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1.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367133

ABSTRACT

Las fracturas de fémur distal, especialmente las abiertas, se asocian con traumas de alta energía. Las lesiones asociadas al-rededor de la rodilla son frecuentes; sin embargo, la asociación con una lesión completa del tendón cuadricipital ha sido poco documentada. El diagnóstico temprano y un adecuado tratamiento de ambas lesiones son fundamentales para conseguir buenos resultados posoperatorios. Presentamos dos casos de fracturas intrarticulares de fémur distal expuestas asociadas con lesiones completas del tendón cuadricipital. La reparación de la lesión tendinosa asociada mediante túneles transóseos luego de la fijación de la fractura permite comenzar un protocolo de rehabilitación temprano, esencial para obtener buenos resultados funcionales.Palabras clave: Fractura; fémur distal; lesión; tendón cuadricipital; aparato extensor. Nivel de Evidencia: V


Fractures of the distal femur, especially open fractures, occur in association with high-energy trauma. The presence of associated injuries around the knee is common; however, the association with a complete quadricipital tendon injury has been poorly documented. Early diagnosis and adequate treatment of both injuries is essential to achieve good postoperative outcomes. We present two cases of exposed intra-articular distal femoral fractures associated with complete quadricipital tendon injuries. The repair of the associated tendon injury with transosseous tunnels after fracture fixation allows an early rehabilitation protocol, essential to obtain good functional outcomes.Key words:Fracture; distal femur; injury; quadricipital tendon; extensor mechanism. Level of Evidence: V


Subject(s)
Adult , Tendon Injuries , Femoral Fractures/surgery , Knee Injuries
2.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367138

ABSTRACT

Introducción: En pacientes con fracturas de fémur distal con alto grado de conminución metafisaria (AO 33 C2, C3) y fracturas periprotésicas (Vancouver tipo C), el uso de doble osteosíntesis brinda mayor estabilidad a la fractura. Las placas helicoidales se emplean cada vez más con el objetivo de evitar dañar elementos nobles relacionados con el abordaje. Materiales y métodos: Entre 2017 y 2021, seis pacientes fueron tratados mediante osteosíntesis con doble placa (por vía lateral y helicoidal por vía medial). La serie se compone de cuatro mujeres y dos hombres. El 66% (4 pacientes) tenía fracturas de fémur distal, y el resto (33%), fracturas periprotésicas tipo Vancouver C. Resultados: Se observó la consolidación radiográfica en todos los pacientes, a los 6 meses de la cirugía, con retorno normal a la actividad previa. Ninguno sufrió una lesión vasculonerviosa asociada. Conclusiones: La placa helicoidal es una gran opción para las fracturas de fémur distal con conminución y las fracturas femorales periprotésicas tipo Vancouver C. Esto demuestra que, aplicando los principios básicos de osteosíntesis, con una técnica sencilla, se pueden suplir materiales más sofisticados, y obtener resultados radiográficos similares. Nivel de Evidencia: IV


Introduction: The use of double osteosynthesis for the treatment of fractures of the distal femur with metaphyseal comminution (AO 33C2, C3) and periprosthetic fractures (Vancouver C) provides greater stability. The use of helical plates has increased in or-der to avoid vascular damage related to the approach. Materials and methods: Between 2017 and 2021, six patients were treated by double plate osteosynthesis (helical plate by medial approach). The series consisted of four females and two males, 66% (4 patients) had distal femoral fractures, and the rest (33%, 2 patients) were diagnosed with Vancouver C periprosthetic fractures. Results: In all cases, radiographic consolidation was observed 6 months after surgery, with a normal return to activities of daily living. None of them presented an associated neurovascular injury. Conclusion: The helical plate is a great option in distal femur fractures and Vancouver C periprosthetic femoral fractures. By applying the basic principles of osteosynthesis, sophisticated ma-terials can be supplied, obtaining good clinical, functional, and radiographic outcomes. Level of Evidence: IV


Subject(s)
Bone Plates , Periprosthetic Fractures , Femoral Fractures/surgery , Fracture Fixation, Internal , Knee Injuries
3.
Int. j. med. surg. sci. (Print) ; 8(3): 1-7, sept. 2021. ilus
Article in English | LILACS | ID: biblio-1292580

ABSTRACT

Hip femoral head fractures are extremely uncommon, but likely associated with traumatic hip dislocations. Both lesions require emergent treatment to avoid further complications.19-year-old male patient was received after a high-energy motor vehicle accident with severe brain and thoraco-abdominal trauma and a displaced femoral head fracture with posterior hip dislocation with no acetabular fracture. An emergent open reduction and internal fixation with 2 headless screws was performed, as well as posterior capsule repair. After 1 month as an inpatient in Intensive Care Unit, he sustained a new episode of posterior hip dislocation. Consequently, a second successful surgical reduction was obtained, and hip stability was achieved by posterior reconstruction with iliac crest autograft fixed with cannulated screw and posterior structure repair. Two years later, he was able to walk independently and he does not present any signs of degenerative joint disease nor avascular necrosis.


Las fracturas de la cabeza femoral son extremadamente raras y están asociadas comúnmente con una luxación de cadera traumática. Ambas lesiones requieren tratamiento urgente con el objetivo de evitar complicaciones posteriores. Un paciente varón de 19 años fue trasladado tras un accidente de tráfico de alta energía en el que sufrió un traumatismo craneoencefálico y toracoabdominal grave, además de una fractura de cabeza femoral desplazada junto a una luxación posterior de cadera sin afectación acetabular. De manera urgente, fue intervenido mediante una reducción abierta y fijación interna de la fractura con dos tornillos canulados sin cabeza y reparación de la cápsula articular posterior. Tras un mes de ingreso en la unidad de cuidados intensivos, sufrió un nuevo episodio de luxación posterior de cadera. Debido a ello, se realiza una segunda intervención quirúrgica con reducción abierta y en la que se obtiene una adecuada estabilidad de la cadera mediante reconstrucción posterior con la adición de autoinjerto tricortical de cresta ilíaca y reparación capsular posterior. Después de dos años de seguimiento, el paciente deambula de manera independiente, sin dolor y sin signos degenerativos ni de necrosis avascular en las pruebas de imagen.


Subject(s)
Humans , Male , Young Adult , Transplantation, Autologous/methods , Femoral Fractures/surgery , Femur Head/injuries , Joint Dislocations/complications , Ilium/surgery
4.
Article in Chinese | WPRIM | ID: wpr-879431

ABSTRACT

OBJECTIVE@#To investigate the clinical effect of double plate combined with iliac bone graft in the treatment of femoral nonunion after intramedullary nailing.@*METHODS@#From December 2008 to December 2017, double plate combined with autogenous iliac bone graft was used to treat femoral nonunion after intramedullary nailing. There were 11 cases, including 10 males and 1 female, aged 35 to 62 years, and the time from fracture to nonunion was 12 to 20 months. According to Judet classification, there were 8 cases of atrophic nonunion and 3 cases of proliferative nonunion. Regular follow-up was conducted after operation to record the fracture healing time, load-bearing activity time and complications, and to observe the repair effect of double plate fixation combined with iliac bone graft on nonunion after femoral shaft fracture operation.@*RESULTS@#All patients were followed up for 12 to 22 months. The operation time was 70 to 130 min and the blood loss was 180 to 350 ml. After operation, 2 cases had knee stiffness, which recovered after passive exercise with CPM machine for 2 weeks;1 case had pain in iliac bone donor area, which was relieved after 3 months. The time of fracture healing was 24 to 40 weeks, and the time of complete weight-bearing activity was 14 to 32 weeks. SF-36 quality of life score at the final follow-up:body pain 70 to 82, activty 70 to 82, social function 72 to 83, the overall health 72 to 82. At the end of the follow-up, there were no complications such as limb shortening, infection, poor wound healing, internal fixation failure (fracture, loosening).@*CONCLUSION@#It is an effective method to treat nonunion of femur after intramedullary nailing by using double plate combined with autogenous iliac bone graft.


Subject(s)
Adult , Bone Nails , Bone Plates , Bone Transplantation , Female , Femoral Fractures/surgery , Femur , Fracture Fixation, Intramedullary , Fracture Healing , Fractures, Ununited/surgery , Humans , Male , Middle Aged , Quality of Life , Treatment Outcome
5.
Article in Chinese | WPRIM | ID: wpr-879425

ABSTRACT

OBJECTIVE@#To analyze and compare the clinical efficacy of different types of surgical treatment of periprosthetic femoral fracture(PFF) after hip arthroplasty (HA).@*METHODS@#From September 2010 to September 2016, 47 patients (47 hips) with periprosthetic fractures after total hip arthroplasty were retrospectively analyzed, including 13 males and 34 females. According to Vancouver classification, there were 2 patients with type AG, 17 patients with type B1, 19 patients with type B2, 7 patients with type B3 and 2 patients with type C. The age of patients ranged from 56 to 94 (71.5±8.3) years. After admission, nutritional risk screening (NRS2002) was used to assess the nutritionalstatus of the patients. Eighteen patients (38%) had malnutrition risk (NRS>3 points). After admission, the patients were given corresponding surgical treatment according to different types. Intraoperative blood loss was recorded. Harris score was used to evaluate the hip function. VAS pain score was performed on admission and after operation.@*RESULTS@#All the 47 patients were followed up for 19 to 62 (34±11) months. The Harris scores were (41.8±12.1) and (89.0±2.6) respectively before and 1 year after operation, and the difference was statistically significant (@*CONCLUSION@#The treatment of hip periprosthetic fracture patients should be based on the general situation of patients, imaging data, intraoperative correction classification, etc. to develop individualized treatment plan in line with patients. For patients with preoperative malnutrition risk, preoperative nutritional intervention may reduce intraoperative bleeding.


Subject(s)
Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/adverse effects , Female , Femoral Fractures/surgery , Fracture Fixation, Internal , Hip Prosthesis , Humans , Male , Middle Aged , Periprosthetic Fractures/surgery , Reoperation , Retrospective Studies , Treatment Outcome
6.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353934

ABSTRACT

Introducción: La indicación de realizar una osteosíntesis con un clavo endomedular retrógrado en las fracturas de fémur se ha incrementado en los últimos años y, con ello, la cantidad de complicaciones. Se describen tres técnicas quirúrgicas para el manejo del fragmento proximal de la osteosíntesis endomedular rota. Desde marzo de 2001 hasta enero de 2019, se realizaron 321 osteosíntesis con clavos endomedulares retrógrados de fémur en nuestra institución. La tasa de rotura del implante asociada a una seudoartrosis fue del 0,9%. Se realizaron técnicas mínimamente invasivas para la extracción del implante, preservando las partes blandas. Se logró la reosteosíntesis definitiva con la consiguiente consolidación en un tiempo medio de 140 días. Conclusiones: Las técnicas utilizadas fueron simples, seguras, mínimamente invasivas y muy reproducibles. Nivel de Evidencia: IV


background: The indication for osteosynthesis with a retrograde intramedullary nail in femur fractures has increased in recent years and with it, the number of complications. Three surgical techniques are described for the management of the proximal fragment of the broken intramedullary osteosynthesis. From March 2001 to January 2019, 321 osteosyntheses with retrograde femoral intramedullary nails were performed at our institution. The implant rupture rate associated with nonunion was 0.9%. Minimally invasive techniques were performed to remove the implant, preserving the soft tissues. Definitive reosteosynthesis was achieved with the consequent consolidation in an average time of 140 days. Conclusions: The techniques used were simple, safe, minimally invasive, and reproducible. Level of Evidence: IV


Subject(s)
Adolescent , Middle Aged , Aged , Rupture , Bone Nails/adverse effects , Device Removal , Femoral Fractures/surgery , Fracture Fixation, Intramedullary/adverse effects
7.
Article in Chinese | WPRIM | ID: wpr-921926

ABSTRACT

OBJECTIVE@#To summarize the complications of core drilling intramedullary nail in the treatment of femoral shaft closed fracture and explore the treatment strategy.@*METHODS@#From August 2014 to June 2018, a total of 215 patients with closed femoral shaft fractures were treated with closed reduction core drill intramedullary nail, including 129 males and 86 females, aged from 18 to 62 years, with an average of (44.2±10.6) years old. The time from injury to operation was 3 to 21 days. There were 102 cases of AO type A fracture, 82 cases of AO type B fracture and 31 cases of AO type C fracture. The time of operation, the amount of blood loss during operation, the duration of hospitalization, the time of fracture healing and the HSS score of knee joint function at the last follow-up were recorded. The observation of complications included:iatrogenic fracture, core drill broken, core drill twist, postoperative infection, and fracture nonunion.@*RESULTS@#The average operation time was (63.2± 15.6) min and intraoperative blood loss was (150.0±34.5) ml. All the incisions reached grade A healing. Patients were follow up for a mean of (18.5±3.2) months, the average hospital stay was (4.3±1.2) days, and the average fracture healing time was (5.6±2.3) months. At the final follow-up, the average HSS score of knee joint was 90.3±4.7. Related complications occurred in 37 cases (17.2%). The core drill related complications occurred in 13 cases (6.0%), including core drill broken in 5 cases (2.3%), core removal in 1 case and slotting in 4 cases;core drill twist in 8 cases (3.7%). After the core was cut, the core was removed. Similar complicationsof conventional intramedullary nail:iatrogenic fracture was performed in 12 cases (5.6%), including 10 cases of fracture end split and 2 cases of distal perimedullary fracture of intramedullary nail. The patients with cleavage at the fracture end were not treated after judging their stability, and the patients with fracture around the distal end of the intramedullary nail were fixed with auxiliary steel plate during operation;1 case(0.4%) with delayed infection after operation, debridement and external fixation was replaced and healed after bone transfer; fracture nonunion occurred in 11 cases (5.1%), of which 7 cases (3.3%) were hypertrophic nonunion and healed with additional plate. Atrophic nonunion occurred in 4 cases (1.9%), which healed after additional steel plate and bone graft.@*CONCLUSION@#Core drilling intramedullary nail is an effective method for the treatment of closed femoral shaft fracture, and the complications include core drill related complications and conventional intramedullary nail similar complications. Accurate preoperative evaluation, careful operation during operation and early postoperative symptomatic treatment can effectively reduce the occurrence of related complications.


Subject(s)
Adult , Bone Nails , Female , Femoral Fractures/surgery , Fracture Fixation, Intramedullary/adverse effects , Fracture Healing , Fractures, Closed , Humans , Male , Middle Aged , Treatment Outcome
8.
Acta ortop. mex ; 34(1): 47-52, ene.-feb. 2020. graf
Article in English | LILACS | ID: biblio-1345085

ABSTRACT

Abstract: Introduction: Anterior dislocation is a rare complication of total hip arthroplasty (THA). There exist only three cases in the literature. None of them report disassembly of the prosthesis components. We present a morbidly obese woman who suffered an irreducible obturator dislocation of an infected total hip arthroplasty (THA), due to uncontrolled adduction during an early debridement surgery. Following unsuccessful closed reduction attempts, a Vancouver B2 periprosthetic fracture and disassembly of the prosthetic components were observed. Two-stage revision THA was necessary to resolve the infection and restore hip functionality. In obturator dislocation, the femoral head prosthetic can be trapped in the obturator foramen, and this may disassemble the prosthesis components during reduction maneuvers; there's also risk of periprosthetic fracture. This mandate an open reduction of the joint. Patient obesity could be a determining factor for this rare type of hip arthroplasty dislocation. Obturator dislocation is an extremely rare complication of the total hip arthroplasty, whose reductions should be handled with caution given the risks of periprosthetic fractures. In most cases, an open reduction of the joint is required. Clinical importance: Our work is likely to be of great interest because it offers tips for the management of this rare complication based on our experience.


Resumen: Introducción: La luxación anterior es una complicación poco frecuente de la artroplastia total de cadera (ATC). Sólo existen tres casos en la literatura. Ninguno de ellos informa del desmontaje de los componentes de la prótesis. Presentamos el caso una mujer obesa que sufrió una luxación irreducible de una artroplastia total de cadera (THA), la cual estaba infectada, debido a la aducción no controlada durante una cirugía de desbridamiento temprano. Después de los intentos fallidos de reducción cerrada, se presentó una fractura periprotésica clasificada como Vancouver B2 y el desmontaje de los componentes protésicos. Ameritó cirugía de revisión en dos etapas, lo cual se realizó para resolver la infección y restaurar la funcionalidad de la cadera. En la luxación obturatriz, la cabeza femoral puede quedar atrapada en el agujero obturador y, como consecuencia, favorecer la disociación de los componentes protésicos al intentar la reducción, asimismo puede favorecer un brazo de palanca que produzca una fractura periprotésica. La obesidad puede ser un factor determinante para la producción de esta rara complicación. Por todo lo anterior, se recomienda considerar de entrada la reducción abierta. La luxación obturatriz es una complicación rara en la artroplastia total de cadera; su tratamiento puede ser difícil y asociarse a fracturas. La relevancia de este caso es que permite mostrar algunas estrategias de manejo para prevenir complicaciones catastróficas.


Subject(s)
Humans , Female , Obesity, Morbid/surgery , Obesity, Morbid/complications , Arthroplasty, Replacement, Hip/adverse effects , Periprosthetic Fractures/surgery , Periprosthetic Fractures/etiology , Femoral Fractures/surgery , Hip Dislocation/surgery , Hip Dislocation/etiology , Hip Prosthesis/adverse effects , Reoperation
9.
Rev. Col. Bras. Cir ; 47: e20202590, 2020. graf
Article in English | LILACS | ID: biblio-1136535

ABSTRACT

ABSTRACT Introduction: the number of hip fractures is estimated to increase from 1.66 million in 1990 to 6.26 million by 2050. Internal fixation is the most common surgical treatment for intertrochanteric fractures. Objectives: the objective of the present research is to describe a minimally invasive technique with a modified instrument for the treatment of stable proximal femoral trochanteric fractures using the standard DHS, classified as Tronzo types 1 and 2 (AO 31A1.2), and presenting a case series. Methods: a case was selected to present the technique. Patients operated by this technique undergo a clinical evaluation and preoperative preparation as routine. The criteria for inclusion in the study were the presence of stable fracture of the proximal femur verified by two hip specialist orthopedists, and operated by the minimally invasive technique with a modified instrument using a standard DHS. Exclusion criteria were cases of patients operated for unstable fractures, and the use of other surgical techniques. A case series of 98 patients was performed and discussed. Results: minimally invasive technique with a modified instrument using the standard DHS device can reduce bleeding, it decreases soft tissue injuries, surgical time, and hospital stay, as any other MIPO procedures. Ninety-eight patients underwent the operation (Tronzo types I and II), 59 female and 39 male, ages from 50 to 85 years old. Immediate post-operative complications were shortening of the lower limb, loss of fracture reduction, and death by clinical complications. Conclusion: the present study describes a minimally invasive surgical technique using a modified instrument to perform proximal femoral osteosynthesis for stable trochanteric fractures, using the standard DHS.


RESUMO Introdução: estima-se que o número de fraturas de quadril aumente de 1,66 milhão em 1990 para 6,26 milhões em 2050. A fixação interna é o tratamento cirúrgico mais comumente utilizado para as fraturas intertrocantéricas. Objetivos: o objetivo da presente investigação é descrever uma técnica minimamente invasiva com um instrumento modificado para o tratamento de fraturas trocantéricas femorais proximais estáveis, classificadas como tipos I e II de Tronzo (AO 31A1.2), usando o DHS padrão, e apresentar uma série de casos. Métodos: foi selecionado um caso aleatório para apresentar a técnica. Os pacientes operados por essa técnica passam por avaliação clínica e preparo pré-operatório de rotina. Os critérios para inclusão no estudo foram a presença de fratura estável do fêmur proximal, verificada por dois ortopedistas especialistas em quadril, e operada pela técnica minimamente invasiva com um instrumento modificado usando um DHS padrão. Os critérios de exclusão foram os casos de pacientes operados por fraturas instáveis e o uso de outras técnicas cirúrgicas. Uma série de casos de 98 pacientes foi realizada e é discutida. Resultados: a técnica minimamente invasiva com o instrumento modificado usando o dispositivo DHS padrão pode reduzir a hemorragia, as lesões dos tecidos moles, o tempo cirúrgico e a estadia hospitalar, tal como quaisquer outros procedimentos de osteossíntese minimamente invasivos. Noventa e oito pacientes foram operados (tipos I e II de Tronzo), 59 do sexo feminino e 39 do masculino, com idades entre 50 e 85 anos. As complicações pós-operatórias imediatas foram encurtamento do membro inferior, perda da redução da fratura e morte por complicações clínicas. Conclusão: o presente estudo descreve uma técnica cirúrgica minimamente invasiva, utilizando um instrumento modificado para realizar osteossíntese femoral proximal para fraturas trocantéricas estáveis, utilizando o DHS padrão.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Minimally Invasive Surgical Procedures/methods , Femoral Fractures/surgery , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Reference Standards , Bone Screws , Treatment Outcome , Middle Aged
10.
Rev. bras. anestesiol ; 69(6): 569-579, nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057481

ABSTRACT

Abstract Background and objectives: Perioperative management of femoral fractures in elderly patients has been studied to determine modifiable causes of complications and death. The aim of this study was to evaluate the mortality rate and its causes in the elderly population with FF. We also evaluated perioperative complications and their association with postoperative mortality. Method: In this prospective and observational study, we evaluated 182 patients, by questionnaire and electronic medical record, from the moment of hospitalization to one year after surgery. Statistical analyzes using the multivariate Cox proportional hazards model and Kaplan-Meier curves were performed to detect independent mortality factors. Results: Fifty-six patients (30.8%) died within one year after surgery, and the main cause of death was infection followed by septic shock. The main complication, both preoperatively and postoperatively, was hydroelectrolytic disorder. For every one-unit (one-year) increase in age, the odds ratio for death increased by 4%. With each new preoperative complication, the odds ratio for death increased by 28%. Patients ASA III or IV had a 95% higher odds ratio for death than patients ASA I or II. Conclusions: Increasing age and number of preoperative complications, in addition to ASA classification III or IV, were independent factors of increased risk of death in the population studied. The mortality rate was 30.8%, and infection followed by septic shock was the leading cause of death.


Resumo Justificativa e objetivos: O manejo perioperatório das fraturas de fêmur em pacientes idosos tem sido estudado com o intuito de determinar causas modificáveis de complicações e óbito. Este estudo tem por objetivo avaliar taxa de mortalidade e suas causas na população idosa com fraturas de fêmur. Avaliamos também complicações perioperatórias e sua associação com mortalidade pós-operatória. Método: Neste estudo prospectivo e observacional, avaliamos 182 pacientes, por questionário e prontuário eletrônico, desde o momento da internação até um ano após a cirurgia. Análises estatísticas pelo modelo multivariado de riscos proporcionais de Cox e curvas de Kaplan-Meier foram feitas para detectar fatores independentes de mortalidade. Resultados: Cinquenta e seis pacientes (30,8%) obituaram em até um ano de pós-operatório, sendo que a principal causa determinada de óbito foi infecção seguida de choque séptico. A principal complicação, tanto pré quanto pós-operatória, foi distúrbio hidroeletrolítico. Para cada aumento de uma unidade (em ano) na idade, a razão de chance de vir a óbito aumentou em 4%. A cada nova complicação pré-operatória apresentada, a razão de chance de óbito aumentou em 28%. Os pacientes ASA III ou IV apresentaram razão de chance de óbito, em um ano, 95% maior do que aqueles ASA I ou II. Conclusões: O aumento da idade e do número de complicações pré-operatórias, além da classificação de ASA III ou IV, foram fatores independentes de risco aumentado de óbito na população estudada. A taxa de mortalidade foi de 30,8%, sendo que a infecção seguida de choque séptico foi a principal causa determinada de óbito.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Postoperative Complications/epidemiology , Perioperative Care/methods , Femoral Fractures/surgery , Postoperative Complications/mortality , Prospective Studies , Surveys and Questionnaires , Risk Factors , Age Factors , Hospital Mortality
11.
Rev. chil. ortop. traumatol ; 60(3): 79-85, dic. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1146621

ABSTRACT

OBJETIVO: Evaluar los resultados radiológicos de pacientes con fractura de fémur proximal tratados con clavo cefalo-medular y reducción abierta a través de abordaje mini-open. MATERIAL Y MÉTODOS: Estudio retrospectivo-descriptivo de una serie consecutiva de 45 pacientes (38 hombres, 7 mujeres, edad promedio 52 años) con fractura de cadera de alta energía tratados con clavo cefalo-medular y reducción a través de abordaje miniopen. Se registró el mecanismo del accidente y presencia de lesiones asociadas. En todos los casos se contó con radiografías preoperatorias y tomografía axial computada (TAC). Se clasificaron de acuerdo a la AO. Se registró en número de fragmentos que presentaba la fractura. Se tomaron radiografías de control en forma mensual hasta la consolidación. Se midió el ángulo cervico-diafisiario operado y contralateral. RESULTADOS: Todos los casos fueron secundarios a un accidente de alta energía. Veintidós pacientes presentaron lesiones asociadas. El número de fragmentos promedio fue de 3. La diferencia entre el ángulo cervico-diafisiario post operatorio de la cadera fracturada versus la cadera contralateral fue de 4,9 grados. Un paciente presentó no-unión. El tiempo promedio hasta la consolidación radiográfica fue de 3,7 meses. CONCLUSIÓN: El uso de clavos cefalo-medulares asociado a reducción a través de miniopen en pacientes jóvenes con fractura de fémur proximal de alta energía, presenta buenos resultados radiológicos con bajo número de complicaciones.


OBJECTIVE: To evaluate radiologic results of patients with proximal femur fracture treated with cephalo-medullary nails and open reduction through mini-open approach. MATERIALS AND METHODS: A retrospective-descriptive study of 45 patient consecutive series (38 male, 7 female. Mean age 52 years old) with high energy hip fracture treated with cephalo-medullary nails and open reduction through mini-open approach. Accident mechanism and associated lesions were documented. Every case was evaluated with pre-operative radiography and CT-scan. Fractures were classified according to AO classification. Patients were radiographically controlled monthly until bone healing. Cervical-diaphysial angle was measured and compared bilaterally. RESULTS: Every case was secondary to high energy trauma. 22 patients presented associated lesions. The mean number of bone fragments was 3. The difference between postoperative cervical-diaphysial angle versus contralateral hip was 4.9°. Only 1 patient presented non-union. The mean time until consolidation confirmed with radiography was 3.7 months. CONCLUSION: The use of cephalo-medullary nails associated to open reduction through a mini-open approach in young patients with high energy associated proximal femur fractures, presents satisfactory radiologic results with a low amount of complications.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Bone Nails , Femoral Fractures/surgery , Fracture Fixation/methods , Accidents , Epidemiology, Descriptive , Retrospective Studies , Treatment Outcome , Open Fracture Reduction , Hip Fractures/surgery
12.
Rev. bras. ortop ; 54(4): 387-391, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1042420

ABSTRACT

Abstract Objective To verify the predictive value of the Lee score for mortality in a one-year period after proximal femur fracture surgery. The present study also evaluated the isolated predictive capacity of other variables. Methods A sample of 422 patients with surgically-treated proximal femur fractures was evaluated. Data was collected through a review of medical records, appointments, and contact by telephone. Results The Lee score was applied to 99.3% of the patients with proximal femur fractures submitted to surgical treatment. Themortality rate was of 22% of the sample, and the majority were classified as class I risk. The Lee score had no significant association with mortality (p = 0.515). High levels of serum creatinine (p = 0.001) and age (p = 0.000) were directly associated with death. Conclusion The Lee score was not predictive of mortality in a one-year period after proximal femur fracture surgery; however, a statistical significance was observed between age and serum creatinine levels, considered separately, and death.


Resumo Objetivo Verificar o valor preditivo do escore de Lee para a mortalidade no primeiro ano pós operatório de fraturas de fêmur proximal. O estudo também avaliou a capacidade preditiva isolada de outras variáveis. Método Uma amostra de 422 pacientes com fraturas do fêmur proximal submetidos a cirurgia foi avaliada neste estudo. Os dados foram coletados por meio de revisão de prontuários, consultas presenciais e contatos telefônicos. Resultados O escore de Lee foi aplicado em 99,3% dos pacientes com fraturas de fêmur proximal submetidos a tratamento cirúrgico. A taxa de mortalidade da amostra foi de 22%, a maioria classificada como classe I de risco. O escore de Lee não apresentou associação significativa com a mortalidade (p = 0,515). Os valores elevados de creatinina sérica (p = 0,001) e a idade (p = 0,000) estiveram diretamente associados com o desfecho de morte. Conclusões O escore de Lee não é preditivo para amortalidade emumperíodo de um ano após cirurgia de fraturas de fêmur proximal; entretanto, observou-se significância estatística entre a idade e a dosagem sérica da creatinina, isoladamente, com o desfecho de morte.


Subject(s)
Humans , Male , Female , Postoperative Complications , Femoral Fractures/surgery , Femoral Fractures/ethnology , Femoral Fractures/mortality
13.
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
14.
Rev. bras. anestesiol ; 69(2): 204-207, Mar.-Apr. 2019. graf
Article in English | LILACS | ID: biblio-1003396

ABSTRACT

Abstract Objective: The aim of this report is to represent the role of the use of bedside ultrasound by the anesthesiologist, offering an individualized approach to the specific condition of the patient, without unnecessary postponement of femur fracture surgical repair in the elderly. Case report: Female patient, 86 years old, hypertensive, victim of trochanteric fracture of the femur, taken to the operating room after being released by cardiology service. A bedside ultrasound exam allowed the identification of aortic stenosis, left ventricular hypertrophy, carotid stenosis, and signs of hypovolemia. From these findings, it was decided to use an ultrasound-guided block of the nerves femoral and lateral cutaneous of the thigh as an anesthetic technique. Conclusions: The use of ultrasound guidance by the anesthesiologist can provide relevant information for individualizing the anesthetic technique, without postponing the surgical intervention, which usually occurs when the patient is referred for complete examination by the specialist.


Resumo Objetivo: Exemplificar o papel do emprego da ultrassonografia à beira do leito pelo anestesiologista e oferecer uma abordagem individualizada para a condição específica do paciente, sem que haja postergação desnecessária de correções cirúrgicas de fraturas de fêmur em idosos. Relato do caso: Paciente feminina, 86 anos, hipertensa, vítima de fratura trocantérica de fêmur, levada ao bloco cirúrgico após liberação cardiológica. O exame ultrassonográfico à beira do leito possibilitou a identificação de estenose aórtica, hipertrofia ventricular esquerda, estenose de carótida e indícios de hipovolemia. A partir desses achados, decidiu-se pelo bloqueio nos nervos femoral e cutâneo lateral da coxa guiado pela ultrassonografia como técnica anestésica. Conclusão: O uso da ultrassonografia direcionada à beira do leito pelo anestesiologista pode fornecer informações relevantes para a individualização da técnica anestésica, sem que haja postergação da intervenção cirúrgica, a qual comumente ocorre quando o paciente é referenciado para exame completo pelo especialista.


Subject(s)
Humans , Female , Aged, 80 and over , Ultrasonography/methods , Point-of-Care Systems , Femoral Fractures/surgery , Preoperative Care/methods , Ultrasonography, Interventional/methods , Nerve Block/methods
15.
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
16.
Int. j. morphol ; 37(1): 363-368, 2019. graf
Article in Spanish | LILACS | ID: biblio-990052

ABSTRACT

RESUMEN: Las fracturas intertrocantéricas en adulto mayor presentan gran dificultad para lograr una cicatrización ósea estable y una fijación en la artroplastía, para la recuperación completa y funcional del anciano. En pacientes adultos mayores sin stock óseo, se recomienda realizar anexo a la artroplastía de cadera, la colocación de una banda de tensión, con la finalidad de brindar mayor estabilidad a los fragmentos y sustentación a la artroplastía primaria, con el objetivo de lograr un retorno a la calidad de vida normal. A las cuatro semanas de la cirugía, se evidencia una mejora en la escala funcional alcanzando una puntuación media de 83, considerandose un buen resultado. En los controles subsecuentes se evidencia una media en la escala de Harris de 87. Los pacientes volvieron a su nivel de actividad preoperatoria, más de la mitad de los pacientes fueron capaces de caminar sin apoyos, y finalmente, no se reportaron complicaciones en los controles postquirúrgicos al seguimiento de un año.


SUMMARY: The intertrochanteric fractures in the elderly are very difficult to achieve stable bone healing and fixation in arthroplasty for complete and functional recovery of the elderly. In elderly patients without bone stock, it is recommended to make an attachment to the hip arthroplasty the placement of tension band with the purpose of providing greater stability to the fragments and support to the primary arthroplasty with the aim of a return to the normal quality of life, in the results at 4 weeks post-surgery an improvement in the functional scale is evidenced having as average score 83 taken as good results. In the subsequent controls a mean on the Harris scale of 87 was evidenced, the patients returned to their level of preoperative activity, more than half of the patients were able to walk without support, no complications were reported in the postoperative follow-up controls. of 1 year of patients.


Subject(s)
Humans , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Femoral Fractures/surgery , Osteoporotic Fractures/surgery , Fracture Fixation, Internal/methods , Treatment Outcome , Recovery of Function
17.
Rev. chil. ortop. traumatol ; 59(2): 72-81, sept. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-947111

ABSTRACT

Las fracturas de los cóndilos femorales en el plano coronal (Hoffa), son lesiones que afectan directamente la biomecánica de la rodilla. Están expuestas a un factor intrínseco de inestabilidad causado por el compromiso de los ligamentos y tendones insertados al fragmento condilar fracturado y a un factor extrínseco de inestabilidad dependiente del estrés mecánico en varo/valgo durante la fase de apoyo de la marcha y movimientos de flexo-extensión. El tratamiento quirúrgico con tornillos canulados sólo permite la compresión interfragmentaria y cierto grado de estabilidad rotacional, sin embargo, ese tipo de fijación podría no ser suficiente para soportar o neutralizar las cargas. Distintos autores han publicado otros métodos de osteosíntesis con el uso de placas en el plano lateral o posterior más la colocación de tornillos en sentido postero-anterior, pero siguen siendo opciones controversiales debido al tipo de morbilidad inherente a cada constructo. El objetivo de este artículo es realizar una revisión de la literatura para analizar la validez de los principios quirúrgicos y biomecánicos en el tratamiento de fracturas tipo hoffa.


Coronal plane fractures of the femoral condyles are commonly known as Hoffa fractures. These are intraarticular fractures that directly affect the biomechanics of the knee and have intrinsic and extrinsic instability patterns. The tendons and ligaments that remain attached to the condylar fragment produce the intrinsic instability. The extrinsic instability is due to the varus/valgus stress applied during the stance phase in the gait cycle as well as the flexion-extension movements. Surgical treatment with cannulated screws only achieves interfragmentary compression and certain amount of rotational stability that is not enough to support or neutralize the loads. Some authors have published different methods of osteosynthesis with lateral or posterior plates in conjunction with screws implanted in the posterior-anterior direction, still these techniques remain controversial due to the morbidity inherent to each construct. The purpose of this article is to review the current concepts of Hoffa fractures including biomechanics and surgical principles with the intention of analyzing their treatment efficacy.


Subject(s)
Humans , Femoral Fractures/surgery , Fracture Fixation, Internal/methods , Biomechanical Phenomena , Bone Screws , Femoral Fractures/classification , Femoral Fractures/physiopathology
18.
Acta ortop. mex ; 32(3): 126-130, may.-jun. 2018. tab
Article in Spanish | LILACS | ID: biblio-1054768

ABSTRACT

Resumen: Introducción: El clavo cefalomedular es utilizado para el tratamiento de la fractura de cadera; sin embargo, existen pocos estudios que permitan identificar datos sobre las complicaciones del uso de estos dispositivos y los resultados en términos de restauración de la funcionalidad del paciente. Métodos: Se realizó un estudio de corte transversal en pacientes con fractura de fémur durante el período de Enero de 2008 a Diciembre de 2012. Se recopiló información de variables demográficas y clínicas. Se llevó a cabo un seguimiento telefónico hasta seis meses postoperatorios. Se efectuó un análisis descriptivo utilizando medidas de frecuencia absolutas y relativas. Las variables cuantitativas se presentan con promedios y desviación estándar o mediana y rango intercuartil, según la normalidad de los datos. Resultados: De los pacientes, 82.9% logró caminar con o sin ayuda dentro de los seis meses posteriores a la cirugía. El tiempo de hospitalización fue de cuatro días en promedio; las principales complicaciones fueron anemia (16.2%), infección urinaria (9.7%), neumonía (9.5%) e infarto del miocardio (0.7%). De quienes fueron incluidos, 57.1% tenían un nivel ASA ≥ 3; se identificó una mortalidad de 16% en ellos. Discusión: El clavo cefalomedular muestra resultados positivos en cuanto a recuperación funcional de la movilidad y una baja prevalencia de complicaciones, con una mortalidad similar a la reportada en la literatura dentro de los primeros 6 meses de nuestro seguimiento.


Abstract: Introduction: Cephalomedullary nails are used for the treatment of hip fractures; however, there are few studies that allow identifying data on the complications of the use of these devices and the results in terms of restoration of the functionality of the patient. Methods: A cross-sectional study of patients with femur fracture was conducted during the period from January 2008 to December 2012. Data on demographic and clinical variables were collected. Telephone follow-up was performed up to six postoperative months. A descriptive analysis was done using absolute and relative frequency measurements. Quantitative variables are presented with averages and standard deviation or median and interquartile range, according to the normality of the data. Results: 82.9% of the patients managed to walk with or without help within six months after surgery; anemia (16.2%), urinary tract infection (9.7%), pneumonia (9.5%) and myocardial infarction (0.7%) were the main complications. Of the patients included, 57.1% had an ASA level ≥ 3; a mortality rate of 16% was identified. Discussion: Cephalomedullary nails show positive results regarding recovery of functional mobility and a low prevalence of complications, with similar mortality to that reported in the literature at 6 months of follow up.


Subject(s)
Humans , Bone Nails , Femoral Fractures/surgery , Fracture Fixation, Intramedullary , Hip Fractures/surgery , Postoperative Complications , Cross-Sectional Studies , Treatment Outcome
19.
Acta ortop. mex ; 32(1): 48-52, ene.-feb. 2018. graf
Article in Spanish | LILACS | ID: biblio-1019328

ABSTRACT

Resumen: Introducción: Las fracturas periprotésicas de cadera son aquéllas que ocurren a nivel femoral y acetabular. A estas fracturas se asocia una amplia variedad de problemas como la conminución, la pérdida ósea y con frecuencia el aflojamiento del vástago femoral. El tratamiento de estas fracturas ha estado históricamente asociado a altas tasas de fracasos del tratamiento, de complicaciones y de resultados insatisfactorios. Objetivo: Presentar el caso clínico-radiográfico del tratamiento de una fractura periprotésica con revisión femoral y reconstrucción metafisaria con lajas de cortical y cables de acero en un paciente multioperado. Material y métodos: Se presenta el caso de un paciente con luxación de prótesis total de cadera izquierda de revisión + fractura periprotésica Vancouver B3, a quien se le realiza revisión de componente femoral y reconstrucción metafisaria proximal de fémur con aloinjerto óseo en lajas y fijación con cables de acero. Resultados: El paciente cursa con adecuada evolución al año de postoperado, deambulando con apoyo de bastón, control radiográfico y adecuada congruencia de los componentes protésicos y datos de consolidación de la fractura. Discusión: En el tratamiento de las fracturas periprotésicas es posible recurrir a la reconstrucción mediante el uso de aloinjertos en laja de cortical, cerclados con cables de acero, con buenos resultados funcionales y radiológicos.


Abstract: Introduction: Periprosthetic hip fractures are those that occur at the femoral and acetabular level. These fractures are associated with a wide variety of problems such as comminution, loose of bone stock and loosening of the femoral stem. Treatment of these fractures has historically been associated with high rates of treatment failures, complications and unsatisfactory outcomes. Objective: To present the clinical-radiographic case of the treatment of a periprosthetic hip fracture, with a femoral revision and metaphyseal reconstruction with cortical strut allograft and cerclage cables, in a multioperated patient. Material and methods: We present the case of a patient with a dislocation of a revision total hip prosthesis with a periprosthetic fracture type B3 of the Vancouver classification, who underwent a revision of the femoral component and a proximal metaphyseal reconstruction of the femur with cortical strut allograft and cerclage cables. Results: The patient had an adequate evolution at the postoperative year, walking with a cane, radiographic control with adequate congruence of the prosthetic components and data of consolidation of the fracture. Discussion: In the treatment of periprosthetic fractures, reconstruction can be done with use of cortical strut allograft and cerclage cables, with good functional and radiological results.


Subject(s)
Humans , Arthroplasty, Replacement, Hip , Periprosthetic Fractures/surgery , Femoral Fractures/surgery , Hip Fractures/surgery , Hip Prosthesis , Reoperation , Treatment Outcome , Allografts
20.
Rev. Asoc. Argent. Ortop. Traumatol ; 82(4): 306-311, dic. 2017. []
Article in Spanish | LILACS, BINACIS | ID: biblio-896273

ABSTRACT

Comunicamos un caso de seudoartrosis infectada de fémur secundaria a una fractura expuesta de tipo IIIC, tratada con osteogénesis por distracción. Hombre de 32 años con una fractura expuesta de fémur derecho con lesión arterial por disparo de escopeta. Es operado de urgencia y se le efectúa limpieza quirúrgica, fijación externa y reparación arterial. Evoluciona con una seudoartrosis infectada femoral distal, por lo que, a los 24 meses de evolución, es sometido a una resección amplia y queda un defecto óseo de 12 cm, que se resuelve mediante distracción osteogénica. La osteogénesis por distracción es útil para obtener la reparación y la consolidación de variados defectos óseos. Requiere de un paciente comprometido con un proceso terapéutico demandante. Nivel de Evidencia: IV


We report a case of infected nonunion secondary to a type IIIC open femoral fracture, treated by distraction osteogenesis. A 32-year-old man with a gunshot open fracture of the distal right femur with arterial injury. Surgical debridement, external fixation and arterial repair are performed as emergency procedure. The patient develops a femoral infected nonunion, so 24 months later a wide resection is performed leaving a 12 cm bone defect that is regenerated by distraction osteogenesis. Distraction osteogenesis is a useful procedure for the repair and consolidation of several bone defects. It requires patient´s commitment to a demanding therapeutic process. Level of Evidence: IV


Subject(s)
Adult , Pseudarthrosis/therapy , Bone Lengthening/methods , Femoral Fractures/surgery , Femoral Fractures/therapy , Fractures, Open/complications , Treatment Outcome
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