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1.
Rev. medica electron ; 43(4): 1118-1130, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1341541

ABSTRACT

RESUMEN Con el paulatino incremento de accidentes automovilísticos, de trabajo, y la violencia urbana, las fracturas expuestas y complejas constituyen traumatismos de creciente incidencia y de difícil solución, con largos períodos de convalecencia que ponen en peligro la vida o la conservación del miembro lesionado. Un gran número de ellas dejan secuelas invalidantes. Existen varios tratamientos, entre ellos la fijación externa, utilizando el sistema creado por el profesor Rodrigo Álvarez Cambras, con varias ventajas que proporcionan una mejor evolución. Se realizó este trabajo con el objetivo de mostrar la evolución y los resultados de un paciente ingresado y operado con el diagnóstico de lesión expuesta, compleja y grave de la extremidad inferior, específicamente de tibia. Este presentó varias complicaciones, por lo que se le colocó un aparato de osteosíntesis de fijación externa Álvarez Cambras en el Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane, de Matanzas (AU).


ABSTRACT With the gradual increase of automobile and work accidents as well as urban violence, exposed and complex fractures are traumas of increasing incidence and difficult solution, with long periods of convalescence that endanger the life or the conservation of the injured member. A large number of them leave invalidating sequels. There are several treatments, including external fixation using the system created by Professor Rodrigo Alvarez Cambra, with several advantages that provide a better evolution. The current work was carried out with the objective of showing the evolution and results of a patient who entered the Teaching Provincial Clinical-surgical Hospital Jose Ramon Lopez Tabrane, of Matanzas, and underwent a surgery with the diagnosis of exposed, complex and serious lesion in the lower limb, specifically of tibia. The patient had several complications and so he was put an Alvarez Cambra external fixation osteosynthesis devise (AU).


Subject(s)
Humans , Male , Tibial Fractures/surgery , External Fixators , Therapeutics , Tibial Fractures/complications , Tibial Fractures/diagnosis , Tibial Fractures/therapy , Wounds and Injuries/surgery , Fracture Fixation, Internal/methods , Fractures, Open/surgery , Fractures, Open/diagnosis
2.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(2): 136-142, jun. 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1003022

ABSTRACT

Introducción: Las secuelas postraumáticas de la tibia representan un problema común al que nos enfrentamos los ortopedistas día a día. El método Ilizarov, mediante una planificación minuciosa, ha dado grandes resultados. Objetivo: Valorar el resultado del tratamiento de desejes y discrepancias postraumáticas de la tibia mediante el fijador circular de tipo Ilizarov. Materiales y Métodos: Se evaluó a 13 pacientes mediante criterios clínicos y radiográficos durante un seguimiento mínimo de 24 meses. Los resultados fueron buenos y excelentes, y se logró la consolidación ósea en todos los pacientes. Conclusión: El método Ilizarov es útil y versátil para resolver cualquier tipo de secuela postraumática de la tibia, sin necesidad de injertos o sustitutos óseos. Nivel de Evidencia: IV


Introduction: Post-traumatic sequelae of the tibia are a common problem faced by orthopedists every day. The Ilizarov method, through careful planning, has achieved great results. Objective: To assess the outcome of the treatment of post-traumatic deformities and discrepancies of the tibia treated with the Ilizarov circular fixator. Methods: Thirteen patients were evaluated by clinical and radiological criteria during a minimum follow-up of 24 months. The results were good and excellent in all cases, and bone consolidation was achieved in all patients. Conclusion: The Ilizarov method is useful and versatile to solve any type of post-traumatic sequelae of the tibia, without the need for grafts or bone substitutes. Level of Evidence: IV


Subject(s)
Adult , Pseudarthrosis , Tibial Fractures/complications , External Fixators , Ilizarov Technique , Follow-Up Studies , Treatment Outcome
3.
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
4.
Rev. cuba. anestesiol. reanim ; 17(2): 1-7, mayo.-ago. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-991029

ABSTRACT

Introducción: El tétanos es una enfermedad infecciosa prevenible que puede causar la muerte. Las manifestaciones clínicas son debidas a una potente toxina secretada por el Clostridiumtetani, un bacilo Gram positivo que penetra a través de pérdidas de continuidad de la piel, independientemente del tamaño de la herida. Objetivo: Presentar la evolución clínica de una paciente residente en una zona rural en Latacunga, Cotopaxi, Ecuador. Desarrollo: Paciente sin antecedentes de inmunización previa que acudió a sala de emergencias por fractura cerrada de tibia y peroné en miembro inferior izquierdo como secuela de un accidente de tránsito. El diagnóstico clínico de tétanos generalizado se basó en la aparición al noveno día del trauma de disfagia, trismus, rigidez nucal y posteriormente contracturas generalizadas con opistóstono, parada cardiorrespiratoria y disfunción autonómica. Con una prolongada estadía hospitalaria de 82 días, recibió anestesia en críticas condiciones durante 15 ocasiones, sufrió complicaciones graves y amenazantes para la vida que requirió la permanencia durante 46 días en sala de cuidados intensivos. Conclusiones: Este caso enfatiza la amenaza permanente del tétanos en este entorno, así como la necesidad de implementar esquemas de inmunización de una forma más abarcadora y constante(AU)


Introduction: Tetanus is a preventable infectious disease that can cause death. The clinical manifestations are due to a powerful toxin secreted by Clostridiumtetani, a Gram-positive bacillus that penetrates through losses of skin continuity, regardless of the wound's size. Objective: To present the clinical evolution of a female patient living in a rural area in Latacunga, Cotopaxi, Ecuador. Development: Patient with no history of previous immunization who went to the emergency room due to a closed fracture of the tibia and the fibula in the left lower limb as a result of a traffic accident. The clinical diagnosis of generalized tetanus was based on the appearance on the ninth day of dysphagia´s trauma, trismus, nuchal rigidity, and later on: generalized contractures with opistho-tonus, cardiorespiratory arrest, and autonomic dysfunction. With a prolonged hospital stay of 82 days, she received anesthesia under critical conditions in 15 occasions, and suffered serious complications. She remained for 46 days in the intensive care unit. Conclusions: This case emphasizes the permanent threat of tetanus in this environment, as well as the need to implement immunization schemes in a more comprehensive and constant manner(AU)


Subject(s)
Humans , Female , Middle Aged , Tibial Fractures/complications , Fibula/injuries , Fractures, Closed/complications , Tetanus/complications , Tetanus/therapy
5.
Rev. chil. ortop. traumatol ; 58(3): 106-111, dic. 2017. ilus
Article in Spanish | LILACS | ID: biblio-910080

ABSTRACT

OBJETIVO: Presentar un caso de complicación de fractura de platillos tibiales Schatzker VI y su manejo quirúrgico. MATERIAL Y MÉTODO: Se presenta un caso de fractura de platillos tibial Schatzker VI que evoluciona con malalineamiento en valgo secundario a hundimiento del platillo tibial, junto a una revisión de la literatura y la descripción del manejo quirúrgico. RESULTADOS: Se realizó una osteotomía en cuña de cierre medial de tibia proximal y se estabilizó con placa bloqueada (TomoFix), con una corrección completa de la deformidad sin complicaciones. Discusión: La osteotomía en cuña de cierre medial en tibia proximal es una técnica descrita en el manejo de artrosis secundaria a malalineamiento en valgo de la rodilla. Mediante dos osteotomías iniciadas por la cortical medial hacia la lateral con un fulcro esa última, se retira una cuña de dimensiones conocidas y se mantiene la reducción con algún elemento de osteosíntesis. De esa forma, se permite la corrección angular de la deformidad, previamente planificada. Los resultados en distintas series son en general favorables. CONCLUSIÓN: El malalineamiento de la extremidad posterior a una fractura de platillos tibiales y la consecuente sobrecarga del compartimento afectado en la rodilla, asociado al daño articular, evoluciona con degeneración articular que termina en una artrosis unicompartimental secundaria, la cual puede ser prevenida con el uso de osteotomías correctoras de ejes como la osteotomía de tibia proximal, permitiendo normalizar la distribución de las cargas en los compartimentos mediante la corrección del eje mecánico alterado y así prolongar la sobrevida articular.


OBJECTIVE: To present a Schatzker VI tibial plateau fracture case complication and its surgical management METHODS: We present a case of tibial plateau fracture, type VI according to Schatzkeŕs classification, that developed limb malalignment secondary to tibial plateau depression resulting in a genu valgum deformity, along with a literature review and a brief description of the surgical technique. Results: High tibial medial closing wedge osteotomy, stabilized with locking plate (tomoFix) was performed, with a complete correction of the deformity without complications. DISCUSSION: High tibial medial closing wedge is a known procedure used in the management of valgus knee malalignment secondary osteoarthritis. By means of two osteotomies made from medial to lateral cortices, using the latter as a fulcrum, a wedge with known dimensions is subtracted and reduction is maintained with some osteosynthesis element. In this fashion, it allows the previously planned angular correction. Results in different reports are mostly favorable. CONCLUSION: The malalignment of the limb after a tibial plateau fracture and the consequent overload of the affected knee compartment; associated with joint damage, evolves in joint degeneration and eventually, in a secondary unicompartmental osteoarthritis. This can be avoided with the use of corrective osteotomies such as the proximal tibial osteotomy, which allows a proper distribution of loads in the compartments by correcting the altered mechanical axis and thus, prolonging joint survival.


Subject(s)
Humans , Male , Middle Aged , Genu Valgum/surgery , Knee/surgery , Osteotomy/methods , Genu Valgum/etiology , Tibial Fractures/complications
6.
Rev. chil. ortop. traumatol ; 57(3): 70-75, sept.-dic. 2016. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-909740

ABSTRACT

El enfrentamiento y el manejo de las fracturas de platillos tibiales de alta energía representan un desafío para todo cirujano. El compromiso de partes blandas y la conminución articular secundaria a la energía involucrada determinan una mayor tasa de complicaciones y morbilidad. OBJETIVOS: Evaluar la tasa de complicaciones en fracturas de platillos tibiales de alta energía. MATERIALES Y MÉTODO: Estudio clínico imagenológico retrospectivo de fracturas de platillo tibial Schatzker V y VI con mecanismo de alta energía, tratadas con fijador externo y osteosíntesis diferida, entre 2007-2013. Análisis estadístico usando STATA 12.0. RESULTADOS: Cincuenta y dos fracturas se presentaron durante el periodo de estudio, 39 de ellas fueron seleccionadas considerando los criterios de inclusión. Promedio edad 42,4 años, seguimiento 41,8 meses. Complicaciones: neuropraxia 5%, infección Schatzker V (20%) 16,2%, VI (80%) 12,1% (p=0,759). Sin asociación entre infección y edad (p=0,6056), mecanismo involucrado (p=0,131), tiempo de prefijador externo (p=0,0556), ni tiempo en el uso de fijador externo (p=0,53). DISCUSIÓN: Las fracturas de platillos tibiales secundarias a traumatismos de alta energía se asocian a un importante compromiso de partes blandas. La reducción y osteosíntesis inmediata determina altas tasas de complicaciones; utilizar fijador externo transitorio las disminuiría. El abordaje anterior en línea media ha mostrado elevadas complicaciones, mientras que el uso de doble abordaje regularía esta situación. CONCLUSIÓN: Al afrontar el tratamiento de las fracturas de platillos tibiales de alta energía debemos considerar el uso de fijador externo transitorio para un adecuado control de la fractura y de las partes blandas para la cirugía definitiva.


The approach and management of high energy tibial plateau fractures is a challenge for every surgeon. Soft tissue injuries and joint comminution due to the energy involved are associated with a higher rate of complications and morbidity. OBJECTIVES: To evaluate the rate of complications in high energy tibial plateau fractures. MATERIALS AND METHODS: A retrospective imaging-clinical study of Schatzker type V and IV high-energy tibial plateau fractures, treated with an external fixation and delayed osteosynthesis, was conducted between 2007 and 2013. Statistical analysis was performed using STATA 12.0. RESULTS: A total of 52 fractures were treated during the study period, of which 39 met the criteria for selection. The mean age of the patients was 42.4 years, with a follow-up time of 41.8 months. The complications include, neuropraxia, 5%, Schatzker V infection (20%), 16.2%, and Vl (80%), 12.1% (P=.759). There was no relationship between infection and age (P=.6056), mechanism involved (P=.131), time between accidents and the installation of an external fixator (P=.0556), or the time used for external fixation (P=.53). DISCUSSION: High-energy tibial plateau fractures are associated with significant soft tissue injuries. Immediate reduction and osteosynthesis are determining factors for high rates of complications, while using transient external fixation should decrease them. A midline anterior approach has shown increased complications, while a double approach could improve this situation. CONCLUSION: The approach to high energy tibial plateau fractures must consider the use of a temporary external fixation for an adequate control of the fracture and the soft tissue for a definitive surgical treatment.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Postoperative Complications/epidemiology , Tibial Fractures/surgery , Tibial Fractures/complications , Fracture Fixation/adverse effects , Tibial Fractures/classification , Retrospective Studies , Follow-Up Studies , Range of Motion, Articular , Soft Tissue Injuries , Observational Studies as Topic
7.
Rev. chil. radiol ; 22(3): 114-120, set. 2016. ilus
Article in Spanish | LILACS | ID: biblio-830183

ABSTRACT

Abstract. Triplane fractures (TF) are a special type of fracture that typically occur in the distal tibia, in a specific age group, and require specific treatment. It should be diagnosed early to avoid complications and irreparable consequences. Imaging techniques play a fundamental role. A review of TF is performed, and cases are presented in order to understand how they occur, and thus diagnose them properly.


Resumen. Las fracturas triplanares (FT) son un tipo especial de fracturas que se producen clásicamente en la tibia distal, en un grupo etario acotado y que requieren un tratamiento específico. Su diagnóstico debe ser oportuno para evitar complicaciones y secuelas irreparables, por lo que las imágenes cumplen un rol fundamental. Se realiza una revisión sobre las FT y una muestra de casos para comprender cómo se generan y así realizar un adecuado diagnóstico de ellas.


Subject(s)
Humans , Tibial Fractures , Tibial Fractures/complications , Tomography, X-Ray Computed
8.
Acta ortop. mex ; 30(1): 25-27, ene.-feb. 2016. graf
Article in Spanish | LILACS | ID: biblio-827719

ABSTRACT

Resumen: El seudoaneurisma arterial en la extremidad inferior es una entidad poco frecuente, en particular en el segmento infrapoplíteo. Comúnmente se le asocia a reparaciones vasculares o secundario a una lesión arterial localizada, posterior a fractura o a un evento quirúrgico. En México poco se ha documentado sobre esta entidad que afecta la arteria tibial anterior secundaria a proceso traumático y osteosíntesis. El sangrado súbito debido a una ruptura del seudoaneurisma es un posible desenlace catastrófico para la viabilidad del segmento, por lo cual es de suma importancia detectarla y diagnosticarla a tiempo. Las indicaciones en cuanto al tratamiento siguen siendo controvertidas en las publicaciones internacionales. Las opciones resolutivas pueden ser quirúrgicas o endovasculares. Según reportes actuales, la mejor opción terapéutica es el injerto autólogo de vena safena que mantiene el flujo sanguíneo y minimiza el riesgo de isquemia periférica. El objetivo de este trabajo es exponer el caso de un paciente que presentó la complicación descrita previamente y de la misma forma, realizar una revisión de la bibliografía consultada. Es importante indagar más sobre este tema, que bien puede pasar inadvertido en un gran número de casos por su sintomatología silente.


Abstract: Arterial pseudoaneurysm of the lower limb is an infrequent entity, particularly in the infrapopliteal segment. It is commonly associated to vascular repairs or follows a localized arterial lesion, a fracture or a surgical procedure. There is little information in Mexico about this entity in cases involving the anterior tibial artery, and secondary to trauma and osteosynthesis. Given that sudden bleeding due to rupture of the pseudoaneurysm is a possible catastrophic outcome for the viability of the segment, it is important to timely detect and diagnose the pseudoaneurysm. Treatment indications contained in the international literature are controversial. Solution-oriented approaches may be either surgical or endovascular. Current reports show that the best treatment option is an autologous saphenous vein graft, which maintains blood flow and minimizes the risk of peripheral ischemia. The purpose of this paper is to report the case of a patient who sustained the above mentioned complication and provide a literature review. This topic should be further investigated, as this condition may go unnoticed in a large number of cases, given that its symptoms are silent.


Subject(s)
Humans , Tibial Fractures/complications , Tibial Arteries/pathology , Aneurysm, False/etiology , Tibia , Mexico
9.
Clinics ; 70(6): 419-422, 06/2015. tab
Article in English | LILACS | ID: lil-749786

ABSTRACT

OBJECTIVES: Pilon fracture is a complex injury that is often associated with severe soft tissue damage and high rates of surgical site infection. The goal of this study was to analyze and identify independent risk factors for surgical site infection among patients undergoing surgical fixation of a pilon fracture. METHODS: The medical records of all pilon fracture patients who underwent surgical fixation from January 2010 to October 2012 were reviewed to identify those who developed a surgical site infection. Then, we constructed univariate and multivariate logistic regressions to evaluate the independent associations of potential risk factors with surgical site infection in patients undergoing surgical fixation of a pilon fracture. RESULTS: A total of 519 patients were enrolled in the study from January 2010 to October 2012. A total of 12 of the 519 patients developed a surgical site infection, for an incidence of 2.3%. These patients were followed for 12 to 29 months, with an average follow-up period of 19.1 months. In the final regression model, open fracture, elevated postoperative glucose levels (≥125 mg/dL), and a surgery duration of more than 150 minutes were significant risk factors for surgical site infection following surgical fixation of a pilon fracture. CONCLUSIONS: Open fractures, elevated postoperative glucose levels (≥125 mg/dL), and a surgery duration of more than 150 minutes were related to an increased risk for surgical site infection following surgical fixation of a pilon fracture. Patients exhibiting the risk factors identified in this study should be counseled regarding the possible surgical site infection that may develop after surgical fixation. .


Subject(s)
Humans , Young Adult , Fracture Fixation, Internal/adverse effects , Fractures, Open/surgery , Surgical Wound Infection/etiology , Tibial Fractures/surgery , Antibiotic Prophylaxis , Cefazolin/therapeutic use , Follow-Up Studies , Fractures, Open/complications , Hyperglycemia/complications , Medical Records , Multivariate Analysis , Operative Time , Postoperative Care , Retrospective Studies , Risk Factors , Smoking/adverse effects , Tibial Fractures/complications , Tibial Fractures/drug therapy
10.
Article in English | IMSEAR | ID: sea-159277

ABSTRACT

Introduction : Infection following implant surgery in orthopaedics is a disaster both for surgeon and patient. Management of infected non-union is a most challenging task an orthopaedic surgeon can ever face. Infection following implant surgery not only leads to repeated surgeries, long term antibiotic use, stiffness of neighbouring joints and long term hospital stay but also effects patients economic, social, psychological status. Cases : Here we present report of 2 cases infected non-union ulna which was managed by stabilisation of non-union site by altering position of existing plate followed by period of open dressing till healthy granulation tissue appears. Later open bone grafting procedure done. Both patients were followed up for 15 months. Results : At the end of 4 months both patients achieved bony union without recurrence of infection. So, we conclude management of infected nonunions by altering plate position and by following papineau method of open bone grafting leads to satisfactory results. Conclusion : This technique is simple, effective and done with minimal expenditure and could be best procedure of choice in patients where cost benefit analysis appears critical.


Subject(s)
Adult , Bone Plates/methods , Bone Transplantation/adverse effects , Bone Transplantation/methods , Fractures, Ununited/complications , Fractures, Ununited/surgery , Humans , Male , Osteotomy/instrumentation , Osteotomy/methods , Tibial Fractures/complications , Tibial Fractures/surgery
11.
Artrosc. (B. Aires) ; 22(1): 26-30, mar. 2015.
Article in Spanish | LILACS, BINACIS | ID: lil-767471

ABSTRACT

Se presenta un caso de fractura de espina tibial (Tipo IV) en un adulto joven que evolucionó con pseudoartrosis del foco de fractura, a pesar de un tratamiento quirúrgico, generando una enfermedad articular degenerativa de rápida evolución.


We present a case of a tibial spine fracture (type IV) in a young adult who developed nonunion of the fracture despite surgical treatment, generating rapidly evolving degenerative joint disease.


Subject(s)
Adult , Knee Joint/surgery , Arthroscopy/methods , Tibial Fractures/complications , Osteoarthritis, Knee/diagnosis , Pseudarthrosis
12.
Article in English | WPRIM | ID: wpr-128624

ABSTRACT

A 30-year-old male was involved in a car accident. Radiographs revealed a depressed marginal fracture of the medial tibial plateau and an avulsion fracture of the fibular head. Magnetic resonance imaging showed avulsion fracture of Gerdy's tubercle, injury to the posterior cruciate ligament (PCL), posterior horn of the medial meniscus, and the attachments of the lateral collateral ligament and the biceps femoris tendon. The depressed fracture of the medial tibial plateau was elevated and stabilized using a cannulated screw and washer. The injured lateral and posterolateral corner (PLC) structures were repaired and augmented by PLC reconstruction. However, the avulsion fracture of Gerdy's tubercle was not fixed because it was minimally displaced and the torn PCL was also not repaired or reconstructed. We present a unique case of pure varus injury to the knee joint. This case contributes to our understanding of the mechanism of knee injury and provides insight regarding appropriate treatment plans for this type of injury.


Subject(s)
Adult , Fibula/injuries , Humans , Knee Injuries/complications , Male , Multiple Trauma/complications , Tibial Fractures/complications
14.
JSP-Journal of Surgery Pakistan International. 2013; 18 (2): 92-96
in English | IMEMR | ID: emr-148390

ABSTRACT

To evaluate the efficacy of percutaneous autologous bone marrow grafting in patients with tibial diaphyseal non-union. Descriptive case series. Orthopaedic Surgery Unit, Mardan Medical Complex Teaching Hospital, Bache Khan Medical College Mardan, from March 2011 to October 2012. Fifteen patients [mean age 41.6 year] with tibial non-union were treated with a single percutaneous autologous bone marrow injection. The bone marrow was aspirated from the anterior iliac crest and injected at fracture site. The procedure was carried out under general or spinal anesthesia. The patients were followed up after every four weeks and the rate of healing was assessed clinically as well as radiologically. Union Scale Score was used to assess the progress of union. A score of six or more was considered as sound union. Majority [73.3%, n=11] of the patients achieved a solid union after an average period of 14 weeks [range 12-20 weeks]. Four [26.6%] patients however could not achieve union. The average time duration between the procedure and injury was 37 weeks [range 36-40 weeks]. The average pre injection Union Scale Score was 2 [0-3]. The mean Union Scale Score at the end of study was 5.8 [0-7] and in united cases it was 6.4 [6-7]. Percutaneous autologous bone marrow injection provided an effective safe and easy bone grafting in non-union tibia


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

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Tibial Fractures/complications , Morbidity Surveys , Femoral Fractures/complications , Knee Injuries/surgery , Motor Vehicles , Orthopedic Procedures , Fractures, Bone
16.
Acta ortop. bras ; 18(1): 44-48, 2010.
Article in Portuguese | LILACS | ID: lil-545324

ABSTRACT

As fraturas da diáfise da tíbia nas crianças e adolescentes são lesões relativamente comuns e geralmente têm boa evolução com os métodos clássicos de tratamento conservador. Sua elevada frequência se deve ao alto grau de exposição da criança nas suas atividades físicas e também pela anatomia e topografia da tíbia, expondo-a ao trauma direto ou indireto. Algumas particularidades devem ser consideradas e respeitadas na sua abordagem, que compreendem aspectos atinentes à faixa etária, local de acometimento (se proximal ou distal), tipo de fratura e de terapêutica instituída. A vantagem anatômica do periósteo mais espesso e a relativa flexibilidade na acomodação de impactos angulares podem proporcionar na criança de menor idade, maior estabilidade e consequente tendência ao melhor prognóstico. Nas crianças maiores e nos adolescentes o grau de exposição a traumas de maior energia, a maior gravidade e complexidade das lesões têm tornado mais comum a estabilização cirúrgica. Complicações encontradas nessas fraturas nos adultos como infecção, retarde de consolidação e pseudartrose são muito menos frequentes nas crianças, mas o risco de instalação de síndromes compartimentais é uma eventualidade que requer atenção, principalmente nas condutas incruentas com imobilizações gessadas.


Tibial diaphyseal fractures in children and adolescents are relatively common injuries and often evolve with good results when treated through traditional methods of conservative treatment. Their elevated frequency is due to the high degree of exposure of children in physical activities and also to the topographic location, exposing them to direct or indirect trauma. The approach used should consider and respect some features regarding age, place of affection (whether proximal or distal), type of fracture and therapy. The anatomical advantage of a thicker periosteum and flexibility when submitted to angular impacts can provide younger children with greater stability and, consequently, increases their chances of a better prognosis than older children and adolescents. In the latter, the degree of exposure to high-energy trauma and the greater complexity and severity of injuries have caused the recent trend towards stabilization surgery to become more common. Frequent complications in the evolution of fractures in adults such as infection, delayed union and non-union are much less common in children, although the risk of occurrence of compartment syndrome is an event that requires attention, especially with plaster.


Subject(s)
Humans , Child , Tibial Fractures/complications , Tibial Fractures/epidemiology , Tibial Fractures , Tibial Fractures/therapy , Tibia/anatomy & histology , Brazil , Tibial Fractures/rehabilitation , Magnetic Resonance Spectroscopy
17.
Rev. AMRIGS ; 53(4): 368-373, out.-dez. 2009. ilus
Article in Portuguese | LILACS | ID: lil-566939

ABSTRACT

Introdução: As fraturas da tíbia são comuns. Muitas necessitam tratamento conservador. O trabalho tem como objetivo verificar o perfil epidemiológico das fraturas de tíbia tratadas cirurgicamente. Metodologia: Estudo descritivo transversal através da avaliação epidemiológica em prontuários de 50 pacientes operados no Hospital Independência no período de 5 anos. Resultados: Dos 50 pacientes, 39 (78%) eram do sexo masculino e 11(22%), do feminino. Quanto à idade, observamos que há mais fraturas em pacientes entre 26 e 36 anos (30%). A idade média dos pacientes foi de 37,4 anos, com um desvio-padrão de 14,8 anos. Não houve diferença significativa quando analisamos a idade média entre os sexos. Podemos constatar também que os pacientes operados por fratura de tíbia eram em sua maioria solteiros (52%). Em relação à cor do paciente, observamos que houve prevalência em pacientes da cor negra (50%). Conclusão: As fraturas de tíbia, tratadas cirurgicamente no Hospital Independência entre 2001 e 2005, foram mais frequentes em pacientes jovens e com trauma de alta energia.


Introduction: Tibia fractures are common and often require conservative treatment. This work was designed to determine the epidemiological profile of the fractures of the tibia treated surgically. Methods: A descriptive, transversal study carried out through the epidemiological evaluation of the medical records of 50 patients operated in a 5-year period. Results: Of the 50 patients, 39 (78%) were males and 11 (22%) were females. As for age, it was found that there were more fractures in the 26-36 years bracket (30%). Patient mean age was 37.4 years with a standard deviation of 14.8 years. There was no significant gender difference as the mean age was analyzed. Most of the patients (52%) were single. Also, there was a prevalence of black patients (50%). Conclusion: The tibia fractures treated surgically in the Independência Hospital from 2001 to 2005 were more frequent in patients who were young and had highenergy trauma.


Subject(s)
Humans , Male , Female , Adult , Cross-Sectional Studies , Tibial Fractures/surgery , Tibial Fractures/complications , Tibial Fractures/diagnosis , Tibial Fractures/pathology , Tibial Fractures/psychology , Tibial Fractures/therapy , Prevalence , Tibia/pathology
18.
Rev. bras. ortop ; 44(6): 468-474, 2009. ilus
Article in Portuguese | LILACS | ID: lil-538060

ABSTRACT

As fraturas do planalto tibial são lesões articulares cujos princípios de tratamento envolvem a redução anatômica da superfície articular e a restauração funcional do eixo mecânico do membro inferior. Contribuem para a tomada de decisões no tratamento dessas fraturas o perfil do paciente, as condições do envelope de tecidos moles, a existência de outros traumatismos associados e a infraestrutura disponível para abordagens cirúrgicas. Para as fraturas de alta energia, o tratamento estagiado, seguindo o princípio do controle de danos, tem como prioridade a manutenção do alinhamento do membro enquanto se aguarda a resolução das más condições de tecidos moles. Já nos traumas de baixa energia, desde que os tecidos moles não sejam um fator adverso, o tratamento deve ser realizado em tempo único, com osteossíntese definitiva. Fixação estável e movimento precoce são variáveis diretamente relacionadas com os melhores prognósticos. Desenvolvimentos recentes, como os implantes com estabilidade angular, substitutos ósseos e imagens tridimensionais para controle intraoperatório, deverão contribuir para cirurgias menos invasivas e melhores resultados.


Tibial plateau fractures are joint lesions that require anatomical reduction of joint surface and functional restoration of mechanical axis of a lower limb. Patient profile, soft tissue conditions, presence of associated injuries and the available infrastructure for the treatment all contribute to the decision making about the best treatment for these fractures. High-energy fractures are usually approached in a staged manner respecting the principle of damage control, and are primarily targeted to maintain limb alignment while the resolution unfavorable soft tissue conditions is pending. Low-energy trauma can be managed on a single-stage basis, provided soft tissues are not an adverse factor, with open reduction and internal f-ixation. Stable fixation and early painless joint movement are related to a better prognosis. New developments as locked plates, bone replacements, intraoperative 3D imaging are promising and will certainly contribute for less invasive procedures and better outcomes.


Subject(s)
Humans , Tibial Fractures/complications , Tibial Fractures/diagnosis , Tibial Fractures/therapy
19.
León; s.n; feb. 2008. 55 p. tab, graf.
Thesis in Spanish | LILACS | ID: lil-593009

ABSTRACT

En el presente estudio los resultados en los tres controles se dieron en la consulta externa, son muy buenos con un 95 porciento de consolidación en fracturas de tibia y un 100 porciento de consolidación en fracturas del fémur. El 87 porciento dio resultado funcional normal en articulación de pacientes con fractura del fémur y un 95 porciento lo fue par la tibia. El sexo con mayor proporción de casos fue el masculino con un 70 porciento, el grupo etáreo más afectado fue de 20 a34 años con un 35 porciento y la ocupación fue obrero con un 50 porciento, proveniente del área rural con un 50 porciento. El sitio mas afectado en la diáfisis del hueso fue el segmento medio con un 70 porciento, el trazo de fractura que mayor presento fue le oblicuo con un 73 porciento, y el mecanismo de producción predominante fue trauna indirecto con un 72 porciento. El tiempo estancia intrahospitalaria promedio fue 1 a 2 semana con un 57 porciento. La complicación encontrada en fracturas de tibia, fue un paciente (5 porciento) con una seudoartrosis infectada...


Subject(s)
Fracture Fixation, Intramedullary , Tibial Fractures/surgery , Tibial Fractures/complications , Femoral Fractures/surgery , Femoral Fractures/complications
20.
J. bras. pneumol ; 34(1): 34-41, jan. 2008. ilus, tab
Article in Portuguese | LILACS | ID: lil-474295

ABSTRACT

OBJETIVO: Analisar a evidência disponível sobre o efeito do corticosteróide na prevenção da síndrome da embolia gordurosa (SEG) após fratura de osso longo do membro inferior e/ou pélvis. MÉTODOS: Pesquisamos as bases de dados eletrônicas do Medline, Excerpta Medica, Cochrane Library, Literatura Latino-Americana e do Caribe em Ciências da Saúde e Scientific Electronic Library Online em março de 2007. Selecionamos estudos randomizados e controlados que compararam corticosteróide com placebo (ou cuidados de rotina) na prevenção da SEG após fratura de osso longo de membro inferior e/ou pélvis. Também revisamos as referências contidas nos estudos incluídos. RESULTADOS: Seis estudos foram incluídos. O risco relativo total de desenvolver SEG foi 0,16 (IC95 por cento: 0,08-0,35) no grupo que recebeu corticosteróide em comparação com o grupo controle. O risco relativo total de desenvolver hipoxemia foi 0,34 (IC95 por cento: 0,19-0,59) no grupo que recebeu corticosteróide em comparação com o grupo controle. CONCLUSÃO: A análise da evidência mostrou que o corticosteróide diminui o risco de SEG e hipoxemia após fratura de ossos longos de membro inferior.


OBJECTIVE: To analyze the available evidence regarding the effect that corticosteroids have on the prevention of fat embolism syndrome after long bone fracture of the lower limbs or pelvic fracture. METHODS: In March of 2007, we performed a search of various electronic databases, including Medline, the Excerpta Medica database, the Cochrane Library, the Latin American and Caribbean Health Sciences Literature database and the Scientific Electronic Library Online. We selected randomized controlled trials that compared the effect of corticosteroids with that of placebo (or standard care) on the prevention of fat embolism syndrome after long bone fracture of the lower limbs or pelvic fracture. References from the studies included were also reviewed. RESULTS: Six studies were included. The pooled relative risk for developing fat embolism syndrome was 0.16 (95 percent CI: 0.08-0.35) in the corticosteroid group as compared with the control group. The pooled relative risk for developing hypoxemia was 0.34 (95 percent CI: 0.19-0.59) in the corticosteroid group as compared with the control group. CONCLUSION: The analysis of evidence showed that corticosteroids decrease the risk of developing fat embolism syndrome and hypoxemia after long bone fracture of the lower limbs.


Subject(s)
Humans , Adrenal Cortex Hormones/therapeutic use , Embolism, Fat/prevention & control , Fractures, Bone/complications , Leg Injuries/complications , Evidence-Based Medicine , Embolism, Fat/etiology , Femoral Fractures/complications , Randomized Controlled Trials as Topic , Tibial Fractures/complications
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