Fracturas de tobillo en adultos mayores / Ankle Fracture Treatment in Aged Adults

RESUMEN Introducción: El tratamiento de las fracturas del tobillo tiene importancia en la recuperación de la movilidad e independencia del paciente geriátrico. Objetivo: Evaluar el resultado obtenido al transcurrir un año del tratamiento quirúrgico mediante reducción y fijación de las fracturas inestables en pacientes mayores de 65 años. Métodos: Estudio descriptivo y prospectivo; pacientes mayores de 65 años, atendidos entre enero de 2017 y diciembre de 2018 por fractura de tobillo desplazada, en el Hospital Universitario General Calixto García Íñiguez y el Centro de Investigaciones en Longevidad, Envejecimiento y Salud, que fueron evaluados un año después. Resultados: De un total de 31 pacientes, 6 hombres y 25 mujeres con una edad media de 73,4 ± 3,5 años, 12 presentaban deterioro cognitivo, 18 llevaban terapia anticoagulante y 14 ingerían más de cuatro medicamentos diariamente. Predominaron los grupos con 3 y 4 puntos del índice de Charlson, la mayoría se ubicó en ASA III de riesgo anestésico y fracturas Dannis-Weber tipo C, 29 fracturas fueron cerradas. Las complicaciones fueron escasas; 27 de 31 pacientes se ubicaron como excelente o bueno según la escala AOFAS; 3 ± 2 en la escala visual de dolor; 86 por ciento podían realizar sus actividades de la vida diaria, Conclusiones: El resultado del tratamiento quirúrgico de las fracturas de tobillo en mayores de 65 años fue bueno y con baja incidencia de complicaciones que pueden relacionarse con condiciones mórbidas previas(AU)

ABSTRACT Introduction: The ankle fracture treatment is important in the recovery of mobility and independence of geriatric patients. Objective: To evaluate the results after one year of surgical treatment by reduction and fixation of unstable fractures in patients older than 65 years. Methods: A descriptive and prospective study was carried out in patients older than 65 years, treated from January 2017 to December 2018 due to displaced ankle fracture, at General Calixto García Íñiguez University Hospital and the Research Center for Health, Longevity and Aging. These patients were assessed a year later. Results: Out of a total of 31 patients, 6 men and 25 women with a mean age of 73.4 ± 3.5 years, 12 had cognitive impairment, 18 were on anticoagulant therapy and 14 were taking more than four medications daily. Groups with 3 and 4 points of Charlson index predominated, the majority were located in ASA III of anesthetic risk and Dannis-Weber type C fractures, 29 fractures were closed. Complications were rare and 27 out of 31 patients ranked as excellent or good according to the AOFAS scale, 3 ± 2 on the visual pain scale, 86 percent of performing activities of their daily life. Conclusions: The result of the surgical treatment of ankle fractures in people older than 65 years was good and with a low incidence of complications that may be related to previous morbid conditions(AU)

The Result of Open Reduction and Fixation in Sternal Fracture with Displacement

PURPOSE: Sternal fractures after blunt thoracic trauma can cause significant pain and disability. They are relatively uncommon as a result of direct trauma to the sternum and open reduction is reserved for those with debilitating pain and fracture displacement. We reviewed consecutive 11 cases of open reduction and fixation of sternum and tried to find standard approach to the traumatic sternal fractures with severe displacement. METHODS: From December 2008 to August 2010, the medical records of 11 patients who underwent surgical reduction and fixation of sternum for sternal fractures with severe displacement were reviewed. We investigated patients' characteristics, chest trauma, associated other injuries, type of open reduction and fixation, combined operations, preoerative ventilator support and postoperative complications. RESULTS: The mean patient age was 59.3years (range, 41~79). The group comprised 6 male and 5 female subjects. Among 11 patients who underwent open reduction and fixation for sternal fracture with severe displacement, 6 cases had isolated sternal fractures and the other 5 patients had associated other injuries. Sternal fractures were caused by car accidents (9/11, 81.8%), falling down (1/11, 9.1%) and direct blunt trauma to the sternum (1/11, 9.1%), respectively. 3 of the 7 patients (42.9%) who underwent sternal plating with longitudinal plates showed loosening of fixation. Otherwise, none of the 4 patients who underwent surgical fixation using T-shaped plate had stable alignment of the fracture. CONCLUSION: Sternal fractures with severe displacement need to be repaired to prevent chronic pain, instability of the anterior chest wall, deformity of the sternum, and even kyphosis. In the present study, a T-shaped plate with a compression-tension mechanism constitutes the treatment of choice for displaced sternal fractures.

Reduction and Fixation of Spondylolisthesis by Using Pedicle Screw

There were many methods to treat spondylolisthesis since the past but completely satisfiable method was not developed until now. Recently, many spinal instruments were introduced and used worldwidely to treat spondylolisthesis. The author reports the experience of nine patients of transpedicular screw instrumentation of obtain reduction and fixation of the spondylolisthesis. Follow-up period was between 7 to 33 months after operation with average 19 months. The result was as follows: The age of the patients was 46 years in average ranging from 29 to 61 years. 2) Types of spondylolisthesis were isthmic type in 6 cases and degenerative type in 3 cases. The level of lesion were L4-5 in 5 cases. L5-S1 in 3 cases and L3-4 in 1 case. 3) Preoperative clinical feature include low back pain(100%), sensory disturbance(78%), radiating pain(67%), neurologic claudication(56%). 4) The amount of displacement measured by Boxall was 22.6% preoperatively to 7.3% postoperatively and the amount of angle by Meschan was from 12.7 degree preoperatively to 4 degree postoperatively. 5) Postoperative complications were urinary tract infection(3 cases), screw loosening(1 case), superficial wound infection(1 case), deep wound infection(1 case), and meralgia paresthetica(1 case). 6) The overall result was satisfactory except 1 case due to screw loosening, and satisfiable bony fusion was obtained except 1 case.