Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures / 中华创伤杂志(英文版)

PURPOSE@#Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.@*METHODS@#This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0).@*RESULTS@#Average malunion (degrees) in the MIPPO group was 5 (3-7) ± 1.41 vs. 10.22 (8-14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001).@*CONCLUSION@#Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.

Locking compression plate combined with medial buttress plate for the treatment of osteoporotic comminuted proximal humerus fractures / 中国骨伤

OBJECTIVE@#To explore clinical effect of lateral locking compression plate combined with medial buttress plate in treating osteoporotic comminuted fractures of proximal humerus.@*METHODS@#From May 2017 to December 2021, 12 patients with osteoporotic comminution of proximal humerus were treated by lateral locking compression plates combined with medial buttress plates, including 5 males and 7 females, aged from 55 to 78 years old, bone mineral density(BMD) less than -2.5 g/cm3, the time from injury to operation was from 2 to 6 days. According to Neer classification, 7 patients were type Ⅲ, 4 patients were type Ⅳ and 1 patient was type Ⅵ. Postoperative complications, fracture healing and internal fixation were observed and Constant-Murley score of shoulder joint was used to evaluate clinical effects at 6 months after operation.@*RESULTS@#Postoperative wound healed well at stage I. All patients were followed up from 6 to 18 months. Humeral head collapse and necrosis occurred in 1 patient and humeral head varus in 1 patient. No impact of shoulder joint, internal fixation loosening occurred. Constant-Murley score at 6 months ranged from 45 to 90 points, and 6 patients got excellent result, 3 good, and 3 poor.@*CONCLUSION@#Locking compression plate combined with medial buttress plate could effectively reconstruct medial humeral column support and enhance fracture stability, and receive satisfactory clinical results. However, no control group was established in this study, and function of shoulder joint has not been evaluated many times after operation, so it cannot dynamically reflect changes of shoulder joint function.

Fracturas ipsilaterales proximales y diafisarias de fémur: ¿existe una mejor opción terapéutica?: revisión bibliográfica / Ipsilateral proximal and shaft femoral fractures: is there a better therapeutic option?: review / Fracturas ipsilaterais proximais e diafisárias do fémur: existe uma melhor opção terapêutica?: revisão bibliográfica

Introducción: Las fracturas ipsilaterales proximales de fémur ocurren en el 1 al 9% de las fracturas diafisarias. Existen múltiples tratamientos propuestos para dicha asociación lesional. El objetivo de este trabajo es revisar los diferentes métodos de tratamiento propuestos, y comparar sus resultados funcionales y principales complicaciones. Materiales y Métodos: Se utilizaron los buscadores electrónicos: PubMed, Lilacs, Cochrane y Ovid SP. La búsqueda llegó a un total de 1829 trabajos, de los cuales se seleccionaron 21 según criterios de inclusión y exclusión. Discusión: No existe un consenso acerca de cuál es el mejor método de fijación para esta asociación lesional. Esta ocurre en pacientes jóvenes por un mecanismo axial de alta energía cinética y la opción elegida debe buscar la reducción anatómica de la fracturas proximales de fémur. Las complicaciones como la pseudoartrosis de cuello femoral y la necrosis avascular son de difícil manejo en este grupo etario. Conclusión: Las fracturas ipsilaterales proximales y diafisarias de fémur son lesiones que presentan un problema diagnóstico y terapéutico. Hay un subdiagnóstico de las mismas y no existe un implante ideal, ni un consenso de cual es el mejor método de fijación.

Introduction: Ipsilateral proximal femoral fractures ocurred in 1 to 9% of femoral shaft fractures. There are multiple treatments proposed for these injuries. The objetive of the present work is revise the different treatment options and compare their functional results and main complications Materials and methods: A comprehensive literature search was carried out using: Pubmed, Lilacs, Cochrane and OVID SP. Initially there were identified a total of 1829 studies. Only 21 studies remained after inclusion and exclusion were applied. Discussion: There is no consensus about which is the best fixation option for these injuries. These occurred in young patients as a result of a high energy axial trauma, and the selected treatment must achieve anatomic reduction of the proximal femoral fracture. Complications such as femoral neck no-union and avascular necrosis are difficult to manage at this age. Conclusion: Ipsilateral proximal and shaft femoral fractures present diagnostic and therapeutic problems. There is an underdiagnosis of these injuries, and there is no ideal implant or consensus on which is the best fixation method.

Introdução: As fraturas proximais ipsilaterais do fêmur ocorrem em 1 a 9% das fraturas diafisárias. Existem vários tratamentos propostos para essa associação lesional. O objetivo deste trabalho é rever os diferentes métodos de tratamento propostos, e comparar os seus resultados funcionais e principais complicações. Materiais e Métodos: Foram utilizados os buscadores eletrônicos: Pubmed, Lilacs, Cochrane e Ovid SP. A busca chegou a um total de 1829 trabalhos, dos quais foram selecionados 21 segundo critérios de inclusão e exclusão. Discussão: Não há consenso sobre qual é o melhor método de fixação para esta associação lesional. Esta ocorre em pacientes jovens por um mecanismo axial de alta energia cinética e a opção escolhida deve procurar a redução anatômica da fratura proximal do fêmur. Complicações como a pseudoartrose do pescoço femoral e a necrose avascular são de difícil manejo neste grupo etário. Conclusão: As fraturas ...(SUPRIMIR LO PRECEDENTE)Conclusão: As fracturas ipsilaterais proximais e diafisárias do fémur são lesões que apresentam um problema diagnóstico e terapêutico. Há um subdiagnóstico das mesmas e não existe um implante ideal, nem um consenso de qual é o melhor método de fixação.

Errores de osteosíntesis en fracturas laterales de cadera tratadas con placa/tornillo deslizante / Failed internal fixation of intertrochanteric hip fractures with dynamic hip screws

Introducción: El uso de los sistemas placa/tornillo deslizante para fracturas intertrocantéricas ha demostrado ser un método de fijación eficaz, pero no está exento de fallas. El propósito de este estudio fue evaluar las causas de falla en los pacientes con fracturas laterales de cadera, tratados con placa/tornillo deslizante, puntualizando los defectos técnicos en la colocación. Materiales y Métodos: En nuestro centro, se trató a 177 pacientes por fractura lateral de cadera, a 151 de ellos se les practicó osteosíntesis con placa/tornillo deslizante. Se analizaron la adecuada reducción posoperatoria, la medición de la distancia punta a vértice, la posición del tornillo cefálico en la cabeza femoral y las posibles complicaciones. Resultados: La serie quedó conformada por 143 pacientes. El seguimiento promedio fue de 18 meses (rango 12-48). La tasa de fallas fue del 8,4% (n = 12): 7 (4,8%) por migración cefálica (cut-out) del tornillo proximal, 2 (1,4%) por migración medial (cut-through), 2 (1,4%) presentaron seudoartrosis y un caso (0,70%) de reducción inadecuada en varo. El porcentaje de una segunda operación fue del 7,7% (n = 11). La peor posición fue la superior/posterior con un 100% de migración (n = 4) (p <0,001, diferencia estadísticamente significativa). Conclusión: El posicionamiento superior/posterior del tornillo cefálico podría incrementar la posibilidad de migración y, en consecuencia, la tasa de falla del sistema. Nivel de Evidencia: IV

Objectives: The use of dynamic hip screws (DHS) for intertrochanteric fractures has proven to be an effective, but infalible, fixation method. The purpose of this study was to evaluate the reason behind fixation failure in patients with this type of hip fracture treated with a DHS. Materials and Methods: 177 patients were treated in our center for intertrochanteric hip fractures. A DHS was placed in 151 of them. Our analysis included quality of reduction after surgery, tip-apex distance, femoral head lag screw position, and possible complications. Results: The series included 143 patients. The average follow-up was 18 months (range 12-48). The failure rate was 8.4% (n = 12): 7 (4.8%) cases were due to intrapelvic migration of the lag screw ("cut-out") and 2 (1.4%) were due to medial perforation ("cut-through"), while 2 (1.4%) cases presented with pseudarthrosis and 1 (0.70%) with varus deformity after reduction. The revision rate was 7.7% (n = 11). Lag screws placed in a superior/posterior position had the highest failure rate (100% migration rate) (n = 4) (p <0.001, statistically significant difference). Conclusions: Superior/posterior positioning of the lag screw may increase the possibility of migration and, consequently, the failure rate of the DHS system. Level of Evidence: IV

Patología tendinosa en pacientes con placa bloqueada palmar de radio distal: incidencia y resultado clínico del tratamiento / Tendon pathology in patients with distal radius palmar locked plate: incidence and clinical outcome of their treatment

Introducción: El objetivo de este estudio es comunicar la incidencia de complicaciones tendinosas en pacientes con fracturas de radio distal tratados con placa bloqueada palmar y el resultado clínico del tratamiento mediante la sola extracción del implante. Materiales y Métodos: Se realizó una evaluación retrospectiva de 992 pacientes con fracturas de radio distal. Se incluyó a quienes se les extrajo la placa por irritación o rotura tendinosa. La evaluación final de los resultados, una vez extraído el implante, se efectuó con el puntaje DASH y una escala analógica visual de 0 a 10 para dolor en reposo, durante la actividad y para el resultado funcional. Resultados: Treinta y cuatro pacientes tuvieron complicaciones tendinosas: 20 tendinitis de flexores (2%), 13 tendinitis de extensores (1,3%) y una rotura de tendón flexor. Todos fueron tratados sólo con extracción del implante. En la escala analógica visual, los pacientes con tendinitis flexora obtuvieron un puntaje de 1 para dolor en reposo, de 1 para dolor durante la actividad y de 8 para resultado funcional, y un puntaje DASH de 13. La evaluación final promedio de los pacientes con tendinitis extensora fue: dolor en reposo 0, dolor durante la actividad 3, funcional 9 y DASH 15, respectivamente. Conclusiones: La incidencia de complicaciones tendinosas en el tratamiento de las fracturas de radio distal con placas palmares es baja. El tratamiento precoz mediante la sola extracción del implante lleva a la desaparición de los síntomas y evita la rotura tendinosa. Nivel de Evidencia: IV

Introduction: The aim of this paper is to report the incidence of tendon complications in patients with distal radius fractures treated with volar locking plates and the clinical results after plate removal. Methods: A total of 992 patients with distal radial fracture treated with volar locking plates were retrospectively evaluated. Cases with plate removal due to tendon irritation were included in this study. Clinical results were evaluated using DASH score and a visual analogue scale for pain at rest, during activity and functional result. Results: Thirty-four patients had tendon complications: 20 with flexor tendonitis (2%), 13 with extensor tendonitis (1.3%), and a flexor tendon rupture. All cases were treated only with implant removal. Final mean results were: visual analogue scale, 1 for pain at rest, 1 for pain during activity, and 8 for function; DASH score 13 in patients with flexor tendinitis; and 0, 3, 9, respectively, and DASH score 15 for those with extensor tenosinovitis. Conclusions: Tendon complications are infrequent in patients with distal radial fractures treated with volar locking plate. The early removal of the implant improves tendon irritation symptoms and prevents tendon rupture. Level of Evidence: IV

Heating produced by therapeutic ultrasound in the presence of a metal plate in the femur of canine cadavers / Aquecimento gerado pelo ultrassom terapêutico em presença de placa óssea metálica no fêmur de cadáveres caninos

The present study aimed to assess the heat generated by a therapeutic ultrasound (TUS) in a metal bone plate and adjacent structures after fixation to the femur of canine cadavers. Ten pairs of hind limbs were used, and they were equally distributed between groups that were subjected to 1- and 3-MHz frequencies, with each frequency testing 1- and 2-W/cm² intensities. The right hind limb was defined as the control group (absence of the metal plate), and the left hind limb was the test group (presence of the metal plate). Therefore, the control groups (CG) were denominated CGI, using TUS with 1-MHz frequency and 1-W/cm² intensity; CGII, using 1-MHz frequency and 2-W/cm² intensity; CGIII, using 3-MHz frequency and 1-W/cm² intensity; and CGIV, using 3-MHz frequency and 2-W/cm² intensity. For each control group, its respective test group (TG) was denominated TGI, TGII, TGIII and TGIV. The TUS was applied to the lateral aspect of the thigh using the continuous mode and a 3.5-cm² transducer in a 6.25-cm² area for 2 minutes. Sensors were coupled to digital thermometers that measured the temperature in different sites before (t0) and after (t1) of the TUS application. The temperatures in t1 were higher in all tested groups. The intramuscular temperature was significantly higher (P<0.05) in the groups used to test the 3-MHz frequency in the presence of the metal plate. The therapeutic ultrasound in the continuous mode using frequencies of 1 and 3 MHz and intensities of 1 and 2 W/cm2 for 2 minutes caused heating of the metal plate and adjacent structures after fixation to the femur of canine cadavers...

O objetivo deste estudo foi avaliar o aquecimento gerado pelo ultrassom terapêutico (UST) na placa óssea metálica e estruturas adjacentes após a fixação no fêmur de cadáveres caninos. Foram utilizados dez pares de membros pélvicos, distribuídos igualmente entre os grupos que utilizaram as frequências de 1 e 3 MHz. Cada frequência testou as intensidades de 1 e 2 W/cm², sendo que o membro pélvico direito foi definido grupo controle (ausência da placa óssea metálica) e o membro pélvico esquerdo o grupo teste (presença da placa óssea metálica). Portanto, os grupos controles foram denominados GCI, com UST na frequência de 1 MHz e intensidade de 1 W/cm²; GCII, com 1 MHz e 2 W/cm²; GCIII, com frequência de 3 MHz e intensidade de 1 W/cm²; e GCIV, com 3 MHz e 2 W/cm². Para cada grupo controle, seu respectivo grupo teste foi denominado GTI, GTII, GTIII e GTIV. O UST foi aplicado na face lateral da coxa, utilizando o modo contínuo, transdutor de 3,5cm², em uma área de 6,25cm², durante dois minutos. Foram utilizados sensores acoplados a termômetros digitais que mediram a temperatura em diferentes locais antes (t0) e após (t1) a aplicação do UST. Pode-se verificar que as temperaturas em t1 foram maiores em todos os grupos testados. Os grupos que testaram a frequência de 3 MHz demonstraram que a temperatura intramuscular foi significativamente maior (P<0,05) na presença da placa óssea metálica. O ultrassom terapêutico no modo contínuo de 1 e 3 MHz e intensidades de 1 e 2 W/cm2 durante dois minutos promove o aquecimento da placa óssea metálica e estruturas adjacentes após a fixação no fêmur de cadáveres caninos...

Efficacy of PEEK Cages and Plate Augmentation in Three-Level Anterior Cervical Fusion of Elderly Patients

BACKGROUND: To evaluate the clinical efficacy of three-level anterior cervical arthrodesis with polyethyletherketone (PEEK) cages and plate fixation for aged and osteoporotic patients with degenerative cervical spinal disorders. METHODS: Twenty one patients, who had undergone three-level anterior cervical arthrodesis with a cage and plate construct for degenerative cervical spinal disorder from November 2001 to April 2007 and were followed up for at least two years, were enrolled in this study. The mean age was 71.7 years and the mean T-score using the bone mineral density was -2.8 SD. The fusion rate, change in cervical lordosis, adjacent segment degeneration were analyzed by plain radiographs and computed tomography, and the complications were assessed by the medical records. The clinical outcomes were analyzed using the SF-36 physical composite score (PCS) and neck disability index (NDI). RESULTS: Radiological fusion was observed at a mean of 12.3 weeks (range, 10 to 15 weeks) after surgery. The average angle of cervical lordosis was 5degrees preoperatively, 17.6degrees postoperatively and 16.5degrees at the last follow-up. Degenerative changes in the adjacent segments occurred in 3 patients (14.3%), but revision surgery was unnecessary. In terms of instrument-related complications, there was cage subsidence in 5 patients (23.8%) with an average of 2.8 mm, and loosening of the plate and screw occurred in 3 patients (14.3%) but there were no clinical problems. The SF-36 PCS before surgery, second postoperative week and at the last follow-up was 29.5, 43.1, and 66.2, respectively. The respective NDI was 55.3, 24.6, and 15.9. CONCLUSIONS: For aged and osteoporotic patients with degenerative cervical spinal disorders, three-level anterior cervical arthrodesis with PEEK cages and plate fixation reduced the pseudarthrosis and adjacent segment degeneration and improved the clinical outcomes. This method is considered to be a relatively safe and effective treatment modality.

[Plates and screws removal after sagital split osteotomy]

In contemporary orthognatic surgery, osteotomy and rigid internal fixation procedures are commonly used to restore stability and function of the jaws, and to obtain comfort for patients. Although there are many good reasons for utilization of this type of fixation, in some patients the need to remove plates and screws after surgery may arise due to related complications. The present study investigated plate removal after sagital split osteotomy and its reasons. In this prospective study, 67 patients in need of sagital spilt osteotomy or bimaxillary osteotomy were selected from two university departments during the period of 2005 to 2007. All patients were followed up for 14 month after surgery and number of plates removed was recorded. In addition, information regarding age, sex, duration of operation, medical condition, splitting during surgery, smoking habits, and need to extract wisdom teeth at the time of surgery were gathered. The data were analyzed using a linear logistic regression model with the SPSS software version 12. Infection was the sole reason for plate removal in this study. From 134 plates used in 67 patients 14 plates [10.5%] were removed in 10 patients. Age was the only statistically significant factor to affect plate removal and the effect of other factors were not statistically significant. According to the findings of this study only a few patients needed plate removal. Routine removal of plate does not appear to be clinically indicated

Estudo prospectivo e randomizado de pacientes com fraturas expostas da diáfise do fêmur submetidos a osteossíntese com placa e haste intramedular bloqueada a foco aberto / Prospective and randomized study of patients with open fractures of the femoral shaft, treated with plate or open intramedullary locked nail

Trata-se de um estudo prospectivo e randomizado de duas técnicas de osteossíntese no tratamento das fraturas expostas diafisárias do fêmur, realizado entre janeiro de 2002 a abril de 2004. Haste intramedular bloqueada fresada realizada a foco aberto e placa e parafusos foram empregadas no tratamento de 20 pacientes em cada grupo. De acordo com a classificação de Gustilo, 26 (65 por cento) foram tipo I, 10 (25 por cento) tipo II e 4 (10 por cento) tipo IIIA. Quanto ao mecanismo das fraturas, 21 por trauma contuso e 19 por ferimentos de arma de fogo.Três pacientes foram excluídos nas avaliação final. Houve complicação em 12 (32,4 por cento),sendo 4 no grupo de placas e 8 no grupo das hastes. O grupo de haste bloqueada apresentou 2 (10 por cento) infecções profundas, 2 infecções superficiais (10 por cento), 1 falha de consolidação (5 por cento).O grupo de placa e parafusos resultou em 1 infecção profunda associada à falha de consolidação (5,8 por cento), 1 infecção superficial (5,8 por cento). Pela classificação de resultados de Thorensen obteve-se bons e excelentes resultados em 28 (75,7 por cento) fraturas, 3 (7.5 por cento) casos regulares e 6 (15 por cento) casos ruins. A estabilização com placas e parafusos, trouxe menores taxas de complicações, quando comparadas com o uso de hastes fresadas a foco aberto,embora sem significado estatístico.

We assessed the complications and treatment outcomes in a prospective and randomized study of two osteosynthesis techniques in open femoral shaft fractures. Between January 2002 and April 2004, 40 patients with open fractures of the femoral shaft were assessed, with 20 being treated with open reamed intramedullary locked nail and 20 with plate. Twenty-six (65 percent) fractures were classified as Gustilo type -I open fractures; ten (25 percent) as type II and four (10 percent), as type IIIA. There were 21 blunt injuries and 19 gunshot injuries. Three patients were excluded from the final assessment. Complications were observed in 12 (32.4 percent) patients, 4 in the plate group and 8 in the nail group. Reamed intramedullary locked nail resulted in two deep infections (10 percent), two superficial infections (10 percent), and one nonunion (5 percent). With plate techniques, we had one deep infection associated to nonunion (5,8 percent) and one superficial infection (5.8 percent). Good and excellent outcomes were found in 28 fractures (75.7 percent), fair (7.5 percent) in three cases, and poor (15 percent) in six, according to Thorensen's criteria. In this study, the stabilization with plate results in lower complications rate when compared to the open intramedullary nail, although with no statistical significance.

Management of tibial plateau fractures in patients having compromised soft tissue envelope using hizarov external fixator

Complex fractures of the tibial plateau are associated with considerable displacement of the articular surface together with either open wounds or severe soft tissue injury. Adequate Condition of the soft tissue is an important prerequisite before reconstruction of the tibial plateau. Conventional treatment by open reduction and internal fixation by plate and screws necessitates extensive dissection through compromised soft tissue with high rates of shin necrosis and infection. Twenty three patients with tibial plateau fractures having compromised soft tissue envelope were treated using the Ilizarov method with or without minimal internal fixation. There were nineteen male [82.6%] and four female [17.4%] patients with average age 39.4 years [range 22 to 65 years]. The mechanism of injury was road traffic accident in seventeen patients [73.9%], fall from height in five patients [21.7%] and one patient [4.4%] injured by wall collapse. Using the criteria of Honkonen and Jarvinen as regard functional results, fifteen patients [65.2%] were considered to have excellent results, six [26.1%] good and two [8.7%] fair. The Ilizarov method for treatment of tibial plateau fractures with or without minimal internal fixation is considered a mini invasive procedure with low morbidity for a fracture that would otherwise require an extensive dissection and internal fixation with plates and screws with further soft tissue compromise and high rate of complications

Indications and techniques for anterior cervical plating.

Anterior cervical plating is commonly performed to stabilize anterior cervical fusions. Modern plating options include dynamic plates, with screws that can either toggle within fixed holes or translate within slotted holes. Regardless of the plating system used, paramount to success and avoidance of complications with plated anterior cervical fusions are meticulous plating techniques, exacting graft carpentry, and understanding the biomechanical limitations of plating in certain situations, such as multilevel corpectomies reconstructed with a single-strut graft. In order to prevent graft-related complications associated with long-strut grafts, additional posterior fixation and fusion, or alternative corpectomy constructs, such as multilevel anterior cervical discectomy and fusion, corpectomy-discectomy, and corpectomy-corpectomy, should be considered instead if the pattern of stenosis allows.

Anterior cervical plating.

Although anterior cervical instrumentation was initially used in cervical trauma, because of obvious benefits, indications for its use have been expanded over time to degenerative cases as well as tumor and infection of the cervical spine. Along with a threefold increase in incidence of cervical fusion surgery, implant designs have evolved over the last three decades. Observation of graft subsidence and phenomenon of stress shielding led to the development of the new generation dynamic anterior cervical plating systems. Anterior cervical plating does not conclusively improve clinical outcome of the patients, but certainly enhances the efficacy of autograft and allograft fusion and lessens the rate of pseudoarthrosis and kyphosis after multilevel discectomy and fusions. A review of biomechanics, surgical technique, indications, complications and results of various anterior cervical plating systems is presented here to enable clinicians to select the appropriate construct design.

Complications associated with rigid internal fixation of mandibular fractures.

A clinical evaluation is made in twenty patients with twenty seven mandibular fractures, managed with rigid internal compression plate and screw osteosynthesis. An analysis regarding complications of this method is made and discussed.

Estudio epidemiológico de las fracturas cervicales y transtrocantéreas del fémur / Epidemiologic trial of trans-trochanteric and cervical fractures of the femur

Se realizó un estudió epidemiológico de fracturas cervicales y trans-trocantéreas del fémur del 1º de abril de 1992 al 31 de diciembre de 1993, para analizar los resultados de las técnicas quirúrgicas utilizadas en su tratamiento. De 200 casos revisados, 76 correspondieron a fracturas del cuello femoral, que fueron tratadas con prótesis de Thompson, Spotorno, y Müller. Los 124 casos restantes fueron de fracturas trans-trocantérea, que se trataron con placa angulada del 130 o 95 grados. En general el resultado fue satisfactorio, excepto por la iniciación tardía de la marcha en los casos operados con placa. Como complicaciones tardías, cinco pacientes con prótesis de Thompson sufrieron protrusión acetabular y ocho pacientes operados con placa angulada nunca lograron caminar

Replating femoral shaft fracture

Replating of the femoral shaft fracture was used in 18 patients. 16 cases were studied and 2 cases were excluded because the follow-up period was less than one year. The study comprises 7 cases with broken plate and 7 cases with pulling out of the screws and 2 cases with nonunion not associated with mechanical failure. Mild infection was found in 4 cases- In all cases revision surgery was done by replating and in 14 cases we applied autogenous cancellous iliac bone graft. Preoperative, operative and follow-up data were discussed. However we didn't study the causes of failure of previous operations. All cases showed union within an average period of 5 months after the revision surgery. Persistent mild infection was observed in the cases that were previously infected. Metal removal after bony union was performed and infection subsided. We concluded that mechanical failure or nonunion after plating of the femoral shaft fracture can by treated successfully by replating with the addition of bone graft

Fracturas complejas de las mesetas tibiales: tratamiento quirúrgico con placa de sostén y compresión radial / Complex fractures of the tibial platteau: surgical treatment by support screw-plates and radial compression

Se presenta una serie de 70 casos con fractura de los platillos tibiales. Se excluyó a 12 por tratarse de fracturas tipo A, que fueron sometidas a tratamiento conservador. Solamente quedaron integrados para la presente serie los 58 casos con fractura tipo B (37 por ciento) y tipo C (63 por ciento). Los 58 casos fueron tratados quirúrgicamente mediante placas y tornillos de compresión radial. El dato de mayor importancia para el presente estudio muestra un resultado malo como consecuencia de la fijación interna en nueve de las 21 fracturas correspondientes al tipo C3, que son las de mayor severidad. Los resultados para los restantes casos fueron uniformemente satisfactorios o buenos

Treatment of unstable intertrochanteric fractures of the femur: dynamic hip screw versus conventional nail-plate

In a prospective randomized study of treatment of fifty-two cases with unstable intertrochanteric fractures of the hip, the use of conventional nail-plate was compared with the use of dynamic screw-plate. There were no significant differences in the two groups as regard pain and morbidity. Patients with DHS showed earlier mobilization and shorter hospital stay. Failure of stabilization both clinically and radiologically were fewer in the group of DHS. Although the slightly longer and more difficult operative procedure and the higher cost of DHS, at the end of 6 months most patients in this group were more mobile and returned to their independent existence [86% compared to 75% of the other group]