Sindesmosis tibioperonea: diagnóstico, métodos de fijación y artroscopia

Introducción: Las lesiones de la sindesmosis tibioperonea son frecuentes tanto de forma aislada o asociadas a fracturas del maléolo posterior. El diagnóstico clínico es corroborado mediante estudios imagenológicos. Los métodos de fijación pueden ser rígidos o dinámicos. Objetivo: Actualizar aspectos sobre las lesiones de la sindesmosis tibioperonea en cuanto al diagnóstico, métodos de fijación y el empleo de la vía artroscópica. Método: La búsqueda y análisis de la información se realizó en un periodo de 61 días (1 de octubre al 30 de noviembre de 2022) y se emplearon las siguientes palabras: syndesmosis injury, ankle syndesmosis instability, syndesmosis instability AND tight rope ankle instability, posterior maleolar fracture. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 258 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote. Desarrollo: Se hizo referencia a las maniobras clínicas para el diagnóstico y las clasificaciones tomográficas en caso de fractura asociada del maléolo posterior. Se mencionaron los métodos de fijación rígidos y dinámicos, donde se describieron las características de cada uno basado en varios factores. Se expusieron las ventajas de la vía artroscópica tanto para el diagnóstico como para el tratamiento. Conclusiones: Las lesiones de la sindesmosis tibioperonea distal son frecuentes. Los estudios tomográficos ofrecen ventajas al determinar la extensión de la fractura del maléolo posterior. La vía artroscópica ofrece múltiples ventajas diagnósticas y terapéuticas.

Introduction: Tibioperoneal syndesmosis injuries are frequent both in isolation or associated with posterior malleolus fractures. Clinical diagnosis is confirmed on imaging studies. Fixation methods might be rigid or dynamic as well. Objective: Provide new aspects related to tibioperoneal syndesmosis injuries in terms of diagnosis, fixation methods and the use of arthroscopic procedure. Method: Search and analysis of information needed were carried out in a period of 61 days (from October 1 to November 30, 2022) and the following words were used: syndesmosis injury, ankle syndesmosis instability, syndesmosis instability AND tight rope ankle instability, posterior maleolar fracture. Based on the information obtained, a bibliographic review of the total of 258 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the search engine and reference manager EndNote. Development: It was expressed in the study aspects related to clinical management used in diagnostic and classification on the types of CT scan for fracture associated with posterior malleolar fracture. The rigid and dynamic fixation methods and its characteristics were mentioned as well. The arthroscopic approaches and its advantages for both diagnosis and treatment were presented. Conclusions: Distal tibioperoneal syndesmosis injuries are frequent ankle injury. Tomographic studies offer some advantages for determining how large the posterior malleolus fracture is. The arthroscopic approach offers multiple diagnostic and therapeutic advantages too.

Introdução: As lesões da sindesmose tibiofibular são frequentes isoladamente ou associadas a fraturas do maléolo posterior. O diagnóstico clínico é confirmado por exames de imagem. Os métodos de fixação podem ser rígidos ou dinâmicos. Objetivo: Atualizar aspectos das lesões da sindesmose tibiofibular quanto ao diagnóstico, métodos de fixação e uso da abordagem artroscópica. Método: A busca e análise das informações foi realizada em um período de 61 dias (1º de outubro a 30 de novembro de 2022) e foram utilizadas as seguintes palavras: syndesmosis injury, ankle syndesmosis instability, syndesmosis instability AND tight rope ankle instability, posterior maleolar fracture. Com base nas informações obtidas, foi realizada uma revisão bibliográfica de um total de 258 artigos publicados nas bases de dados PubMed, Hinari, SciELO e Medline, utilizando o gerenciador de busca e Gerenciador de referências do EndNote. Desenvolvimento: Foi feita referência a manobras clínicas para diagnóstico e classificações tomográficas em caso de fractura associada do maléolo posterior. Foram citados métodos de fixação rígidos e dinâmicos, onde foram descritas as características de cada um com base em vários fatores. As vantagens da abordagem artroscópica tanto para o diagnóstico quanto para o tratamento foram discutidas. Conclusões: As lesões da sindesmose tibiofibular distal são frequentes. Os estudos tomográficos oferecem vantagens na determinação da extensão da fratura do maléolo posterior. A abordagem artroscópica oferece múltiplas vantagens diagnósticas e terapêuticas.

Treatment of Pathological Humerus-Shaft Tumoral Fractures with Rigid Static Interlocking Intramedullary Nail-22 Years of Experience / Tratamento de fraturas patológicas tumorais diafisárias do úmero com haste intramedular rígida bloqueada estática - Experiência de 22 anos

Abstract Objective This was a retrospective observational study in patients submitted to intramedullary nail fixation after established or impeding pathological humerus-shaft tumoral fracture in the context of disseminated tumoral disease along 22 years of experience at the same institution. Methods Sample with 82 patients and 86 humeral fixations with unreamed rigid interlocking static intramedullary nail by the antegrade or retrograde approaches. Results The most prevalent primary tumors were breast carcinoma (30.49%), multiple myeloma (24.39%), lung adenocarcinoma (8.54%), and renal cell carcinoma (6.10%). The average surgical time was 90.16 ± 42.98 minutes (40-135 minutes). All of the patients reported improvement in arm pain and the mean Musculoskeletal Tumor Society (MSTS) score rose from 26% in the preoperative period to 72.6% in the evaluation performed in patients still alive 3 months after the surgery. The overall survival was 69.50% 3 months after the surgery, 56.10% at 6 months, 26.70% at 1 year, and 11.90% at 2 years. No death was related to the surgery or its complications. There were only 4 surgery-related complications, 1 intraoperative and 3 late, corresponding to a 4.65% complication risk. Conclusion Closed unreamed static interlocking intramedullary nailing (both in the antegrade or retrograde approaches) of the humerus is a fast, safe, effective, and low morbidity procedure to treat pathological fractures of the humerus shaft, assuring a stable arm fixation and consequently improving function and quality of life in these patients during their short life expectation.

Resumo Objetivo Estudo retrospectivo observacional em pacientes submetidos à fixação com haste intramedular de fratura patológica tumoral consumada ou iminente da diáfise do úmero em contexto de doença tumoral disseminada ao longo de 22 anos na mesma instituição. Métodos Amostra com 82 pacientes e 86 fixações do úmero com haste intramedular rígida bloqueada estática não fresada anterógrada ou retrógrada. Resultados Os tumores primários mais prevalentes foram carcinoma da mama (30,49%), mieloma múltiplo (24,39%), adenocarcinoma do pulmão (8,54%) e carcinoma das células renais (6,10%). O tempo médio de intervenção cirúrgica para fixação com haste foi 90,16 ± 42,98 minutos (40-135). Todos os pacientes referiram melhoria das queixas álgicas no nível do braço e velicou-semelhoria do scoreMSTSmédio de 26% no pré-operatório para 72,6% na avaliação efetuada nos pacientes ainda vivos aos três meses de pós-operatório. A taxa de sobrevivência aos três meses após a cirurgia foi de 69,50%, 56,10% aos seis meses, 26,70% em um ano e 11,90% em dois anos. Nenhuma dasmortes decorreu da cirurgia ou de complicações dela. Apenas se registaramquatro complicações relacionadas com a cirurgia, uma intraoperatória e três tardias, corresponderam a risco de complicações de 4,65%. Conclusão O uso de haste intramedular não fresada estática bloqueada (anterógrado ou retrógrado) no úmero é um método rápido, seguro, eficaz e com baixa morbilidade no tratamento das fraturas patológicas da diáfise umeral, garante fixação estável do braço e consequentemente melhora a funcionalidade e a qualidade de vida desses pacientes durante a sua curta expectativa de vida.

Frecuencia de genioplastia en cirugía ortognática en el servicio de cirugía oral y maxilofacial del Hospital Militar Central de Bogotá / Genioplasty frequency in orthognathic surgery at the Bogota Central Military Hospital oral and maxillofacial surgery service

Introducción: La genioplastia es un procedimiento versátil que maneja alteraciones en la región mentoniana, aisladas o en combinación con Anomalías Dentofaciales (ADF). Objetivo: Describir la frecuencia de genioplastia así como los diferentes métodos de fijación utilizados en pacientes sometidos a cirugía ortognática. Materiales y métodos: Estudio observacional descriptivo de los pacientes sometidos genioplastia en conjunto con cirugía ortognática en el Servicio de Cirugía Oral y Maxilofacial del Hospital Militar Central de Bogotá entre 2009 y 2015. Resultados: El 80% de las cirugías ortognáticas (197 pacientes) requirieron genioplastia como procedimiento complementario. El movimiento más frecuente fue de avance en 158 pacientes (77.8%) con predominio de pacientes ADF Clase III (91 pacientes, 44.82%), el método de fijación mas frecuente fue alambres intraóseos en el 37.05% (73 casos). Conclusiones: La genioplastia es un procedimiento predecible, con bajo riesgo de complicaciones, que maneja los defectos anatómicos y estructurales del mentón, ofreciendo resultados estéticos favorables..

Introduction: Genioplasty is a versatile procedure which handles defects of the chin, isolated or in combination with Dentofacial Deformities (DFD). Objective: To describe the frequency of genioplasty and the different methods of fixation used in patients undergoing orthognathic surgery. Materials and methods: Descriptive observational study of patients undergoing genioplasty in conjunction with orthognathic surgery at the Bogotá Central Military Hospital, Oral and Maxillofacial Department from January 2009 to January 2015. Results: 80% of orthognathic surgery (197 patients) required genioplasty as adjunctive procedure. The most frequent movement was advance genioplasty in 158 patients (77.8%), prevalence of DFD Class III (91 patients, 44.82%), the most frequent method was intraosseous wire fixation in 37.05% (73 cases). Conclusions: Genioplasty is a predictable procedure with low risk of complications, which handles anatomical and structural defects of the chin, offering favorable aesthetic results.

Treatment of the Tile B and Tile C Morel-Lavallée lesions with a texas scottish rite hospital (TSRH) system and external fixation / 中国医师杂志

Objective To review a treatment of Tile B and Tile C Morel-Lavallée lesions with a texas scottish rite hospital (TSRH) and external fixation.Methods From September 2008 to September 2013,21 patients were operated with a treatment with TSRH system and external fixation.Results Those 21 cases were followed up from 12 to 24 months with an average of 15.8 months.All fractures were healed without osteomyelitis and patients showed no sing of limp.The rate of good recovery was reached 80.9％(17/21).Conclusions Internal fixation with TSRH system and external fixation for treating Tile B and Tile C Morel-Lavallée lesions can result in a high success rate.

Analysis of set-up accuracy of two body membrane fixation methods in radiotherapy for thoracic neoplasms / 中华放射肿瘤学杂志

Objective To study the set-up accuracy in radiotherapy of thoracic neoplasms by improving the body immobilization method.Methods Fifty patients with thoracic neoplasms were randomly divided into conventional group (without electrode paste) and improved group (with electrode paste).Using simulator for position calibration and center field digital image reconstruction from treatment planning system.Then compare the set-up accuracy of two groups with different body methods by grouped t-test.Results Set-up error in the left-right,superior-inferior,anterior-posterior direction were 2.5 ± 1.5 and 2.4 ± 1.4(P =0.010),4.4 ± 2.0 and 2.2 ± 1.2 (P =0.000),2.2 ± 1.3 and 2.1 ± 1.0 (P =0.100) in conventional group and improved group,respectively.Conclusions The improved body immobilization method improves setup accuracy in radiotherapy for thoracic neoplasms which also will be effective for clinical treatment.

Clinical analysis of fixation methods and sites in treatment of zygomatic complex fractures / 实用口腔医学杂志

Objetive:To analyze the fixation methods and sites in treatment of zygomatic complex fractures of 152 patients. Methods:The clinical data of 152 patients from 1990 to 2004 were investigated and analyzed, which focused on the changing trend of etiology and treatment methods. Results:Traffic accident was the primary reason for zygomatic complex fractures in China.152 patients received primary, timely reduction and fixation; Scalp coronal incision in combination with other incisions or alone was applied in 108 patients, the rest were treated by single local incisions. Rigid internal fixation was applied in 123 cases, and the single application of transosseous wire fixation was performed in 22 patients. 328 Ti plates were used. As to the fixation sites, 96 were applied at the zygomatic-frontal suture, 45 plates at zygomatic-maxillary suture and zygomatic crest, 92 plates at zygomatic-temporal suture, and 95 plates across the fracture line. Conclusion:Scalp coronal incision in combination with other incisions or alone can provide satisfactory outcome. Early, timely reduction and rigid internal fixation may result in better treatment results. The sites are focused at zygomatic-frontal suture, zygomatic-maxillary suture and zygomatic crest, zygomatic-temporal suture and the fracture line which restore the horizontal and vertical force route.