of lower extremities by femorotibial bypass with autologous saphenous vein. Surgical technic and long-term results

De 16 pacientes portadores de isquemia severa da extremidade inferior, devido a oclusao da arteria poplitea e arterias distais, com risco iminente de uma amputacao, 15 (94%) receberam pontes femoro-tibiais de veia safena autologa, na tentativa de salvar suas extremidades e o periodo de observacao se estende de 17 a 66 meses. Os autores descrevem a tecnica cirurgica e estudam os resultados a longo prazo. Das 15 pontes efetuadas, 11 (73%) permaneceram patentes por mais de 2 meses.Estudaram 14 pacientes quanto a patencia a longo prazo das pontes: tiveram 8 (57%) ocluidas (4 pacientes com oclusoes precoces que necessitaram amputacao e 4 pacientes com oclusoes tardias que tiveram suas extremidades preservadas) e 6(43%) pacientes com pontes patentes a longo prazo por periodos de 36 a 66 meses e que estao presentemente vivos e com as pontes patentes e as extremidades preservadas ou que faleceram com as pontes pervias e as extremidades preservadas. Dez pacientes (62,5% do total de 16) tiveram suas extremidades preservadas e sao os 4 pacientes com oclusoes tardias e os 6 pacientes com as pontes patentes a longo prazo