Cadera flotante: análisis comparativo de resultados y lesiones asociadas / Floating hip: comparative analysis of outcomes and associated injuries

Objetivo: Describir los tiempos de internación, cirugía y rehabilitación de una serie de pacientes con cadera flotante. El objetivo secundario fue comparar los resultados obtenidos en función de la reinserción laboral con los de pacientes que sufrieron fracturas de pelvis o acetábulo sin fractura femoral asociada. Materiales y Métodos: Estudio descriptivo, retrospectivo y multicéntrico de pacientes con trauma de pelvis y acetábulo de alta energía, divididos en dos grupos de estudio según la presencia de fractura de fémur asociada homolateral (cadera flotante) para su comparación, durante el período comprendido entre enero de 2014 y marzo de 2019. Resultados: Se incluyó a 102 pacientes con trauma de pelvis o acetábulo agrupados en 2 poblaciones según la presencia de cadera flotante (cadera flotante 23; pelvis/acetábulo 79). Las medianas de días de internación [cadera flotante 15,5 (rango 4-193); pelvis/acetábulo 7 (rango 3-31); p = 0,0001] y de la cantidad de cirugías por paciente [cadera flotante 5 (rango 3-8); pelvis/acetábulo 2 (rango 1-4); p = 0,0001] fueron mayores en los pacientes con cadera flotante. Además, la incapacidad laboral temporaria fue más alta (p = 0,00012), sin diferencias significativas en la tasa de recalificación laboral (p = 0,11). Conclusión: La asociación de la lesión cadera flotante aumentó significativamente el tiempo de internación, los procedimientos quirúrgicos necesarios y el tiempo de recuperación según la incapacidad laboral temporaria en pacientes con trauma de pelvis o acetábulo. Nivel de Evidencia: III

Objective: We aim to describe the lengths of hospitalization, surgery, and rehabilitation of a series of patients with floating hip. As a secondary objective, to compare the outcomes obtained in terms of return to work in patients who had suffered fractures of the pelvis or acetabulum without an associated femoral fracture. Materials and Methods: Descriptive, retrospective, and multicenter study of patients with high-energy trauma to the pelvis and acetabulum divided into two study populations according to the presence of associated ipsilateral femur fracture (floating hip) for comparison, during the period January 2014 - March 2019. Results: 102 patients with pelvis and/or acetabulum trauma were included, grouped into 2 populations according to the presence of a float-ing hip (Floating hip: 23 patients; Pelvis/acetabulum: 79 patients). The median days of hospitalization [floating hip: median = 15.5 (range = 4-193); pelvis/acetabulum: 7 (3-31); p = 0.0001] and the number of surgeries per patient [FH: median = 5 (range = 3-8); pelvis/acetabulum: 2 (1-4); p = 0.0001] were higher in patients with floating hip. Additionally, temporary work disability was higher (p = 0.00012), with no significant differences in the rate of job retraining (p = 0.11). Conclusion: Floating hip significantly increased the length of hospitalization, necessary surgical procedures, and recovery times according to temporary work disability in patients with trauma to the pelvis and/or acetabulum. Level of Evidence: III

Tratamiento de las fracturas de pelvis APCII. Variables que afectan el resultado final / Treatment of APCII pelvic fractures. Variables that affect the outcomes

Introducción: Las fracturas de pelvis se asocian frecuentemente a un trauma de alta energía. La tasa de mortalidad varía del 5% al 46%. El objetivo de este estudio fue explorar si las variables analizadas se asociaron con el resultado final del tratamiento de las fracturas de pelvis APCII (AO/OTA: 61B2.3). materiales y métodos:Se evaluó a 23 de 79 pacientes luego de aplicarles los criterios de selección. Las fracturas fueron clasificadas, según Young y Burgess, en una radiografía panorámica de pelvis, de entrada y de salida, y tomografía computarizada. Se evaluó el resultado clínico según la escala funcional de Majeed. Las variables evaluadas fueron: tratamiento en la urgencia, lesiones asociadas, días de espera hasta la cirugía, fijación utilizada, reducción posquirúrgica inmediata, infección del sitio quirúrgico. Resultados: No se halló una diferencia estadísticamente significativa entre el tipo de tratamiento realizado en la urgencia, las lesiones asociadas, los días de espera hasta la cirugía y el tipo de fijación, con el resultado final a largo plazo. Los pacientes que tuvieron una reducción posoperatoria inmediata <1 cm y los que no sufrieron una infección del sitio quirúrgico obtuvieron mejores resultados funcionales, de manera estadísticamente significativa. Conclusión: Las variables calidad de la reducción posquirúrgica inmediata e infección del sitio quirúrgico en pacientes con fractura de pelvis APCII se asocian directamente con los resultados funcional y clínico a largo plazo. Nivel de Evidencia: IV

Introduction: Pelvic fractures are frequently associated with high-energy trauma. Mortality varies from 5%-46%. In these patients, the factors related to poor outcomes are still controversial. Purpose: To explore if the variables analyzed were related with the long term outcomes of the treatment of an anterior-posterior compression type II pelvic fracture (APCII; AO/OTA: 61B2.3). Materials and methods: 79 cases were analyzed and 23 patients remained for evaluation according to inclusion and exclusion criteria. Pelvic radiographs (anteroposterior, inlet and outlet) and CT-scans were evaluated. The Young & Burgess classification was used to define the fracture pattern and the Majeed Score for clinical outcomes. Variables analyzed: emergency treatment, associated injuries, delay for definitive fixation, method of fixation, quality of immediate postoperative reduction and surgical site infection. Results: We did not find any statistical relation between the type of emergency treatment, associated injuries, delay for definitive fixation, method of fixation, and the long-term clinical outcome. Patients who had an immediate postoperative reduction of less than 1 cm and those who did not have a surgical site infection obtained better functional outcomes (statistically significant). Conclusion: The quality variables of immediate postoperative reduction and surgical site infection in patients with APCII pelvic fracture had a direct relation with long-term functional and clinical outcomes. Level of Evidence: IV

Lesiones traumáticas de pelvis / Traumatic Pelvic Injuries

Introducción: El tratamiento del traumatismo pélvico es uno de los más complejos en la atención al trauma. La tasa de mortalidad es alta. Objetivo: Examinar los criterios actuales acerca de las lesiones traumáticas de pelvis y las posibles estrategias existentes para su tratamiento. Métodos: Se realizó una búsqueda de artículos publicados en la base de datos PubMed entre los años 2011-2020. Se excluyeron trabajos porque estaban duplicados o los datos de origen eran insuficientes. Resultados: Se analizaron los mecanismos de las lesiones, su fisiopatología, principios y pilares de la atención médica y recomendaciones para el uso de herramientas de diagnóstico en el trauma, entre otras. Las complicaciones se presentan en pacientes con trauma pélvico abierto que pueden tener secuelas crónicas como incontinencia fecal y urinaria, impotencia, dispareunia, discapacidad residual en las funciones físicas, absceso perineal y pélvico, dolor crónico y complicaciones vasculares como embolia o trombosis. La mayoría de las muertes (44,7 por ciento) ocurren el día del trauma. Un enfoque multidisciplinario en la atención a las lesiones traumáticas de pelvis, contribuye a una mejora en el rendimiento y en los resultados de los pacientes. Conclusiones: Las lesiones traumáticas del anillo pélvico son consecuencia de accidentes de alta energía y constituyen una de las lesiones de mayor gravedad a las que está expuesto el ser humano. La posibilidad de inestabilidad mecánica asociada a alteraciones hemodinámicas obliga a la adopción de protocolos de actuación inmediata, para evitar la elevada mortalidad que se asocia a estas lesiones(AU)

Introduction: The treatment of pelvic trauma is one of the most complex in trauma care. Mortality rate is high. Objective: To examine the current criteria about traumatic pelvic injuries and the possible existing strategies for their treatment. Methods: A search was carried out for articles published in PubMed database from 2011 to 2020. Works that were duplicated or had insufficient source data were excluded. Results: We analyzed injury mechanisms, pathophysiology, classifications, principles and pillars of medical care, and recommendations for the use of diagnostic tools in pelvic trauma, among others. Complications with functional limitations occur in patients with open pelvic trauma who may have chronic sequelae such as fecal and urinary incontinence, impotence, dyspareunia, residual disability in physical functions, perineal and pelvic abscess, chronic pain, and vascular complications such as embolism or thrombosis. Most deaths (44.7 percent) occur on the day of the trauma. A multidisciplinary approach to treating traumatic pelvic injuries contributes to improved performance and patient outcomes. Conclusions: Traumatic injuries to the pelvic ring are the consequence of high-energy accidents and constitute one of the most serious injuries to which humans are exposed. The possibility of mechanical instability associated with hemodynamic alterations requires the adoption of protocols for immediate action, to avoid the high mortality associated with these injuries(AU)

Comportamiento de las lesiones traumáticas del anillo pélvico / Behavior of the traumatic lesions of the pelvic ring

RESUMEN Introducción: las lesiones traumáticas del anillo pélvico constituyen un desafío para los cirujanos ortopedistas por su alta morbimortalidad y las consecuencias que de ellas derivan. Objetivo: describir el comportamiento de variables demográficas y clínicas en los pacientes atendidos por lesiones traumáticas del anillo pélvico en el Hospital Universitario "Comandante Faustino Pérez Hernández" de Matanzas Materiales y Métodos: se realizó un estudio longitudinal prospectivo descriptivo de los pacientes ingresados en el servicio de ortopedia y traumatología por presentar lesiones traumáticas del anillo pélvico en dicho centro en el período comprendido de enero del 2009 a enero del 2019. Se seleccionaron variables demográficas y clínicas Resultados: el estudio incluyó a 48 pacientes. Predominó el sexo masculino 29 pacientes para un 60,4%, la edad de mayor frecuencia estuvo entre 31 a 50 años. Predominaron las fracturas tipo B con 24 pacientes para 50% y el tratamiento quirúrgico con 27 pacientes para 56,2%, dentro de las complicaciones inmediatas predominó el shock hipovolémico en 14 pacientes para 29.1%, en las tardías la sepsis superficial con 6 pacientes, 12.5%. Conclusiones: las lesiones traumáticas del anillo pélvico siempre deben ser tratadas como lesiones graves, por lo que deben ser valoradas de forma multidisciplinaria y apegados a protocolos de actuación, y con especialistas de alta experiencia profesional (AU).

SUMMARY Introduction: pelvic ring traumatic lesions are a challenge for orthopedic surgeons due to their high morbi-mortality and the consequences derived from them. Objective: to describe the behavior of clinical and demographic variables in patients cared due to pelvic ring traumatic lesions in the University Hospital "Comandante Faustino Perez Hernandez" of Matanzas. Method: a descriptive, prospective, longitudinal research was carried out in patients admitted to the Orthopedics and Traumatology Service of the before-named hospital for presenting pelvic ring traumatic lesions in the period from January 2009 until January 2019. Clinical and demographic variables were chosen. Results: the study included 48 patients. Male sex predominated, 29 patients, 60.4 %; the most frequent age ranged between 31 and 50 years. Type B fractures predominated with 24 patients and 50 %; surgical treatment also predominated with 27 patients and 56.2 %; among the immediate complications, hypovolemic shock predominated in 14 patients for 29.1 %; among the late ones, surface sepsis predominated with 6 patients, 12.5 %. Conclusions: pelvic ring traumatic lesions should be always treated like serious lesions; therefore they should be evaluated in a multidiscipline way, adhered to the intervention protocols, and by highly experienced professionals (AU).

Flegmasia cerúlea dolens posquirúrgica inmediata en el tratamiento de una fractura de pelvis: Reporte de un caso / Immediate phlegmasia cerulea dolens in the postoperative treatment of pelvic fracture. Case report

La flegmasia cerúlea dolens es una presentación poco habitual y grave de una trombosis venosa profunda producida por una obstrucción al flujo venoso de salida de la extremidad inferior, que conlleva un alto grado de morbilidad. Este cuadro no ha sido comunicado como complicación del tratamiento definitivo de una fractura de pelvis. Consideramos que una breve descripción del tema y la presentación de un caso pueden ser útiles para el cirujano ortopédico ante una situación similar. Nivel de Evidencia: IV

Phlegmasia cerulea dolens (PCD) is an unusual and serious presentation of deep venous thrombosis (DVT) caused by an obstruction to the venous outflow of the lower limb, which is associated with significant morbidity. To our knowledge, this complication has not yet been reported as a complication of the definitive treatment of a pelvic fracture. We believe that a brief description of the subject matter and the description of the case may be useful to Orthopedic surgeons in similar situations. Level of Evidence: IV

Protocolo de embolizacion arterial como parte del control de la hemorragia por fractura pélvica: serie de casos en un centro de referencia de trauma / Arterial embolization protocol as control of pelvic fracture hemorrhage: case series in a trauma reference center

Introducción Las fracturas pélvicas se asocian a sangrado arterial y/o venoso, ocasionando mortalidad elevada. El objetivo del estudio es diseñar, implementar y evaluar un protocolo para el tratamiento de fracturas pélvicas Materiales y métodos estudio prospectivo observacional, de pacientes con fractura pélvica que ingresaron a la clínica Medical. Variables: edad, sexo, arteria comprometida, lesión unilateral o bilateral, tipo de fractura pélvica (clasificación de Tile), indicación de la arteriografía, acceso uni o bilateral, éxito angiográfico, complicaciones del procedimiento, lesiones asociadas, mortalidad a 30 días, mecanismo de trauma, días de estancia en cuidado intensivo. Resultados 56 pacientes con fractura pélvica, 17 pacientes se llevaron a arteriografía pélvica por sospecha de sangrado, 14 pacientes tenían sangrado arterial, promedio de 36 años, las arterias más comúnmente lesionadas fueron la arteria hipogástrica, arteria sacra lateral y la arteria obturatriz. la mayoría de sangrados se asociaron a fracturas tipo C, las lesiones asociadas se encontraron en un 34% de casos, la indicación de la arteriografía fue inestabilidad hemodinámica al momento del ingreso, el control del sangrado se logró en el 86% de casos, la punción fue única en el 100% de casos, se requirió empaquetamiento pélvico 12% de casos. Discusión El trauma pélvico asociado a accidentes de motocicleta es común, el manejo multidisciplinario y la oportuna intervención del cirujano vascular es decisiva para el diagnóstico y tratamiento temprano de las lesiones vasculares pélvicas; la realización de un protocolo de manejo con un algoritmo de embolización mostró ser efectivo y seguro para el control del sangrado pélvico. Nivel de Evidencia: III

Background Pelvic fractures are frequently associated with arterial and / or venous bleeding, leading to high mortality (10 and 50%). Aim of study is to show our experience, based on an institutional protocol developed for the management of the patient with major pelvic trauma. Methods We conducted a prospective observational study for a 3 years period of time. The variables analyzed were: age, sex, artery involved, unilateral or bilateral lesion, type of pelvic fracture (Tile classification), indication of arteriography, unilateral or bilateral access, angiographic success, complications of the procedure, associated injuries, mortality at 30 days, trauma mechanism, days of stay in ICU and floor. Results We found 56 patients with pelvic fracture, 17 patients were taken to pelvic arteriography due to suspected bleeding, 14 patients had arterial bleeding, with an average age of 36 years, the arteries most commonly injured were the hypogastric artery, lateral sacral artery and the obturator artery, 50% of cases the bleeding was bilateral, the majority of bleeds were associated with type C fractures, associated lesions were found in 34% of cases, the indication of arteriography was hemodynamic instability at the time of admission, control of bleeding was achieved in 86% of cases (n: 15), the puncture was unique in 100% of cases (n: N: 14), pelvic packing was required in 2 patients (12%) Discussion Pelvic embolization for pelvic fracture is a safe and feasible procedure. A multidisciplinary approach and a high suspicion of pelvic arterial injury must be always in mind. Mortality in our trial was very low comparative with previous reports. Evidence Level: III

Lesiones ortopédicas asociadas a fractura de cadera / Orthopedic injuries associated with hip fracture

Resumen: Introducción: La información que demuestra lesiones ortopédicas al mismo tiempo que fractura de cadera es escasa. Nuestro objetivo es determinar si existe relación entre el tipo de lesiones ortopédicas asociadas en pacientes con fractura de cadera y sus variables demográficas, el trazo de fractura y el mecanismo de lesión. Material y métodos: Diseño transversal, descriptivo y retrospectivo. Se revisaron los casos con fracturas de cadera y que tuvieran alguna lesión ortopédica asociada del 01 de Noviembre de 2012 al 31 de Octubre de 2016. Resultados: Se incluyeron 103 pacientes, de los cuales 61.2% fueron mujeres; media de edad 64 ± 21 años. Los mayores de 65 años representaron 59% (n = 61/103), 61.2% tuvieron fractura pertrocantérica (AO/OTA tipo 31-A1 a A3) (n = 63), el resto de cuello (AO/OTA tipo 31-B1 a B3) (n = 40); 21.4% tuvieron dos o más lesiones asociadas a fractura de cadera (n = 22). Las lesiones asociadas en mujeres fueron las de radio distal, mientras que en hombres fueron las del acetábulo, pelvis u otras. No hubo diferencias en cuanto a sexo, edad, mecanismo de lesión o número de lesiones asociadas dependiendo de la clasificación AO de la fractura de cadera. Discusión: Existe un número considerable de lesiones asociadas en fracturas de cadera, independientemente de la edad, el sexo o localización.

Abstract: Introduction: There Is little information showing orthopedic injuries at the same time as a hip fracture. Our objective is to determine if there is association between the type of orthopedic injuries associated in patients with hip fractures and their demographic variables, fracture pattern and mechanism of injury. Material and methods: Transversal design, descriptive and retrospective. We reviewed cases with hip fractures and had an associated orthopedic lesion from November 01, 2012 to October 31, 2016. Results: We included 103 patients, of whom women 61.2%; average age 64 ± 21 years. Over 65 years old accounted for 59% (n = 61/103), 61.2% had Perthrocanteric fracture (AO/OTA type 31-A1 to A3) (n = 63), the rest of the neck (AO/OTA type 31-B1 to B3) (n = 40); 21.4% had two or more injuries associated with hip fracture (n = 22). The lesions associated with women were those of distal radio, while in males were those of the acetabulum, pelvis or others. There were No differences in sex, age, injury mechanism or number of associated injuries depending on the AO classification of the hip fracture. Discussion: There is a significant number of injuries associated with hip fractures regardless of age, sex, or location.

Mechanical analysis of transversal iliac fracture stabilization using dynamic compression plate or screws and PMM in polyurethane bone model / Avaliação mecânica de estabilização de fratura ilíaca transversa com placa de compressão dinâmica ou polimetilmecatrilato associado à parafusos utilizando modelo de osso sintético de poliuretano

Pelvic fractures correspond to 20 to 30 % of the fractures observed in dogs. Complete fractures, especially with bone axis deviation should be surgically treated. The mechanical study of surgical techniques is of utmost importance to assess the best way of treating these injuries. This study compared, biomechanically, the use of a dynamic compression plate (DCP) and screws (group 1) or screws and polymethylmethacrylate (PMMA) (group 2) to stabilize an iliac fracture using a static test. Sixteen canine synthetic hemi-pelvises (test specimens) with a transverse iliac osteotomy were used. After fixation with implants, a load was applied to the acetabulum until failure. Group 1 maximal compressive load was 133.9±18.60 N, displacement at yield 21.10±3.59mm and stiffness 125.22±12.25N/mm. Group 2 maximal compressive load was 183.50±27.38N, displacement at yield 16.66±5.42mm and stiffness 215.68±33.34N/mm. The stabilization with polymethylmethacrylate was stronger than dynamic compression plate since it resisted a greater load in all test specimens.(AU)

As fraturas da pelve são frequentes em cães, correspondendo a 20-30% das fraturas encontradas na espécie. A grande maioria delas é tratada cirurgicamente, principalmente aquelas que apresentam desvio ósseo. O estudo mecânico das técnicas cirúrgicas é de extrema importância para avaliação da melhor maneira de tratamento destas lesões. O objetivo deste estudo foi comparar, do ponto de vista biomecânico, a fixação das fraturas do ílio utilizando uma placa de compressão dinâmica ou parafusos associados ao polimetilmetacrilato, por meio de um teste estático. Foram utilizadas 16 hemipelves caninas de origem sintética, nas quais uma osteotomia transversa foi realizada no corpo do ílio. As fixações foram divididas em dois grupos: fixação com placa de compressão dinâmica e parafusos (grupo1) ou parafusos associados ao polimetilmetacrilato (grupo 2). Posteriormente à fixação dos implantes foi aplicada uma carga no acetábulo de cada corpo de prova até a falha. O grupo 2 apresentou força máxima de aplicação de carga a média de 133.9±18.60N, deflexão 21.10±3.59mm e rigidez 125.22±12.25N/mm. O grupo 2 apresentou força máxima de aplicação de carga a média de 183.50±27.38N, deflexão 16.66±5.42mm e rigidez 215.68±33.34N/mm. A estabilização com o polimetilmetacrilato mostrou ser mais resistente, pois resistiu a uma maior quantidade de carga em relação à placa de compressão dinâmica, em todos os corpos de prova.(AU)

Does MRI help in the pre - operative evaluation of pelvic fracture urethral distraction defect? - a pilot study

ABSTRACT Objectives To study the usefulness of MRI in preoperative evaluation of PFUDD. Can MRI provide additional information on urethral distraction defect (UDD) and cause of erectile dysfunction (ED)? Materials and Methods In this prospective study, consecutive male patients presenting with PFUDD were included from Feb 2011 till Dec 2012. Those with traumatic spinal cord injury and pre-existing ED were excluded. Patients were assessed using IIEF questionnaire, retrograde urethrogram and micturating cystourethrogram (RGU+MCU) and MRI pelvis. Primary end point was erectile function and secondary end point was surgical outcome. Results Twenty patients were included in this study. Fourteen patients (70%) were ≤40years; fifteen patients (75%) had ED, seven patients (35%) had severe ED. MRI findings associated with ED were longer median UDD (23mm vs. 15mm, p=0.07), cavernosal injury (100%, p=0.53), rectal injury (100%, p=0.53), retropubic scarring (60%, p=0.62) and prostatic displacement (60%, p=0.99). Twelve patients (60%) had a good surgical outcome, five (25%) had an acceptable outcome, three (15%) had a poor outcome. Poor surgical outcome was associated with rectal injury (66.7%, p=0.08), cavernosal injury (25%, p=0.19), retropubic scarring (18.1%, p=0.99) and prostatic displacement (16.7%, p=0.99). Five patients with normal erections had good surgical outcome. Three patients with ED had poor outcome (20%, p=0.20). Conclusions MRI did not offer significant advantage over MCU in the subgroup of men with normal erections. Cavernosal injury noted on MRI strongly correlated with ED. Role of MRI may be limited to the subgroup with ED or an inconclusive MCU.

Fracturas osteoporóticas de ramas pélvicas: A Benign Injury? / Fractures ostéoporotiques des branches pubiennes, est-ce qu'elles sont bénignes? / Osteoporotic Pubic Rami Fracture

Objetivo: analizar los pacientes tratados por fractura osteoporótica de ramas pélvicas en nuestro hospital. Métodos: se analizan retrospectivamente pacientes con fracturas de ramas pélvicas atendidos en el Servicio de Urgencias de nuestro hospital. Los parámetros examinados incluyen datos demográficos, diagnósticos, lesiones asociadas, comorbilidades, autonomía previa, complicaciones y mortalidad al año. Resultados: 60 pacientes (51 mujeres) con una edad media de 83,5 años (rango, 65,1-99) presentaron fractura osteoporótica de ramas pélvicas; 6 pacientes presentaban antecedentes de fractura de ramas pélvicas y 23 de fractura osteoporótica de otra localización. En 27 casos se asociaban a lesiones en otras localizaciones de la pelvis, 3 pacientes asociaban fracturas extrapélvicas y 6 traumatismos craneoencefálicos; 41 pacientes experimentaron complicaciones de algún tipo. Se requirió ingreso hospitalario en 8 casos, con una estancia media de 18 días. La mortalidad al año fue de 13,3 por ciento. Conclusiones: las fracturas osteoporóticas de ramas pélvicas afectan predominantemente a mujeres con numerosas comorbilidades. Muchas son las complicaciones descritas en estos pacientes con una mortalidad anual elevada. Es recomendable un adecuado tratamiento analgésico que permita la movilización precoz del paciente tras descartar lesiones asociadas en la pelvis(AU)

Objective: we analysed patients treated for osteoporotic rami fractures in our hospital. Methods: the records of patients were examined presenting to the emergency department with osteoporotic low-impact rami fractures. Demographic, previously ambulatory ability, diagnosis, associated injuries; comorbidity, complications, and 1-year mortality were described. Results: 60 patients (51 women) with mean age of 83,5 (range, 65,1-99) years had osteoporotic rami fracture. Six patients had previous rami fracture and 23 a osteoporotic fracture. Twenty-seven patients had other pelvic fracture associated. Three patients had other extra pelvic fracture and six had crane encephalic trauma. Forty-one patients had some kind of complication at follow up. Eight patients (13, 3 percent) were admitted to hospital with median length of stay in the hospital of 18 days. Eight (13, 3 percent) patients died within 1 year of injury. Conclusions: low-impact rami fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of complications is described in these fractures with high annual mortality. Early rehabilitation therapy with adequate analgesic therapy is recommended(AU)

Objectif: l'objectif de cette étude est d'analyser les patients traités à cause de fractures ostéoporotiques des branches pubiennes à l'hôpital universitaire Miguel Servet, hôpital de référence du secteur 2 à Zaragoza (Espagne). Méthodes: une étude rétrospective de patients atteints de fractures des branches pubiennes, et soignés au service d'urgences de cet hôpital, a été réalisée. On a examiné des paramètres, tels que données démographiques, diagnostics, lésions associées, comorbidités, autonomie préalable, complications, et taux de mortalité par an. Résultats: soixante patients (51 femmes), dont l'âge moyen a été 83,5 ans (rang 65,1-99), souffraient de fractures ostéoporotiques des branches pubiennes ; 6 patients avaient une histoire de fractures des branches pubiennes, et 23 étaient atteints de fractures ostéoporotiques ayant une autre localisation. Dans 27 cas, les fractures étaient liées à des lésions ayant d'autres localisations du bassin, 3 patients souffraient de fractures extra-pelviennes associées, et 6 des traumatismes cranio-encéphaliques ; 41 patients ont éprouvé des complications de quelque type. Huit patients ont été hospitalisés, ayant un séjour hospitalier de 18 jours en moyenne. Le taux de mortalité par an a été 13,3 pourcent. Conclusions: les fractures ostéoporotiques pelviennes touchent souvent les femmes souffrant plusieurs comorbidités. Un grand nombre de complications se produisent chez ces patients, provoquant ainsi un haut taux de mortalité par an. Après avoir écarté la possibilité de lésions associées au niveau du bassin, il est conseillé d'appliquer un traitement analgésique permettant la mobilité précoce du patient(AU)

Fractura de pelvis en niños / Pelvic fractures in children

A pesar de que las fracturas de pelvis son relativamente frecuentes en los adultos y se tiene una amplia disponibilidad de datos en la literatura, el ortopedista general debe tener conocimiento de la entidad en los niños para que cuando esta se presente elmanejo sea inmediato y eficaz. Las fracturas de la pelvis en los niños no son frecuentes; reportes actuales en la literatura hablan de 2,4 a 7,5% de todos los ingresos por traumatismos cerrados; otros reportes indican que se presentan en uno de cada 100.000 niños al año, con un 25% de mortalidad. Este tipo de fracturas en niños tienen una epidemiología, una incidencia y unmanejo distintos que en los adultos. Las principales diferencias están basadas en condiciones anatómicas que merecen un manejo distinto, ya que la pelvis absorbe mayor energía antes de fracturarse, lo que indica que cuando estamos frente a un niño con fractura de pelvis, se trata de un trauma mayor, multisistémico, que requiere apoyo multidisciplinario. En la literatura se encuentra gran cantidad de información para la población adulta a diferencia de la escasa para la población pediátrica...(AU)

Although pelvic fractures are relatively common in adults, and have been widely reported in the literature, the general orthopaedic surgeon should have knowledge of these fractures in children, in order for them to be able to manage them immediately and effectively. Pelvic fractures are uncommon in children. Current reports in the literature estimate that they account for 2.4 to 7.5% of all admissions for closed injuries. Other reports indicate that they are presented in one per 100,000 children per year, with a mortality of 25%. These types of fractures in children have an epidemiology, incidence, and management different to that of adults. The main differences are based on anatomical conditions that require a particular management, since the pelvis absorbs more energy before fracturing. This means that when faced with a child with a pelvic fracture, it is treated as a major multisystemic trauma that requires multidisciplinary support. A large amount of information on the adult population can be found in the literature, whereas it is limited in the case of paediatrics...(AU)

Stoppa Approach for Anterior Plate Fixation in Unstable Pelvic Ring Injury

BACKGROUND: The Stoppa (intrapelvic) approach has been introduced for the treatment of pelvic-acetabular fractures; it allows easy exposure of the pelvic brim, where the bone quality is optimal for screw fixation. The purpose of our study was to investigate the surgical outcomes of unstable pelvic ring injuries treated using the Stoppa approach for stable anterior ring fixation. METHODS: We analyzed 22 cases of unstable pelvic ring injury treated with plate fixation of the anterior ring with the Stoppa approach. We excluded cases of nondisplaced rami fracture, simple symphyseal diastasis, and parasymphyseal fractures, which can be easily treated with other techniques. The average age of the study patients was 41 years (range, 23 to 61 years). There were 10 males and 12 females. According to the Young and Burgess classification, there were 12 lateral compression, 4 anteroposterior compression, and 6 vertical shear fracture patterns. The fracture location on the anterior ring was near the iliopectineal eminence in all cases and exposure of the pelvic brim was required for plate fixation. All patients were placed in the supine position. For anterior plate fixation, all screws were applied to the anterior ramus distally and directed above the hip joint proximally. Radiologic outcomes were assessed by union time and quality of reduction by Matta method. The Merle d'Aubigne-Postel score was used to evaluate the functional results. RESULTS: The average radiologic follow-up period was 16 months (range, 10 to 51 months). All fractures united at an average of 3.5 months (range, 3 to 5 months). According to the Matta method, the quality of reduction was classified as follows: 16 anatomical (73%) and 6 nearly anatomical (27%) reductions. There were no cases of screw or implant loosening before bone healing. The functional results were classified as 7 excellent (32%), 12 good (55%), and 3 fair (13%) by the Merle d'Aubigne-Postel score. There were no wound complications, neurovascular injuries, or other complications related to the surgical approach. CONCLUSIONS: Stable anterior ring fixation placed via the Stoppa approach can result in excellent reduction and stable screw fixation with a low complication rate.

Utilização do filme de quitosana na reparação de tendão em coelhos / Use of the film of chitosan in the repair of tendons in rabbits

Com este trabalho objetivou-se avaliar o processo de cicatrização do tendão em coelhos, utilizando-se no grupo tratamento o filme de quitosana, por meio de uma análise clínico-cirúrgica e histológica. Foram utilizados 12 coelhos adultos, separados em grupo controle (GC) e grupo tratamento (GT), nos quais se realizou uma secção parcial do tendão gastrocnêmio de ambos os membros pélvicos. A avaliação clínica baseou-se na presença de reação inflamatória, infecção, dor e deiscência da sutura. Para a avaliação histológica, foi realizado um estudo comparativo do processo cicatricial por meio do tipo de células, da quantidade de tecido conjuntivo e da organização das fibras colágenas entre os grupos e os momentos. Nas feridas cirúrgicas, não foram observadas secreção, dor ou deiscência. Na histologia comparativa entre os grupos, o GC apresentou melhor processo cicatricial em relação ao GT, aos 60 dias. Aos 90 dias, no GT a cicatrização já esboça recuperação do tendão, com reorganização da celularidade e das fibras colágenas no tecido conjuntivo denso modelado. Concluiu-se que a quitosana estimula rápido crescimento celular, mas de forma desorganizada, e que a cicatrização completa só ocorre após 90 dias da sua implantação no tecido...

This work aimed to evaluate the process of tendon healing in rabbits, using the treatment group in chitosan film through a clinical, surgical and histological analysis. In the experiment, 12 adult rabbits were used, divided into control group (CG) and treatment group (TG), which were held in the partial section of the gastrocnemius tendon of both limbs. Clinical assessment was based on the presence of inflammation, infection, pain and suture dehiscence. For histological evaluation a comparative study of the healing process through the cell type, amount of connective tissue and collagen fiber organization was performed between groups and times. In surgical wounds no secretion, pain or dehiscence were observed. In the comparative histology between groups, the CG showed better healing compared to TG, at 60 days. On day 90 the TG already outlines tendon recovery with reorganization of cellularity and collagen fibers in the dense connective tissue modeled. It was concluded that chitosan stimulates faster cell growth, but it is haphazardly, and that complete healing occurs after 90 days of their implantation in tissue...

Tratamiento de las lesiones del anillo pélvico con un fijador interno anterior: estudio experimental: presentación de resultados preliminares / Internal anterior fixator for pelvic ring injury treatment: experimental study: preliminary results presentation

La fijación externa para el tratamiento de las lesiones del anillo pélvico es una técnica bien descrita y ampliamente utilizada para la estabilización inicial de estas lesiones y en ocasiones como tratamiento definitivo. Sin embargo, se ha asociado con complicaciones como infección en el trayecto de los pines, aflojamiento aséptico, pérdida de la reducción, lesión neurológica, entre otras. Presentamos un método novedoso de fijación interna anterior para el tratamiento de las lesiones del anillo pélvico mediante el uso de tornillos pediculares espinales supra acetabulares unidos a una barra subcutánea. Se realizó un estudio experimental de tipo prueba terapéutica, en una institución de nivel IV, donde se trataron 4 pacientes desde enero a junio de 2012. Tiempo de curación, calidad y pérdida de la reducción, incidencia de complicaciones y movilidad y confort del paciente, entre otras variables, fueron evaluadas. Presentamos los resultados preliminares del tratamiento de las fracturas del anillo pélvico con esta técnica(AU)

External fixation for the treatment of pelvic ring injuries is a well described and widely used technique for initial stabilization of these injuries and sometimos as definitive treatment. However, it has been associated with complications such as infection in the path of the pins, aseptic loosening, loss of reduction, neurologic injury, among others. We present a novel method of anterior internal fixation for the treatment of pelvic ring injuries by using pedicle screw spinal supra acetabular aboye a bar attached to the skin. An experimental study was made conducted in a Level IV institution, where 4 patients were treated from January to June 2012. Healing time, quality and loss of reduction, incidence of complications and patient mobility and comfort, among other variables, were evaluated. We present preliminary results of treatment of pelvic ring fractures with this technique(AU)

Trauma de extremidades: avaliação e manejo inicial das lesões graves e ameaçadoras da vida / Trauma of limbs: evaluation and initial management of severe, life-threatening injuries

Este artigo versará sobre as lesões musculoesqueléticas graves que podem trazer risco à vida, na importância do seu reconhecimento precoce e manejo inicial dessas lesões, que deverão ser realizadas pelo médico no departamento de emergência.

This article discusses the severe musculoskeletal injuries that can bring serious risk to life, the initial evaluation and management of these injuries that must be performed by the physician in the emergency department.

Estenose retal secundária à embolização arterial em trauma pélvico: relato de caso / Rectum stenosis secondary to arterial embolization for pelvic fracture: case report

A embolização de ramos da artéria ilíaca interna é uma técnica empregada no controle da hemorragia secundária à fratura pélvica. Apesar de largamente utilizada, são poucas as complicações relatadas relacionadas ao uso dessa técnica. Apresentamos um caso de estenose isquêmica de reto secundária à embolização da artéria sacral lateral para controle de hemorragia em uma paciente com fratura pélvica.

Transcatheter arterial embolization of the internal iliac artery branches is an accepted technique for the control of the hemorrhage due to pelvic fracture. Despite its widespread use, complications of the technique are rarely described. We reported a rectum ischemic stenosis following embolization of lateral sacral artery to control intractable hemorrhage from a pelvic fracture.

Lesiones deportivas en niños y adolescentes / Pediatric and adolescent sports injuries

El aumento en la actividad deportiva de niños y adolescentes ha derivado en un aumento de las lesiones esqueléticas atribuidas a la actividad física. El aparato locomotor infantil presenta particularidades que hacen que los patrones de lesión difieran a lo que ocurre en los adultos. Se producen lesiones agudas y de sobrecarga que se presentan en edades y sitios específicos. Debido a la alta frecuencia de aparición de ellas, es necesario que los médicos que atienden niños estén familiarizados con los cuadros más frecuentes. En este artículo se revisan los aspectos más importantes de las principales lesiones deportivas en niños y adolescentes resumiendo las principales consideraciones diagnósticas, terapéuticas y pronósticas.

The increase in sport activity of children and adolescents has led to an increase in skeletal lesions attributed to physical activity. The children’s musculoskeletal system presents particularities that make injury patterns defer to those that occur in adults. Acute and overluse injuries are produced, which occur in specific locations and ages. Due to the high frequency of their occurrence, it is necessary that physicians who treat children are familiar with the most frequent conditions. In this article the most important aspects of major sports injuries in children and adolescents are reviewed by summarizing the main diagnostic, therapeutic and prognostic considerations.