Fracturas múltiples de la tibia: a propósito de un caso / Multiple fractures of the tibia: a case report

RESUMEN Fundamento: las fracturas múltiples son lesiones infrecuentes provocadas por mecanismos tanto únicos como combinados. En la actualidad su incidencia va en aumento debido a la complejidad y alta energía de los traumatismos. Objetivo: conocer un paciente con fractura múltiple de la tibia y la conducta tomada con este enfermo, que logró recuperar su capacidad funcional. Presentación del caso: paciente femenina de 60 años de edad, blanca, sin antecedentes mórbidos de salud, la cual sufre accidente al bajarse de un carruaje y es traída al servicio de urgencias de Ortopedia y Traumatología por presentar dolor a nivel de la pierna izquierda, que le impedía la marcha y los movimientos de la zona afectada. Al examen radiográfico se detectó fractura de la meseta tibial lateral y oblicua larga de la tibia que necesitó de intervención quirúrgica mediante la colocación de placa subcutánea a través de dos incisiones. Conclusiones: las fracturas múltiples son lesiones infrecuentes, más aún cuando se presentan en el mismo hueso por mecanismos de producción distintos. Al ser enfermedades atípicas, la conducta es basada en las características propias de las lesiones asociadas.

ABSTRACT Background: multiple fractures are uncommon injuries caused by isolated or combined mechanisms. Nowadays, its incidence grows up due to high energy trauma and complex lesions. Objective: to show a patient with a multiple fracture of the tibia, the used treatment modality to ensure functional recovery. Case report: a 60 years old white female patient without morbid antecedents, was taken to the emergency services of Orthopedic and Traumatology complaining of pain, swelling and limitation of movement of the left leg after falling from a carriage. X-rays showed a tibia plateau fracture associated to oblique diaphyseal tibia fracture. Surgical treatment was needed to reduce and fix fractures; a subcutaneous plate was used by two small incisions. Conclusions: multiple fractures are unusual lesions, even more when the same bone is affected due to different mechanisms. As being atypical lesions treatment is based on fractures features.

Clinical Features and Treatment Outcomes of Acute Multiple Thoracic and Lumbar Spinal Fractures: A Comparison of Continuous and Noncontinuous Fractures

OBJECTIVE: The treatment of multiple thoracolumbar spine fractures according to fracture continuity has rarely been reported. Herein we evaluate the clinical features and outcomes of multiple thoracolumbar fractures depending on continuous or noncontinuous status.METHODS: From January 2010 to January 2016, 48 patients with acute thoracic and lumbar multiple fractures who underwent posterior fusion surgery were evaluated. Patients were divided into two groups (group A : continuous; group B : noncontinuous). We investigated the causes of the injuries, the locations of the injuries, the range of fusion levels, and the functional outcomes based on the patients’ general characteristics.RESULTS: A total of 48 patients were enrolled (group A : 25 patients; group B : 23 patients). Both groups had similar pre-surgical clinical and radiologic features. The fusion level included three segments (group A : 4; group B : 5) or four segments (group A : 19; group B : 5). Group B required more instrumented segments than did group A. Group A scored 23.5 and group B scored 33.4 on the Korean Oswestry Disability Index (KODI) at the time of last follow-up. In both groups, longer fusion was associated with worse KODI score.CONCLUSION: In this study, due to the assumption of similar initial clinical and radiologic features in both group, the mechanism of multiple fractures is presumed to be the same between continuous and noncontinuous fractures. The noncontinuous fracture group had worse KODI scores in long-term follow-up, thought to be due to long fusion level. Therefore, we recommend minimizing the number of segments that are fused in multiple thoracolumbar and lumbar fractures when decompression is not necessary.

Clinical Features and Treatment Outcomes of Acute Multiple Thoracic and Lumbar Spinal Fractures: A Comparison of Continuous and Noncontinuous Fractures

OBJECTIVE: The treatment of multiple thoracolumbar spine fractures according to fracture continuity has rarely been reported. Herein we evaluate the clinical features and outcomes of multiple thoracolumbar fractures depending on continuous or noncontinuous status. METHODS: From January 2010 to January 2016, 48 patients with acute thoracic and lumbar multiple fractures who underwent posterior fusion surgery were evaluated. Patients were divided into two groups (group A : continuous; group B : noncontinuous). We investigated the causes of the injuries, the locations of the injuries, the range of fusion levels, and the functional outcomes based on the patients’ general characteristics. RESULTS: A total of 48 patients were enrolled (group A : 25 patients; group B : 23 patients). Both groups had similar pre-surgical clinical and radiologic features. The fusion level included three segments (group A : 4; group B : 5) or four segments (group A : 19; group B : 5). Group B required more instrumented segments than did group A. Group A scored 23.5 and group B scored 33.4 on the Korean Oswestry Disability Index (KODI) at the time of last follow-up. In both groups, longer fusion was associated with worse KODI score. CONCLUSION: In this study, due to the assumption of similar initial clinical and radiologic features in both group, the mechanism of multiple fractures is presumed to be the same between continuous and noncontinuous fractures. The noncontinuous fracture group had worse KODI scores in long-term follow-up, thought to be due to long fusion level. Therefore, we recommend minimizing the number of segments that are fused in multiple thoracolumbar and lumbar fractures when decompression is not necessary.

Approach for naso-orbito-ethmoidal fracture

The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.

Bilateral Talus and Navicular Fractures accompanied with Unilateral Calcaneal Fracture: A Case Report

@#An 18-year old male patient, with a history of paragliding accident, sustaining a coronal shear fracture of the body of the talus, an anterior process fracture of the calcaneus extending to the calcaneocuboid joint and a nondisplaced navicular body fracture at the right foot and a displaced fracture of the navicular body accompanied with posteromedial process fracture of the talus at the left side was referred to our emergency clinic. For the right foot, the coronal plane fracture of the talar body was anatomically reduced and fixed with screws. For the left foot, screw fixation was performed through the lateral aspect to fix the large posteromedial fragment. Small bone fragments were removed from the left navicular fracture, and the main fragments were also fixed with screw. The talo-navicular joint was stabilised with a Kirschner wire. At 36 months follow-up, bilateral foot and ankle functions were satisfactory, Maryland scores of the right and left foot were 85 (good) and 90 (excellent), respectively, and the patient regained his full activity level by the 5th month postoperatively. With reference to the number and types of fractures in this one patient, we present a standard protocol for treatment of isolated talus, navicular and calcaneal fractures presenting together in a single foot injury.