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1.
An. Facultad Med. (Univ. Repúb. Urug., En línea) ; 9(2): e301, dic. 2022. ilus, graf, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1403136

ABSTRACT

Introducción: Las fracturas de la diáfisis femoral son lesiones que requieren gran energía y a menudo asocian otras lesiones. Este es el caso de las lesiones ligamentarias de rodilla, las cuales pueden pasar desapercibidas por el equipo médico tratante. El objetivo de nuestro trabajo es revisar la literatura existente sobre esta asociación lesional. Dentro de la misma se buscará la metodología diagnóstica utilizada y la incidencia de las lesiones ligamentarias. Materiales y métodos: Se realizó una búsqueda bibliográfica de forma sistematizada a través de los portales de búsqueda PubMed y Timbó. La búsqueda alcanzó un total de 3099 artículos y de acuerdo a los criterios de inclusión y exclusión se seleccionaron 15 trabajos. Resultados: Los diferentes artículos utilizaron examen físico bajo anestesia, radiografías en estrés, artroscopía o resonancia nuclear magnética para establecer el diagnóstico de las lesiones ligamentarias asociadas a las fracturas de diáfisis femoral. Un 22,5% de las fracturas femorales asoció lesión ligamentaria de rodilla, siendo la lesión del ligamento cruzado anterior el 34% de las lesiones reportadas. Discusión: Se evidencia una gran variabilidad en la incidencia de lesiones ligamentarias y de cuál es el ligamento más frecuentemente lesionado, yendo desde 5,3% a 52,5% en estudios tanto retrospectivos como prospectivos con bajos números de pacientes. Se plantea un algoritmo diagnóstico para los pacientes que puedan presentar esta asociación lesional, para evitar que los mismos pasen desapercibidos al equipo médico tratante. Logrando un diagnóstico precoz se puede mejorar el pronóstico de estos pacientes. Conclusión: De nuestra revisión se desprende que en el contexto de una fractura de diáfisis femoral un 22,5% de los pacientes presenta lesiones ligamentarias de rodilla con un 34% de compromiso del LCA. Sin embargo, estas cifras son muy variables en los distintos trabajos. Por esta razón, creemos necesario llevar a cabo un estudio prospectivo con mayor número de pacientes para lograr valorar la verdadera epidemiología de estas lesiones.


Introduction: Femoral shaft fractures require great energy and are often associated with other injuries. This is the case of knee ligament injuries, which can go unnoticed by the treating physician The objective of our work is to review the existing literature on this injury association. Within it, the diagnostic methodology used and the incidence of ligamentous injuries will be sought. Materials and methods: A bibliographic search was carried out in a systematic way through the search portals PubMed and Timbó. The search reached a total of 3099 articles and according to the inclusion and exclusion criteria, 15 works were selected. Results: The different articles used physical examination under anesthesia, stress radiographs, arthroscopy or magnetic resonance imaging to establish the diagnosis of ligamentous injuries associated with femoral diaphysis fractures. 22.5% of femoral fractures were associated with knee ligament injury, with anterior cruciate ligament accounting for 34% of reported injuries. Discussion: There is evidence of a great variability in the incidence of ligament injuries and which is the most frequently injured ligament, ranging from 5.3% to 52.5% in both retrospective and prospective studies with low numbers of patients. A diagnostic algorithm is proposed for patients who may present this lesional association, to prevent them from going unnoticed by the treating medical team. Achieving an early diagnosis can improve the prognosis of these patients. Conclusion: Our review shows that in the context of a femoral diaphysis fracture, 22.5% of patients present knee ligament injuries with 34% of ACL involvement. However, these figures are highly variable in the different studies. For this reason, we believe it is necessary to carry out a prospective study with a larger number of patients in order to assess the true epidemiology of these lesions.


Introdução: As fraturas da diáfise do fêmur são lesões que requerem grande energia e muitas vezes estão associadas a outras lesões. É o caso das lesões ligamentares do joelho, que podem passar despercebidas pela equipe médica que o trata. O objetivo do nosso trabalho é revisar a literatura existente sobre essa associação lesional. Dentro dele, será buscada a metodologia diagnóstica utilizada e a incidência de lesões ligamentares. Materiais e métodos: Foi realizada uma busca bibliográfica de forma sistemática através dos portais de busca PubMed e Timbó. A busca atingiu um total de 3099 artigos e de acordo com os critérios de inclusão e exclusão, 15 trabalhos foram selecionados. Resultados: Os diferentes artigos utilizaram o exame físico sob anestesia, radiografias de estresse, artroscopia ou ressonância magnética para estabelecer o diagnóstico de lesões ligamentares associadas às fraturas da diáfise do fêmur. 22,5% das fraturas do fêmur foram associadas à lesão ligamentar do joelho, sendo a lesão do ligamento cruzado anterior responsável por 34% das lesões relatadas. Discussão: Há evidências de uma grande variabilidade na incidência de lesões ligamentares e qual é o ligamento mais frequentemente lesado, variando de 5,3% a 52,5% em estudos retrospectivos e prospectivos com baixo número de pacientes. Um algoritmo diagnóstico é proposto para os pacientes que podem apresentar essa associação lesional, para evitar que passem despercebidos pela equipe médica responsável. O diagnóstico precoce pode melhorar o prognóstico desses pacientes. Conclusão: Nossa revisão mostra que no contexto de fratura da diáfise do fêmur, 22,5% dos pacientes apresentam lesões ligamentares do joelho com 34% de envolvimento do LCA. No entanto, esses números são altamente variáveis ​​nos diferentes estudos. Por esse motivo, acreditamos ser necessário realizar um estudo prospectivo com um número maior de pacientes para avaliar a verdadeira epidemiologia dessas lesões.


Subject(s)
Humans , Femoral Fractures/complications , Joint Instability , Knee Injuries/diagnosis , Incidence , Femoral Fractures/epidemiology , Knee Injuries/etiology , Knee Injuries/epidemiology
2.
Autops. Case Rep ; 11: e2021296, 2021. graf
Article in English | LILACS | ID: biblio-1285389

ABSTRACT

Anaplastic lymphoma kinase (ALK) positive, anaplastic large cell lymphoma involving the non-mammary implant is an extremely rare presentation. Irrespective of the type or site, the implant-associated primary ALCL is morphologically and immunophenotypically similar to ALK-negative ALCLs. Herein, we present the case of a 42-year-old male who developed a lytic lesion after an implant for a right femur fracture. The lytic lesion biopsy revealed anaplastic large cell lymphoma with ALK protein expression. Imaging findings showed the widespread dissemination of disease all over the body, entrapping the implant too. ALCL involving the bone implant is a very unusual and rare presentation that needs to be documented.


Subject(s)
Humans , Male , Adult , Lymphoma, Large-Cell, Anaplastic , Femoral Fractures/complications , Anaplastic Lymphoma Kinase , Prostheses and Implants
4.
Acta cir. bras ; 35(8): e202000803, 2020. tab, graf
Article in English | LILACS | ID: biblio-1130672

ABSTRACT

Abstract Purpose To evaluate different concentrations of ciprofloxacin to prevent infection after open fracture contaminated with S. aureus in rats using absorbable local delivery system. Methods Fifty-two Wistar rats were assigned to six groups. After 4 weeks, all animals underwent 99mTc-ceftizoxima scintigraphy evaluation, callus formation measurement and histological analysis. ANOVA, t-Student and Kruskal Wallis were used for quantitative variables statistical analysis, whereas qui square and exact Fisher were used for qualitative variables. Results Treatment using 25% and 50% of ciprofloxacin incorporated at the fracture fixation device were effective in preventing bone infection compared to control group (p<0.05). Chitosan were not effective in preventing bone infection when used alone compared to control group (p>0.05). Histological findings demonstrated bone-healing delay with 50% of ciprofloxacin. No difference in callus formation were observed (p>0.05). Conclusion Local delivery treatment for contaminated open fracture using chitosan with ciprofloxacin is effective above 25%.


Subject(s)
Humans , Animals , Rats , Ciprofloxacin , Infection Control , Fracture Healing , Chitosan/therapeutic use , Femoral Fractures/complications , Staphylococcus aureus , Bony Callus , Rats, Wistar , Femoral Fractures/surgery , Fractures, Open , Infections
6.
Geriatr., Gerontol. Aging (Impr.) ; 13(2): 75-79, abr-jun.2019. tab
Article in Portuguese | LILACS | ID: biblio-1096818

ABSTRACT

OBJETIVO: Correlacionar as principais características clínicas do idoso internado por fratura de fêmur com a incidência de delirium e mortalidade durante a internação. MÉTODOS: Estudo transversal em pacientes com idade acima de 65 anos internados em enfermaria de ortopedia com fratura de fêmur. Foi aplicada aos pacientes e/ou cuidadores uma entrevista elaborada pelos autores para levantamento de suas características clínicas, sendo posteriormente realizada a correlação entre o perfil e a taxa de delirium e mortalidade. Para análise estatística, foi usado o programa Statistical Package for the Social Sciences (SPSS), o teste t de Student e o teste do χ2. Foi considerado estatisticamente significativo o valor p < 0,05. RESULTADOS: Noventa pacientes com média de idade de 83 anos (65­99), sendo 77,8% mulheres. O tempo médio de internação foi de 19,7 dias, sendo identificado delirium em 39,9% dos pacientes, e a taxa de mortalidade foi de 17,8%. O delirium esteve significativamente associado à idade avançada (p = 0,046), ao uso de psicotrópicos ­ especialmente a quetiapina ­ , à maior taxa de mortalidade, ao diabetes mellitus, à síndrome demencial e à baixa funcionalidade. Mortalidade, por sua vez, apresentou associação com insuficiência renal crônica, menor funcionalidade e síndrome demencial. CONCLUSÃO: Encontramos que o delirium esteve associado a idades mais elevadas, à menor funcionalidade, ao diabetes mellitus, à síndrome demencial, ao maior desfecho de óbitos e ao uso de psicotrópicos; e a mortalidade, à síndrome demencial, à insuficiência renal crônica e à pior funcionalidade.


OBJECTIVE: To correlate the main clinical characteristics of geriatric patients hospitalized for femur fracture with delirium incidence and mortality during hospitalization. METHODS: Cross-sectional study in patients over 65 years old admitted to an orthopedics unit with femoral fracture. The authors interviewed patients and / or caregivers to investigate their clinical characteristics, and subsequently correlate their profiles to the rates of delirium and mortality. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), Student's t-test and χ2 test. Significance was established at p < 0.05. RESULTS: Participants included 90 patients with a mean age of 83 years (65­99), 77.8% women. The mean length of stay was 19.7 days, with delirium identified in 39.9% of patients, and a mortality rate of 17.8%. Delirium was significantly associated with advanced age (p = 0.046), use of psychotropic drugs ­ especially quetiapine ­ , higher mortality rate, diabetes mellitus, dementia syndrome, and low functionality. Mortality, in turn, was associated with chronic kidney disease, lower functionality, and dementia syndrome. CONCLUSION: We found that delirium was associated with advanced age, lower functionality, diabetes mellitus, dementia syndrome, higher death outcomes, and the use of psychotropic drugs; and mortality was associated to dementia syndrome, chronic kidney disease, and worse functionality. KEYWORDS: geriatrics; femoral fractures; delirium; mortality.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Delirium/diagnosis , Delirium/mortality , Femoral Fractures/surgery , Femoral Fractures/complications , Femoral Fractures/mortality , Psychotropic Drugs/therapeutic use , Health of the Elderly , Risk Factors , Hospital Mortality , Hospitalization
7.
Article in Spanish | LILACS, BINACIS | ID: biblio-1003004

ABSTRACT

Introducción: Los defectos óseos segmentarios infectados son entidades de complejo tratamiento. La técnica de Masquelet representa una alternativa para estos casos. El objetivo de este estudio retrospectivo multicéntrico fue mostrar los resultados clínicos y radiográficos obtenidos con esta técnica de reconstrucción en defectos óseos segmentarios infectados de fémur y tibia, caracterizar los defectos tratados y describir los diferentes aspectos de la técnica quirúrgica. Materiales y Métodos: Analizamos a 24 pacientes (14 hombres y 10 mujeres; edad promedio 36.16 años [rango 18-67]) tratados con la técnica de Masquelet, operados entre 2011 y 2016. El seguimiento promedio fue de 16.5 meses (rango 12-27) desde el segundo tiempo quirúrgico. Se analizaron el hueso afectado, la longitud del defecto (en cm), el tiempo de consolidación y el control del proceso infeccioso. Resultados: La longitud del defecto óseo tratado fue, en promedio, de 5,7 cm (rango 3-12), fue superior a 4 cm en el 50% de los casos, el defecto óseo segmentario de mayor tamaño en la tibia fue de 12 cm y de 10 cm en el fémur. Se logró la consolidación ósea, en todos los casos, en 4.5 meses. Un paciente presentó una recidiva del proceso infeccioso a los 12 meses de la consolidación. Conclusiones: La técnica de Masquelet o de la membrana inducida ofrece una alternativa razonable y sencilla para un problema altamente desafiante como son los defectos óseos segmentarios infectados. La tasa de consolidación es superior al 90% aun en casos complejos. Nivel de Evidencia: IV


Introduction: Infected segmental bone defects are challenging conditions, which require a complex treatment. The Masquelet technique is an alternative for these cases. The aim of this retrospective, multicenter study was to show clinical and radiological outcomes achieved with the use of this reconstruction technique in infected femoral and tibial segmental defects in order to characterize the defects treated and describe different aspects of this surgical approach. Methods: We analyzed 24 patients (14 men and 10 women; average age 36.16 years [range 18-67]) treated with the Masquelet technique between 2011 and 2016. The average follow-up was 16.5 months (range 12-27) from the second surgical stage. We analyzed the affected bone, defect length (cm), consolidation time and infection control. Results: Average length of treated bone defect was 5.7 cm (range 3-12), exceeding 4 cm in 50% of the cases. The largest segmental bone defect was 12 cm at the tibia and 10 cm at the femur. Bone consolidation was achieved in all cases, on an average of 4.5 months. One patient presented a recurrent infection 12 months after the successful consolidation. Conclusions: The Masquelet technique, or induced membrane technique offers a reasonable and simple alternative to a highly challenging problem, such as infected segmental bone defects, achieving a consolidation rate greater than 90% even in complex cases. Level of Evidence: IV


Subject(s)
Adult , Osteomyelitis , Tibial Fractures/surgery , Tibial Fractures/complications , Fracture Healing , Reconstructive Surgical Procedures , Femoral Fractures/surgery , Femoral Fractures/complications , Fractures, Closed/complications , Fractures, Open/complications , Treatment Outcome
8.
Coluna/Columna ; 14(4): 276-280, Oct.-Dec. 2015. tab, graf
Article in English | LILACS | ID: lil-770241

ABSTRACT

Objective : To evaluate the quality of life related to the spine in patients with proximal femoral fractures. Methods : Study conducted in a tertiary public hospital in patients with proximal femoral fractures caused by low-energy trauma, through the Oswestry Disability Index questionnaire to asses complaints related to the spine at the time of life prior to the femoral fracture. The thoracic and lumbar spine of patients were also evaluated applying the radiographic index described by Gennant (Spinal Deformity Index), which assesses the number and severity of fractures. Results : Seventeen subjects completed the study. All had some degree of vertebral fracture. Patients were classified in the categories of severe and very severe disability in the questionnaire about quality of life. It was found that the higher SDI, the better the quality of life. Conclusion : There is a strong association of disability related to the spine in patients with proximal femoral fracture, and this complaint must be systematically evaluated in patients with appendicular fracture.


Objetivo : Avaliar a qualidade de vida relacionada com a coluna vertebral em pacientes com fratura da parte proximal do fêmur. Métodos : Estudo realizado em um hospital público terciário em pacientes com fraturas do fêmur proximal causado por trauma de baixa energia, por meio de aplicação do questionário Oswestry Disability Index, para avaliar as queixas relacionadas com a coluna vertebral no momento de vida prévio à fratura femoral. Avaliaram-se também as colunas torácica e lombar dos pacientes aplicando-se o índice radiográfico descrito por Gennant (Spinal Deformity Index), que avalia o número e a gravidade das fraturas. Resultados : Dezessete sujeitos concluíram o estudo. Todos apresentaram algum grau de fratura vertebral. Os pacientes enquadraram-se nas categorias de incapacidade severa e muito severa do questionário de qualidade de vida. Verificou-se que quanto maior o SDI, melhor a qualidade de vida. Conclusão : Há forte associação de incapacidade relacionada à coluna vertebral em pacientes e fratura do fêmur proximal, devendo esta queixa ser avaliada sistematicamente em pacientes com a fratura apendicular.


Objetivo : Evaluar la calidad de vida relacionada con la columna vertebral en pacientes con fracturas de la parte proximal del fémur. Métodos : Estudio realizado en un hospital público terciario en pacientes con fracturas femorales proximales causadas por un traumatismo de baja energía, a través del cuestionario Oswestry Disability Index para evaluar las quejas relacionadas con la columna vertebral en el momento de la vida antes de la fractura femoral. También se evaluaron columna torácica y lumbar de los pacientes por el índice radiográfico descrito por Gennant ( Índice de deformidad de la columna), que evalúa el número y la gravedad de las fracturas. Resultados : Diecisiete sujetos completaron el estudio. Todos tenían algún grado de fractura vertebral. Los pacientes fueron clasificados en las categorías de discapacidad grave y severa del cuestionario sobre calidad de vida. Se encontró que cuanto mayor sea el SDI, mejor será la calidad de vida. Conclusión : Hay una fuerte asociación de la discapacidad relacionada con la columna vertebral en pacientes con fractura del fémur proximal y esta queja debe ser evaluada de forma sistemática con fractura apendicular.


Subject(s)
Humans , Femoral Fractures/complications , Quality of Life , Spinal Injuries , Sickness Impact Profile
9.
ABC., imagem cardiovasc ; 28(3): 185-189, jul.-set. 2015. ilus, tab
Article in Portuguese | LILACS | ID: lil-764284

ABSTRACT

Embolia gordurosa (EG) é definida como a presença de partículas de gordura na circulação sanguínea as quais têm potencial para gerar fenômenos embólicos e lesão tecidual local, principalmente em pacientes vítimas de traumas e fraturas dos ossos longos. Síndrome de embolia gordurosa (SEG) caracteriza-se pelo surgimento de sinais e sintomas específicos secundários ao acometimento de órgãos-alvo como pulmões, cérebro e pele, na vigência de EGDiscutiremos o caso de uma paciente feminina jovem com síndrome de embolia gordurosa e “cor pulmonale” agudo 48 horas após acidente de trânsito com fratura do fêmur.


Subject(s)
Humans , Female , Young Adult , Diagnosis, Differential , Pulmonary Heart Disease/diagnosis , Pulmonary Heart Disease/physiopathology , Embolism, Fat/diagnosis , Embolism, Fat/physiopathology , Anticoagulants/therapeutic use , Heart/physiopathology , Femoral Fractures/complications , Heparin/therapeutic use , Pulmonary Embolism
10.
Coluna/Columna ; 13(3): 228-231, Jul-Sep/2014. tab, graf
Article in English | LILACS | ID: lil-727079

ABSTRACT

OBJECTIVE: To investigate the prevalence of fractures of the vertebral bodies in patients with femur proximal third fracture. METHODS: Cross-sectional study conducted at Hospital de Clínicas, Unicamp, SP, Brazil, between May and December 2012, which referred the patients with proximal femur fracture to radiographs of the spine. Fractures were evaluated according to number, severity and localization, applying the Genant index. RESULTS: Of the 15 subjects who completed the study, 14 had fractures of the vertebral bodies. The most commonly affected level was T8. There was no increased prevalence of fractures at the apex of the thoracic kyphosis and lumbar lordosis. CONCLUSION: There is strong epidemiological association between femur proximal third fractures and fractures of vertebral bodies caused by insufficiency. .


OBJETIVO: Pesquisar a prevalência de fraturas dos corpos vertebrais em pacientes com fratura do terço proximal do fêmur. MÉTODOS: Estudo transversal realizado no Hospital de Clínicas da Unicamp, SP, Brasil, entre maio e dezembro de 2012, que submeteu os pacientes com fratura do terço proximal do fêmur a radiografias da coluna vertebral. As fraturas foram avaliadas segundo o número, a gravidade e a localização, aplicando-se o índice de Genant. RESULTADOS: Dos 15 sujeitos que concluíram o estudo, 14 tinham fraturas dos corpos vertebrais. O nível mais comumente acometido foi o T8. Não se observou maior prevalência de fratura no ápice da cifose torácica e da lordose lombar. CONCLUSÃO: Existe forte associação epidemiológica entre fraturas do terço proximal do fêmur e fraturas de corpos vertebrais causadas por insuficiência. .


OBJETIVO: Investigar la prevalencia de las fracturas de los cuerpos vertebrales en pacientes con fractura del tercio proximal del fémur. MÉTODOS: Estudio transversal realizado en el Hospital de Clínicas, Unicamp, SP, Brazil, entre mayo y diciembre de 2012, en el cual, los pacientes con fractura del tercio proximal del fémur fueron sometidos a radiografías de la columna vertebral. Las fracturas se evaluaron de acuerdo con el número, la gravedad y la localización, aplicando el índice de Genant. RESULTADOS: De los 15 sujetos que completaron el estudio, 14 tenían fracturas de los cuerpos vertebrales. El nivel más afectado fue T8. No hubo aumento de la prevalencia de fracturas en el vértice de la cifosis torácica y lordosis lumbar. CONCLUSIÓN: Existe una fuerte asociación epidemiológica entre las fracturas del tercio proximal del fémur y las fracturas de los cuerpos vertebrales causadas por insuficiencia. .


Subject(s)
Humans , Spinal Fractures/epidemiology , Diagnostic Imaging , Radiography , Femoral Fractures/complications
12.
Article in Spanish | LILACS | ID: lil-742495

ABSTRACT

Introducción: La seudoartrosis de fémur es una complicación poco frecuente luego del enclavado endomedular. Existe controversia sobre el tratamiento que genera mejores resultados luego de esta complicación. En casos específicos, las no uniones femorales pueden ser correctamente tratadas mediante estabilización con placas sobre el clavo endomedular previo. Materiales y Métodos: Estudio retrospectivo de 16 seudoartrosis diafisarias (12 atróficas, 4 hipertróficas), asépticas de fémur tratadas inicialmente con clavo endomedular. Abordaje lateral de fémur para la osteosíntesis con placa. En todos los casos, se conservó el clavo endomedular colocado antes. En 12 pacientes, se realizó descorticación en el foco de no unión con colocación de injerto óseo autólogo; en 3 de ellos, se colocaron también factores de crecimiento. En 4 pacientes, se colocó la placa sin el agregado de injerto. Resultados: Todas consolidaron en 5,3 meses promedio desde la osteosíntesis con placa, sin cirugías adicionales. Un paciente sufrió una infección posquirúrgica que se curó con tratamiento antibiótico oral. Conclusiones: El cambio de clavo endomedular es el método de elección para la mayoría de las seudoartrosis diafisarias, asépticas de fémur, pero es más complejo de realizar en seudoartrosis metafisarias, en seudoartrosis atróficas con importante defecto óseo y cuando el clavo colocado previamente es el de mayor diámetro posible. La placa proporciona compresión y estabilidad del foco de fractura, y resulta una buena alternativa para tratar esta complicación. Recomendamos mínimo desbridamiento de partes blandas y descorticación que se limite sólo al foco de la no unión...


Background: Femoral nonunion is a rare complication after intramedullary nailing. There is controversy about the best treatment option. In specific cases, femoral nonunions can be successfully treated by stabilization with plates over an intramedullary nail. Methods: Retrospective review of 16 femur nonunions previously treated with intramedullary nails (12 atrophic, 4 hypertrophic). Lateral approach was used for plate fixation. Previous intramedullary nail was maintained in all cases. Twelve patients underwent osteoperiosteal decortication and autologous bone graft; in 3 of them platelet growth factors were added. In 4 hypertrophic nonunions, no bone graft was added to plate osteosynthesis. Results: Average healing time was 5.3 months after plate fixation. No additional surgeries were needed. One patient suffered a superficial wound infection successfully treated with oral antibiotics. Conclusions: Exchange of intramedullary nail is the method of choice for most aseptic nonunions of femoral diaphysis, but this technique is more demanding in metaphyseal nonunions, in atrophic nonunions with bone defects, and when the biggest intramedullary nail is already in place. Plate provides compression and stability to the fractures, being a good alternative to treat this complication. Minimal debridement of soft tissue and decortication limited to the nonunion is recommended...


Subject(s)
Adult , Young Adult , Middle Aged , Bone Nails , Fracture Fixation, Intramedullary/methods , Femoral Fractures/surgery , Femoral Fractures/complications , Fractures, Ununited/surgery , Pseudarthrosis , Leg Injuries , Retrospective Studies , Treatment Outcome
13.
Professional Medical Journal-Quarterly [The]. 2014; 21 (5): 1075-1077
in English | IMEMR | ID: emr-153954

ABSTRACT

The case report is of a 30-year male patient who had a fracture shaft of femur and after open reduction and internal fixation developed swelling which was painful and was present on the medial aspect of the thigh. It was decided to do an angiogram as the swelling was expansile and confirmed superficial femoral artery pseudo aneurysm and the reason was thought to be over penetration of the bit of the drill while doing the surgery for shaft of femur fracture. Treatment decided by the multidisciplinary team was to remove the condylar buttress plate, resection of the aneurysm and repair of the aneurysm with inter-positional graft


Subject(s)
Humans , Male , Fracture Fixation, Internal , Femoral Artery , Femoral Fractures/complications
14.
Rev. bras. anestesiol ; 63(2): 220-222, mar.-abr. 2013. ilus
Article in Portuguese | LILACS | ID: lil-671565

ABSTRACT

JUSTIFICATIVA E OBJETIVOS: A síndrome de Leigh (SL) é uma doença rara causada por anomalias na produção de energia mitocondrial. O sistema nervoso central é afetado com mais frequência, com retardo psicomotor, convulsões, nistagmo, oftalmoparesia, atrofia óptica, ataxia, distonia ou insuficiência respiratória. Os procedimentos cirúrgicos e anestésicos provocam irritabilidade traqueal e podem exacerbar os riscos de aspiração, sibilação, dificuldade respiratória, respiração ofegante, hipoventilação e apneia. RELATO DE CASO: Apresentamos uma abordagem anestésica usada em um menino de seis anos com a forma grave de SL que envolve reparação de uma fratura de fêmur. Propofol e remifentanil foram infundidos para anestesia geral. O paciente foi atentamente monitorado durante a anestesia e sua permanência na unidade de terapia intensiva no período pós-operatório inicial. CONCLUSÕES: Uma atenta monitoração intraoperatória dos pacientes, que inclui pressão arterial invasiva e mensurações frequentes da gasometria, glicose e lactato, faz esse procedimento transcorrer sem problemas. A terapia intensiva e a assistência respiratória ao paciente com SL sob sedação, com uma combinação de analgésicos durante o período pós-operatório inicial, minimizaram a resposta ao estresse causado pela dor pós-cirúrgica.


BACKGROUND AND OBJECTIVES: Leigh syndrome (LS) is a rare disease caused by abnormalities of mitochondrial energy generation. The central nervous system is most frequently affected, with psychomotor underdevelopment, seizures, nystagmus, ophthalmoparesis, optic atrophy, ataxia, dystonia, or respiratory failure. Surgical and anesthetic procedures stimulate the tracheal irritability, and could exacerbate risks of aspiration, wheezing, breathing difficulties, gasping, hypoventilation, and apnea. CASE REPORT: We present the anesthetic management for a six-year-old boy with severe form of LS, involving repair of a femur fracture. Propofol and remifentanil were infused for general anesthesia. The patient was closely monitored during anesthesia and in the intensive care unit in the early postoperative period. CONCLUSIONS: Close intraoperative monitoring of patients, including invasive arterial blood pressure monitoring and frequently measuring the levels of blood gases, glucose, and lactate, made this procedure run smoothly. Intensive care and breathing support for the patient with LS, under sedation with an analgesic combination during the early postoperative period, minimized the stress response due to pain after surgery.


JUSTIFICATIVA Y OBJETIVOS: El síndrome de Leigh (SL) es una enfermedad rara causada por anomalías en la producción de energía mitocondrial. El sistema nervioso central está afectado más a menudo, con el retardo psicomotor, convulsiones, nistagmo, oftalmoparesia, atrofia óptica, ataxia, distonía o insuficiencia respiratoria. Los procedimientos quirúrgicos y anestésicos provocan irritabilidad traqueal y pueden exacerbar los riesgos de aspiración, sibilancias, dificultad respiratoria, respiración extenuante, hipoventilación y apnea. RELATO DE CASO: Presentamos un abordaje anestésico usado en un niño de 6 años, con la forma grave de SL que nos ocupa con la reparación de una fractura de fémur. El propofol y el remifentanilo se infundieron para la anestesia general. El paciente fue monitoreado con mucho cuidado durante la anestesia y durante su permanencia en la unidad de cuidados intensivos en el período postoperatorio inicial. CONCLUSIONES: Una meticulosa monitorización intraoperatória de los pacientes, que incluye monitorización de presión arterial invasiva y mensuraciones frecuentes de la gasometría, glucosa y lactato, posibilita el perfecto transcurso del procedimiento. Los cuidados intensivos y la asistencia respiratoria al paciente con SL bajo sedación con una combinación de analgésicos durante el período postoperatorio inicial, minimizaron la respuesta al estrés causado por el dolor postquirúrgico.


Subject(s)
Child , Humans , Male , Anesthesia , Femoral Fractures/surgery , Leigh Disease , Femoral Fractures/complications , Leigh Disease/complications
15.
Rev. venez. cir. ortop. traumatol ; 45(1): 58-62, 2013. ilus, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1281963

ABSTRACT

La rodilla flotante es la asociación simultánea de fracturas ipsilaterales del fémur y la tibia que incluye una combinación de fracturas diafisiarias, metafisiarias e intraarticulares. Su tratamiento representa un reto terapéutico. Se realizó un estudio retrospectivo, analítico, observacional de cohorte hospitalaria conducido en un centro de IV nivel. Se incluyeron todos los pacientes de ambos sexos con edad igual o mayor a 16 años, que ingresaron con diagnóstico de rodilla flotante, desde enero 1980 a diciembre 2010. Se incluyeron 314 pacientes. 71 % de sexo masculino y edad promedio de 28,22 años. El grupo etario de 16-25 años fue el más afectado. 66% fueron abiertas. Los accidents automovilísticos fueron la causa en 92% de los casos. 58% fueron tipo I de Fraser. La técnica quirúrgica que se relacionó con los mejores resultados clínicos y radiológicos al término del seguimiento fue el enclavado endomedular bloqueado tanto para el fémur como para la tibia. La tasa de infección fue 14% y mortalidad del 6%(AU)


A floating knee is the simultaneous ipsilateral association fractures of the femur and tibia which includes a combination of diaphyseal, metaphyseal and intraarticular fractures. lts an high-energy injury caused trauma and is associated with high risk of morbidity and mortality. Treatment of floating knee representa a therapeutic challenge. We performed a prospective, analytic cohort observational hospital conducted a level IV center. We included all patients of both sexes, aged greater than or equal to 16 years, admitted with the diagnosis of knee Floating Hospital Universitario de Los Andes, from January 1980 to December 2010. 314 patients were found. 71 % were male and mean age 28.22 years. The age group 16-25 years was the most affected. 66% were open. The cause was motor vehicle accidents in 92% of cases. 58% were type I Fraser. The surgical technique was associated with better clinical and radiological follow-up was at the end of the locked intramedullary nailing both the femur and tibia for. The infection rate was 14% and mortality of 6%(AU)


Subject(s)
Humans , Male , Female , Tibial Fractures/complications , Morbidity Surveys , Femoral Fractures/complications , Knee Injuries/surgery , Motor Vehicles , Orthopedic Procedures , Fractures, Bone
16.
Rev. med. (Säo Paulo) ; 91(4): 267-271, out.-dez. 2012. ilus, graf
Article in Portuguese | LILACS | ID: lil-747312

ABSTRACT

As fraturas diafisárias do fêmur são frequentemente graves e decorrem de acidentes de alta energia, que podem acometer outros órgãos. A melhor abordagem terapêutica para as fraturas diafisárias do fêmur é eminentemente cirúrgica. Na atualidade muitos ortopedistas e traumatologistas preferem a opção terapêutica por hastes intramedular, que é um dos exemplos de fixação biológica, que por apresentar um procedimento com técnica cirúrgica simples e padronizada, contribui para uma melhor estabilização das fraturas com um mínimo de manipulação dos fragmentos a fim de manter sua vascularização, menores danos aos tecidos moles e o potencial de consolidação ser maior e permitindo assim uma carga precoce. Mas isto não a isenta de complicações, sendo a infecção pós-operatória a mais temida. Objetivo: Analisar as publicações científicas sobre as complicações que mais acometem os pacientes submetidos a esta técnica cirúrgica. Metodologia: Revisão da literatura através de uma pesquisa bibliográfica, localizados através da Biblioteca Virtual em Saúde (BVS) Resultado: Foram avaliados 20 artigos científicos e, observamos um total de 326 pacientes.Onde encontramos 215 complicações, destas complicações a anisomelia tem uma maior incidência (50,70%); falha na consolidação vem em seguida com (17,21%); infecção de partes moles(6,98%); limitação do arco do movimento do joelho (5,58%); desvio rotacional (4,65%); desvio angular (4,19%); inserção da haste na bursa (2,33%); embolia gordurosa (1,86%); pneumonia (1,40%), dor (0,93%), infecção da ferida operatória (0,93%) eembolia pulmonar (0,93%), osteomielite (0,47%), necrose epifisária (0,47%), TVP (0,47%), insuficiência respiratória (0,47%) e perfuração do córtex do colo femural (0,47%). Conclusão: Foi observado um número muito reduzido nas complicações com esta técnica, não considerando qualquer outro fator quevenha a desencadeá-la. Nas próximas pesquisas deverão ser analisados se estes valores são referentes a técnica realizada...


The femoral shaft fractures are frequent and often serious accidents result from high-energy, which can affect other organs. Nowadays many orthopedists and traumatologists prefer therapeutic option for intramedullary rods, which is an example of fixation, which present a procedure with a simple surgical technique, standardized, contributes to better stabilize the fracture with minimal manipulation of the fragments order to maintain its vascularization, reduced damage to soft tissues and the potential for consolidation be greater, thus allowing an early load. But this is not free of complications, and postoperative infection the most feared. Objective: To analyze the scientificpublications about the complications that most affect patients undergoing this surgical technique. Methodology: Literature review through a literature search. located through the VirtualHealth Library (VHL) Result: A total of 16 scientific papers and observed a total of 326 patients. Where we found 215 complications, these complications anisomelia has a higher incidence (50.70%), fails to consolidate follows with (17.21%), soft tissue infection (6.98%), limited arc of motion knee (5.58%); rotational deviation (4.65%), angular deviation (4.19%), insertion of the rod in the bursa (2.33%), fat embolism (1.86%) and pneumonia (1.40%), pain (0.93%)., wound infection (0.93%). and pulmonary embolism (0.93%), osteomyelitis(0.47%), epiphyseal necrosis (0.47%), DVT (0.47%), respiratory failure (0.47%) and perforation of the cortex of the femoral neck (0.47%). Conclusion: We found very few complications with this technique in not considering any other factors that will unleash it. In future research were to be analyzed if these values arerelated to the technique performed, or the reduction of risk factors for the surgical procedure.


Subject(s)
Diaphyses/injuries , Fracture Fixation, Intramedullary/methods , Fractures, Bone/surgery , Fractures, Bone/complications , Femoral Fractures/complications , Review Literature as Topic
18.
Rev. bras. ortop ; 47(5): 575-580, set.-out. 2012. tab
Article in Portuguese | LILACS | ID: lil-660906

ABSTRACT

OBJETIVO: Avaliar as indicações, epidemiologia, lesões associadas, complicações e prognóstico das fraturas diafisárias instáveis do fêmur na criança tratadas com hastes intramedulares elásticas de titânio. MÉTODO: Estudo retrospectivo composto por 24 pacientes com fraturas diafisárias instáveis do fêmur com idade entre cinco e 12 anos, submetidos a tratamento cirúrgico com hastes intramedulares elásticas de titânio no Hospital Universitário Cajuru - Curitiba, PR. Pacientes atendidos no período de abril de 2002 a março de 2008, com seguimento mínimo de 36 meses, submetidos à avaliação de dados epidemiológicos, desvios angulares, encurtamento e consolidação óssea. RESULTADOS: Foram reavaliados os prontuários de 113 casos operados de abril de 2002 a março de 2008, destes, incluídos no estudo 24 casos com fraturas de fêmur diafisárias instáveis tratadas com hastes intramedulares elásticas de titânio com inserção retrógrada. Apresentando duas fraturas bilaterais, duas fraturas expostas, sete pacientes do sexo feminino e 17 masculinos, com idade média de 8,3 anos. Apresentaram, ao final do estudo: encurtamento, desvios em varo ou valgo, retrocurvato ou antecurvato final igual a zero, não havendo ainda presença de retardo de consolidação ou pseudartrose. CONCLUSÕES: As hastes intramedulares elásticas de titânio são de fácil colocação e remoção. Consideramos a utilização das hastes intramedulares elásticas de titânio uma boa opção para a fixação de fraturas instáveis do fêmur em crianças.


OBJECTIVE: To evaluate the indications, epidemiology, associated lesions, complications and prognosis among children with unstable femoral diaphysis fractures who were treated with titanium elastic intramedullary nails. METHOD: This was a retrospective analysis on 24 patients aged 5-12 years with unstable femoral diaphysis fractures who underwent surgical treatment with elastic titanium intramedullary nails at the Cajuru University Hospital, Curitiba-PR between April 2002 and March 2008, with a minimum follow-up of 36 months. The epidemiological data, angular deviations, leg shortening and bone consolidation were evaluated. RESULTS: The medical files of 113 cases operated between April 2002 and March 2008 were reassessed. From these, 24 cases of unstable femoral diaphysis fractures treated with elastic titanium intramedullary nails with retrograde insertion were included in the study. There were two bilateral fractures and two exposed fractures. Seven patients were female and 17 were male, and the mean age was 8.3 years. The following were presented at the end of the study: shortening, varus or valgus displacement, final retrocurvatum or antecurvatum of zero, and absence of delayed consolidation or pseudarthrosis. CONCLUSIONS: The elastic titanium intramedullary nails were easily placed and removed. We believe that using elastic titanium intramedullary nails is a good option for fixation of unstable femoral fractures in children.


Subject(s)
Humans , Male , Female , Child , Fracture Fixation , Fracture Fixation, Intramedullary , Femoral Fractures/complications , Internal Fixators , Orthopedic Fixation Devices , Titanium
19.
Journal of Tehran University Heart Center [The]. 2010; 5 (1): 42-44
in English | IMEMR | ID: emr-93305

ABSTRACT

Vascular injuries with acute or chronic arterial hemorrhage after femoral shaft fractures are a rare but a life -threatening complication. We observed a case of iatrogenic rupture of the profunda femoris artery after the internal fixation of a femoral shaft fracture. The pseudoaneurysm, presenting with painful expansile swelling and hemodynamic instability, together with the rupture was evident on femoral angiography. Endovascular stent graft placement was performed successfully, and there was no sign or symptom at 9 months' follow-up


Subject(s)
Humans , Male , Adolescent , Femoral Fractures/complications , Femoral Fractures/surgery , Stents , Fracture Fixation/adverse effects , Angiography , Iatrogenic Disease
20.
Article in English | WPRIM | ID: wpr-192616

ABSTRACT

BACKGROUND: The number of human immunodeficiency virus (HIV)-infected patients is increasing constantly, and it is well known that there is a significantly high prevalence of osteonecrosis of the femoral head in HIV-infected patients. Therefore, it is important to develop methods that can ensure the safety of both the patients and medical personnel who participate in surgery on HIV-infected patients. Recently, the authors performed 8 procedures on 5 HIV-infected patients. This paper reports our experience. METHODS: This study examined the medical records and radiological studies of 5 HIV-infected patients who had undergone surgery around the hip joint from January, 2005 to September, 2007. During the procedures, their mean age was 38.6 years (range, 23 to 53 years) and all were male. Four of them were under an anti-retroviral therapy program. The reasons for the operations were nonunion of the femoral shaft after trauma in two patients and osteonecrosis of both femoral heads in three. One autologous bone grafting, one screw fixation with autologous bone grafting, five total hip replacement arthroplasties, and one multiple drilling were performed. All procedures were carried out according to the guidelines of HIV infection control made by the Korea Centers for Disease Control and Prevention. The mean follow-up period was 16.6 months (range, 4 to 37 months). RESULTS: The preoperative CD4 count was 130 in one patient, and 200 to 499 in the other 4. The viral loads were 15100 and 420 in two patients, and negative in the other 3. Bony union was achieved in those who had undergone autologous bone grafting. There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty. There were no immediate postoperative complications, such as infection. During the follow-up period, one patient died from esophageal variceal bleeding. However, no surgery-related complications were observed in the other 4 patients. CONCLUSIONS: There were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal. In addition, the safety of medical personnel can be assured when the operation is performed in line with the guidelines of HIV infection control.


Subject(s)
Adult , Arthroplasty, Replacement, Hip/adverse effects , Bone Transplantation , CD4 Lymphocyte Count , Femoral Fractures/complications , Femur Head Necrosis/complications , Fractures, Ununited/complications , HIV Infections/complications , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Male , Middle Aged , Postoperative Complications , Viral Load , Young Adult
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