Fractura compleja del húmero asociada a parálisis radial / Complex Fracture of the Humerus Associated with Radial Paralysis

Las fracturas de la diáfisis humeral son lesiones que se producen con frecuencia como parte de caídas o de accidentes de alta energía y se asocian con parálisis del nervio radial. Se presenta paciente de 43 años de edad, masculino, que sufre accidente automovilístico que le produce fractura diafisaria del húmero derecho multifragmentaria, por lo cual se le realiza reducción cerrada y osteosíntesis con clavo intramedular acerrojado y tratamiento conservador para la parálisis radial. La evolución fue satisfactoria, el paciente se recuperó de la parálisis a los 4 meses y logró la consolidación completa a los 5 meses. Tras un año de evolución no presenta dolor en el hombro, y tiene movilidad completa del hombro, muñeca y dedos a la extensión(AU)

Diaphyseal fracture of humerus are frequent lesions, resulting from falls or high energy accidents; they are associated to radial nerve palsy. We report the case of a 43 years old male patient, who suffered a multifragment diaphyseal fracture of his right humerus, as a result of a car accident. He underwent a closed reduction and osteosynthesis using a locking intramedullary nail for the radial paralysis. His evolution was satisfactory; this patient recovered from the paralysis after four months and he managed full consolidation five months later. After a year, he did not have any pain in his shoulder, he has full mobility of his shoulder, wrist and fingers when extendind(AU)

Manejo de fracturas abiertas de tibia en Cuba / Management of Open Tibial Fractures in Cuba

Introducción: Las fracturas abiertas de tibia son un subconjunto de la carga de traumatismos en América Latina. Se examinaron cuestiones relacionadas con el tratamiento potencialmente críticas en Cuba, país con recursos limitados, pero con un programa nacional de salud estandarizado, coherencia en educación y similitudes de programas de posgrado. Objetivos: Describir los patrones de tratamiento de la fractura abierta de tibia en Cuba, y comparar las características del manejo agudo y tardío en siete provincias del país. Métodos: Se encuestaron 67 cirujanos ortopédicos para evaluar cuatro aspectos en el tratamiento de la fractura abierta: profilaxis antibiótica, irrigación y desbridamiento, estabilización y tratamiento de heridas. Se utilizó el método de muestreo por conveniencia para identificar a los cirujanos y el análisis se realizó mediante la prueba exacta de Fisher (p < 0,05). Resultados: Se administraron antibióticos posoperatorios durante más de 72 horas para las fracturas GA-I/II (49 por ciento) y las fracturas GA-III (70 por ciento). Los cirujanos de La Habana (n= 32) utilizaron con más frecuencia la fijación interna primaria para las fracturas GA-I/II, que los cirujanos en las restantes provincias (n= 35) (64,3 porciento vs. 30,3 por ciento, p= 0,008). Los cirujanos de otras provincias realizaron cierre primario en el momento de la fijación definitiva de fracturas GA-I /II con más frecuencia que los de La Habana (62,9 por ciento vs. 32,3 por ciento, p= 0,013). Para fracturas GA-III, la mayoría de los cirujanos habaneros (88,6 %), al igual que los de las restantes provincias (96,8 por ciento) prefirieron realizar cierre diferido.Conclusiones: El tratamiento de fracturas abiertas de tibia en Cuba es generalmente consistente con otros países de América Latina. Se describen las características del manejo de fracturas abiertas de tibia en Cuba y se comparan las diferencias en los métodos de estabilización y tratamiento de heridas entre provincias, lo cual resulta útil para evaluar si son resultado de diferencias en la práctica quirúrgica, o en la disponibilidad de recursos. Esto representa una ayuda al abordar las formas de optimizar la atención al paciente, a través de la capacitación especializada y la asignación de los recursos(AU)

Introduction: Open tibia fractures are a significant subset of the overall trauma burden in Latin America. Latin American countries vary in their access to orthopaedic care resources, and country-specific orthopaedic recommendations are necessary. Cuba, a country with limited resources, has a standardized national health program, consistencies in education, and similarities across post-graduate training programs. This study aimed to identify management preferences for open tibia factures in Cuba. Objectives: To describe the treatment of open tibial fractures in Cuba, and to compare the characteristics of acute and delayed management across seven Cuban provinces. Methods: Sixty-seven orthopaedic surgeons were surveyed to evaluate four aspects of open fracture management, regarding antibiotic prophylaxis, irrigation and debridement, stabilization, and wound management. The convenience sampling method was used to identify surgeons and the analysis was performed using Fisher's exact test (p <0.05). Results: Postoperative antibiotics were administered for more than 72 hours for GA-I / II fractures (49 pecent) and GA-III fractures (70 percent). Surgeons in Havana (n = 32) used primary internal fixation for GA-I / II fractures more frequently than surgeons in the remaining provinces (n = 35) (64.3 pecent vs. 30.3 percent p = 0.008). Surgeons from other provinces performed primary closure at the time of definitive fixation of GA-I / II fractures more frequently than those from Havana (62.9 percent vs. 32.3 percent, p = 0.013). For GA-III fractures, the majority of Havana surgeons (88.6 percent), as well as those of the remaining provinces (96.8 percent) preferred to perform deferred closure. Conclusions: The treatment of open tibial fractures in Cuba is generally consistent with other Latin American countries. The characteristics of the management of open tibial fractures in Cuba are described and differences in wound stabilization and treatment methods between provinces are compared, which is useful to assess whether they are the result of differences in surgical practice, or in availability of resources. This is helpful in addressing ways to optimize patient care through specialized training and resource allocation(AU)

Enclavado endomedular elástico para el tratamiento de refracturas de antebrazo en niños / Elastic stable intramedullary nailing for the treatment of forearm refractures in children

Introducción: La diáfisis del antebrazo es el sitio más frecuente de refracturas en niños. Estas lesiones suelen ocurrir en el tercio medio o proximal antes del año de la fractura inicial. Hay poca información sobre el tratamiento de este tipo de lesiones. El objetivo de este estudio fue evaluar los resultados y las complicaciones en pacientes con refracturas de antebrazo que requirieron fijación interna con clavos elásticos endomedulares. Materiales y Métodos: Se registró la siguiente información: datos demográficos, mecanismo de lesión, clasificación, tiempo desde la consolidación de la fractura original hasta la refractura, tipo de reducción y tiempo de consolidación. Los resultados fueron evaluados según la escala propuesta por Martus y las complicaciones, con una adaptación de la clasificación de Clavien-Dindo. Resultados: Se evaluaron 17 pacientes (14 varones) con 17 refracturas de antebrazo (15 cerradas y 2 expuestas). La edad era de 11 años (RIC 7, mín.-máx. 5-15). La lesión ocurrió a las 12 semanas de la fractura inicial (RIC 4.7, mín.-máx. 4-28). El 47% requirió reducción abierta. El tiempo de consolidación fue de 8 semanas (RIC 4, mín.-máx. 6-28). El seguimiento fue de 43 meses (RIC 47, mín.-máx. 12-103). Fue posible evaluar clínicamente a 16 pacientes (1 pérdida en el seguimiento). El resultado fue excelente en 15 casos y regular en uno. Un paciente tuvo pérdida del rango de movilidad (15º); uno, retraso de la consolidación (cúbito) y 3 sufrieron una segunda refractura. Conclusiones: La fijación interna con clavos elásticos endomedulares fue una técnica eficaz para tratar las refracturas de antebrazo en niños. Si bien un alto porcentaje necesita reducción abierta, el tiempo de consolidación y la tasa de complicaciones serían similares a los de las fracturas primarias tratadas con la misma técnica. Nivel de Evidencia: IV

Introduction: Forearm diaphysis is the most frequent site of re-fractures in children. These lesions usually occur in the middle or proximal third within a year of the initial fracture. There is little information on the treatment of this type of lesions. The aim of this study was to evaluate outcomes and complications in patients with forearm re-fractures requiring internal fixation with elastic stable intramedullary nails. Methods: Demographic data, mechanism of injury, classification, time from consolidation of the original fracture to refracture, type of reduction and time of consolidation were documented. Outcomes were evaluated according to Martus scale, and complications were evaluated with an adaptation of Clavien-Dindo classification. Results: Seventeen patients (14 men) with 17 forearm re-fractures (15 closed and 2 open) were identified. Median age was 11 years (IQR 7, min-max 5-15). Lesion occurred 12 weeks after the initial fracture (RIC 4.7, min-max 4-28). Fortyseven percent required open reduction. Union was achieved at 8 weeks (IQR 4, min-max 6-28). Follow-up was 43 months (IQR 47, min-max 12-103). Sixteen patients were clinically evaluated (1 lost at follow-up). Fifteen patients presented excellent results and one had a fair result. One had 15º loss of motion, one had delayed union (ulna) and three patients had a second re-fracture. Conclusions: In this series, elastic stable intramedullary nails represented an effective technique for the treatment of forearm re-fractures in children. Although many require open reduction, time to union and complication rate seem to be similar to primary fractures treated with the same technique. Level of Evidence: IV

Nueva clasificación para la rodilla flotante en adultos / A new classification for Floating knee in adults

La clasificación de Fraser para la rodilla flotante, ha sido desde su publicación, la más difundida y utilizada a nivel mundial para estadificar esta lesión. En la rodilla flotante, el compromiso intraarticular se ha relacionado con mayor tasa de complicaciones y con los resultados funcionales más pobres. Sin embargo, la clasificación de Fraser, no toma en cuenta el compromiso de los tejidos blandos, lo cual también es importante para determinar el tratamiento, complicaciones y pronóstico. Otra lesión asociada a la rodilla flotante y que ha sido ampliamente documentada, es el compromiso de los ligamentos de la rodilla y las fracturas de rótula. Otros sistemas de clasificación propuestos posteriormente a la clasificación de Fraser, no toman en cuenta estos y otros elementos. Consideramos que una clasificación para la rodilla flotante, debe tomar en cuenta cuatro aspectos fundamentales para su diagnótico, tratamiento y pronóstico: morfología de la lesión, compromiso articular, compromiso de las partes blandas y compromiso de los ligamentos de la rodilla y afectación de la rótula. Con esta investigación proponemos un nuevo sistema de clasificación para la rodilla flotante que toma en cuenta estas variables, y que además, es simple y proporciona importante información para su diagnóstico, tratamiento y pronóstico(AU)

The Fraser classification for floating knee has been since its publication, the most widespread and worldwide used to stage this injury. In the floating knee, intra-articular commitment has been linked to higher rates of complications and poorer functional outcomes. However, the classification of Fraser, does not take into account the commitment of the soft tissues, which is also important in determining treatment, complications and prognosis. Another lesion associated with floating knee and has been widely documented, is the commitment of the ligaments of the knee and patella fractures. Other classification systems subsequently proposed to Fraser classification, do not take into account these and other elements. We think that a classification for floating knee should include four key factor for diagnosis, treatment and prognosis: lesion morphology, joint involvement, commitment soft tissue and commitment of knee ligament and patellar involvement. With this research we propose a new classification system for floating knee that takes into account these variables, and furthermore, is simple and provides important information for diagnosis, treatment and prognosis(AU)

Diaphyseal femoral fractures; treatment by close v/s open intramedullary interlocking nail

To assess the best results of diaphyseal femoral fractures treated by closed intramedullary interlocking nail and open intramedullary interlocking nail. Cross sectional. Jan 2009 to Jan 2011. LUH Jamshoro / Hyderabad. Total 40 fractures of shaft of femur in 40 patients were treated with IMILN. All patients have same post operative follow up. Early range of motion exercises of hip and knee joint was started, pain management and 3rd generation cephalosporin intravenous antibiotics given for 5 days followed by oral antibiotics. Patients discharged as early as possible when patient's condition allowed and removal of stitches after two weeks. Patient's assessment regarding wound condition, range of movement of proximal and distal joints and fractures assessment radiologically and clinically was done every month. Majority of the cases were with the age groups of 37.5% between 21-30 years. RTA was found most common 70% of the cases. According to the AO classification oblique fractures were found most common 45%. On the assessment of final results in both close and open methods, 5% infection found in close method and 7.5% infection were in open method, less union time was found in closed group, deformity was equally found in both groups and heeling time was also less found in closed group. It is concluded that closed intramedullary interlocking nailing method is the best procedure with excellent union for the femoral fracture

Outcome of the closed diaphyseal humeral fracture treated with dynamic compression plate

To determine the treatment outcome of the closed diaphyseal humeral fracture treated with dynamic compression plate at Liaquat university hospital Hyderabad. Total 30 patients having displaced diaphyseal humeral fracture were included in the study. All the patients having fracture of less than 10 days and between the ages 15 - 45 years were selected. All the patients selected after counseling and diagnosed as a case of closed diaphyseal humeral shaft fracture on the basis of clinical examination and X-rays. In this study dynamic compression plates [DCP] were used for stabilization of humeral shaft fracture as assessed by pre operative workup, operative findings and outcomes were recorded with postoperative complications. To avoid the radial nerve palsy it is isolated during operative procedure. Present study was comprises of 30 patients with humeral fracture with the mean age of 30.29 +/- 8.92 years and male/ female ratio of 7:3. On the radiological findings most common type of fracture was oblique in 54%. From the complications, postoperative pain was found in 6.6% of the cases along with postoperative Infections in 10%. 90% fractures united while 10% fractures found with non union. Excellent result were seen in 60% of the cases, while 30% cases were noted with satisfied results and very poor results were found in 10% of the cases. It is concluded that DCP is the good option for the fixation of diaphyseal humerus fracture. Radial nerve palsy is less likely if isolated during operation

Fractura diafisiaria de tibia: resultados y complicaciones con clavo endomedular no fresado. Hospital Alberto Sabogal Sologuren de Agosto del 2004 a Diciembre del 2010 / Diaphyseal fracture of tibia: results and complications with intramedullary nail unreamed. Hospital Alberto Sabogal Sologuren from August 2004 to December 2010

Objetivo: Describir la experiencia del enclavado endomedular bloqueado no fresado como tratamiento para fracturas tibiales en el Hospital Alberto Sabogal Sologuren entre agosto del 2004 a diciembre del 2010. Métodos: Estudio de tipo observacional, descriptivo, transversal y retrospectivo. Se incluyó a toda la población de pacientes atendidos en el Servicio de Traumatología por fracturas tibiales y sometidos a tratamiento con clavo endomedular bloqueado no fresado entre agosto 2004 a diciembre 2010 del Hospital Alberto Sabogal Sologuren. Se revisó las historias clínicas y los reportes operatorios de todos los pacientes. La investigación fue aprobada por el Comité Etico y Metodológico del Hospital Alberto Sabogal Sologuren. Resultados: En el periodo de estudio se trataron 30 fracturas tibiales con clavo endomedular bloqueado sin fresado. La media de edad fue de 35.9±13.9 años. El mecanismo de lesión principal fue la caída en 50 por ciento de los casos. Se encontró diferencias significativas entre la clasificación de la fractura (AO y Tscherne y Gotzen), y el tiempo de consolidación, así como el tiempo transcurrido hasta el retorno laboral (p<0.001). La principal complicación fue el dolor articular en rodilla. Conclusiones: El tratamiento con clavo endomedular bloqueado resulta una técnica eficiente -para lograr la resolución clínica del paciente. Se debe tener en cuenta que los pacientes con clasificaciones de la fractura que impliquen severidad, se encuentran en mayor riesgo de presentar consolidación tardía y mayor tiempo sin actividad laboral, por lo cual se debe brindar un soporte especial y multidisciplinario que le permita llevar mejor su evolución clínica.

Objective: To describe the experience of unreamed locked intramedullary nailing as a treatment for tibial fractures at the Hospital Alberto Sabogal Sologuren from August 2004 to December 2010. Methods: Observational, descriptive, cross-sectional and retrospective study. It included the entire population of patients treated in the orthopedic service for tibial fractures and undergoing treatment with unreamed locked intramedullary nail at Alberto Sabogal Sologuren Hospital between August 2004 to December 2010 We reviewed the medical records and operative reports of all patients. The research was approved by the Ethics and Methodological Committee of Alberto Sabogal Sologuren Hospital. Results: During the study period were treated 30 tibial fractures with unreamed locked intramedullary nail. The mean age was 35.9±13.9 years. The main mechanism of injury was the fall in 50 per cent of cases. We found significant differences between fracture classification (AO and Tscheme and Gotzen), and the healing time and the time to return to work (p<0.001). The main complication was joint pain in knee. Conclusions: Treatment with locked intramedullary nailing is an efficient technique to achieve clinical resolution of patient. Should be aware that patients with fracture classifications that involve severity are at increased risk of delayed consolidation and longer time without work activity it should be given special and multidisciplinary support that allows better clinical outcome.

Complicações do uso de haste intramedular bloqueada no tratamento de fraturas de fêmur / Complications of use locked intramedullary nail in the treatment of fractures of femur

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

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

Salvataje de miembro superior en pacientes pediátrico con sarcoma de Ewing: a propósito de un caso / Upper limb salvage in pediatric patients with Ewing sarcoma: report of a case

El sarcoma de Ewing es un tumor maligno perteneciente al grupo de tumores neuroectodérmicos primitivos. Se conoce poco acerca de los factores etiológicos y generalmente afecta la diáfisis de hueso largo y la pelvis. Rara vez puede localizarse extraesqueléticamente. La tendencia es a presentarse en gente joven durante la fase de mayor crecimiento. Representa el 1 por ciento de los tumores en la infancia y es el segundo tumor maligno primario del hueso en la niñez y adolescencia, con un pico de edad entre 5 y 13 años. En el presente se reporta el caso de un paciente masculino de 10 años de edad, con diagnóstico de Sarcoma de Ewing Primario en Húmero Izquierdo Estadio III. Fue tratado con esquema de Quimioterapia y Radioterapia; en vista de su buena evolución se ofreció Cirugía Reconstructiva como medida de salvataje del miembro superior. Se realizó resección del húmero con márgenes quirúrgicos amplios y se colocó aloinjerto óseo de tibia, estabilizándose con material de osteosíntesis proximal y distalmente. Como resultado se observó remodelación ósea y osteointegración completa del injerto, así como rangos de movilidad aceptables en el primer año de evolución. Los procedimientos quirúrgicos para la reconstrucción de los miembros, después de la extirpación del Sarcoma de Ewing Primario, constituyen una alternativa en un intento por evitar la amputación.

The Sarcoma of Ewing is a malignant tumor pertaining to the gruop of primitive neuroectodermal tumors. Little is known about the etiologic factors and it generally affects the diaphysis of long bones and pelvis. Rarely it can be located extraskeletally. The tendency is to appear in young people during the phase of greater growth. It represents 1 percent of the tumors in the childhood and is the second primary malignant tumor of the bone in the childhood and adolescence, with a tip of age between 5 and 13 years. In the present work the case of a masculine patient of 10 years of age is resported, with diagnosis of Sarcoma of Primary Ewing in Left Chimney Stage III. It was dealed with schemes Chemotherapy and X-ray; in view of its good evolution Reconstructive Surgery was offered like measurement of salvataje of the member superior. Resection of the chimmey with ample surgical margins was realised and aloinjerto bony of tibia was placed distate, becoming stabilized with material of proximal osteosynthesisand as result were observed bony remodeling and complete osseointegration of the graft, as well as acceptable ranks of mobility in the first yeras of evolution. The surgical procedures for the reconstruction of the members, after the extirpation of the Sarcoma of Primary Ewing, constitute an alternative in an attempt to avoid the amputation.

Evaluación de las fracturas cerradas de la diiafisis de tibia tratadas con clavado endomedular de enero del 2006 a diciembre del 2007, en el Hospital Militar Doctor Alejandro Dávila Bolaños / Evaluation of the closed fractures of the tibia diafisis tried with having nailed endomedular of January from the 2006 to December of the 2007, in the Military Hospital Doctor Alejandro Dávila Bolaños

Se presente estudio tipo descriptivo de corte transversal, prospectivo, realizado a 41 pacientes con fracturas diafisiarias cerradas tratadas con clavado endomedular en el Hospital Militar Escuela Dr. Alejandro Dávila Bolaños en el período de enero del 2006 a diciembre del 2007. Se observó que las fracturas oblicuas cortas fueron el trazo fractuario mas frecuente en 41.6 porciento de los pacientes, relacionados con los accidentes por automotres (moticicletas). Se encontró que del 100 porciento de pacientes operados sólo el 14.6 porciento, sufrieron complicaciones, no hubo relación directa con el tipo de trazo de fractura, pero si se encontró relación de las complicaciones con la estancia intrahospitalaria ya que los que permanecieron de 4 a 6 días fueron lo que mas se relacionaron con las infecciones superficiales. En relación al tiempo quirúrgico con las complicaciones se encontró que el 66.6 porciento de las infecciones superficiales se relacionaron con tiempo quirúrgico mayores de 60 minutos. Se puedo observar que los resultados han sido satisfactorios con respecto a las complicaciones ya que se trata de fracturas cerradas, en donde el tiempo quirúrgico es menos que si realiza un RAFI (reducción abierta fijación interna) hay menos daño de las partes blandas, no hay desperiotización, lo que nos conlleva todo ello a uan evolución satisfactoria para el paciente. La incorporación laboral d elos pacientes la mayoría fue entre los 3 a 6 meses con un total de 32 (78 porciento) pacientes, 4 (9.8 porciento) se incorporaron a sus labores entre los 6 a 8 mese y 5 (12.2 porciento) no se han incorporado a sus labores. La distribución de los pacientes según los resultados finales fue de bueno en 35 (85.4 porciento), regular en 4 (9.7 porciento) y malo en 2 (4.9 porciento) de los pacientes...

Functional bracing in the management of diaphysial fractures of Tibia

Tibia is the most commonly fractured long bone in the body, because its particular blood supply and high complications rate we always try to find out the best method to manage such fracture with minimal disturbance to its blood supply and early mobilizations. The fracture brace is one of the best methods of treatment of fractures regarding safety and early mobilization. We used the brace in closed and compound [Gustillo I and II] in adult, and shows its advantage over other methods regarding safety, mobility, and low complication rate. Nineteen patient with tibial shaft fracture was investigated during the treatment with tibial castbrace Fractures were classified according to AO/ASIF classification. Patients were treated primarily by back slab followed by plaster application from toes to above the knee Fracture brace was applied after the pain and swelling had subsided. Serial x-ray films were taken regularly in a fixed dates to observe and prevent any unacceptable misalignment cast brace was discarded after union, when it found safe to walk independently. The average time needed for application of the cast after injury was [4.8] weeks for closed fractures and [6.1] weeks for open Fractures. Union occurred in an average of [17.2] weeks for type A1 [AO/ASIF], [16.2] weeks for A2, and the longest healing time [22.2] weeks was obtained in type C. Neither a significant shortening was obtained with a range of [8.6-13.4 mm.] nor an angulations range of [1-7.5[°]] if compared with the acceptable figures. Functional bracing is another method in accomplishing the goal of early introduction of function after bone union. It does not replace other methods of treatment which have its specific indications. Functional bracing is successful in type A, and can be used in type B and C of AO/ASIF classification .The misalignments obtained are mostly within acceptable range if compared with the standard figures

Comparative study of the locked intramedullary nail and Ender pins in the treatment of tibial diaphyseal fractures

OBJECTIVE: To compare the locked, unreamed intramedullary nail with Ender pins in the treatment of open Gustilo grade I or II or closed tibial diaphyseal fractures of type A, B, or C2 of the AO classification. MATERIALS AND METHODS: Forty-four patients with unilateral tibial diaphyseal fractures were treated with intramedullary nails or Ender pins. Twenty patients were treated with an unreamed intramedullary nail with access via the patellar tendon with static locking. Twenty-four patients were treated with Ender pins introduced medially and laterally with respect to the tuberosity of the tibia. The main parameters analyzed were type of reduction, complications, union rate, deformities, joint mobility, pain, gait, effort capacity, presence of neurovascular disorders, and complaints related to the synthesis material. RESULTS: During 1 year of follow-up, the fractures of 90.0 percent of the patients with intramedullary nails and 95.7 percent of patients with Ender pins healed within an average of 21.5 weeks and 20.9 weeks, respectively. The significant findings were as follows: patients treated with Ender pins had less mobility of the subtalar joint; patients treated with intramedullary nails were more likely to have pain in the knee; both groups showed shortening of the tibia at the end of 1 year of treatment. CONCLUSIONS: The two methods are similar in the treatment of type A, B, and C2 tibial diaphyseal fractures.

OBJETIVO: Comparar a haste intramedular bloqueada não-fresada com os pinos de Ender no tratamento das fraturas da diáfise da tíbia tipos A, B ou C2 da classificação AO, fechadas ou expostas graus I ou II de Gustilo. MATERIAIS E MÉTODOS: 44 pacientes com fratura unilateral da diáfise da tíbia, tratados com HIB ou com pinos de Ender. Vinte pacientes foram tratados com uma haste intramedular bloqueada não fresada por acesso através do tendão patelar e com bloqueio estático; vinte e quatro pacientes com pinos de Ender introduzidos medial e lateralmente à tuberosidade da tíbia. Principais parâmetros analisados: tipo de redução, complicações, consolidação, deformidades, mobilidade articular, dor, marcha, capacidade para esforços, distúrbios neuro-vasculares e desconforto pelo material de síntese. RESULTADOS: No seguimento de um ano, 90,0 por cento das hastes intramedulares e 95,7 por cento dos pinos Ender dos pacientes apresentaram consolidação da fratura com tempo médio de 21,5 e 20,9 semanas, respectivamente. Os achados significantes foram: mobilidade da articulação subtalar menor nos pacientes tratados com pinos de Ender; dor no joelho mais freqüente nos pacientes tratados com HIB; encurtamento da tíbia nos dois grupos ao final de um ano de tratamento. CONCLUSÕES: Os dois métodos são semelhantes no tratamento das fraturas da diáfise da tíbia tipos A, B e C2.

Comparative multicenter study of treatment of multi-fragmented tibial diaphyseal fractures with nonreamed interlocking nails and with bridging plates

OBJETIVOS: Estudo prospectivo e randomizado comparou pacientes com fraturas diafisárias multifragmentárias fechadas de tíbia, tratados com dois métodos de fixação: hastes intramedulares bloqueadas não-fresadas e placas em ponte. MATERIAL E MÉTODOS: Foram estudados 45 pacientes sendo utilizadas 22 placas em ponte e 23 hastes bloqueadas. Todas as fraturas foram tipos B e C (Classificação AO). RESULTADOS: A consolidação clínica e radiográfica ocorreu em todos os casos. Não houve caso de infecção. Verificou-se que o tempo de consolidação dos pacientes que receberam haste foi maior (em média 4,32 semanas) do que o tempo de consolidação daqueles que receberam placa (p = 0,026). Não foram observadas diferenças estatisticamente significantes entre os dois métodos no tocante à mobilidade do tornozelo nos pacientes dos dois grupos. CONCLUSÕES: O tempo de consolidação foi menor com uso de placas em ponte, porém sem diferenças funcionais significantes.

Reconstruction of bone loss of diaphyseal tibial bone using circular external fixator

Aim was to achieve filling of large diaphyseal defect and simultaneous weight bearing of injured extremity till union was achieved. A metaphyseal corticotomy and gradual distraction of bone segment was performed. We used ilzarove frame on all the cases. Good alignment and stable fixation of bone fragments were achieved. A bone fragment of adequate length [4-10 cm] was created after corticotomy, which was done in proximal or distal tibial metaphyseal area. 7-10 days after corticotomy, fragments were traveled axially across the defect. The transportation was achieved by the use of olive wires and central transporting ring. Regeneration of distraction gap was achieved in all 16 patients. Union at the docking site was achieved in 15 patients and union was not related to length of bone defect. In one patient there was failure of the union at docking site. This was due to incomplete removal of ebernated and atrophic bone ends which was addressed by excision of bone ends and bone grafting. Healing of infection occurred in all patients without second operation. Residual varus deformity remained in two patients with 10 degree and 12 degree respectively. The Ilizarove technique for treatment of segment defects of diaphyseal long bones are effective and offer many advantages. One of the greater advantages of technique is that it allows simultaneous treatment of bone loss, infection, nonunion, deformity and allows weight bearing

Surgical management of non-union of humeral diaphyseal fracture

To evaluate results of operative management of established non-union of humeral diaphysis with Dynamic compression plating [DCP] and Rush pinning with cancellous bone graft. Hospital based prospective study. Conducted at Department of Orthopedic Surgery, Jinnah Postgraduate Medical Centre, Karachi. A total of 21 patients of established un-united humeral diaphyseal fracture, between 15 to 65 years were included in this study. Patients underwent DCP and Rush pinning with bone grafting. Union of fractures clinico-radiographically and functional outcomes with Modified Constant and Murley Scale for shoulder and range of motion for elbow were considered. Among 18 available patients, 14/18 nonunion [77.8%] united within 5.1 +/- 1.8 months. For DCP group 11/13 [84.6%] united in 4.45 +/- 0.96 months. For Rush pin group 3/5 [60%] united in 7.7 +/- 2.1 month [P< 0.001]. Modified Constant and Murley Scale for shoulder assessment, for DCP group, excellent 05, good 03, fair for 03, poor 02 and for Rush pin group excellent 00, good 00, fair 02 and poor 03. Average range of motion of elbow joint 71.7 +/- 15.3% to 82.7 +/- 16.0%. Persistent non-union in four, radial nerve palsy in one, implant failure in two and shoulder impingement in one case noticed. No severe deep infection occurred. Dynamic compression platting with bone graft has shown significantly higher union rate for non-union of humeral diaphysis, while the functional outcome regarding shoulder [P<0.03] and elbow movements [P<0.05] are also proved to be significantly better in DPT as compared to Rush pin

Percutaneous intramedullary kirschner wiring of displaced diaphyseal forearm fractures in children

Displaced fractures of the forearm in children are often treated conservatively, but there is a relatively high incidence of redisplacement, malunion and consequent limitation of function. Percutaneous Kirschner [K] wire fixation had been performed for 17 children under the age of 14 years, 16 children had both radius and ulna fractured and one patient had fracture ulna only. The mean initial angulation was 19° in the lateral plane and 9° in the anteroposterior plane for the radius and 15° and 9° respectively for the ulna. In 13 patients [76%] we performed closed reduction, while in the remaining 4 patients closed reduction failed and open reduction through a minimal approach was required before K wiring. At a mean follow up of 20 months all patients had good functional results with an excellent range of motion. Only 1 patient had angulation of 10°, and non had nonunion, premature epiphyseal closure or deep infection. Percutaneous intramedullary K wiring for forearm diaphyseal fractures is a convenient effective and safe operation with minimal complications

Fracturas diafisarias de fémur en niños: Clavos intramedulares elásticos o fijadores externos / Fractures of the femoral shaft in children. Elastic intramedullary nailing or external fixation

En el presente trabajo descriptivo-comparativo de tipo serie de casos, se recoge la experiencia acumulada en el Hospital Universitario San Jorge de Pereira en el manejo de 15 fracturas de diáfisis de fémur entre 2001 y 2003, en niños entre los 4 y los 12 años, mediante el uso de clavos endomedulares flexibles de titanio (tens), y se compara con los resultados obtenidos en un trabajo previo presentado en el 43° Congreso de la SCCOT en 1998, en el tratamiento de 9 pacientes con el mismo tipo de fractura y del mismo grupo de edad, tratados con fijadores externos.

Resultados de la fijación intramedular con clavo colchero a cielo abierto con bloqueo y fresado del canal en fractura de fémur en el servicio de Ortopedia Hospital Roberto Calderón G diciembre 2000 a enero 2003 / Results of the fixing intramedular with nail colchero to sky opened with blockade and fresado of the channel in femur fracture in the Orthopedics service Hospital Roberto Calderón G December 2000 to January 2003

Estudio observacional, ambilectivo transversal, cuyo objetivo fue evaluar las fracturas de la diafisis femoral, tratadas con clavo endomedular colchero, en el servicio de Ortopedia y Traumatología, Hospital Roberto Calderón, durante el periodo Diciembre 2000 a Enero 2003. El seguimiento promedio fue de 24 meses. Sin embargo, para valorar resultados y complicaciones se estableció 24 semanas como rango desde que el paciente fue intervenido hasta su alta de consulta externa, ya que posterior a las 16 o 20 semanas se espera un pobre resultado y por ende complicaciones derivadas del procedimiento. En este periodo se manejaron 15 pacientes, de los cuales el 80 porciento pertenecieron al sexo masculino, y un 20 porciento al sexo femenino. El sistema de clasificación., utilizado (Winquist), tomó en cuenta el grado de conminución y porcentaje de cortical femoral afectada, siendo la tipo IV la que se encontró con mayor frecuencia ( 53.3 porciento). Se valoró resultados tomando en cuenta parámetros clínicos y radiológicos en escala nominal, siendo en un 26.7 porciento resultados excelentes, 46.7 porciento buenos, 26.7 porciento entre regulares y malos.Llama la atención el alto índice de población joven afectada 31 años como promedio económicamente activa.Consideramos que los parámetros de evaluación, utilizados en el análisis del paciente, fractura y tratamiento, tienen una correlación directa sobre los resultados y complicaciones...

Revisión de las fracturas diafisarias tratadas con enclavado endomedular, desde enero 1999 a octubre 2001: Hospital Vargas de Caracas / Review of the diaphyseal fractures treated with endomedullary enclaved, from january 1999 to october 2001: Hospital Vargas from Caracas

En el tratamiento de las fracturas diafisarias se han empleado numerosas técnicas desde el tratamiento ortopédico pasando por la ostesíntesis con placas y clavos endomedulares. El objetivo del tratamiento es promover la consolidación, la movilización precoz y restauración de la función, conservando la longitud, rotación, y ejes mecánicos de la extremidad. Elegir el implante depende de la personalidad de la fractura, los clavos con pernos de bloqueo proximal y distal permiten controlar las inestabilidades axiales o rotacionales. Se identificaron 132 historias clínicas, la información se tabuló mediante formato de recolección de datos y los resultados se analizaron y reportaron en cuadros y figuras . Esta revisión pone en evidencia que las fracturas diafisarias con una gran frecuencia afectan a la población adulta joven 68,1 por ciento, con predominio del sexo masculino 86 por ciento, quienes se encuentran expuestos principalmente a hechos violentos, en el 50,7 por ciento de los casos estuvo comprometido el fémur, el 68,9 por ciento ameritó tratamiento quirúrgico a cielo abierto y el 53,7 por ciento más de dos horas de cirugía, requiriendo hasta de treinta días de hospitalización en el 75,7 por ciento para su resolución quirúrgica

Evaluacion, manejo y complicaciones de la fractura expuesta de la diafisis tibial / Management of open fractures of tibial shaft

Estudio observacional descriptivo tipo serie de casos de fracturas expuestas de la diáfisis tibial que ingresaron al servicio de urgencias del Hospital Universitario del Valle. Se manejaron 334 pacientes en el periodo comprendido entre 1º de Enero 1999 y el 31 de Diciembre del ano 2000. Se realizó una revisión de las Historias clínicas y radiografías de todos los pacientes controlados por consulta externa del departamento de Ortopedia por un mínimo de 1 año (12 meses). Se estudiaron 287 pacientes, la mayoría hombres jóvenes (76 por ciento), siendo la primera causa de las fracturas los accidentes en vehículos automotores (88 por ciento), destacándose los accidentes en moto (41 por ciento). El mayor número de fracturas fueron expuestas grado I y II, (Gustilo y Anderson), 139 (48 por ciento). Las complicaciones más frecuentes fueron la seudoartrosis (6 por ciento) y la osteítis (14 por ciento); las más complicadas proporcionalmente fueron las fracturas expuestas grado III. Sin embargo, las fracturas expuestas grado I presentaron un porcentaje de complicaciones (11 por ciento) mayor al reportado en la literatura mundial. Este estudio describe posibles causas que nacen de las observaciones realizadas