RESUMO
The posterior malleolar fracture is relatively common fracture of the foot and ankle, but several aspects of this are still controversial. If the posterior malleolus is involved in the ankle fracture, the prognosis is usually poor. A computed tomography scan is essential for accurate diagnosis and treatment planning. Although indirect reduction and the anterior to posterior screw fixation technique have the advantages of a small incision with the requirement of relatively simple skills, direct open reduction and fixation from the posterior side provide a more biomechanically stable and accurate reduction. The precise reduction of the posterior malleolar fragment helps to achieve congruency of the tibia and fibula in the incisura and contributes to syndesmotic stability. It is important to determine the indications for surgical treatment by comprehensively evaluating the three-dimensional structure of the posterior malleolar fracture and all related injuries to the ankle.
RESUMO
Objective@#: To evaluate the effectiveness and long-term outcome predictors of percutaneous sacroplasty (PSP). @*Methods@#: This single-center study assessed 40 patients with sacral insufficiency fractures using the short-axis technique under C-arm flat-panel detector computed tomography (CT). Two radiologists reviewed the patients’ magnetic resonance and CT images to obtain imaging findings before PSP and determine technical success, respectively. The short-term outcomes were visual analog scale score changes and opioid usage reductions. Long-term outcomes were determined using telephone interviews and the North American Spine Society (NASS) patient-satisfaction index at least one year after PSP. @*Results@#: Technical success was achieved without any significant complications in 39 patients (97.5%). Telephone interviews were possible with 12 patients and failed in 10 patients; death was confirmed in 18 patients. Fifteen patients (50%) re-visited the hospital and received conservative treatment, including spinal injections. Nine patients reported positive satisfaction (NASS patient-satisfaction index 1 or 2), while the negative satisfaction group (NASS patient-satisfaction index 3 or 4, n=3) showed a higher incidence of compression fractures at the thoracolumbar spine level (66.7% vs. 22.2%) and previous spinal injection history (66.7% vs. 33.3%). The poor response group also showed higher incidences of facet joint arthrosis (100% vs. 55.6%), central canal stenosis (100% vs. 22.2%), neural foraminal stenosis (33.3% vs. 22.2%), scoliosis (100% vs. 33.3%), and sagittal malalignment (100% vs. 44.4%). @*Conclusion@#: PSP was effective for sacral insufficiency fractures and showed good long-term outcomes. Combined compression fractures in the thoracolumbar spine and degenerative lumbar pathologies could be possible poor outcome predictors.
RESUMO
Traditionally, adult intussusception has required a bowel resection because of the malignancy risk. A patient with anorexia, weight loss, and abdominal pain visited our clinic. A physical exam and imaging study revealed no acute peritoneal signs. A colonoscopy for biopsy and bowel reduction was attempted. The tissue sample was consistent with intestinal tuberculosis. We report intestinal tuberculosis complicating intussusception which was treated without surgical intervention.