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.

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.

Férula de acrílico y alambres circunmandibulares para el tratamiento de una fractura de mandíbula / Splint made from acrylic and circummandibular wires for treatment of mandible fracture

Se presenta el caso de una niña que sufrió una caída desde una altura de varios metros y presentó una fractura en el fémur izquierdo y en el cuerpo mandibular del lado izquierdo. Como tratamiento se empleó una férula de acrílico y alambres circunmandibulares para reducir y estabilizar la fractura de la mandíbula; la fractura del fémur fue reducida por método abierto con placa y tornillos. La férula se retiró a las semanas de la fractura. Se le realizó un seguimiento clínico y radiográfico durante 3 meses, y se constató una excelente evolución, con excelente consolidación ósea y oclusión. Los resultados demostraron la utilidad de este medio de fijación de fracturas, sobre todo porque es poco agresivo para los niños y con él se evitan muchas complicaciones(AU)

This is the case of a girl fell from some meters height and had a fracture of left femur and in the left side of mandibular body. As treatment we used an acrylic and circummandibular wires to reduce the mandible fracture; the femur's fracture was reduced by open method using plates and screws. A few weeks later splint was removed. A clinical and radiographic follow-up was made over three months, confirming an excellent course, bone consolidation and occlusion. Results showed the usefulness of this method of fracture's fixation mainly because it is not much aggressive for children avoiding in this way many complications(AU)