Reporte de caso de una niña de 9 años de edad con una fractura acetabular fisaria desplazada tratada quirúrgicamente: 5 años de seguimiento / Case report of an acetabular displaced physeal fracture in a 9-year-old girl treated surgically: follow-up of 5 years / Relato de caso de uma menina de 9 anos com fractura de acetábulo desviada tratada cirurgicamente: seguimento de 5 anos

Las fracturas acetabulares con compromiso del cartílago trirradiado (CTR) en pacientes pediátricos son muy poco frecuentes, difíciles de diagnosticar y complejas de tratar; pudiendo dejar graves secuelas. Generalmente son producto de accidentes de tránsito de alta energía cinética. Debido a su baja prevalencia no hay grandes series en la bibliografía y por ende tampoco existe un consenso terapéutico. Realizamos una puesta a punto del tema a propósito de un atípico caso de una niña de 9 años con una fractura del acetábulo con compromiso del CTR, producido por un traumatismo de baja energía cinética. Registramos su diagnóstico y tratamiento quirúrgico, evaluamos su resultado clínico - radiológico y funcional mediante el Hip Harris Score (HHS) al final de su seguimiento de 5 años.

Acetabular fractures with compromise of the triradiate cartilage (TRC) in pediatric patients are very rare, difficult to diagnose and complex to treat, also can leave serious consequences. They are generally product of high energy kinematics. Due to its low prevalence, there are no large series in the literature and therefore there is no therapeutic consensus. We carried out a recapitulation of the subject regarding an atypical case of a 9-year-old girl with an acetabulum fracture with compromise of the TRC, produced by a low kinetic energy trauma. We recorded the diagnosis and surgical treatment, and also, we evaluated the clinical-radiological and functional results through the Hip Harris Score (HHS) at the end of their 5-year follow-up.

As fraturas acetabulares com compromisso da cartilagem trirradiada (TRC) em pacientes pediátricos são muito poco frecuentes, de difícil diagnóstico e complexas de tratar; e podem deixar sérias consequências. Geralmente são o produto de acidentes de trânsito de alta energia cinética. Devido à sua baixa prevalência, não há grandes séries na literatura e, portanto, não há consenso terapêutico. Realizamos uma atualização do tema referente a um caso atípico de uma menina de 9 anos com fratura de acetábulo com comprometimento do CTR, produzida por um trauma de baixa energia cinética. Registramos seu diagnóstico e tratamento cirúrgico, avaliamos seus resultados clínico-radiológicos e funcionais por meio do Hip Harris Score (HHS) ao final de seu seguimento de 5 anos.

Redução aberta de fratura nasal: relato de caso / Open reduction of nasal fracture: case report / Reducción aberta de la fractura nasal: reporte de un caso

As fraturas nasais são de grande incidência dentre as fraturas faciais, podendo envolver também outras estruturas da face. O diagnóstico é baseado no exame físico, o qual muitas vezes é dificultado devido ao edema formado na região. A palpação dos contornos ósseos, verificação de presença de crepitação nasal, alterações de permeabilidade e assimetrias locais são algumas das alterações sugestivas de fraturas nasais. Além disso, a inserção do ligamento cantal medial pode ser perdida devido ao trauma ou devido ao deslocamento ósseo em que ele se encontra inserido. Exames de imagem, como radiografias e Tomografias Computadorizadas, são utilizados para a visualização das fraturas ósseas e planejamento cirúrgico. A redução aberta dos ossos nasais é indicada para fraturas de maior complexidade e cominuição, tendo em vista o adequado reposicionamento dos ossos, cartilagens e ligamentos deslocados. Assim, o objetivo deste estudo é relatar a redução aberta de uma fratura dos ossos nasais com perda de inserção do ligamento cantal medial direito, sob anestesia geral... (AU)

Nasal fractures are of great incidence among facial fractures, and may also involve other facial structures. The diagnosis is based on physical examination, which is often hampered due to the edema formed in the region. Palpation of bone contours, checking for the presence of nasal crackling, changes in permeability and local asymmetries are some of the changes suggestive of nasal fractures. In addition, the insertion of the medial canthal ligament may be lost due to trauma or due to the bone displacement in which it is inserted. Imaging exams, such as radiographs and CT scans, are used for visualizing bone fractures and surgical planning. The open reduction of the nasal bones is indicated for fractures of greater complexity and comminution, in view of the appropriate repositioning of the bones, cartilage and dislocated ligaments. Thus, the aim of this study is to report the open reduction of a fracture of the nasal bones with loss of insertion of the right medial canthal ligament, under general anestesia... (AU)

Las fracturas nasales son de gran incidencia entre las fracturas faciales, y también pueden involucrar otras estructuras faciales. El diagnóstico se basa en el examen físico, que a menudo se ve obstaculizado por la inflamación que se forma en la región. La palpación de los contornos óseos, confirmación de la presencia de crepitantes nasales, alteraciones de la permeabilidad y asimetrías locales son algunas de las alteraciones sugestivas de fracturas nasales. Además, la inserción del ligamento cantal medial puede perderse debido a un traumatismo o al desplazamiento del hueso en el que se inserta. Las pruebas de imagen, como las radiografías y las tomografías computadorizadas, se utilizan para visualizar las fracturas óseas y planificar la cirugía. La reducción abierta de los huesos nasales está indicada para las fracturas de mayor complejidad y conminución, en vista del reposicionamiento adecuado de los huesos, cartílagos y ligamentos dislocados. Así, el objetivo de este estudio es relatar la reducción abierta de una fractura de los huesos nasales con pérdida de inserción del ligamento cantal medial derecho, bajo anestesia general... (AU)

Tratamiento de las fracturas supracondíleas de húmero en niños y fijación interna percutánea versus reducción sin fijación interna / Treatment of Supracondylar Fractures of the Humerus in Children and Percutaneous Internal Fixation versus Reduction with no Internal Fixation

Introducción: Las fracturas supracondíleas de húmero constituyen el segundo tipo de fracturas más frecuentes en niños. La prevalencia mundial oscila entre 3 y 16 por ciento, con predominio en varones. La urgencia de una atención inmediata radica en la prevención de complicaciones y secuelas. Objetivo: Describir los resultados del tratamiento de las fracturas supracondíleas de húmero en niños con fijación interna percutánea. edad, sexo, tipo de tratamiento empleado, complicaciones, y resultados finales obtenidos. Métodos: Se realizó un estudio descriptivo retrospectivo, en pacientes con fracturas supracondíleas de húmero en niños, atendidos en el Hospital Carlos Manuel de Céspedes de Bayamo, entre 2018 y 2019. Se calcularon frecuencias absolutas y porcentajes. Se evaluaron las siguientes variables: edad, sexo, tipo de tratamiento empleado, complicaciones, y resultados finales obtenidos. Resultados: Las fracturas supracondíleas de húmero fueron más frecuentes en el sexo masculino (69,6 por ciento) y en el grupo de edad comprendido entre 6 y 10 años para ambos sexos. El 60,8 por ciento de estas fracturas se trataron con reducción y fijación interna con agujas de Kirchner. En el grupo con fijación interna predominaron las de tipo IV y en el grupo que no requirió fijación interna predominó el tipo I. En general, en los pacientes con fijación interna predominaron los resultados excelentes y buenos. Conclusiones: Se obtuvieron mejores resultados en los casos donde se realizó la reducción combinada con fijación interna(AU)

Introduction: Supracondylar fractures of the humerus are the second most frequent type of fractures in children. The worldwide prevalence ranges between 3 and 16 percent, with predominance in males. The urgency of immediate care lies in the prevention of complications and sequelae. Objective: To describe the results of the treatment of supracondylar fractures of the humerus in children with percutaneous internal fixation. Methods: A retrospective descriptive study was carried out in patients with supracondylar fractures of the humerus in children, treated at Carlos Manuel de Céspedes Hospital in Bayamo, from 2018 to 2019. Absolute frequencies and percentages were calculated. The variables evaluated were age, sex, type of treatment used, complications, and final results obtained. Results: Supracondylar fractures of the humerus were more frequent in males (69.6 percent) and in the age group between 6 and 10 years for both sexes. 60.8 percent of these fractures were treated with reduction and internal fixation with Kirchner wires. In the group with internal fixation, type IV predominated, also type I predominated in the group that did not require internal fixation. In general, excellent and good results predominated in patients with internal fixation. Conclusions: Better results were obtained in patients who underwent reduction combined with internal fixation(AU)

Management of Supracondylar Humeral Fracture in Children / Manejo da fratura supracondiliana do úmero na criança

Abstract Supracondylar humeral fracture represents ~ 3 to 15% of all fractures in children. It is the fracture that most requires surgical treatment in the pediatric population. Advances in treatment and care have contributed to a reduction in the most dramatic complication: Volkmann ischemic contracture. Nevertheless, the risks inherent to the fracture remain. Absence of palpable pulse in type-III fractures is reported in up to 20% of the cases. Careful sensory, motor, and vascular evaluation of the affected limb is crucial in determining the urgency of treatment. Older children, male patients, floating elbow, and neurovascular injury are risk factors for compartment syndrome. Medial comminution can lead to varus malunion, even in apparently innocent cases. The recommended treatment of displaced fractures is closed reduction and percutaneous pinning. Technical errors in pin placement are the main cause of loss of reduction. There is enough evidence for the addition of a third lateral or medial Kirschner wire in unstable fractures (types III and IV). Medial comminution may lead to cubitus varus even in mild displaced fractures. Based on current concepts, a flowchart for the treatment of supracondylar humeral fracture in children is suggested by the authors.

Resumo A fratura supracondiliana do úmero representa cerca de 3 a 15% de todas as fraturas na criança, sendo a que mais requer tratamento cirúrgico na população pediátrica. Apesar de os avanços no tratamento e na assistência terem contribuído para uma redução drástica da complicação mais temida, a contratura isquêmica de Volkmann, os riscos inerentes à fratura permanecem. Ausência de pulso palpável em fraturas tipo III é reportada em até 20% dos casos. Uma cuidadosa avaliação sensitiva, motora e vascular do membro acometido é fundamental na determinação da urgência do tratamento. Crianças mais velhas, sexo masculino, cotovelo flutuante, e lesão neurovascular são fatores de risco para a síndrome de compartimento. A cominuição medial pode levar à consolidação em varo, mesmo nos casos aparentemente inocentes. O método de escolha para o tratamento da fratura desviada é a redução fechada e fixação percutânea. Os erros na fixação e posicionamento inadequado dos implantes são as principais causas de perda de redução. Já existem evidências suficientes para a utilização de um terceiro fio de Kirschner, lateral ou medial, nas fraturas instáveis (tipo III e IV). Baseado nos conceitos atuais, um fluxograma para o tratamento da fratura supracondiliana do úmero na criança é sugerido pelos autores.

Ostéoporose et évaluation du risque fracturaire par l'outil frax chez des patients Congolais présentant un rhumatisme axial Une série des cas multicentriques

Contexte et objectif. L'enjeu majeur dans le management de l'ostéoporose est l'identification des sujets à risque par la quantification du risque fracturaire. L'objectif de l'étude était d'évaluer le risque fracturaire chez les patients ayant consulté pour douleur du squelette axial. Méthodes. Il s'agissait d'une série des cas multicentriques menée sur des patients recrutés dans 8 hôpitaux de Kinshasa. Les paramètres d'intérêt comme l'âge, le sexe, l'alcoolisme, le tabagisme, la fracture de hanche chez un parent de 1er degré ou une fracture personnelle de fragilité ont été collectés auprès de chaque patient. La mesure de la densité osseuse avait été réalisée par absorptiométrie biphotonique à rayons X. Le risque fracturaire a été évalué par le calcul de l'indice fracturaire FRAX. Ce risque était élevé lorsque la probabilité de survenue de fracture de hanche était ≥ 3% et/ou des fractures ostéoporotiques majeures ≥ 20%. Des tests statistiques usuels ont été utilisés pour l'analyse des résultats. Résultats. 90 patients dont 75 femmes étaient inclus. Leur âge moyen était de 63, 5±12ans.L'ostéoporoseétaitdiagnostiquée chez 34,4% des patients, l'ostéopénie chez 43,9% et 16,7% avaient une densité minérale osseuse normale. Aucune fracture ostéoporotique n'a été observée dans la présente étude, mais près de 30% de l'ensemble de l'échantillon avaient un risque fracturaire élevé. L'ostéoporose était associée, dans environ 80% des cas (p<0,005), à un risque fracturaire élevé. Conclusion. La présente étude a montré que le risque fracturaire était élevé chez les patients atteints d'ostéoporose. Elle met en lumière la nécessité d'un dépistage précoce de cette pathologie.

Severe hand contracture treated by external fixation after proximal row carpectomy and awake tenolysis after general anesthesia: A case report / 中华创伤杂志(英文版)

Wide-awake local anesthesia has many advantages. We describe a new method to use wide-awake local anesthesia with more flexibility. A 32-year-old man with a severe right-hand contracture after an iatrogenic tourniquet accident during an anterolateral thigh flap for a partial hand amputation underwent contracture release using external fixation after proximal row carpectomy and subsequent tenolysis. We performed most of the tenolysis procedure under general anesthesia and the final stage with an intraoperative assessment of active finger movement and dissection under local anesthesia. He regained his grip strength 2.5 years post-injury. General anesthesia is useful to treat a surgical site with extensive hard scars, whereas local anesthesia is useful for adjusting tension in an awake patient. The indication for wide-awake surgery is yet to be established; our method of combining general and local anesthesia in the tenolysis procedure illustrates the possibilities in expanding this method.

Effect of calcium sulfate on promoting natural healing of docking sites during bone transport / 中国骨伤

OBJECTIVE@#To observe clinical effect of calcium sulfate on promoting natural healing of docking sites during bone transport.@*METHODS@#A retrospective study was performed on the patients with posttraumatic chronic osteomyelitis treated by bone transport and calcium sulfate implantation from January 2013 to January 2018. There were 23 males and 4 females, aged from 20 to 61 years old with an average of (44.30±10.00) years, the courses of disease ranged from 3 to 86 months with an average of(13.26±16.47) months. Sixteen patients with posttraumatic chronic osteomyelitis were caused by internal fixation of closed fractures, and 11 patients were caused by open fractures. The length of bone defects after debridement ranged from 4 to 14 cm with an average of(9.11±2.57) cm. Postoperative complications, natural healing rate of the docking sites, external fixation index were observed, Checketts & Otterburn pin-tract infection classification was used to evaluate pin-tract infection, and Paley evaluation criteria was used to evaluate bone and function results.@*RESULTS@#Twenty-seven patients were followed up from 26 to 41 months with an average of (31.32±3.37) months. It did not happened skin embedded between bone stumps in all patients. All patients obtained bone union at (17.78±5.43) months after operation.Among them, 25 patients healed naturally in the docking sites, 2 patients with poor compliance healed after debridement and bone grafting in the docking sites. One patient occurred equines deformity, and no re-fracture or recurrence of infection occurred. According to Checketts & Otterburn pin tract infection classification, 22 patients (41 pin tracts)occurred pin-tract infection with varying degrees. The average external fixation index was (2.02±0.24) months/cm(ranged from 1.6 to 2.4 months/cm). According to Paley evaluation criteria, bony results showed 21 patients obtained excellent results, 5 good, and 1 moderate;functional results showed 19 patients got excellent results, 7 good, and 1 moderate.@*CONCLUSION@#During bone transport, the implantation of calcium sulfate on the bone defect areas could prevent skin embedding between the bone stumps, benefit for the natural healing of the docking sites, and could avoid the second-stage debridement and bone grafting for most patients. However, it should be noted that compliance needs to be increased.

Intramedullary Fixation with Headless Screws versus Bouquet in Unstable Metacarpal Neck Fractures in Active Patients: A Randomized Study / Fixação intramedular com parafusos de compressão versus técnica do buquê em fraturas instáveis do colo do metacarpo em pacientes ativos: Ensaio clínico randomizado

Abstract Objeticve To compare the range of motion (ROM), return-to-work time, visual analogue score (VAS), disability of the arm, shoulder, and hand (QuickDASH), and radiographic outcomes of two methods of definitive internal fixation in active patients with boxer's fractures, operated in the first week. Methods This was a prospective, randomized trial, in which 50 patients, with a mean age range of 18 to 40 years old, were randomized and treated to definitive intramedullary fixation using 2 headless screws (n = 20) or bouquet (2 or 3 Kirschner wires) (n = 20). The patients were assessed on return-to-work time, ROM, patient reported QuickDASH outcome, VAS, and radiographic evaluation at 6 months. Results At 6 months, there were no differences between the two groups in terms of ROM, postoperative pain (VAS), or QuickDASH score. The overall complication rate was 4.76% in the screw group, compared with 5% in the bouquet-fixation group. Conclusions In the treatment of the active patients with unstable boxer's fractures, headless screws and bouquet fixation proved to be a safe and reliable treatment. The outcomes were similar in both groups.

Resumo Objetivo Comparar a amplitude de movimento (ADM), o tempo de retorno de trabalho, a pontuação na escala visual analógica (EVA), o escore no questionário abreviado incapacidade do braço, ombro e mão (QuickDASH, na sigla em inglês) e os resultados radiográficos de dois métodos de fixação interna definitiva em pacientes ativos com fraturas do boxer; operados na primeira semana. Métodos Este foi um ensaio prospectivo randomizado, no qual 50 pacientes, com idade mediana na faixa de 18 a 40 anos, foram randomizados e tratados com fixação intramedular definitiva utilizando 2 parafusos de compressão (n = 20) ou buquê (2 ou 3 fios de Kirschner) (n = 20). Os pacientes foram avaliados em relação ao tempo de retorno ao trabalho, à ADM, ao desfecho relatado pelo paciente no questionário QuickDASH, à EVA e à avaliação radiográfica aos 6 meses. Resultados Aos 6 meses, não houve diferenças entre os 2 grupos em termos de ADM, dor pós-operatória (EVA) ou escore no QuickDASH. A taxa global de complicações foi de 4,76% no grupo de fixação com parafusos, em comparação com 5% no grupo de fixação com a técnica do buquê. Conclusões Parafusos de compressão e fixação com buquês provaram ser tratamentos seguros e confiáveis para pacientes ativos com fraturas instáveis. Os resultados foram semelhantes nos dois grupos.

Fractura osteocondral traumática de rodilla en edad pediátrica: reporte de un caso / Traumatic osteochondral knee fracture in pediatric age: report of a case / Fratura osteocondral traumática do joelho em idade pediátrica: relato de um caso

Las fracturas osteocondrales (FOC) traumáticas de rodilla en la edad pediátrica, son lesiones que acompañan hasta un 30% de las luxaciones agudas de rótula (LAR). Si no se mantiene una elevada sospecha clínica, es frecuente su retraso diagnóstico, pudiendo generar potenciales complicaciones. A propósito, presentamos el caso de una paciente de 12 años con una FOC post LAR que pasó inadvertida en la primera consulta, requiriendo la fijación del fragmento osteocondral con tornillos HCS a los 5 meses, logrando un excelente resultado funcional a los 54 meses de seguimiento.

Traumatic osteochondral fractures (OCF) of the knee in pediatric age are injuries that accompany up to 30% of acute patellar dislocations (APD). If high clinical suspicion is not maintained, its diagnostic delay is frequent, and may generate potential complications. Incidentally, we present the case of a 12-year-old patient with a post-APD OCF that went unnoticed in the first consultation, requiring fixation of the osteochondral fragment with HCS screws at 5 months. Achieving an excellent functional result at 54 months follow-up.

As fraturas osteocondrais traumáticas (FOC) do joelho em idade pediátrica são lesões que acompanham até 30% das luxações agudas da patela (LAP). Se uma alta suspeita clínica não for mantida, seu atraso no diagnóstico é frequente e pode gerar complicações potenciais. A propósito, apresentamos o caso de um paciente de 12 anos com FOC pós-LAP que passou despercebido na primeira consulta, exigindo fixação do fragmento osteocondral com parafusos HCS em 5 meses. Obtendo um excelente resultado funcional aos 54 de acompanhamento.

Surgical Treatment of Multiple Osteoporotic Fractures of the Dorsolumbar Spine: Case Report / Tratamento cirúrgico de fraturas osteoporóticas múltiplas da coluna dorsolombar: Relato de caso

Abstract Osteoporotic vertebral fractures are a common type of fracture and affect a significant number of subjects with osteoporosis. Despite the high fracture risk, the concomitant occurrence of vertebral fractures at non-contiguous levels is very rare. We report the case of a patient with three burst dorsolumbar spine fractures at non-contiguous levels who was treated with percutaneous kyphoplasty and transpedicular posterior fixation. Six months after the surgery, the patient walks autonomously and without pain; in addition, there is no radiological evidence of fracture reduction loss.

Resumo As fraturas vertebrais osteoporóticas são um tipo comum de fratura e afetam um número significativo da população com osteoporose. Apesar do elevado risco de fratura, a ocorrência concomitante de fraturas vertebrais em níveis não contíguos é muito rara. Reportamos o caso de uma paciente com três fraturas explosivas da coluna dorsolombar em níveis não contíguos, tratada com cifoplastia e fixação posterior transpedicular por via percutânea. Seis meses após a cirurgia, a paciente tem marcha autônoma, sem dor, e, radiologicamente, não existem evidências de perda de redução das fraturas.

Preoperative Prediction of Gartland IV Supracondylar Fractures of Humerus: Is it Possible? / Previsão pré-operatória de fraturas supracondilares de úmero Gartland IV: É possível?

Abstract Objectives The present study aims to identify preoperative characteristics of the patient, of the injury, as well as of imaging, which would point towards a type IV fracture. The present study shall help the operating team to predict more accurately the type IV pattern preoperatively, leading to improved counselling of the caregivers, planning of surgery, as well as preparedness regarding open reduction, if such situation arises. Methods A retrospective study was conducted, including patients that met the following criteria: 1) age < 16 years old; 2) Gartland type-III and type-IV supracondylar fractures; and 3) with complete records. Demographic data like age, gender, laterality, mode of injury, hospital duration of the injury, history of previous attempts of closed reduction, open/closed fracture, distal neurovascular status, and radiographic data like angulation, translation, osseous apposition and fracture comminution were collected. Results Hospital duration of the injury and previous attempts of closed reduction were the factors that had a statistically significant difference among types III and IV fractures (p < 0.05). A diagnosis of type IV supracondylar fractures was significantly more likely in the presence of valgus angulation of the distal fragment ≥ 17º (odds ratio [OR] = 20.22; 95% confidence interval [CI] = 3.45-118.65). Flexion angulation ≥ 10º (OR = 5.32; 95% CI = 0.24-119.88) of the distal fragment predicted Gartland type IV with a sensitivity of 41% and a specificity of 100%. Conclusion The preoperative evaluation of suspected Gartland IV fractures can help the operating surgeon in predicting such injuries. Nonradiographic factors like increased hospital duration of the injury, attempts at previously closed reduction, and radiographic parameters like valgus and flexion angulation were more likely to be associated with type IV fractures. Level of evidence III.

Resumo Objetivos O presente estudo tem como objetivo identificar características pré-operatórias do paciente e da lesão, bem como da imagem que apontaria para uma fratura tipo IV. O presente estudo ajudará a equipe operacional a prever com mais precisão o padrão tipo IV pré-operatório, levando a um melhor aconselhamento dos cuidadores e planejamento da cirurgia, bem como a uma melhor preparação em relação à redução aberta, se tal situação surgir. Métodos Um estudo retrospectivo foi realizado, incluindo pacientes que atendiam os seguintes critérios: 1) idade < 16 anos; 2) fraturas supracondilares Gartland tipos III e IV; e 3) com registros completos. Foram coletados dados demográficos como idade, gênero, lateralidade, modo de lesão, duração hospitalar de lesão, histórico de tentativas anteriores de redução fechada, fratura aberta/fechada, estado neurovascular distal e dados radiográficos como angulação, translação, aposição óssea e cominação de fratura. Resultados A duração hospitalar de lesões e as tentativas anteriores de redução fechada foram os fatores com diferença estatisticamente significativa entre as fraturas tipo III e IV (p < 0,05). O diagnóstico de fraturas supracondilares tipo IV foi significativamente mais provável na presença de angulação em valgo de fragmento distal ≥ 17º (odds ratio [OR] = 20,22; intervalo de confiança [IC] 95% = 3,45-118,65). A angulação de flexão ≥ 10º (OR = 5,32; IC95% = 0,24-119,88) do fragmento distal previram Gartland tipo IV com sensibilidade de 41% e especificidade de 100%. Conclusão A avaliação pré-operatória de suspeitas de fraturas de Gartland IV pode ajudar o cirurgião operacional a prever tais lesões. Fatores não radiográficos, como o aumento da duração da lesão hospitalar, tentativas de redução previamente fechada e parâmetros radiográficos como valgo e angulação de flexão foram mais propensos a estarem associados a fraturas tipo IV. Nível de evidência III.

Energy Required for Fracture in Synthetic Proximal Femoral Models After Synthesis Material Removal: a Biomechanical Study Using Cannulated Screws, Dynamic Hip Screws, and Proximal Femoral Nails / Energia necessária para a ocorrência de fratura em modelos sintéticos de fêmur proximal após retirada de material de síntese: Um estudo biomecânico com parafuso canulado, parafuso dinâmico do quadril e haste femoral proximal

Abstract Objective The present study aims to identify the energy required for synthetic proximal femoral fracture after removal of three implant types: cannulated screws, dynamic hip screws (DHS), and proximal femoral nail (PFN). Methods Twenty-five synthetic proximal femur bones were used: 10 were kept intact as the control group (CG), 5 were submitted to the placement and removal of 3 cannulated screws in an inverted triangle configuration (CSG), 5 were submitted to the placement and removal of a dynamic compression screw (DHSG), and 5 were submitted to the placement and removal of a proximal femur nail (PFNG). All samples were biomechanically analyzed simulating a fall on the greater trochanter using a servo-hydraulic machine to determine the energy (in Joules [J]) required for fracture. Results All samples presented basicervical fractures. The energy required for fracture was 7.1 J, 6.6 J, 6 J, and 6.7 J for the CG, CSG, DHSG and PFNG, respectively. There was no statistically significant difference (considering a 95% confidence interval) in energy among the study groups (p = 0.34). Conclusion There was no statistically significant difference in the energy required to cause a synthetic proximal femoral fracture after removing all three implant types and simulating a fall over the greater trochanter.

Resumo Objetivo Identificar a energia necessária para ocorrência de fratura do fêmur proximal em osso sintético após retirada de três modelos de implantes: parafusos canulados, parafuso dinâmico do quadril (dynamic hip screw-DHS) e haste femoral proximal (proximal femoral nail-PFN). Métodos Foram utilizados 25 modelos de ossos sintéticos da extremidade proximal do fêmur: 10 unidades de grupo controle (GC), 5 unidades após colocação e retirada de 3 parafusos canulados colocados em configuração de triângulo invertido (GPC), 5 unidades após colocação e retirada do parafuso de compressão dinâmico (GDHS), e 5 unidades após colocação e retirada da haste de fêmur proximal (GPFN). Uma análise biomecânica foi realizada em todas as amostras simulando uma queda sobre o grande trocânter utilizando uma máquina servo-hidráulica com o objetivo de verificar a energia (em Joules [J]) necessária até a ocorrência de fratura nos diferentes grupos. Resultados Todos os grupos apresentaram fratura basocervical. Os grupos GC, GPC, GDHS e GPFN apresentaram, respectivamente, valores de 7.1J, 6.6J, 6J e 6.7J de energia até ocorrência da fratura. Não houve diferença estatisticamente significativa (intervalo de confiança de 95%) na energia entre os grupos de estudo (p = 0,34). Conclusão Não houve diferença estatisticamente significativa nos valores de energia necessária para ocorrência de fratura da extremidade proximal do fêmur após a retirada de três tipos de implantes utilizando modelos sintéticos simulando queda sobre o grande trocânter.

Fratura do complexo zigomático orbitário: relato de caso / Fracture of the Zygomatic Orbital Complex: Case report

Fraturas faciais podem ocorrer de forma isolada ou concomitante a outras lesões. O complexo zigomático orbitário (CZO) ocupa uma posição proeminente da face, deixando-o bastante susceptível a traumas de alto e baixo impacto, que podem causar afundamento facial. O trauma de face frequentemente resulta em danos ao tecido ósseo, tecido mole e elementos dentários, causando prejuízo na função e estética do paciente. Os acidentes automobilísticos são uma das causas mais significativas de traumas faciais. As fraturas do terço médio da face incluem as que afetam a maxila, o zigoma e complexo NOE. O presente estudo tem por objetivo relatar o caso clínico de um paciente de 47 anos, sexo masculino, vítima de acidente automobilístico (carro x carro). Diagnosticado com fratura do CZO direito, classe IV. Foi realizada redução incruenta da fratura de arco zigomático; redução e fixação interna rígida de fratura de parede lateral de órbita e pilar zigomático com instalação de camadas de surgicel na região para melhora do contorno, resultando em regressão do afundamento malar e consequente reestabelecimento estético funcional. Estudos como este podem ser fonte de referência em busca constante pelo aprimoramento profissional, objetivando completo domínio teórico-prático das formas de condutas e tratamentos específicos à situação em questão... (AU)

Facial fractures may occur in isolation or concomitantly with other injuries. The zygomatic orbital complex (ZOC) occupies a prominent position of the face, leaving it quite susceptible to high and low impact trauma, which can cause facial sinking. Face trauma often results in damage to bone tissue, soft tissue and dental elements, causing injury to the patient's function and aesthetics. Auto accidents are one of the most significant causes of facial trauma. Fractures of the middle third of the face include those affecting the maxilla, the zygoma, and the NOE complex. The present study aims to report the clinical case of a 47-year-old male patient, victim of an automobile accident (car x car). Diagnosed with right CZO fracture, class IV. A non-invasive reduction of the zygomatic arch fracture was performed; reduction and rigid internal fixation of lateral wall orbital fracture and zygomatic pillar with installation of surgicel layers in the region to improve the contour, resulting in regression of the malar sinking and consequent functional aesthetic reestablishment. Studies like this can be a source of reference in constant search for professional improvement, aiming at a complete theoretical-practical domain of the forms of conduct and treatments specific to the situation in question... (AU)

Tratamento cirúrgico de fratura Le Fort II: relato de caso / Surgical Treatment of Le Fort II Fracture: Case Report

Fraturas faciais geralmente resultam traumas, e podem ocorrer de forma isolada ou concomitante a outras lesões. O trauma na região facial resulta em danos não só em tecido ósseo, mas também em tecido mole e dentição, causando um prejuízo na função e na estética do paciente. Os acidentes automotores permanecem sendo uma das causas mais significativas de traumas faciais. As fraturas do terço médio da face incluem a maxila, zigoma e o complexo naso órbito etimoidal; podem ser classificadas em: fraturas Le Fort I, II ou III, fraturas do complexo zigomático maxilar, fraturas de arco zigomático ou fraturas naso órbito etimoidais. Elas podem ser unilaterais ou bilaterais, simétricas ou assimétricas. Este estudo objetiva-se em relatar o caso clínico de um paciente do sexo masculino, 31 anos, vítima de acidente automobilístico (carro/ anteparo). O paciente foi diagnosticado com fratura do tipo Le Fort II e nasal onde foi realizado o tratamento de redução e fixação interna rígida das fraturas de maxila e redução incruenta de fratura nasal, resultando em melhora da condição do paciente. As fraturas Le Fort são predominantemente causadas por colisões de alta energia. Portanto o tratamento é imprescindível para a devolução da função, estética e autoestima do paciente... (AU)

Facial fractures usually result from trauma, and may occur in isolation or concomitantly with other injuries. Trauma in the facial region results in damage not only to bone tissue but also to soft tissue and dental elements, which causes a loss in the patient's function and esthetics. Automotive accidents remain one of the most significant causes of facial trauma. Fractures of the middle third of the face include maxilla, zygoma and the nasoorbitoethmoid; may be classified as: Le Fort I, II or III fractures, maxillary zygomatic complex fractures, zygomatic arch fractures, or nasoorbitoethmoid. They can be unilateral or bilateral, symmetrical or asymmetric. The present study aims to report the clinical case of a 31 years, male patient, victim of an automobile accident (car/fixed shield). The patient was diagnosed with le Fort II and nasal fracture, where the treatment of reduction and rigid internal fixation of maxilla fractures and reduction of nasal fracture were performed, resulting in improvement of the patient's condiction. Le Fort fractures are predominantly caused by high energy collisions. Therefore the treatment is essential for the return of the function, aesthetics and increase of the patient's self-esteem... (AU)

Fracturas avulsivas tibiales del ligamento cruzado posterior fijadas con tornillos: un estudio clínico y radiológico / Screw fixation of posterior cruciate ligament tibial avulsion fractures: a clinical and radiographic study

OBJETIVO: Realizar la evaluación clínica, imagenológica y funcional de pacientes con fracturas avulsivas tibiales del ligamento cruzado posterior (FTALCPs) fijadas con tornillos canulados con técnica abierta. MÉTODOS: Los pacientes con FTALCP operados entre 2010 y 2017 fueron revisados retrospectivamente. Criterios de inclusión: fracturas agudas, desplazadas, test de cajón posterior grado III, lesiones combinadas de rodilla, seguimiento > 12 meses. Se excluyeron pacientes > 65 años, con FTALCPs bilaterales, lesiones del ligamento cruzado posterior (LCP) intrasustancia, test de cajón posterior grados I-II, fracturas expuestas, lesiones neurovasculares, y seguimientos < 12 meses. Objetivo primario: medir la estabilidad clínica mediante test de cajón posterior y radiografía de estrés arrodillada comparativa. Objetivos secundarios: nvaluar la consolidación en radiografías, complicaciones y funcionalidad con las escalas de Lysholm y Tegner. Resultados Se incluyeron 20 pacientes, con edad media de 41 años (rango: 32 a 61 años). El seguimiento promedio fue de 33,9 meses (rango: 12 a 82 meses). La estabilidad clínica mejoró en 93% (cajón posterior postoperatorio grados 0 y I) de los pacientes. La radiografía de estrés arrodillada mostró una diferencia promedio de 2,6 mm (rango: 0,1 mm a 6,8 mm) de traslación posterior al comparar con el lado sano. Todas las fracturas consolidaron. Siete pacientes presentaron complicaciones. El puntaje promedio de la escala de Lysholm al final del seguimiento fue de 85,17. El promedio preoperatorio del puntaje en la escala de Tegner no varió significativamente en comparación con el postoperatorio. CONCLUSIONES: La fijación de fracturas avulsivas tibiales del LCP con tornillos canulados con técnica abierta es efectiva en restaurar la estabilidad posterior y lograr la consolidación ósea. La funcionalidad clínica a mediano plazo es buena, a pesar del alto número de complicaciones y lesiones concomitantes. NIVEL DE EVIDENCIA: tipo IV.

OBJECTIVE: To report mid-term clinical, radiographic, and functional outcomes following open reduction and fixation of posterior cruciate ligament tibial avulsion fractures (PCLTAFs) with cannulated screws. METHODS: This is a retrospective analysis of patients with PCLTAF operated on from August 2010 to April 2017. Patients with acute fractures, with more than 2 mm of displacement and grade III on the posterior drawer test, combined or not to knee injuries, were included. Patients older than 65 years of age, with bilateral avulsion fractures, intrasubstance posterior cruciate ligament (PCL) lesions, stable grade-I to -II on the posterior drawer test, concomitant neurovascular injuries, mid-substance tears, open fractures, and less than 12 months of follow-up were excluded. Primary outcomes: the clinical stability was assessed using the posterior drawer test and a single comparative knee stress radiograph. Secondary outcomes: radiographic consolidation, complications, Lysholm score, and Tegner activity score. RESULTS: In total, 20 patients with a mean age of 41 years (range: 32 to 61 years) were included. The mean follow-up was of 33.9 months (range: 12 to 82 months). Clinical stability (grade 0 or I on the posterior drawer test) was observed in 93% of the patients. The mean difference in contralateral posterior displacement was of 2.6 mm (range: 0.1 mm to 6.8 mm) on a single comparative knee stress radiograph. All fractures presented radiological consolidation. Seven patients developed complications. The mean Lysholm score at the last follow-up visit was of 85.17. The postoperative Tegner activity scores did no vary significantly compared to the preinjury scores. CONCLUSIONS: Cannulated screw fixation of a displaced PCLTAF through a posterior approach restores clinical and radiographic stability and has excellent union rates. The mid-term functional outcomes are good despite the high rates of combined knee lesions and postoperative complications. LEVEL OF EVIDENCE: IV.

Treatment of open fracture of lower limb in high altitude area / 中国骨伤

OBJECTIVE@#To explore the treatment methods and experience of open fracture of lower limb in high altitude area.@*METHODS@#From January 2016 to January 2021, 62 patients with open fractures of lower limbs were treated by staged surgery with the concept of injury control orthopedics, emphasizing wound treatment and combining various fracture fixation methods. There were 51 males and 11 females, ranging in age from 14 to 59 years old, with a mean of (37.2±12.3) years old; and the course of disease ranged from 7 to 59 days, with a mean of (23.7±15.5) days. According to Gustilo Anderson classification, there were 14 cases of typeⅠ, 24 cases of typeⅡ, 14 cases of typeⅢA, 8 cases of typeⅢB and 2 cases of typeⅢC. The fracture repair and wound healing were observed, and the clinical efficacy was evaluated by Johner-Wruhs evaluation standard.@*RESULTS@#Fifty-five patients were followed up, and the duration ranged from 4 to 36 months, with a mean of (14.7±8.5) months, and 7 cases were lost to follow-up. According to Johner-Wruhs evaluation criteria, 33 cases got an excellent result, 16 good, 4 poor and 2 bad. The wound healing was poor in 2 cases, partial necrosis of Achilles tendon in 1 case, nonunion of fracture in 1 case and delayed healing of fracture in 2 cases.@*CONCLUSION@#It is an effective method to treat the open fracture of lower extremity in high altitude area to pay attention to the management of soft tissue injury, the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end. Paying attention to the treatment of soft tissue injury and the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end are effective methods for the treatment of open fracture of lower limbs in high altitude areas.

Application of individualized controllable stress external fixation in open tibial fractures / 中国骨伤

OBJECTIVE@#To study the clinical effect of individualized controllable stress external fixator in the treatment of open tibial fractures.@*METHODS@#From December 2018 to July 2020, 60 patients with open tibial fractures were treated, including 35 males and 25 females;The age ranged from 23 to 58 years;The course of disease was 1.2 to 10.0 h. According to the stress stimulation on the fracture end after operation, all patients were divided into 4 groups, including non stress group (15 cases) and 3 groups with different stress stimulation(15 cases in each group). All patients with open tibial fractures were treated with controllable stress external fixator. Four weeks after operation, the stress group adjusted the elastic external fixator to apply axial stress of 1/6, 2/6 and 3/6 of their own weight to the fracture end based on the patient's weight. The wound healing of all patients after operation was observed, the plain CT images of fracture ends at 4, 6, 8, 10 and 12 weeks after operation were followed up, the average valueof callus area per 10 scanning planes was calculated, and the differences between the groups were compared. The fracture healing was observed and statistically analyzed.@*RESULTS@#The wounds of all patients healed well, of which 7 patients underwent secondary free skin grafting and transferred myocutaneous flap. All patients were followed up for 12 to 24 months, with an average of 16.5 months. The final follow-up results showed that the fracture healing of stress groups and non stress group had significant difference(@*CONCLUSION@#When the controllable stress external fixation technique is used to treat open tibial fractures, the elastic external fixator is adjusted according to the patient's own weight after 4 weeks, and a certain axial stress is applied to the fracture end, which is conducive to the fracture healing of patients, and can reduce the incidence of delayed union or nonunion of open fractures, which has a certain application value.

Closed manipulative reduction and external fixation with cardboard splint for the treatment of Monteggia fracture / 中国骨伤

OBJECTIVE@#To explore clinical efficicacy of closed manipulative reduction and external fixation with cardboard splint in treating Monteggia fracture.@*METHODS@#Fifty-eight children with Monteggia fracture were underwent closed manipulative reduction and external fixation with cardboard splint from January 2010 to Junuary 2018. Among them, including 37 males and 21 females, aged from 3.5 to 12 years old with an average of (8.48±2.29) years old;the courses of disease ranged from 0.5 hours to 9 days with an average of (4.21±1.46) days. Broberg and Morrey scores before treatment, 1, 3 and 6 months after treatment were used to evaluate clinical effects.@*RESULTS@#All children were followed up from 1 to 6 months with an average of (3.35±2.12) months. Broberg and Morrey score (7.24±2.81) before treatment, (32.06 ±8.33) at 1 month after treatment, (73.18±5.56) at 3 months after treatment and (95.87±6.75) at 6 months after treatment; there were statistical differences at each time points after treatment with before treatment (@*CONCLUSION@#Treatment of Monteggia fractures with closed manipulative reduction and external fixation with cardboard splint could reach integration of motion and quietness, also could remove external fixation at early stage, and get obvious short-term and medium-term therapeutic results.