Fijación interna combinada con artroplastia total de cadera en fracturas acetabulares inveteradas complejas en ancianos. Reporte de caso / Internal fixation combined with total hip arthroplasty in complex inveterate acetabular fractures in the elderly. Case report

La fijación interna combinada con artroplastia en pacientes de edad avanzada, está indicada en fracturas acetabulares complejas inveteradas, artrosis preexistente, luxación inveterada, Impactación supero-medial de la cúpula acetabular, la finalidad de la cirugía es lograr la fijación de la columna anterior, columna posterior, lamina cuadrilátera y pared posterior para proporcionar estabilidad adecuada al componente acetabular y restaurar el centro de rotación de la cadera. Debido a la complejidad de estas lesiones, se decide presentar el siguiente caso clínico, que corresponde una paciente femenina de 70 años, quien posterior a traumatismo de baja energía presenta fractura inveterada compleja con patrón en T de Acetábulo de 8 meses de evolución. El Objetivo es: Evaluar los resultados del tratamiento de las fracturas acetabulares complejas en pacientes de edad avanzada con reducción abierta más fijación interna combinada con artroplastia total de cadera. Se realiza en un 1er tiempo: Abordaje Ilioinguinal, ORIF con placa de reconstrucción 3,5 mm para CA, 2do Tiempo: Abordaje de Kocher Langenbeck, ORIF con placa de reconstrucción 3,5 mm para CP y PP. 3er Tiempo: ATC izquierda primaria no cementada, con aporte biológico de injerto óseo autologo. Resultado: Se restableció la integridad de las líneas acetabulares, reducción anatómica según Matta, índice de Harris hip score de 88 puntos. Se concluye que el procedimiento combinado de ORIF mas ATC es el tratamiento ideal de las fracturas acetabulares complejas inveteradas en pacientes de edad avanzada(AU)

Internal fixation combined with arthroplasty in elderly patients is indicated in inveterate complex acetabular fractures, preexisting osteoarthritis, inveterate dislocation, supero medial impaction of the acetabular dome, the purpose of surgery is to achieve fixation of the anterior column (AC), posterior column (PC), quadrilateral plate, and posterior wall (PP) to provide adequate stability to the acetabular component and restore the hip center of rotation. Due to the complexity of these injuries, it is decided to present the following clinical case, which corresponds to a 70-year-old female patient, who, after a low-energy trauma, presents a complex inveterate fracture with a T-pattern of the acetabulum of 8 months of evolution. The Objective is: To evaluate the results of the treatment of complex acetabular fractures in elderly patients with open reduction plus internal fixation (ORIF) combined with total hip arthroplasty (THA). It is performed in a 1st stage: Ilioinguinal approach, ORIF with 3.5 mm reconstruction plate for (CA), 2nd Stage: Kocher Langenbeck approach, ORIF with 3.5 mm reconstruction plate for (CP) and (PP). 3rd Time: Uncemented primary left THA, with biological contribution of autologous bone graft. Result: The integrity of the acetabular lines was restored, anatomical reduction according to Matta, Harris hip score index of 88 points. It is concluded that the combined procedure (ORIF plus ATC) is the ideal treatment of inveterate complex acetabular fractures in elderly patients(AU)

Comparison of a minimally invasive osteosynthesis technique with conventional open surgery for transverse patellar fractures / 中华创伤杂志(英文版)

PURPOSE@#The study aims to compare the efficacy and safety of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures.@*METHODS@#It was a retrospective study. Adult patients with closed transverse patellar fracture were included, and with open comminuted patellar fracture were excluded. These patients were divided into minimally invasive osteosynthesis technique (MIOT) group and open reduction and internal fixation (ORIF) group. Surgical time, frequency of intraoperative fluoroscopy, visual analogue scale score, flexion, extension, Lysholm knee score, infection, malreduction, implant migration and implant irritation in two groups were recorded and compared. Statistical analysis was performed by the SPSS software package (version 19). A p < 0.05 indicated statistical significance.@*RESULTS@#A total of 55 patients with transverse patellar fractures enrolled in this study, the minimally invasive technique was performed in 27 cases, and open reduction was performed in 28 cases. The surgical time in the ORIF group was shorter than that in the MIOT group (p = 0.033). The visual analogue scale scores in the MIOT group were significantly lower than those in the ORIF group only in the first month after surgery (p = 0.015). Flexion was restored faster in the MIOT group than that in the ORIF group at one month (p = 0.001) and three months (p = 0.015). Extension was recovered faster in the MIOT group than that in the ORIF group at one month (p = 0.031) and three months (p = 0.023). The recorded Lysholm knee scores in the MIOT group were always greater than those in the ORIF group. Complications, such as infection, malreduction, implant migration, and implant irritation, occurred more frequently in the ORIF group.@*CONCLUSION@#Compared with the ORIF group, the MIOT group reduced postoperative pain and had less complications and better exercise rehabilitation. Although it requires a long operation time, MIOT may be a wise choice for transverse patellar fractures.

A retrospective study on manual reduction combined with Chinese Orthopaedic ankle external fixator in the treatment of trimalleolar fracture / 中国骨伤

OBJECTIVE@#To evaluate the needle puncture safety and clinical efficacy of manual reduction combined with external fixation of ankle frame in the treatment of trimalleolar fracture under the guidance of Chinese Osteosynthesis (CO) theory.@*METHODS@#The clinical data of 118 patients with trimalleolar fractures admitted from December 2010 to December 2021 were retrospectively analyzed. Fifty-three patients were treated with manual reduction combined with external fixation of ankle frame(observation group). Sixty-five patients were treated with open reduction and internal fixation with plate and screws(control group). The operation time, hospitalization days, non-weight-bearing time of the affected limb, clinical healing time of fracture, incidence of complications, visual analogue scale (VAS) before and 1 month after operation, and American Orthopedic Foot and Ankle Society(AOFAS) score of ankle joint before and 1 year after operation were compared between the two groups.@*RESULTS@#Patients in both groups were followed up for more than 1 year. All patients were followed up, and the duration ranged from 14 to 70 months, with an average of(35.28±14.66) months. There were statistically significant in operation time, hospitalization days, non-load-bearing time of affected limbs, clinical healing time of fractures and VAS score one month after operation between the two groups. One month after operation, the VAS score of the observation group was lower than that of the control group(t=3.343, P=0.001). The operation time of the observation group was significantly shorter than that of the control group(t=9.091, P=0.000). The hospitalization days in the observation group were significantly less than those in the control group(t=5.034, P=0.000). The non-load-bearing time of the affected limb in the observation group was significantly shorter than that in the control group(t=11.960, P=0.000). The clinical healing time of fracture in the observation group was significantly shorter than that in the control group(t=4.007, P=0.000). There was no significant difference in AOFAS score between the two groups one year after operation(t=0.417, P=0.678). In the observation group, there were 2 cases of pinhole infection and 3 cases of loss of reduction less than 2 mm. There were 3 cases of surgical incision infection in the control group. There was no significant difference in the incidence of complications between the two groups(χ2=0.446, P=0.504).@*CONCLUSION@#Manual reduction combined with external fixation is safe and effective in the treatment of trimalleolar fracture under the guidance of CO theory, and the function of ankle joint recovers well after operation. This therapy has good clinical value.

Fractura de astrágalo asociado a fractura del cuboides en un niño de 9 años: reporte de caso / Talar fracture associated with cuboid fracture in a 9-year-old boy: case report / Fratura do tálus associada à fratura do cubóide em menino de 9 anos: relato de caso

Introducción: El astrágalo tiene una anatomía única y juega un papel fundamental en la función del tobillo y pie. Las fracturas de astrágalo se consideran una urgencia ortopédica especialmente las fracturas de cuello desplazadas, debido al alto riesgo de necrosis avascular. Sin embargo, estas son raras en los niños con una prevalencia estimada del 0,008% de todas las fracturas pediátricas. Las fracturas del cuello del astrágalo se asocian con una alta tasa de complicaciones, entre las más importantes se destacan la artrosis postraumática y la necrosis avascular. Éstas están relacionadas principalmente con el grado de desplazamiento inicial del cuello del astrágalo y la incidencia puede ser del 100%. Objetivos: Los objetivos del presente trabajo son demostrar la evolución de un paciente con una patología poco frecuente, con una asociación lesional no reportada hasta el momento y realizar una revisión bibliográfica del tema. Material y métodos: Se evaluó de forma retrospectiva un paciente de sexo masculino de 9 años con una luxo-fractura de cuello de astrágalo de pie izquierdo asociado a una fractura de cuboides. Se evaluaron los resultados clínicos radiológicos y funcionales luego de 3 años de evolución. Resultados: En nuestro caso se realizó reducción abierta y fijación percutánea. Se logró una excelente consolidación ósea sin complicaciones y con buena funcionalidad del tobillo luego de 3 años de seguimiento. Se realizó la escala AOFAS obteniendo una puntuación de 93/100. No presentó limitaciones en cuanto al dolor, con un total de 40 puntos, no mostró limitaciones en cuanto a la función, con un total de 45 puntos. Observamos una leve desaxación en valgo del retropie, asintomático, con un total de 8 puntos. Conclusiones: Las fracturas del astrágalo son raras en la población pediátrica pero pueden ocasionar complicaciones graves. En nuestro caso observamos una fractura grave, con una asociación lesional no descrita hasta el momento, que presentó muy buena evolución, con una consolidación ósea, sin complicaciones y con buen resultado funcional a los 3 años de la cirugía. Al tratarse de una patología muy poco frecuente y rara, la bibliografía revisada es en general de baja evidencia científica y se basa en su mayoría en reporte de casos clínicos, excepto una revisión sistemática con bajo numero de pacientes.

Introduction: The talus has a unique anatomy and plays a fundamental role in the function of the ankle and foot. Talar fractures are considered an orthopedic emergency, especially displaced neck fractures, due to the high risk of avascular necrosis. However, these are rare in children with an estimated prevalence of 0.008% of all pediatric fractures. Talar neck fractures are associated with a high rate of complications, the most important of which include post-traumatic osteoarthritis and avascular necrosis. These are mainly related to the degree of initial displacement of the talar neck and the incidence can be 100%. Objectives: The objectives of this work are to demonstrate the evolution of a patient with a rare pathology, with an injury association not reported so far and to carry out a bibliographic review of the topic. Material and methods: A 9-year-old male patient with a talar neck fracture dislocation of the left foot associated with a cuboid fracture was retrospectively evaluated. Clinical, radiological and functional results were evaluated after 3 years of evolution. Results: In our case, open reduction and percutaneous fixation were performed. Excellent bone union was achieved without complications and with good ankle functionality after 3 years of follow-up. The AOFAS scale was performed, obtaining a score of 93/100. It did not present limitations in terms of pain, with a total of 40 points, it did not show limitations in terms of function, with a total of 45 points. We observed a slight valgus dexation of the hindfoot, asymptomatic, with a total of 8 points. Conclusions: Talar fractures are rare in the pediatric population but can cause serious complications. In our case we observed a serious fracture, with an injury association not described until now, which presented a very good evolution, with bone consolidation, without complications and with good functional result 3 years after surgery. As it is a very infrequent and rare pathology, the literature reviewed is generally of low scientific evidence and is based mostly on clinical case reports, except for a systematic review with a low number of patients.

Introdução: O tálus possui anatomia única e desempenha papel fundamental na função do tornozelo e do pé. As fraturas do tálus são consideradas uma emergência ortopédica, principalmente as fraturas deslocadas do colo, devido ao alto risco de necrose avascular. No entanto, estas são raras em crianças, com uma prevalência estimada de 0,008% de todas as fraturas pediátricas. As fraturas do colo do tálus estão associadas a uma alta taxa de complicações, sendo as mais importantes a osteoartrite pós-traumática e a necrose avascular. Estas estão relacionadas principalmente ao grau de deslocamento inicial do colo do tálus e a incidência pode ser de 100%. Objetivos: Os objetivos deste trabalho são demonstrar a evolução de um paciente com patologia rara, com associação de lesão até o momento não relatada e realizar uma revisão bibliográfica sobre o tema. Material e métodos: Foi avaliado retrospectivamente um paciente do sexo masculino, 9 anos de idade, com fratura luxação do colo do tálus do pé esquerdo associada a fratura do cuboide. Os resultados clínicos, radiológicos e funcionais foram avaliados após 3 anos de evolução. Resultados: No nosso caso foi realizada redução aberta e fixação percutânea. Excelente consolidação óssea foi alcançada sem complicações e com boa funcionalidade do tornozelo após 3 anos de acompanhamento. Foi realizada a escala AOFAS, obtendo pontuação de 93/100. Não apresentou limitações em termos de dor, com um total de 40 pontos, não apresentou limitações em termos de função, com um total de 45 pontos. Observamos leve dexação em valgo do retropé, assintomática, com total de 8 pontos. Conclusões: As fraturas do tálus são raras na população pediátrica, mas podem causar complicações graves. No nosso caso observamos uma fratura grave, com associação de lesão até então não descrita, que apresentou evolução muito boa, com consolidação óssea, sem complicações e com bom resultado funcional 3 anos após a cirurgia. Por se tratar de uma patologia muito pouco frequente e rara, a literatura revista é geralmente de baixa evidência científica e baseia-se maioritariamente em relatos de casos clínicos, exceto uma revisão sistemática com um número reduzido de doentes.

Evaluar los resultados funcionales, radiológicos y las complicaciones en el tratamiento quirúrgico de las fracturas acetabulares bilaterales / Functional, radiological results and complications evaluation in the surgical treatment of bilateral acetabular fractures

Las Fracturas Acetabulares bilaterales tienen una incidencia extremadamente baja. El objetivo es evaluar los resultados funcionales, radiológicos y las complicaciones en el tratamiento quirúrgico de las fracturas acetabulares bilaterales. Este estudio se basa en datos de 722 Fracturas de Acetábulo tratadas por el autor principal durante 15 años desde enero de 2005 a septiembre de 2020. Se realizó un estudio descriptivo y retrospectivo. Se incluyeron 13 casos correspondientes al 1,8% del universo. El 72,7% de las fracturas se presentaron por accidentes de tránsito, el 69,3% corresponden a fracturas de patrón asociado en relación con el 30,7% de fracturas de patrón simple. En el 56,5% se realizó abordaje de Kocher Langenbeck. La reducción anatómica se logró en el 92,30%, en el 7,69% la reducción no fue satisfactoria. Para la evaluación funcional se utilizó el HHS, 88,46% reportaron buenos resultados y 11,53% insatisfactorios. Respecto a las complicaciones, 7,69% presentaron osteoartrosis Tönnis II y 7,69% neuroapraxia del nervio ciático izquierdo. Se encontró supervivencia del 100%. El tiempo ideal para la resolución quirúrgica es antes de las 3 semanas. Los resultados radiológicos y funcionales están directamente relacionados al tiempo de fijación, es importante tomar en cuenta que debido a la magnitud de la energía del impacto que se transmite por ambos acetábulos los patrones de fractura que coexisten entre ambas superficies articulares son diferentes, por lo que optimizar la planificación preoperatoria es fundamental(AU)

Bilateral Acetabular Fractures have an extremely low incidence. The objective is to evaluate the functional and radiological results and the complications in the surgical treatment of bilateral Acetabular Fractures. This study is based on a data of 722 acetabulum fractures cases treated by the lead author for over 15 years from january 2005 to september 2020. A descriptive, retrospective study was made. 13 cases corresponding to 1,8% of the universe were included. 72,7% of the fractures occurred due to traffic accidents, 69,3% correspond to associated pattern fractures in relation to 30,7% of simple pattern fractures. In 56,5% the Kocher Langenbeck approach was performed. The anatomical reduction was achieved in 92,30%, in 7,69% the reduction was not satisfactory. The functional result was evaluated according to the HHS, obtaining good results in 88,46% of the cases and unsatisfactory results in 11,53%. Regarding complications, we found 7,69% with Tönnis II osteoarthrosis, 7,69% with neuropraxia of the left sciatic nerve. Successful results with 100% survival were found. The ideal time for surgical resolution is before 3 weeks. The radiological and functional results are directly related to the fixation time. It is important to take into account that due to the magnitude of the impact energy that is transmitted by both acetabulums, the fracture patterns that coexist between both articular surfaces are different, so optimizing preoperative planning is essential(AU)

Fratura complexa de teto de órbita associada disjunção traumática do complexo zigomático / Complex Orbit Roof Fracture Associated with Traumatic Disjunction of the Zygomatic Complex / Fractura Compleja del Techo de la Órbita Asociada a Disyunción Traumática del Complejo Cigomático

Objetivo: As fraturas do complexo zigomático-maxilar (CZM) constituem as principais fraturas do terço médio da face. O diagnóstico é complexo, por envolver uma área alternente sensorial e nobre da face. Portanto o tratamento não visa apenas devolver os contornos ósseos, mas também preservar as funções oculares. No presente caso paciente apresentou severo trauma facial associado a TCE com afundamento do frontal e teto de órbita. Relato de caso: Paciente do sexo masculino, 33 anos, vítima de queda da própria altura. No exame físico notou-se FCC extenso em região frontal, se estendendo para a região supra-orbital esquerda, blefaroedema periorbital esquerdo, com oclusão palpebral e distopia ocular. Escoriações em face e afundamento em região fronto parietal esquerda e perda de consciência. O diagnóstico apontou para fratura do complexo zigomático-maxilar associada a afundamento do osso frontal. Paciente submetido à osteossíntese das fraturas com por meio da ferida e complementado com acesso subciliar e caldwel luc. Foi alcançada boa reabilitação estética e funcional. Conclusão: Portanto, a redução aberta com fixação funcional estável com placas e parafusos segue sendo o padrão ouro para o tratamento de fraturas complexas do CZM. Sendo imperativo uma adequada redução e o reestabelecimento do continente orbitário... (AU)

Objective: Fractures of the zygomatic-maxillary complex are the main fractures of the middle third of the face. The diagnosis is complex, as it involves an alternating sensory and noble area of the face. Therefore, the treatment is not only aimed at restoring bone contours but also preserving ocular functions. In the present case, the patient presented severe facial trauma associated with TBI with frontal and orbital sinking. Case Report: Male patient, 33 years old, victim of a fall from standing height. Physical examination revealed extensive CCF in the frontal region, extending to the left supraorbital region, left periorbital blepharoedema, with eyelid occlusion and ocular dystopia. Excoriations on the face and sinking in the left fronto-parietal region and loss of consciousness. The diagnosis pointed to fracture of the zygomatic-maxillary complex associated with frontal bone sinking. Patient undergoing osteosynthesis of fractures through the wound and complemented with subciliary access and caldwell luc. Good aesthetic and functional rehabilitation were achieved. Conclusion: Therefore, open reduction with stable functional fixation with plates and screws remains the gold standard for the treatment of complex ZMC fractures. An adequate reduction and reestablishment of the orbiting continent is imperative... (AU)

Objetivo: Las fracturas del complejo cigomático maxilar son las principales fracturas del tercio medio de la cara. El diagnóstico es complejo, ya que involucra una zona sensorial y noble alternada de la cara. Por lo tanto, el tratamiento no solo está dirigido a restaurar los contornos óseos sino también a preservar las funciones oculares. En el presente caso, el paciente presentó trauma facial severo asociado a TCE con hundimiento frontal y orbitario. Caso Clínico: Paciente masculino, 33 años, víctima de caída desde altura de pie. A la exploración física destacaba FCC extensa en región frontal, con extensión a región supraorbitaria izquierda, blefaroedema periorbitario izquierdo, con oclusión palpebral y distopía ocular. Excoriaciones en la cara y hundimiento en la región fronto-parietal izquierda y pérdida del conocimiento. El diagnóstico apuntó a fractura del complejo cigomático-maxilar asociada a hundimiento del hueso frontal. Paciente con osteosíntesis de fractura a través de herida y complemento acceso subciliar y calwell luc. Se logró una buena rehabilitación estética y funcional. Conclusión: Por lo tanto, la reducción abierta con fijación funcional estable con placas y tornillos sigue siendo el estándar de oro para el tratamiento de fracturas CCM complejas. Es imperativo una adecuada reducción y restablecimiento del continente en órbita... (AU)

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)

Reduccion de la luxación glenohumeral anteroinferior aguda en el sistema de salud de la Argentina. Perspectiva nacional / Reduction of acute anterior inferior glenohumeral joint dislocation in the Argentine health care system. A national perspective

Objetivo: Conocer los métodos utilizados para el tratamiento inicial del primer episodio de luxación glenohumeral anteroinferior aguda y comparar las conductas entre los diferentes niveles de especialización. Nuestra hipótesis es que los métodos utilizados en la Argentina presentan una gran variabilidad. materiales y métodos: Se realizó una encuesta mediante formularios de Google, que se difundió a través del Comité de Morbimortalidad de la Asociación Argentina de Ortopedia y Traumatología y la Asociación Argentina de Cirugía de Hombro y Codo. El cuestionario consta de 13 preguntas con respuesta de opción múltiple que incluyen: grado de especialización, ámbito laboral, maniobras utilizadas, empleo de anestesia, complicaciones, posición y tiempo de inmovilización. Resultados: Se obtuvieron 429 respuestas completas. El 52,2% utiliza la maniobra de Kocher como primera elección, seguida del método hipocrático (15,9%). El 72% no utiliza anestesia inicialmente para la reducción; se halló una diferencia esta-dísticamente significativa entre el uso de anestesia y los diferentes niveles de especialización (p = 0,046). De los 120 médicos que sí la emplean, el 85,8% recurre a la anestesia general o la sedación. El 74,8% inmoviliza al paciente en aducción y rotación interna. El 13,8% de los participantes refiere haber tenido alguna complicación relacionada con la reducción. Conclusiones: Existe una gran variabilidad en los métodos utilizados para la reducción de un primer episodio de luxación glenohumeral anteroinferior en los servicios de emergencia de la Argentina. Consideramos oportuno replantear el uso de la anestesia, y proponer la anestesia intra-articular como primera opción. Nivel de Evidencia: IIC

Objective: To know the methods used for the initial treatment of the first episode of acute anterior inferior glenohumeral dislocation and to compare the behaviors of physicians between the different levels of specialization. Our hypothesis was that there is great variability in the methods used in Argentina. Materials and Methods: A survey was conducted using the Google forms platform. It was disseminated through the morbidity and mortality committee of the AAOT and the Argentinian Association of Shoulder and Elbow Surgery. The questionnaire consisted of 13 questions with multiple choice answers that included the degree of specialization, work environment, maneuvers, anesthesia, complications, position, and immobilization time. Results: 429 complete answers were obtained. 52.2% use the Kocher maneuver as their first choice, followed by the Hippocratic method (15.9%). 72% do not use anesthesia to perform the reduction, there is a statistically significant difference between the use of anesthesia and the different levels of specialization (p = 0.046). 85.8% of the 120 surgeons who use anesthesia for the reduction, use general anesthesia or sedation. 74.8% immobilize the patient in adduction and internal rotation. 13.8% reported having complications related to the reduction. Conclusions: There is a great variability regarding the methods used to reduce a first episode of LGHAI in the emergency services in Argentina. We believe it is important to reconsider the use of anesthesia, proposing intra-articular anesthesia as the first option, if needed. Level of Evidence: IIC

Comparación del tratamiento de las fracturas supracondíleas de húmero Gartland II y III con técnica de Dorgan versus técnica Cruzada. Hospital General del Sur "Dr. Pedro Iturbe"+ / Treatment Comparison of Gartland II and III supracondylar humerus fractures with Dorgan technique vs Cross technique. del Sur General Hospital "Dr. Pedro Iturbe"

Se comparó la osteodesis por técnica lateral de Dorgan con la técnica Cruzada tradicional o de "Banderillero" en fracturas supracondíleas de húmero Gartland II y III. Se realizó un estudio descriptivo correlacional con diseño experimental. Se incluyeron 24 pacientes, los cuales se distribuyeron en 2 grupos: Grupo A (13 pacientes): técnica de Dorgan y Grupo B (11 pacientes): la técnica Cruzada. La mayor frecuencia de pacientes se encontró entre los 10 y 14 años para el Grupo A y 6 a 9 años para el Grupo B. Se encontró predominio del sexo masculino con 78% de los casos. El mecanismo de producción de la fractura más frecuente fue el indirecto. Mayor frecuencia de las fracturas Gartland III en 62,5% casos y desplazamiento posterior en 66,66%. Según los Criterios de Flynn, los resultados post operatorios para el Grupo A: Pérdida del Ángulo de Acarreo: 7,7% Excelente, 53,8% Bueno y 38,5% Regular, y Pérdida de Movilidad: 7,7% Excelente, 38,5% Bueno y 53,8% Regular; para el Grupo B: Pérdida del Ángulo de Acarreo: 54,5% Bueno, 27,3% Regular y 18,2% Malo, y Pérdida de Movilidad: 9,1% Excelente, 81,8% Bueno y 9,1% Malo. La tasa de complicaciones fue de 7,7% para el Grupo A y 18,2% para el Grupo B (p<0,05). La osteodesis con técnica de configuración lateral de Dorgan presentó menor tasa de complicaciones comparada con la técnica Cruzada, sin embargo, ésta última tuvo mejor recuperación de los rangos articulares(AU)

Osteodesis using the Dorgan lateral technique was compared with traditional crossover or "Banderillero" technique in Gartland II and III supracondylar humerus fractures. A descriptive correlational study with experimental design was made. 24 patients were included, and distributed into 2 groups: Group A (13 patients): Dorgan's technique and Group B (11 patients): crossover technique. The highest frequency of patients was found between 10 and 14 years for Group A and 6 to 9 years for Group B. A predominance of the masculine sex was found with 78% of the cases. The most frequent mechanism for producing the fracture was indirect. Higher frequency of Gartland III fractures in 62,5% cases and posterior displacement in 66,66%. According to Flynn Criteria, the postoperative results for Group A: Loss of Motion: 7,7% Excellent, 53,8% Good and 38,5% Fair, and Angle of Movement: 7,7% Excellent, 38,5% Good and 53,8% Regular; for Group B: Angle of load: 54,5% Good, 27,3% Regular and 18,2% Bad, and Angle of Movement: 9,1% Excellent, 81,8% Good and 9,1% Bad. The complication rate was 7,7% for Group A and 18,2% for Group B (p <0,05). Osteodesis with the Dorgan lateral configuration technique presented a lower rate of complications compared to the Cross technique, however, the latter had better recovery of the joint ranges(AU)

Fracturas de húmero distal en pacientes mayores de 65 años: ¿cuál es la mejor opción terapéutica? / Distal humerus fractures in patients over 65 years: what is the best therapeutic option? / Fraturas do úmero distal em pacientes maiores de 65 anos: qual é a melhor opção terapêutica?

Introducción: Las fracturas del húmero distal corresponden al 2% de todas las fracturas. Son los pacientes más añosos, los que presentan mayor desafío terapéutico. Suelen presentarse con huesos osteoporóticos, lo que conlleva a producir fracturas con mayor conminución articular y metafisaria; así como también dificultar una fijación estable y rígida de las mismas, que permita una movilidad precoz. Estas características generan controversia a la hora de elegir el tratamiento adecuado. El objetivo de este estudio es revisar la bibliografía de la última década, acerca de cuál es la mejor opción terapéutica para las fracturas de húmero distal en pacientes añosos. Materiales y métodos: Se realizó una búsqueda sistematizada a través de los buscadores electrónicos PubMed y Timbó en agosto 2019. La búsqueda llego a un total de 475 artículos, de los cuales se seleccionaron 24 según criterios de inclusión y exclusión. Discusión: La mayoría de los estudios analizados son estudios de serie de casos retrospectivos. En los trabajos revisados, existen fracturas tanto extra como intra-articulares. Se analizaron los resultados de los distintos tratamientos realizados según parámetros clínicos, scores funcionales y complicaciones. Conclusiones: El tratamiento conservador es una opción válida para aquellos pacientes en los que el terreno no permita una intervención quirúrgica. Para las fracturas tipo extra-articulares y parcialmente articulares, la reducción abierta y fijación interna es el tratamiento de elección. Para las fracturas articulares completas, no hay diferencias significativas en cuanto a scores utilizados entre la reducción abierta y fijación interna con la artroplastia de codo. Faltan estudios prospectivos que comparen ambos tratamientos.

Introduction: Distal humerus fractures account for 2% of all fractures. It is the elderly patients who present the greatest therapeutic challenge. Osteoporotic bones, more common in this population, lead to the production of fractures with greater joint and metaphyseal comminution. As a result, stable and rigid fixation becomes more difficult, hindering early mobility. These characteristics generate controversy when choosing the appropriate treatment. The aim of this study is to review the literature of the last decade regarding the best therapeutic option for distal humerus fractures in elderly patients. Methods: A systematized search was performed through the electronic search engines PubMed and Timbó in august 2019. The search reached a total of 475 articles, of which 24 were selected according to inclusion and exclusion criteria. Discussion: Most of the studies analyzed are retrospective case series studies. In the articles reviewed, there are both extra and intra-articular fractures. The results of the different treatments performed were analyzed according to clinical parameters, functional scores and complications. Conclusions: Conservative treatment is a valid option for those patients where the terrain does not allow surgical intervention. For extra-articular and partial-articular fractures, open reduction and internal fixation is the treatment of choice. For complete articular fractures, there are no significant differences in scores used between open reduction and internal fixation and elbow replacement. There is a lack of prospective studies comparing both treatments.

Introdução: Fraturas do úmero distal correspondem a 2% de todas as fraturas. São os pacientes mais idosos os que apresentam maior desafio terapêutico. Geralmente apresentam-se com ossos osteoporóticos, o que implica produzir fraturas com maior cominuição articular e metafisária; assim como também dificultar uma fixação estável e rígida das mesmas, que permita uma mobilidade precoce. Estas características geram controvérsia na escolha do tratamento adequado. O objetivo deste estudo é rever a bibliografia da última década, sobre qual é a melhor opção terapêutica para fraturas de úmero distal em pacientes idosos. Materiais e métodos: Foi realizada uma pesquisa sistematizada através dos buscadores eletrônicos Pubmed e Timbó em agosto 2019. A pesquisa chegou a um total de 475 artigos, dos quais 24 foram selecionados segundo critérios de inclusão e exclusão. Discussão: A maioria dos estudos analisados são estudos de série de casos retrospectivos. Nos trabalhos revisados, existem fraturas tanto extra como intra-articulares. Foram analisados os resultados dos diferentes tratamentos realizados segundo parâmetros clínicos, scores funcionais e complicações. Conclusões: O tratamento conservador é uma opção válida para os pacientes em que o terreno não permita uma intervenção cirúrgica. Para fraturas tipo extra-articulares e parcialmente articulares, a redução aberta e fixação interna é o tratamento de escolha. Para fracturas articulares completas, não há diferenças significativas em termos de scores utilizados entre a redução aberta e a fixação interna com artroplastia do cotovelo. Faltam estudos prospectivos que comparem os dois tratamentos.

Infección nosocomial por Cronobacter sakazakii tras cirugía de tobillo en un paciente adulto inmunocompetente / Nosocomial Cronobacter sakazakii Infection after Ankle Surgery in an Immunocompetent Adult Patient

RESUMEN Cronobacter sakazakii es una bacteria Gram negativa que pertenece a un grupo emergente de patógenos oportunistas de la familia de los Enterococos, que causa infecciones nosocomiales. Afecta típicamente a los recién nacidos de bajo peso; puede causar graves infecciones como meningitis, sepsis o enterocolitis necrotizante, potencialmente mortales, aunque la gran mayoría de las infecciones se producen en pacientes ancianos, en los que son mucho más leves. Se reporta el primer caso confirmado de infección de herida quirúrgica en España causada por C. sakazakii en un adulto inmunocompetente(AU)

ABSTRACT Cronobacter sakazakii is a Gram negative bacterium that belongs to an emerging group of opportunistic pathogens of the Enterococci family, which causes nosocomial infections. It typically affects low birth weight newborns. It can cause serious infections such as meningitis, sepsis, or life-threatening necrotizing enterocolitis, although the vast majority of infections occur in elderly patients, where they are much milder. We report the first confirmed case of surgical wound infection in Spain, caused by C. sakazakii in an immunocompetent adult(AU)

Treatment of naso-orbito-etmoidal Type III fracture in adolescents: case report / Tratamiento de la fractura naso-orbito-etmoidal Tipo III en adolescentes: relato de un caso

The naso-orbito-ethmoidal region is composed of delicate bones and when fractured may result in significant aesthetic-functional impairment. Diagnosis through clinical and imaging findings is extremely important for surgical planning. This study aims to report a case of type III fracture of the naso-orbito-ethmoidal region. Patient D.R.S., female, 13 years old, attended the emergency department of Hospital dos Fornecedores de Cana de Piracicaba (HFCP) - SP with complaint of pain in the fronto-nasal region and respiratory distress after trauma in face of baseball bat. Physical examination showed edema and short blunt injury in the region of the nasal dorsum and frontal region, bilateral periorbital hematoma, hyposphagma in right eye and traumatic telecanthus. When analyzing the computed tomography, it was observed fracture of the nasal bones, also affecting the medial wall of the orbit. The procedure was osteosynthesis of the fractures and reconstruction of the nasal dorsum. The fracture traces were exposed from coronal access, reduction of fractures and use of calvarial bone graft for nasal dorsum reconstruction. The fracture and the graft were fixed with plates of 1,6mm. Postoperative computed tomography analysis showed good graft positioning, but there was still a slight sinking of the left lateral wall of the nose. In a second moment another surgical intervention was done to reduce this wall and an internal containment device was installed. Currently the patient is in a state of observation and a follow-up period of 665 days. In cases of complex nasoorbito-ethmoidal fractures early diagnosis and treatment is essential to minimize sequelae and provide a better aesthetic and functional result.

La región etmoidal nasoorbital está compuesta de huesos delicados y, cuando se fractura, puede provocar una lesión estética-funcional significativa. El diagnóstico mediante hallazgos clínicos y de imagen es de suma importancia para la planificación quirúrgica. El paciente D.R.S., mujer, 13 años, leucoderma, asistió al servicio de emergencia del Hospital de Proveedores de Caña de Azúcar de Piracicaba quejándose de dolor en la región frontal-nasal y dificultad para respirar después de un traumatismo en la cara con un palo. El examen físico reveló edema y lesión contundente en el dorso nasal y la región frontal, hematoma periorbitario bilateral, hiposfagma del ojo derecho y telecanto traumático. Al analizar la tomografía computarizada se observó fractura de los huesosnasales en libro abierto, afectando también la pared medial de la órbita. El enfoque aplicado fue la osteosíntesis de fracturas y la reconstrucción del dorso nasal. Los rastros de fractura se expusieron del abordaje coronal, se redujeron las fracturas y se usaron injertos de casquete para reconstruir el dorso nasal. La fractura y el injerto se fijaron con placas de sistema de 1,6 mm y se realizó la cantopexia de los ligamentos cantales mediales. Se requirió cirugía reparadora secundaria para la corrección de la pared lateral de la nariz, que persistió en el postoperatorio. Actualmente el paciente se encuentra en un estado de conservación y período de seguimiento de 665 días. En casos de fracturas nasoorbitales-etmoidales complejas, el diagnóstico y el tratamiento tempranos son esenciales para minimizar las secuelas y proporcionar un mejor resultado estético y funcional.

Manejo terapéutico del maléolo posterior en fracturas trimaleolares de tobillo: revisión bibliográfica / Therapeutic management of the posterior malleolus in trimaleolar ankle fractures: review / Manejo terapêutico do maléolo posterior em fraturas do tornozelo trimaleolar: revisão bibliográfica

Introducción: El manejo terapéutico de las fracturas de maléolo posterior en las fracturas trimaleolares de tobillo continúa en debate. Nuestro objetivo fue realizar una búsqueda de la evidencia científica sobre los aspectos terapéuticos de las fracturas de maléolo posterior en el contexto de las fracturas trimaleolares. Materiales y métodos: Se realizó una revisión de la bibliografía sistematizada por dos revisores, centrados en el manejo terapéutico del maléolo posterior. Resultados: Se obtuvieron 16 artículos clínicos de un total de 1029 pacientes, 8 estudios nivel de evidencia II y 8 de nivel IV. Se sistematizaron las indicaciones quirúrgicas y se analizaron los resultados funcionales y las complicaciones. Conclusiones: La comprensión pato-anatómica de estas fracturas es cada día mayor, principalmente por la utilización habitual de tomografías computarizadas (TC). El tratamiento quirúrgico sobre el maléolo posterior está evidenciando buenos y excelentes resultados funcionales. Para una adecuada decisión terapéutica se debería tener en cuenta ciertos factores: inestabilidad tibiotalar y sindesmótica, congruencia articular y características morfológicas del maléolo posterior. La reducción abierta (RA) y fijación interna con placa de sostén es el tratamiento que ha demostrado mejores resultados a corto y mediano plazo, no encontrando estudios con seguimiento a largo plazo.

Introduction: The therapeutic management of posterior malleolus fractures in trimaleolar ankle fractures continues in debate. Our objective was to conduct a search for scientific evidence on the therapeutic aspects of posterior malleolus fractures in the context of trimaleolar fractures. Materials and methods: A review systematic of the literature was carried out by two reviewers, focusing on the therapeutic management of the posterior malleolus. Results: 16 clinical articles were obtained with a total of 1029 patients, 8 studies level of evidence II and 8 studies level IV. The surgical indications were systematized, and the functional results and complications were analyzed. Conclusions: The patho-anatomical understanding of these fractures is increasing every day, mainly due to the usual use of CT scans. Surgical treatment on the posterior malleolus shows good and excellent functional results. For an adequate therapeutic decision certain factors should be taken into account: tibiotalar and syndesmotic instability, joint congruence and morphological characteristics of the posterior malleolus. Open reduction and internal fixation with support plate is the treatment that has shown better results in the short and medium term, not finding studies with long-term follow-up.

Introdução: O tratamento terapêutico das fraturas do maléolo posterior nas fraturas do tornozelo trimaleolar continua em debate. Nosso objetivo foi realizar uma pesquisa de evidências científicas sobre os aspectos terapêuticos das fraturas do maléolo posterior no contexto das fraturas trimaleolares. Materiais e métodos : Uma revisão sistemática da literatura foi realizada por dois revisores, com foco no manejo terapêutico do maléolo posterior. Resultados: foram obtidos 16 artigos clínicos com um total de 1029 pacientes, 8 estudos com nível de evidência II e 8 estudos com nível IV. As indicações cirúrgicas foram sistematizadas e os resultados e complicações funcionais foram analisados. Conclusões: O entendimento anatomopatológico dessas fraturas está aumentando a cada dia, principalmente devido ao uso habitual de tomografias computadorizadas. O tratamento cirúrgico do maléolo posterior mostra bons e excelentes resultados funcionais. Para uma decisão terapêutica adequada, certos fatores devem ser levados em consideração: instabilidade tibiotalar e sindesmótica, congruência articular e características morfológicas do maléolo posterior. A redução aberta e a fixação interna com placa de suporte é o tratamento que apresenta melhores resultados no curto e médio prazo, não encontrando estudos com acompanhamento a longo prazo.

Fracturas de fémur proximal de alta energía tratadas con reducción a través de mini-open y clavo cefalo-medular / High energy proximal femur fractures treated with cephalo-medullary nails and open reduction through mini-open approach

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

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

Tarsal Navicular Fracture in a Parkour Practitioner, a Rare Injury - Case Report and Literature Review / Fratura do escafoide társico em um praticante de parkour, uma lesão rara - Relato de Caso e Revisão da Literatura

Abstract Tarsal navicular fractures, as well as other midfoot injuries, are rare, and can result in severe impairment if not properly treated. Parkour, a modern sport, is gaining popularity among young individuals in urban areas, and is prone to result in high-energy trauma, which is scarcely described in the literature. The following is a report of a rare case of tarsal navicular fracture in a 17-year-old male, sustained during parkour practice, which was treated successfully with open reduction and internal fixation. The description of the case emphasizes the challenges of its approach; the discussion highlights the treatment options and goals. The case should also raise awareness about the increasing occurrence of these uncommon lesions.

Resumo As fraturas do escafoide társico, bem como outras lesões do médiopé, são raras e podem resultar em incapacidade grave se não forem tratadas adequadamente. Parkour, um esporte moderno, está ganhando popularidade entre os jovens em áreas urbanas, e é propenso a traumatismos de alta energia, sendo estes escassamente descritos na literatura. O presente relato trata de um caso de fratura rara do escafoide társico em um paciente do sexo masculino de 17 anos, ocorrida durante a prática de parkour, que foi tratada com sucesso, com redução aberta e fixação interna. A descrição do caso enfatiza os desafios na sua abordagem; a discussão destaca as opções de tratamento e seus objetivos. O caso também deve alertar sobre a ocorrência crescente dessas lesões incomuns.

Isolated Anterior Dislocation of the Radial Head with Atypical Presentation in an Adult: A Case Report / Luxação anterior isolada da cabeça radial com apresentação atípica em um adulto: Relato de caso

Abstract Isolated anterior dislocation of the radial head is rarely reported. To date, only five cases have been reported in the world literature. In all of these cases, the patients presented with restricted supination-pronation movements of the forearm with maintained elbow flexion-extension. We report an unusual case of isolated anterior radial head dislocation in an 18-year-old male, who presented with maintained supination-pronation movements of the forearm but restricted elbow flexion-extension. Closed reduction was attempted, but it failed. Hence, an open reduction was performed. However, the reduction was unstable due to rupture of the annular ligament. Hence, the repair of the annular ligament was performed, and a radio-ulnar Kirschner wire was passed to maintain the reduction of the proximal radio-ulnar joint, thus keeping the annular ligament stress-free, facilitating its healing. At 12 months of follow-up, the patient had normal elbow function and complete range of motion.

Resumo A literatura sobre a luxação anterior isolada da cabeça do rádio é escassa, com apenas cinco casos relatados no mundo inteiro até hoje. Em todos esses casos, os pacientes apresentaram movimentos de supinação-pronação restritos do antebraço, e manutenção da flexão-extensão do cotovelo. Os autores apresentam um caso incomum de luxação de cabeça radial anterior isolada em um paciente do sexo masculino de 18 anos, que apresentou movimentos de supinação-pronação no antebraço e restrição na flexão-extensão do cotovelo. A redução fechada foi tentada, mas sem sucesso. Assim, foi feita a redução aberta. No entanto, a redução foi instável devido à ruptura do ligamento anular. Por isso, o reparo do ligamento anular foi realizado, e um fio de Kirschner rádio-ulnar foi inserido para manter a redução da articulação rádio-ulnar proximal, evitando estresse sobre o ligamento anular, facilitando sua cicatrização. Aos 12 meses de acompanhamento, o paciente apresentava função normal do cotovelo e amplitude de movimento completa.

Fracturas en niños: experiencia en un centro de alta complejidad del suroccidente Colombiano / Fractures in children: experience in a tertiary referral hospital in South west Colombia

Resumen Introducción: Es importante conocer las características demográficas y clínicas de las fracturas en niños para mejorar las estrategias de prevención y tratamiento en estos pacientes. Objetivos: Describir las fracturas en niños y sus características epidemiológicas. Metodología: Estudio tipo corte transversal desde enero 2014 hasta diciembre 2017. Pacientes menores de 18 años que consultaron por fracturas a una clínica en Colombia fueron incluidos. Se incluyeron datos demográficos, lugar donde ocurrió el trauma, huesos fracturados y tipo de tratamiento. Se evaluó la distribución por género y grupo etario. La fuente de información fue la historia clínica. Se utilizaron medidas de tendencia central y dispersión para agrupar los datos. Se calculó la incidencia de fracturas por cada 1000 niños/ año. Este estudio recibió aval del comité de ética de la institución. Resultados: Hubo 2436 niños fracturados, 65.6% (n=1597) ocurrieron en hombres. La mayoría fueron entre 6-11 años (40.7%, n=991), luego entre 12-17 años (36.4%, n=887) y finalmente, menores de 6 años (22.9%, n=558). La localización de la fractura más frecuente entre 0-5 años fue el húmero (30.6%, n=171), seguido por el radio (29%, n=162) y la clavícula (15.9%, n=89); entre 6-11 años fue el radio (45.2%, n=448), seguido por el húmero (18%, n=178) y el cúbito (16.6%, n=165); y entre 12-17 años fue el radio (34.6%, n=307), seguido por los huesos de la mano (22.7%, n=201) y los huesos del pie (10.8%, n=96). Requirieron manejo quirúrgico 30.9% de los niños fracturados (n=752). La incidencia de fracturas fue de 29.7/1000 niños por año. Conclusión: Las fracturas en niños se presentan con mayor frecuencia en el género masculino. Los huesos fracturados varían dependiendo del grupo etario, con un porcentaje importante del radio en todos los grupos. La mayoría se manejan de forma conservadora.

Abstract Introduction: It is important to know the demographic and clinical characteristics of fractures in children to improve prevention and treatment strategies in these patients. Objectives: To describe fractures in children and their epidemiological characteristics. Methodology: Cross-sectional study performed between January 2014 and December 2017. Patients under 18 years old with fractures who consulted to a hospital in Colombia were included. Demographic data, the location where the trauma occurred, fractured bones and type of treatment were included. Age and gender distribution were analyzed. Medical records were the source of information. Central tendency and dispersion measures were used to group the data. Incidence of fractures per 1000 children / year was calculated. This study received approval from the institution's ethics committee. Results: There were 2436 children with fractures, 65.6% (n=1597) occurred in males. Most fractures were in children between 6-11 years old (40.7%, n=991), followed by 12-17 years old (36.4%, n=887) and finally by children under 6 years old (22.9%, n=558). For the group under 6 years, most fractures occurred in humerus (30.6%, n=171), followed by radius (29%, n=162) and clavicle (15.9%, n=89); between 6-11 years old it was in radius (45.2%, n=448), followed by humerus (18%, n=178) and ulna (16.6%, n=165); and between 12-17 years it was in radio (34.6%, n=307), followed by bones of the hand (22.7%, n=201) and bones of the foot (10.8%, n=96). Surgical treatment was required in 30.9% (n=752) of the patients. The incidence of fractures was 29.7/1000 children per year. Conclusions: Fractures in children occur more frequently in males. The fractured bones differ depending on the age group; however, radius fractures represent an important proportion in all groups. Most fractures in children are treated in a conservative manner.

Rare variants of Bosworth fracture-dislocation: Bosworth fracture-dislocation with medial malleolus adduction type fracture / 中华创伤杂志(英文版)

Bosworth ankle fracture-dislocation is rare, known to be an irreducible type of ankle injury, with a high incidence of complication. We present two cases of even rarer variants of Bosworth ankle fracture-dislocation. The first case is a type of supination external rotation adduction, and the second case is a type of supination external rotation adduction. These types have not been described before. In both of the cases we failed to achieve close reduction, and therefore proceeded with emergency surgeries, with open reduction and internal fixation. Both of the cases were performed with a postero-lateral approach to reduce the dislocations, and fix the fractures successfully. Unfortunately in one of the cases, acute compartment syndrome developed post-surgically. However, both cases showed good functional outcomes.

Ipsilateral proximal and distal radius fractures with unstable elbow joint: Which should we address first? / 中华创伤杂志(英文版)

Simultaneous ipsilateral fractures involving radial head and distal end of radius are uncommon. We present our thoughts on which fracture should be addressed first. A 68-year-old lady sustained an ipsilateral fracture of the right radial head and distal end of radius following a fall. Clinically her right elbow was posteriorly dislocated and right wrist was deformed. Plain radiographs showed an intraarticular fracture of the distal end of radius and a comminution radial head fracture with a proximally migrated radius. Magnetic resonance imaging (MRI) showed no significant ligament injuries. We addressed her distal radius first with an anatomical locking plate followed by her radial head with a radial head replacement. Our rationale to treat the distal end radius: first was to obtain a correct alignment of Lister's tubercle and correct the distal radius height. Lister's tubercle was used to guide for the correct rotation of the radial head prosthesis. Correcting the distal end fracture radial height helped us with length selection of the radial head prosthesis and address the proximally migrated radial shaft and neck. Postoperative radiographs showed an acceptable reduction. The Cooney score was 75 at 3 months postoperatively, which was equivalent to a fair functional outcome.

Comparison of two incisions for open reduction and internal fixation of mandibular body fractures: A randomised controlled clinical trial evaluating the surgical outcome / 中华创伤杂志(英文版)

PURPOSE@#The purpose of the study is to compare the surgical access and post-operative outcome of two intra-oral incisions used for approaching a mandibular body fracture.@*METHODS@#This clinical trial involved 60 patients with mandibular body fractures who were randomly allocated to control and study groups. The fractures were approached using the routine vestibular incision in the control group and crevicular incision with vertical release in the study group. The effects of incision design on the post-surgical outcome variables like swelling, trismus, paresthesia, wound healing and gingival recession were statistically analysed with non-parametric tests by using SPSS 22.0 software. Comparison of continuous variables between the groups and time points was done using Mann Whitney test and Friedman test respectively. Chi-square test was used to compare proportions between groups. Dunn's test with Bonferroni correction was used for pair wise comparisons.@*RESULTS@#The study group demonstrated favourable surgical outcome in the immediate postoperative phase as compared to the control group. The difference in mouth opening, swelling and neurosensory impairment between the two groups was found to be statistically significant (p < 0.05).@*CONCLUSION@#Crevicular incision was found to be an ideal alternative to vestibular incision in achieving surgical access and fixation of mandibular body fractures with reduction in postoperative patient discomfort and better surgical outcome.