Estudio comparativo entre clavo endomedular y tratamiento conservador en fracturas de húmero proximal de 2 y 3 fragmentos / Comparative study between intramedullary nailing and conservative treatment in proximal humerus fractures of 2 and 3 fragments

Introducción Hacer objetivas las diferencias relativas a funcionalidad y calidad de vida entre pacientes con fracturas de húmero proximal de 2 y 3 fragmentos tratados de forma conservadora y mediante enclavado endomedular. Materiales y Métodos Estudio descriptivo-retrospectivo realizado en un mismo centro hospitalario entre junio de 2010 y mayo de 2014. Se incluyeron pacientes con fractura de húmero proximal de 2 y 3 fragmentos, excluyendo los menores de 60 años. Se evaluó la movilidad, test de Constant y ASES. El análisis estadístico se realizó con el programa SPSS. Resultados 71 pacientes seleccionados; 43 presentaban fractura de 2 fragmentos y 28 de 3. Mediante enclavado endomedular fueron tratados 15, con una media de edad de 76,7 años, y 38 recibieron tratamiento conservador, con una edad media de 79,8 años; en ambos grupos el número de mujeres fue mayor. Las puntuaciones de los cuestionarios Constant y ASES fueron superiores en el grupo que recibió tratamiento conservador, al igual que su grado de satisfacción y mejor movilidad y funcionalidad. Discusión En las fracturas de 2 y 3 fragmentos el tratamiento conservador es utilizado en gran parte de los casos. La edad no es un factor influyente a la hora de decantarse por una u otra opción terapéutica. La mayoría de los pacientes están satisfechos con el tratamiento recibido. En los test de Constant y ASES obtienen mejor resultado los pacientes tratados de forma conservadora. La abducción y la flexión son ligeramente superiores en pacientes que recibieron tratamiento conservador.

Background To study the differences related to functionality and quality of life between patients with proximal humerus fractures of 2 and 3 fragments treated conservatively and by using intramedullary nailing. Material and Methods Descriptive-retrospective study was conducted in the same hospital between June 2010 and May 2014. Patients with proximal humerus fractures of 2 and 3 fragments were included. Patients under 60 years were excluded. Mobility was evaluated, using the Constant and ASES (American Shoulder and Elbow Surgeons) test. Statistical analysis was performed using the SPSS program. Results Of the 71 selected patients, 43 had a 2 fragments fracture, and 28 had a 3 fragment fracture Intramedullary nailing was used to treat 15 cases (with a mean age of 76.7 years), and 38 (mean age 79.8 years) received conservative treatment. The number of women was higher in both groups. The scores of the Constant and ASES questionnaires were higher in the group that received conservative treatment. They also had a higher level of satisfaction and better mobility and functionality. Discussion In fractures of 2 and 3 fragments conservative treatment is used in a large majority of the cases. Age is not an influential factor when opting for one or another therapeutic option. Most patients are satisfied with the treatment received. Patients treated conservatively obtain better results in the Constant and ASES tests. Abduction and flexion are slightly higher in patients that received conservative treatment.

Resultados anatómicos y funcionales de la cirugía convencional en pacientes con desprendimiento primario de retina / Anatomical and functional results of the conventional surgery in patients with primary retinal detachment

Se realizó un estudio observacional, descriptivo y prospectivo de 23 pacientes con desprendimiento primario de retina, intervenidos quirúrgicamente en el Hospital General "Dr. Juan Bruno Zayas Alfonso" desde enero hasta diciembre de 2012, a fin de describir los resultados anatómicos y funcionales de la cirugía convencional, para lo cual se utilizaron variables de interés para la investigación. Entre los hallazgos principales predominaron: el sexo masculino (73,9 %), los desprendimientos parciales con desgarros temporales superiores (73,9%), la miopía elevada como antecedente patológico personal (39,1 %), el ojo derecho como el más afectado (60,9 %), la rotura en herradura (30,4 %), fundamentalmente en los cuadrantes superiores, y las técnicas combinadas (91,3 %), por citar algunos. Con la aplicación de dichas técnicas se logró la reaplicación de la mayoría de los casos. El éxito anatómico logrado no fue siempre sinónimo de éxito funcional, aunque lo primero es condición obligada para lo segundo.

An observational, descriptive and prospective study of 23 patients with primary detached retina, undergoing surgery in "Dr. Juan Bruno Zayas Alfonso" General Hospital was carried out from January to December, 2012, in order to describe the anatomical and functional results of the conventional surgery, for which variables of interest for the investigation were used. Among the main findings, the male sex (73.9%), the partial detachment with superior temporary lacerations (73.9%), the high myopia as personal pathological history (39.1%), the right eye as the most affected (60.9%), the horseshoe rupture(30.4%), fundamentally in the superior quadrants, and the combined techniques (91.3%), to mention some, prevailed. With the use of these techniques the new implementation was achieved in most of the cases. The anatomical success achieved was not always synonym of functional success, although the first thing is was necessary for the second one.

Tratamiento quirúrgico de fracturas transversas más pared posterior de acetábulo / Surgical treatment of transverse and posterior acetabular wall fractures

Objective: Describe our experience in the surgical treatment of transverse with posterior wall fractures of the acetabulum, the elements that help in the choice of the approach and functional and radiological results of this type of injury. Methods: We retrospectively evaluated 9 patients (9 fractures) with transverse and posterior wall fractures operated between August 2008 and September 2010. Six patients were men and 3 women with an average age of 40.4 years. We reviewed the surgical protocols, the perioperative data and the pre and post operative radiological images. We registered the complications and the functional results with the Merle D’Aubigne and Postel score. Results: All cases were considered secondary to high energy mechanisms. Five patients had posterior dislocation of the hip and 4 had central dislocation. Eight patients had associated injuries. In the early postoperative period there were no complications. One patient had posttraumatic osteoarthritis and required total hip arthroplasty. The average of Merle d’Aubigne score was 16.1 points. Conclusion: Surgical treatment for this type of injury had good results in this group of patients.

Objetivo: Describir nuestra experiencia en el tratamiento quirúrgico de las fracturas transversas más pared posterior de acetábulo, los elementos que ayudan en la elección del abordaje y los resultados funcionales y radiológicos de este tipo de lesiones. Material y Métodos: Estudio retrospectivo y descriptivo de una serie consecutiva de 9 pacientes (9 fracturas) operados de una fractura transversa más pared posterior de acetábulo entre agosto de 2008 y septiembre de 2010. Seis hombres y 3 mujeres con una mediana de edad de 40,4 años se operaron en este período. Se revisaron los protocolos operatorios, las fi chas clínicas y las imágenes pre y postoperatorias. Se evaluaron las complicaciones tempranas y tardías y los resultados funcionales de acuerdo a la escala de Merle D’Aubigne y Postel a un seguimiento promedio de 17 meses. Resultados: Todos los casos se consideraron secundarios a mecanismos de alta energía. Cinco pacientes presentaron luxación posterior de cadera y 4 presentaron luxación central. Ocho pacientes presentaron lesiones asociadas. En el postoperatorio temprano no se presentaron complicaciones. Un paciente presentó artrosis post traumática y requirió artroplastía total de cadera. El puntaje promedio de Merle d’Aubigne fue de 16,1 puntos. Conclusión: El tratamiento quirúrgico para este tipo de lesiones tiene buenos resultados en el corto plazo en este grupo de pacientes.

Treatment of Neglected Monteggia Fracture-Dislocation in Children / 대한정형외과학회잡지

PURPOSE: Our purpose is to evaluate the results of the operative treatment in neglected Monteggia fracture-dislocation in children. MATERIALS AND METHODS: We retrospectively analyzed 10 elbows in 10 patients who underwent surgery. All patients were classified as Bado type I, except one with type III. The mean duration of follow up was 2 years and 5 months. The mean age at the time of operation was 10 years and the mean time from injury to operation was 7 months. All 10 patients underwent open reduction of the radial head and reconstruction of annular ligament. Ulnar osteotomy was performed in 9 cases. Clinical assessment was done by Bruce et al.'s rating system. RESULTS: All 10 patients gained a mean of 35degrees of extension-flexion arc, however lost a mean of 29degrees of pronation-supination arc. And there were three complications, including dislocation of radial head in two patients and breakage of transarticular K-wire in one patient. According to Bruce et al.'s rating system, there were 4 excellent, 1 good, 3 fair, and 2 poor results. CONCLUSION: We found that the effect of the operative treatment of neglected Monteggia fracturedislocation in children was limited in majority of the patients. Particularly, the loss of pronation-supination arc was noticed postoperatively in most patients.

Rehabilitation of Torticollis in Children

The primary treatment goal of torticollis is to prevent the craniofacial deformities, limitation of neck movements and long-term postural changes. In order to offer precise guidelines for the treatment of torticollis regarding the cosmetic and functional results, we analyzed 99 torticollis children retrospectively for the ages at diagnosis and the start of treatment, the duration of treatment, the problems at first visitation, and the size of sternocleidomastoid mass. These patients visited the department of rehabilitation medicine, Holy Family Hospital from April 1991 to June 1997. The results showed that there was no relation between the number of problems at first visitation and the age at the start of treatment, but the group with 1 problem had a significantly shorter duration of treatment than the groups with more than 4 problems. The ages at diagnosis and at the start of treatment for the patients with a palpable neck mass were younger than those of the patients without a neck mass. The duration of treatment was longer for the patients with a larger size of mass by the ultrasonography of the neck. The ages at diagnosis and at the start of treatment, and the duration of treatment were all younger and shorter in the cosmetically satisfactory group than those of the cosmeticlly unsatisfactory group. However there was no significant difference between the functionally satisfactory group and unsatisfactory group in the ages at diagnosis and at the start of treatment, and the duration of treatment. In conclusion, when the treatment of torticollis was started early, especially at less than 3 months old, better cosmetic results were obtained, even though functional results were relatively satisfactory by the proper rehabilitation treatments. We want to emphasize that it is important to detect and treat the torticollis as early as possible for the better cosmetic results.