ABSTRACT
The authors studied 10 consecutive patients with closed femoral shaft or supracondylar fractures who were nonambulatory and who were treated by reamed retrograde intramedullary nailing via an intercondylar notch approach. The study consisted of five women and five men with an average age of 60.7 years (range, 40-89 years). Six patients had spinal cord lesions, one had a brain injury, one had cerebral palsy, one had multiple sclerosis, and one had progressive myelopathy. Three fractures were supracondylar, and seven fractures involved the mid-distal diaphysis. The average time of surgery was 110 minutes (range, 70-225 minutes) with an average estimated blood loss of 288 mL (range, 150-400 mL). There were two postoperative deaths (at 15 days and 2 months, respectively) after the procedure that were attributable to pneumonia. The remaining eight patients were observed for an average of 13 months (range, 6-20 months) after surgery. All fractures healed as evaluated radiographically. Retrograde intramedullary nailing is a simple, safe, and effective alternative to nonoperative treatment for femoral shaft or supracondylar fractures in patients who are nonambulatory. Stabilization by this method allows fracture healing and rapid return of patients to their previous level of function. There were no nonunions, malunions, significant shortening, implant failure, or wound infections.
Subject(s)
Disabled Persons , Femoral Fractures/surgery , Fracture Fixation, Intramedullary , Fractures, Closed/surgery , Spinal Cord Injuries/physiopathology , Adult , Aged , Aged, 80 and over , Female , Femoral Fractures/diagnostic imaging , Follow-Up Studies , Fractures, Closed/diagnostic imaging , Humans , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Radiography , Risk Factors , Survival RateABSTRACT
Pubic ramus fracture nonunion is an unusual problem. Percutaneous retrograde superior pubic ramus medullary screw fixation was successfully used in two patients with prolonged symptomatic nonunions of the superior pubic ramus.
Subject(s)
Bone Screws , Fracture Fixation, Intramedullary/instrumentation , Fractures, Ununited/surgery , Pubic Bone/injuries , Accidental Falls , Accidents, Traffic , Equipment Design , Female , Follow-Up Studies , Fracture Fixation, Intramedullary/methods , Fracture Healing/physiology , Fractures, Ununited/diagnostic imaging , Humans , Middle Aged , Minimally Invasive Surgical Procedures/methods , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Percutaneous fixation of an unstable pelvic ring injury is becoming a popular method of pelvic stabilization. As posterior pelvic percutaneous techniques become more common, the possibility of iatrogenic complications increases. This case report describes an injury to the superior gluteal artery during percutaneous iliosacral screw insertion and the treatment of this potentially devastating injury.
Subject(s)
Arteries/injuries , Buttocks/blood supply , Fracture Fixation, Internal/adverse effects , Fractures, Bone/surgery , Intraoperative Complications/surgery , Pelvic Bones/injuries , Aged , Arteries/surgery , Bone Screws/adverse effects , Fracture Fixation, Internal/instrumentation , Fractures, Bone/diagnostic imaging , Humans , Intraoperative Complications/diagnostic imaging , Male , Pelvic Bones/diagnostic imaging , Pelvic Bones/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The authors reviewed the use of chemotherapy and anterior/posterior spinal fusion without instrumentation to treat children with extensive spinal tuberculosis and kyphosis. Six children underwent anterior and posterior spinal fusion. All of the patients were followed until after maturity, except for 1 child who died of pulmonary tuberculosis 4 months after surgery and thus was excluded from the study. Preoperative kyphotic deformity averaged 100 degrees (range, 75 degrees-130 degrees). The average age at the time of surgery was 7.5 years (range, 4.7-10 years). Spinal involvement extended from 2 to 10 vertebral bodies (average, 7.6) and was limited to the thoracic region from T-2 to T-12. Preoperative, postoperative, and followup anterior/posterior and lateral standing radiographs were obtained. The kyphotic angle was measured from the lateral view. The surgical correction of preoperative kyphosis averaged 28.6 degrees (range, 20 degrees-45 degrees). One patient underwent repeat anterior fusion at 9 months for graft failure. At the time of followup, all grafts had fused and all patients were without pain. The average duration of followup was 12.8 years (range, 9.5-14.5 years). Complications secondary to chronic chemotherapy occurred in 2 children. Long-term followup revealed solid fusion, improvement of the kyphotic deformity, and good functional outcome in all 5 patients.
Subject(s)
Antitubercular Agents/therapeutic use , Kyphosis/microbiology , Spinal Fusion/methods , Tuberculosis, Spinal/surgery , Child , Child, Preschool , Combined Modality Therapy , Female , Fibula/transplantation , Follow-Up Studies , Humans , Male , Radiography , Treatment Outcome , Tuberculosis, Spinal/complications , Tuberculosis, Spinal/diagnostic imagingABSTRACT
A case report of a bilateral traumatic amputee who underwent a cross leg flap to preserve a knee disarticulation level amputation is presented. Salvage of amputated parts in the lower extremities to preserve stamp length provided our patient with better stability and decreased energy expenditure with ambulation.
