Abordaje combinado Kocher-Langenbeck y Stoppa en el tratamiento de fracturas complejas de acetábulo / Combined Kocher-Langenbeck and Stoppa approach in the treatment of complex acetabulum fractures

Resumen: Introducción: Las fracturas de acetábulo complejas son un desafío para los cirujanos ortopedistas. Se realizó una evaluación de la reducción radiográfica y resultado funcional de los pacientes con fractura compleja de acetábulo sometidos a abordaje combinado Kocher-Langenbeck y Stoppa. Material y métodos: Diseño transversal, descriptivo, ambispectivo. Se incluyeron pacientes con fractura compleja de acetábulo que se sometieron a abordaje combinado Kocher-Langenbeck y Stoppa entre 2016 y 2020. Se revisaron los expedientes clínicos y se evaluó la calidad de la reducción radiográfica según criterios de Matta. Además, se realizó evaluación funcional con la escala de Merle d'Aubigné y Postel pasados por lo menos 12 meses de la lesión. Resultados: De los 31 pacientes, el tiempo promedio entre la fecha de fractura y la intervención quirúrgica fue de 13.7 días (de tres a 38 días). En la evaluación radiográfica según criterios de Matta, 21 pacientes tuvieron resultados radiográficos anatómicos (67.7%), siete casi anatómicos (22.5%) y tres imperfectos (9.6%). Los resultados funcionales según la escala Merle d'Aubigné y Postel dieron como resultado ocho pacientes (25.8%) con resultados excelentes, 16 (51.6%) con resultado bueno, con resultado moderado cinco (22.5%) y con resultado malo dos (16.1%). Hubo correlación estadística entre la edad del paciente con el resultado funcional (p = 0.029), también entre el índice de masa corporal y pérdida sanguínea (p = 0.027). Conclusión: Los abordajes combinados Kocher-Langenbeck y Stoppa son una alternativa en estas lesiones, en su mayoría con resultados radiográficos anatómicos y casi anatómicos, según la escala radiográfica de Matta, y con excelentes y buenos resultados funcionales, según la escala de Merle d'Aubigné y Postel.

Abstract: Introduction: Complex acetabulum fractures are a challenge for orthopedic surgeons. An evaluation of the radiographic reduction and functional result of the patients with complex fracture of the acetabulum who underwent the combined Kocher-Langenbeck and Stoppa approach was carried out. Material and methods: Cross-sectional, descriptive, ambispective design. Patients with complex acetabulum fracture who underwent the combined Kocher-Langenbeck approach plus Stoppa between 2016 and 2020 were included. The clinical records were reviewed, and the quality of the radiographic reduction was evaluated according to Matta criteria. In addition, a functional evaluation was performed with the Merle d'Aubigne and Postel scale at least 12 months after the injury. Results: Of the 31 patients, the average time between the date of fractures and the surgical intervention was 13.7 days (3-38 days). In the radiographic evaluation according to Matta criteria, 21 anatomical patients (67.7%), 7 almost anatomical (22.5%), 3 imperfect (9.6%). Functional results according to the Merle d'Aubigne and Postel scale resulted in 8 (25.8%) with excellent results, 16 (51.6%) with good results, 5 (22.5%) moderate and 2 (16.1%) poor patients. There was a statistical correlation between the age of the patient and the functional result (p = 0.029), also between the body mass index and blood loss (p = 0.027). Conclusion: The combined Kocher-Langenbeck plus Stoppa approaches are a valid alternative in these lesions, mostly with anatomical and almost anatomical radiographic results according to the Matta radiographic scale, and with excellent and good functional results according to the Merle d'Aubigne and Postel scale.

Three point fixation is superior to two point fixation technique for zygomatic complex fracture

Background:Isolated zygomatic or malar bone fractures are second most common fracture among facial skeletal injuries. It has been reported that three point fixation is appropriate for isolated zygomaticbone fracture. The objective of current study was to compare the mean difference in terms of malar height outcome by using different fixation techniques (two point and three point)in patients with zygomatic complex fracture.Methods:This randomized controlled trial was conducted at Department of Oral and Maxillofacial Surgery, MMDC, Multan, during a period of six months from 1st June 2017 to 30th November 2017. A total 182 patients of both genders were included in this study. Two point fixation techniques were used in Group-A patients. While 3 point fixation was used in Group-B patients. After 6 weeks follow-up, patients were assessed for malar height. Outcome was measured by comparing the mean difference of pre and postoperative malar height of both techniques. Data were analyzed using computer program SPSS-21. P≤0.05 was taken as significant in all analysis.Results:Among patients in two pointfixation group, the mean malar height was 67.55±2.98 mm and in three pointfixation group, meansmalar height was 71.55±2.36 mm. The difference of malar height among two treatments was highly significant with p<0.01. Conclusions: Using three point fixation results better as compared to two point fixations in terms of malar height outcome

Zygomaticomaxillary complex fractures with infraorbital nerve damage / 华西口腔医学杂志

Zygomaticomaxillary complex (ZMC) fracture is a common type of maxillofacial fracture. In addition to facial depression and diplopia, paresthesia of the lower eyelid, malar regions, nose skin, upper lip skin, and mucous membranes occurs because of infraorbital nerve injury. This article reviewed the anatomy, diagnosis, assessment, treatment, and prognosis of ZMC fracture-related infraorbital nerve injury.

Comportamiento de las fracturas máxilo-malares / Behavior of maxillo-malar fractures

Introducción: el hueso malar es uno de los huesos más afectados en los traumas faciales. Es fracturado con frecuencia, su tratamiento es común para el cirujano maxilofacial. Objetivo: determinar el comportamiento de las fracturas máxilo-malares según, edad y sexo, signos y síntomas, tipo de fractura, causa y modalidad terapéutica empleada. Métodos: se realizó un estudio descriptivo transversal prospectivo de los pacientes atendidos con fracturas máxilo-malares en el Servicio de Cirugía Maxilofacial del Hospital Universitario General Calixto García en el período comprendido entre noviembre de 2008 a mayo de 2011. Los resultados se mostraron en tablas de simple y doble entrada y como medida resumen se utilizó el porcentaje. Resultados: el comportamiento por grupos de edades mostró 18 pacientes de 31 a 40 años, 14 de 41 a 50 años, 12 de 18 a 30 años, 11 de 51 a 60 y 8 de más de 60 años; 44 pacientes (69,8 por ciento) eran masculinos. La agresión física fue causa de 41,3 por ciento de las fracturas, los accidentes de tránsito el 25,4 por ciento, las caídas el 19 por ciento y los accidentes deportivos el 14,3 por ciento. Presentaron dolor 100 por ciento de los pacientes y asimetría facial el 96,8 por ciento. Las fracturas grado III presentes en 50,8 por ciento, 31,8 por cientogrado II, 9,5 y 7,9 por ciento grado IV y I respectivamente. En 24 pacientes se empleó una técnica terapéutica combinada. En 16 pacientes se utilizó la cola de ceja y sólo en un paciente se optó por el abordaje coronal. Conclusiones: de los 63 pacientes los de mayor número fueron, los del sexo masculino y de edades entre 31 y 40 años; el tipo de fractura más frecuente fue la grado III y se identificaron como causas fundamentales las agresiones físicas seguidas de los accidentes de tránsito. Los signos y síntomas más observados fueron el dolor y la asimetría facial La modalidad terapéutica más empleada fue la combinada(AU)

Introduction: malar bone is one of the most affected bones in facial traumas. It is often fractured and its treatment is common for the maxillofacial surgeon. Objective: to determine the behavior of the maxillo-malar fractures according to age, sex, signs and symptoms, type of fracture, cause, and therapeutic modality used. Methods: a descriptive transversal prospective study was conducted in patients attended with maxillo-malar fractures in the Service of Maxillofacial Surgery of "Calixto García" University Hospital during the period November 2008-May 2011. The results were shown in simple and double-entry tables and percentage was used as summary measure. Results: the behavior by age groups showed 18 patients from 31 to 40 years, 14 from 14 to 50 years, 12 from 18 to 30 years, 11 from 51 to 60 years and 8 of 60 years or older; 44 patients (69.8 percent) were male. Physical aggression was the cause of the 41.3 percent of fractures, traffic accidents reported the 25.4 percent, falls the 19 percent and sports accidents reported the 14. 3 percent of the cases. 100 percent of the patients reported to have pain and the 96.8 percent presented facial asymmetry. Grade III fractures were present in the 50.8 percent, the 31.8 percent had Grade II fractures, and 9,5 and 7.9 percent had Grade IV and I fractures, respectively. A combined therapeutic technique was applied in 24 patients. Eyeball tail was used in 16 patients and only in one patient, the coronal approach was decided. Conclusions: of the 63 patients, the male and aged between 31 and 40 years showed the highest number; the most frequent type of fracture was the Grade III one, and physical aggressions followed by traffic accidents were identified as the main causes. The most observed signs and symptoms were pain and facial asymmetry. The most used therapeutic modality was the combined one(AU)

Intramedullary Nailing for Complex Fractures of the Proximal and Midshaft of the Humerus

PURPOSE: To evaluate the results of antegrade interlocking intramedullary nailing for complex fractures of the proximal and midshaft of the humerus. MATERIALS AND METHODS: We retrospectively analyzed the clinical and radiologic results in 11 cases, which were treated by antegrade interlocking intramedullary nail. We assessed clinical outcomes according to ASES scoring system and radiological result. RESULTS: All cases had bony union and the mean union period was 14.7 weeks. Postoperative complications were 1 loss of fixation, 2 proximal protrusion of nail and 2 temporary shoulder pain. A case with loss of fixation was treated open reduction and refixation and had union at 14 weeks postoperatively. The mean ASES score was 85.9 and the clinical outcomes were 4 excellent, 5 good, 1 fair and 1 poor. CONCLUSION: Intramedullary nailing for complex fractures of the proximal and midshaft of the humerus can offer a reliable treatment option.

Clinical Experiences of Facial Asymmetries in Zygomaticomaxillary Complex Bone Fracture Patients

PURPOSE: Zygomaticomaxillary complex(ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum. METHODS: 369 patients, treated for fractures of the ZMC were included in the study. After the operation, such as open reduction and internal fixation(ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3-dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re-evaluated. Gross photographs were obtained at outpatient clinic. RESULTS: Total of 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch(n=2), lateral displaced comminuted fracture of arch(n=6), comminuted arch fracture combined posterior root fracture(n=9), and communited arch and body fracture(n=12), severely contused soft tissue(n=9). After the manipulations outcomes were acceptable. CONCLUSION: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.

Usefulness of the Blink Reflex Study as a Preoperative Evaluation in the Orbitozygomatic Complex Fracture

PURPOSE: As the evaluation of the preoperative sensibility in the orbitozygomatic complex fracture, used by most surgeons, depends on the patient's subjective judgements, it is difficult to make generalization and to use it as an objective evaluation method. We used the blink reflex study to objectively evaluate injury to the infraorbital nerve. METHODS: From December 2008 to November 2009, a total of 16 patients underwent the patient's subjective report on sensory symptoms and the blink reflex study preoperatively. Among patients having orbitozygomatic complex fracture of type III or more according to Henderson's classification and simultaneously suspected as being injured along the infraorbital nerve pathway, patients who had difficulty in checking preoperative sensibility and said 'normal sensibility' were selected as candidates. RESULTS: Fifteen patients showed abnormal R1 on the fracture side. These results suggested that most of patients had injury to the infraorbital nerve. CONCLUSION: Contrary to the existing tests, the blink reflex study is a useful diagnostic tool in reflecting injury to the infraorbital nerve objectively.

Measurement of varus inclination of the proximal tibial and its relevance of functional recovery / 中国矫形外科杂志

0.05).Spearman analysis revealed correlation between postoperative3 tibial plateau varus correction angle and functional recovery of knee joint(r=0.812,P

Application of the Less Invasive Stabilization System in complex fractures around the knee joint / 中国微创外科杂志

Objective To discuss curative effects of the AO Less Invasive Stabilization System(LISS) in the treatment of complex fractures around the knee joint.Methods The internal fixation at distal femur or proximal tibia was performed in 15 cases of closed complex fractures at the metaphysic area near the knee joint by using the LISS(left-sided in 9 cases and right-sided in 6 cases) from April 2004 to June 2005. Results All the 15 cases were followed for 5~26 months(mean,13.2 months).The time to full weight bearing was 12~26 weeks,and the time to bone union under X-ray was 11~24 weeks.No delayed union or disunion was observed.There were 1 case of superficial infection and 2 cases of skin blister,all of which were cured with dressing changes.No deep infection,skin necrosis,or osteofascial compartment syndrome occurred.Functional evaluation according to the Johner-Wruhs system revealed "excellent" results in 11 cases,"good" results in 3,and "fair" in 1,the total satisfactory rate being 93.3%(14/15).Palpable shift and separation inside tibia had occurred in 1 case of tibial plateau fracture(type C3) 2 weeks after operation,and a steel bar was inserted to fix the tibial plateau in a second operation.Bone union was achieved in this case 20 weeks after operation,with "good" evaluation results.Genu varum(tibial plateau angle,82?) had occurred in 1 case of tibial plateau fracture(type C3) 8 weeks after operation,and bone union was noted 20 weeks after operation,with "fair" evaluation results.Conclusions The LISS is indicated for fractures at distal femur or proximal tibia,or osteoporotic fractures of distal femoral shaft.For type C3 complex tibial plateau fracture,fixation with a steel bar on the entocondyle should be employed,rather than relying on the LISS.

Operative management of complex acetabular fractures of Letournel classification / 中华创伤骨科杂志

Objective To discuss the diagnosis and operative treatment of the complex acetabular fractures of Letournel classification. Methods On the basis of the three- dimensional computed tomography, 75 cases of complex acetabular fractures were diagnosed and classified according to Letournel classification. They were treated through the anterior, posterior, combined anterior- posterior and the improved iliofemoral approaches. All the fractures were fixed with screws and AO reconstruction plates. Results All the cases were followed up for 6 to 96 months, with an average time of 46 months. They were evaluated according to D' Aubigne and Pestel criteria for joint functions and Epstein criteria for radiographic manifestation. 34 cases of the series were rated as excellent (45.23% ), 28 case as fine (37.33% ), 8 cases as fair (10.67% ) and 5 cases as poor (6.67% ). Conclusion Enough image data, simulation in vitro on a pelvic specimen, maximal anatomical reduction and appropriate approach are the basis for satisfactory outcomes.

A Retrospective Study on the Injury of Infraorbital Nerve According to Types of Orbitozygomatic Complex Fracture

In the orbitozygomatic complex fracture, sensory impairment due to the damage of the infraorbital nerve is one of the most common symptom and complication. In this report, we have the assumption that surgical approach for rigid fixation method may have correlations to the damage and regeneration of the nerve. Among patients who had open reduction and internal fixation for unilateral orbitozygomatic complex fracture in our hospital from March 1997 to August 2000, we selected 40 cases. The pin-prick test and the 2-point discrimination test on the infraorbital nerve regions were done for testing the sensory impairments. Two different fracture classification methods were used in this research. First, Henderson's method was used. The results of preoperative test results showed that 17 patients out of 40 patients were abnormalities. More specifically, type IV patients had the highest sensory impairments. In a comparison of the approach methods, the patients who adopted both method showed higher tendency of recovery of sensory impairments. From these results, the degree of deviation in the fracture and the type of approach may be an important prognostic factor for the sensory impairments due to the orbitozygomatic complex fracture.

Follow Up Study of the Zygoma Complex Fracture Patients along the Inclusion of Coronary Incision as the Approaches

Zygoma complex has important roles as the contour, and buttreses in the bony skeleton of the midface. Many surgical approaches to the zygoma complex fractures have been discovered, such as the coronal approach, Gillies' approach and the intraoral approach. 387 patients of zygoma complex fracture from March 1990 to March 2001 in Department of Plastic & Reconstructive Surgery, Dong-A University Hospital were studied retrospectively about deformity of facial contour, enophthalmos, scar etc., divided into two groups, operated with and without coronary approach. The postoperative complications were researched through the charts, X-ray findings and clinical photographs. The coronary approach was used mostly in the case of the severe displacement of fractured bony fragments or neurosurgical emergency(traumatic subdural hematoma, ect.). The group with the coronary approach had higher rate of scar, hypoesthesia and anesthesia than the group without the coronary approach but the coronary approach was thought to be useful considering mostly used in severe zygoma bone fractures and its lower rate of deformity than the group without one, nevertheless there was no statistical significance about the facial deformity between the former(2.6%) and the latter(7.3%). We supposed that these outcome help us to choose more suitable approach in zygoma complex fracture operation.

Combined Anterior and Posterior Approach in Operating on Complex Acetabular Fractures / 대한정형외과학회잡지

PURPOSE: To report the results of a combined anterior and posterior approach to complex acetabular fractures and establish the guidelines for the operative treatment of complex acetabular fractures. MATERIALS AND METHODS: Thirteen fractures (8 both column, 5 T-shaped fractures) of thirteen patients (8 men, 5 women) were treated with this combined anterior and posterior approach from August 1995 to December 1999. We reviewed the clinical and radiological results for an average of 33months (range, 12-60) follow-up. RESULTS: This approach resulted in an anatomical reduction in ten (78%) patients and, two imperfect and one poor reduction. The average Harris hip score was 69.2 (range, 58-87) and the clinical results were good in eleven, very good in one and poor in one patient using the D'Aubigne/Postel clinical grading. A poor reduction occurred in one patient who had a both column fracture that extended to the ipsilateral sacroiliac joint combined with a joint subluxation. CONCLUSION: Overall clinical results for most complex acetabular fractures treated by a combined anterior and posterior approach were preferable to other approaches, but we must consider an extensile or extended ilioinguinal approach to be an alternative surgical approach in this complicated fracture that involves the sacroiliac joint.

THE STUDY FOR HEMODYNAMIC CHANGE ON CORONAL APPROACH TO ZYGOMATICO-MAXILLARY COMPLEX FRACTURE

BACKGROUND: The coronal incision is versatile surgical approach to upper and middle region of the facial skeletal including the zygomatic arch. The advantages of coronal approach are minimal injury of facial tissue including facial nerve and satisfactory cosmetic result by hidden scar at hair. But wide exposure of scalp, its disadvantages are operation time and massive blood loss. METHODS: Thirty patients undergoing elective surgery were divided 3 groups. Group I used only coronal approach, group II used coronal with subciliary approach and group III used coronal with subciliary and intraoral approach. And then retrospected of the preoperative, postoperative red blood cell count, hemoglobin(Hb), hematocrit, transfused red blood cell units and platelet cell units, and the amount of infused crystalloids and colloids, and postoperative hemovac count was estimated. RESULTS: 1. Red blood cell count were decreased in all groups at immediated postoperation and decreased in all group of postoperative first day and decreased in group I, II but increased group III of postoperative third day. 2. Hemoglobin and hematocrit were decreased in all group at immediated postoperation and decreased in all group of postoperative first day and decreased in group I, II., but increased group III postoperative third day. 3. Platelet was decreased in all group at immediated postoperation, and decreased in group II, III but increased in group I of postoperative first day and decreased in group I but increased group II, III of postoperative third day. 4. Mean postoperative hemovac mean drainage group I of first day is 48.63+/-21.12ml and second day is 23.92+/-19.53ml and third day is 7.82+/-5.32ml and group II of first day 60.45+/-22.65ml and second day is 22.14+/-13.21ml and third day is 7.32+/-6.25ml. III group of first day 58.16+/-10.13ml and second day is 21.27+/-11.72ml and third day is 7.13+/-4.90ml. 5. Infusion of group I is mean PRC 1.08+/-0.91 pint, FFP 1.03+/-0.75 pint, crystalloid 2562.23+/-1345.53ml and group II is mean PRC 1.05+/-0.89 pint, FFP 1.71+/-0.78, crystalloid 2650.47+/-1096.36ml and group III is mean PRC 1.79+/-1.45 pint, crystalloid 3295.43+/-1472.432ml.

Modular Hemiarthroplasty for the Treatment of Complex Fractures of the Proximal Humerus / 대한정형외과학회잡지

From 1993 to 1996, we have used a new modular shoulder prosthesis for the treatment of acute complex fracture of the proximal humerus. The purpose of this study is to evaluate function, pain relief, and patient satisfaction after moduiar hemiarthroplasty for proximal humerus fractures. The stucly included 12 patients (J2 shoulders) with an average age of 68.5 years (range, 60 to 84 years). According to the Neer classification system, there were 3 four-part fracture-dislocations, 5 four-part fractures, 3 three-part fractures, and #I head splitting fracture. 'fhe hemiarthroplasty was pert'ormed at an average of 4 days (range, 3 to 10 days) following injury. Deltopectoral approach was used in all patients, and the prostheses were implanted with cement in ten cases. Follow-up evaluation, at an average of 32 months post-surgery, included clinical and radio- graphic examination. Active forward elevation averaged 120 degrees; external rotation, 35 degrees; and internal rotation, to the first lumbar vertebra. All of patients, except two who had poor results, were graded as good or excellent according to UCLA shoulder rating scale. Complications consisted of one tuberosity dispiacement, one peri-operative death and one loosening of uncemented humeral prosthesis. We concluded that Modular hemiarthroplasty for acute complex fracture of the proximal humerus especially in severely osteoporotic elderly patients facilitated the restoration of humeral length, anatomic repositioning of tuberosities, and precise soft tissue balance, thereby allowing earliermotion to prevent the developement of painful shoulder stiffness.

Treatment of zygomatic complex fracture with single mini-dynamic compression plate with screws.

During 1993 to 1994, 30 cases of minimally-displaced fracture of the zygomatic complex were treated with open reduction and rigid internal fixation with single 4-hole mini-dynamic compression plates (DCP) and screws at the zygomatico-frontal fracture site. The open reduction was done wth the aid of a bone hook inserted through a tiny stab incision at the zygomatic arch prominence. When good alignment was achieved, the zygomatico-frontal fracture site was fixed with only one 4-hole mini-DCP. The one-point fixation with this type of plate for minimally displaced zygomatic complex fractures reduces morbidity, operative time, and costs.