Fractura de Toddler. Reporte de un caso y revisión de la literatura / Toddler's fracture, case report and review of literature

Resumen: Introducción: La sospecha del diagnóstico de una fractura de Toddler a menudo es complicada debido a una historia poco clara, a la falta de hallazgos específicos en la clínica y a la ausencia de cambios evidentes en las radiografías iniciales. Presentamos el caso de una infante de tres años y siete meses de edad con el antecedente de caída desde su propia altura con mecanismo de rotación del miembro pélvico izquierdo. La finalidad de este escrito es describir la etiología, patología, diagnóstico y el manejo terapéutico en este tipo de fracturas. Discusión: La historia clínica, la exploración física y el uso de estudios de imagenología ayudan a identificar las fracturas de Toddler, patología que debe ser conocida por médicos especialistas para su manejo ideal.

Abstract: Introduction: The suspected diagnosis of a Toddler's fracture can often be complicated by an unclear history, the lack of specific clinical findings and the absence of obvious changes in the initial radiographs. We present the case of an infant of 3 years and 7 months old with a history of falling from her own height with a rotation mechanism of the left pelvic limb. The purpose of this paper is to describe the etiopathology, diagnosis and therapeutic management of these fractures. Discussion: The clinical history, physical examination and the use of imaging studies help identify Toddler's fractures, pathology that must be known to medical specialists for an ideal treatment.

Treatment of tibial shaft fractures with Kuntscher nail without opening fracture cavity in condition of without C-ARM in Da Nang General Hospital

Background: Leg bone fracture is common seen in orthopedic trauma. Currently, the trend of treatment is using a less invasive technique. Especially, with application of C-Arm in surgery, closed Kuntscher nailing technique has made the treatment of leg bone fractures achieving more new improvements. Objectives: To summarize the experiences in the technical implementation process and to assess results of treatment. Subjects and method: A descriptive, retrospective study was conducted on 112 patients was confirmed diagnosed with leg bone fractures (81 males, 31 females, the average aged 29\xb15.3), were operated in Da Nang General Hospital from January, 2004 to June, 2006. All of them were performed with Kuntscher intramedullary nail in tibia without opening fracture cavity, in condition of without C-Arm. Results: The patients with combined injuries included 5 cases of 2 legs fracture, 2 cases of hip fracture, 5 cases of leg fracture in 2 stages, 1 case of collabone fracture. Postoperative observations: no case of infection, patients were discharged after 2-7 days, the average length of hospitalization was 3\xb12.4 days. Complication: 1 case of secondary deviation, no case of any delay to heal bone, broken nails. Recording a case of nail was rise up to cause painfully and synovial capsule inflammation of knee joint. Conclusion: The implementation of this less invasive technique should be orderly done. The most ideal indication was tibial shaft fractures in stage of middle 1/3. Because of a minimally invasive technique so patients were less painful, fracture healing quickly, early mobilization could be set, surrounding joints were not affected.

Immediate Nailing of Open Tibial Shaft Fractures after Removal of External Fixation / 대한정형외과학회잡지

Many authors have recommended delayed conversion to nailing of open tibial shaft fractures which had been treated initially with external fixation. Most authors have agreed that it was safe to first remove the external fixator, temporarily immobilize the limb in a cast or traction to allow for pin tract healing(generally 1 to 3 weeks), and then proceed to nailing. But, as far as we know, there was few data that had proven the time interval for pin tract healing was necessary to decrease the risk of deep infection. The purpose of this study was to evaluate the results of secondary nailing that was done immediately after removal of external fixator in the patients of open tibial shaft fractures. There were 12 males and 1 female with an average age of the 37.2 years(range, 18-64 years). The mean follow up period was 16.7 months(range, 12-23 months). The external fixation had been mainteined for an average of 47.5 days(range, 21-90 days). Indication of conversion to nailing without time interval was abscence of any serous discharge, reddness or local heating around pin-sites and normal range of laboratory data. All 13 fractures had united without additional surgical procedures or major complications such as deep infection. There were three superficial infections controlled with curettage and short period of oral antibiotics. On the basis of the favorable results of this study, we concluded that the time interval for pin tract healing is not an absolute prerequisite for preventing deep infection as far as no pin tract infection is present.

Clinical Study on Open Fractures of the Tibial Shaft / 대한정형외과학회잡지

Open fractures of the shaft of the tibia occur frequently because of the progression of industrialization, Different methods of treatment have been advocated as regards the care of the open wound and the method of stabilization of the fracture fragments. The reports, published until recently, have differed with respect to rates of morbidity and end results. With this in mind, we reviewed a consecutive series of 30 open fractures of the tibia at the Department of Orthopedic Surgery of the Eulji General Hospital between 1981 and 1983 by a variety of methods. The following results were obtained. 1. The highest incidence of fractures was encountered in 3rd decades(43.3%) and male to female ratio was 4: 1. 2. The most common cause of fractures was traffic accident(66.6%). 3. The most common anatomical level of fractures was middle third of the shaft(46.7%). 4. The severity of injury was classified according to the Ellis classification as follows. Minor group, 8 cases(40%), Moderate group, 8 cases(26.7%,), Major group, 10 cases(33.3%). 5. The most common associated injury was ipsilateral fibular fracture. 6. Of 30 cases, 11 patients(36.6%) had an open wound more than 5cm in length, 10(33.3%.) between 2.5 and Scm and 4(13.4%) below 2.5cm, and primary closure after thorough debridement and copious irrigation was done in 17 cases(56.7%). 7. Pin and plaster method was applied in 3 cases of minor group and 3 of moderate group, intramedullary nailing was applied in 9 of minor group and 5 of moderate group, and Hoffmann device was applied in 10 of major group. 8. The majority of cases(66.7%) were operated on within 1 week after injury, 9(30%) between 1 and 2 weeks and 1(3.3%) between 2 and 3 weeks. 9. The fractures in middle third of the shaft of the tibia treated with intramedullary nailing revea.ed the shortest healing time(average 13 weeks). 10. Complications such as delayed union, infection and disabled joint shiffness were encountered mainly in cases with severe soft tissue injuries.

Clinical Study of the Tibial shaft Fracture / 대한정형외과학회잡지

A clinical study of the Tibial Shaft fracture was made on 128 patients, who had been treated at the Department of Orthopedic Surgery, College of Medicine Kyung Hee Universlty from the October, 1971 to May, 1979. The results were as follows: 1. The rate of fracture union was accelerated under the age of 20 years but it was slow in aged group. 2. The poor prognosis of fracture union was shown in junction between middle and distal 1/3 than others. 3. The better prognosis of the fracture type was shown in oblique and spiral fracture than in the comminuted and segmental. 4. There was prolonged rate of union in case of associated fibula fracture. 5. The frequency of delayed and nonunion were more prevalent in open fracture. 6. Among the open comminuted tibial shaft fracture with skin and soft tissue loss, the good results was obtained by the Hoffmanns external skeletal fixation method.