Long term results of lower limb posttraumatic acute bone defects treated with masquelet technique.

INTRODUCTION: Several alternatives are now available when treating posttraumatic acute bone defects. Masquelet's technique represents a safe procedure to treat lower limb open fractures associated with significant bone defects and allows surgeons to try to reduce complications incidence. MATERIAL AND METHODS: Retrospective study based on patients´ record files and images (2015-2017). Twelve patients suffering acute bone defect, treated using Masquelet technique, were evaluated. A total of ten patients were finally included after exclusion criteria were applied. RESULTS: Average time from injury to first stage surgery was 11 days. Free flaps were required in three cases (two latissimus dorsi and one anterolateral thigh flap). Time to second stage surgery was 115 days on average. As bone graft, reaming irrigation-aspiration system was associated to this technique. Consolidation was achieved in all patients but one after an average time of 8.4 months. There was only one case of limb shortening of 20 mm. There was no case of nonunion or infection, and patients could perform daily basic activities independently. VAS mean score was one point one year after final surgery. CONCLUSIONS: Masquelet's technique achieves encouraging results when treating lower limb acute bone defects. Using this technique, surgeons could decrease infection incidence in open fractures with severe bone loss. On the other hand, it is a two-stage surgery process, which makes the process longer.

Analysis of complications after a floating elbow injury.

BACKGROUND: The aim of the present study is to analyse complications after a floating elbow injury, attempting to establish which of them act as a poor prognosis factor regarding clinical and functional results. MATERIALS AND METHODS: Twenty-three patients who suffered a floating elbow injury, treated at our institution from 2004 to 2013, were retrospectively reviewed. Patients were divided into four groups depending on the type of injury. An analysis of demographic data, associated injuries, treatment options and complications was carried out. Clinical evaluation was made by a conventional goniometer, testing flexo-extension and prono-supination ranges. For functional evaluation, the Mayo Elbow Performance Score was employed. Association between radioulnar synostosis, articular surface disruption, nerve injury and clinical and functional results was analysed. RESULTS: Patients with radioulnar synostosis had worse results in functional evaluation than patients without it (56.6 vs. 75); this difference was statistically significant (p = 0.05). Regarding intra-articular extension, we found statistical association with worse results in functional evaluation (p = 0.018); however, nerve palsy does not seem to influence functional results. CONCLUSIONS: Radioulnar synostosis and intra-articular extension of the injury are poor prognosis factor in floating elbow.

Postoperative Symptomatic Anterior Spinal Epidural Hematoma: Complete Drainage Using Corpectomy and a Bladder Catheter.

STUDY DESIGN: A case report. OBJECTIVE: We describe a technique to drain a thoracic and cervical postoperative epidural hematoma causing paraplegia after anterior cervical discectomy and fusion. SUMMARY OF BACKGROUND DATA: Postoperative compressive spinal epidural hematoma (SEH) is a devastating complication and early diagnosis and treatment is essential. The most commonly accepted treatment is decompression and drainage of hematoma. METHODS: A 65-year-old male with a degenerative disc disease located at C4-C5, C5-C6, and C6-C7 levels with disc herniation underwent a standard anterior cervical decompression and fusion at C4-C5-C6-C7. Three hours after the procedure, the patient started complaining of progressive paraplegia and affectation of upper extremity. A magnetic resonance imaging (MRI) revealed a postoperative SEH extending from C3 to T6, causing compression.To resolve this unusual complication, a new surgery was performed. An anterior approach through the previous one was performed, and a C6 corpectomy was done. The anterior epidural hematoma was drained with an elastic urinary catheter. At the end of the surgery, a tricortical iliac crest autograft was placed between C5-C7 and the plate was placed as previously. RESULTS: The patient recovered tactile and vibratory senses, as well as motor function in both hands 12 hours after the second procedure. The complete drainage of the hematoma was MRI-verified the first postoperative day.The patient was discharged from the hospital presenting a complete sensitive recovery and a 3/5 of muscle recovery. At one year, the patient made a full recovery and was able to walk unassisted. CONCLUSION: The treatment of choice in SEH is the early decompression as complete as possible, usually with the same approach or at the level of major compression. In rare cases like this, we recommend the use of an elastic catheter to complete hematoma drainage, distant from the surgical wound. LEVEL OF EVIDENCE: N/A.

Treatment of a Complex Distal Triceps Tendon Rupture With a New Technique: A Case Report.

INTRODUCTION: The distal triceps tendon rupture is an uncommon injury. The acute treatment is well-defined, but when a delayed diagnosis is made or when a tendon retraction is present the alternatives or reconstruction are limited and sometimes complex. CASE PRESENTATION: In this case, we report on a 28-year-old man who presented with a chronic disruption of the distal triceps tendon with a gap of approximately 15 cm. The patient was diagnosed in another center with an inveterate breakage of the distal triceps tendon and was initially treated with an Achilles allograft that was complicated by a wound infection and required more than ten surgeries. Nearly 22 months after the initial trauma, and 12 months after the first surgery, we performed a reconstruction with an Achilles tendon allograft using the new technique of distal attachment. At the 12-month follow-up the patient presented a joint balance from -5º to 110º and presented with no pain. CONCLUSIONS: The use of an Achilles tendon allograft provides excellent results in complex distal triceps tendon ruptures. We report the use of a new technique to anchor a distal Achilles allograft.

Subtalar dislocation: management and prognosis for an uncommon orthopaedic condition.

Subtalar dislocations were first described in 1811 as the simultaneous dislocation of the talo-calcaneal and talo-navicular joints without any tibio-talar or talar neck associated fractures. They were classified in 1853 as: medial, lateral, posterior and anterior based on the displacement of the foot in relationship to the talus. These are uncommon injuries, representing approximately 1 % of all traumatic injuries of the foot and 1-2 % of all dislocations, being associated with high energy trauma.Closed reduction of these dislocations should be performed as early as possible to avoid further damage to the skin and neurovascular structures. If this is not possible, then open reduction without further delay is recommended. Irreducible injuries have been reported in 0 to 47 % of cases. Open dislocations represent between 46 and 83 % of all cases, and have been associated with poor prognosis. Associated fractures have a high incidence, the most frequent ones are the posterior process of the talus, talar head, external malleolus, medial malleolus and the tubercle of the fifth metatarsal.These types of injuries are not faced by orthopaedic surgeons on a daily basis and having a source of information on how to manage and what to expect is important. We present an up-to-date literature review on the epidemiology, clinical presentation, radiologic assessment, treatment options and prognostic factors of these uncommon injuries.

Pediatric Maisonneuve: case report of a rare pattern of injury.

A 12-year-old boy presented to our emergency department complaining of pain and functional limitation on his right ankle after an indirect trauma. Plain radiographs were taken identifying a type II epiphysiolysis of the distal tibia and a proximal fibula fracture. An open reduction and internal fixation was performed without transyndesmal fixation. Maisonneuve fractures are an uncommon injury in the pediatric population. This fracture pattern has not been described by the Dias-Tachdjian classification. It is important to bear in mind that, based on the need for osteosynthesis for the epiphysiolysis, the treatment of these fractures in children usually differs from that in the adults as no transyndesmal screw fixation is required.

Análisis del coste del tratamiento del paciente politraumatizado en un hospital de referencia en España / Cost-analysis of treating patients with multiple injuries in a reference hospital in Spain

Introducción: El objetivo del estudio es analizar el coste que supone el tratamiento de un conjunto de pacientes con traumatismo grave. Adicionalmente investigamos la distribución del gasto entre los diferentes servicios implicados en el manejo de estos pacientes. Material y método Utilizamos para el estudio los datos registrados en la base de datos Traumasur donde se recogen de modo prospectivo los datos de los pacientes que sufren traumatismos graves. Se analizan de modo retrospectivo los datos clínicos de los pacientes recogidos en el año 2008, un total de 131 pacientes. Utilizamos los datos obtenidos por el servicio de control financiero de nuestro centro, con datos del coste global y la división del gasto entre los departamentos implicados en el tratamiento. Resultados El valor medio de ISS y NISS fue respectivamente 31,8 y 39,4. La tasa de mortalidad fue del 17,5%. El coste global de los pacientes fue 3.791.879,3 €. El coste medio por paciente fue 28.945 €. El porcentaje medio del gasto global que supusieron el ingreso en UCI y planta fue respectivamente de 62 y 12,7%. El coste del ingreso en UCI ascendió hasta 68,4% en pacientes con ISS>40. A pesar de que los pacientes fallecidos presentaron lesiones más graves, presentaron menor coste en todos los capítulos. Conclusión Los pacientes con traumatismos graves suponen un importante gasto sanitario; el mayor porcentaje se debe a la estancia hospitalaria sobre todo a la estancia en UCI. Otros capítulos de gasto suponen un porcentaje menor del gasto (AU)

Introduction: The aim of this study is to analyse the costs of the treatment of a group of patients with severe injuries. The distribution of the costs between the different departments involved in the management of these patients is also investigated. Material and method: The data from patients who suffered severe injuries, and recorded in the Traumasur data base, were prospectively gathered to be used in the study. The data from a total of 131 patients treated in the year 2008 were collected. Data obtained from the hospital (..) (AU)

[Cost-analysis of treating patients with multiple injuries in a reference hospital in Spain]. / Análisis del coste del tratamiento del paciente politraumatizado en un hospital de referencia en España.

INTRODUCTION: The aim of this study is to analyse the costs of the treatment of a group of patients with severe injuries. The distribution of the costs between the different departments involved in the management of these patients is also investigated. MATERIAL AND METHOD: The data from patients who suffered severe injuries, and recorded in the Traumasur data base, were prospectively gathered to be used in the study. The data from a total of 131 patients treated in the year 2008 were collected. Data obtained from the hospital finance office were also used, providing the overall cost as well as the separate costs of each of the departments involved in the treatment. RESULTS: The injury severity score (ISS) and the new injury severity score (NISS) mean values were 31.8 and 39.4, respectively. The mortality rate was 17.5%. The overall costs of the patients was 3,791,879.3 €, with a mean cost per patient of 28,945 €. The mean percentage of the overall costs of the treatment incurred by the ICU and the ward was 62% and 12.7%, respectively. The cost of the ICU admission increased up to 68.4% in patients with an ISS>40. Although the patients who died had more serious injuries, they had a lower cost in all areas. CONCLUSION: Patients with multiple injuries represent a significant health cost, with the greater percentage being due to the hospital stay, particularly that in ICU. Other cost areas involve a lower percentage of the cost.

Correlation between pattern and mechanism of injury of free fall.

To define the pattern of injury and aetiology of death of patients who have sustained major trauma due to high fall and its relationship with the mechanism of free fall. A total of 188 consecutive patients who sustained a high fall were included after the TRAUMASUR database was retrospectively reviewed. Demographic characteristics, severity scores, injury type, aetiology of high fall, mortality rate and aetiology of death were analysed. The mean age was 39.7 years (SD 15.5). The main aetiologies were work related (40.4 %) and suicide attempt (22.3 %). The mean injury severity score (ISS) and New Injury Severity Score (NISS) were 27.3 and 34.1, respectively. The most common cause of mortality within the intentional group was exsanguination (66 %), and the most frequent aetiology of death within the non-intentional group was endocranial hypertension (69 %). Differences were found with regard to the pattern of injuries and the aetiology of death according to the mechanism of free fall.

Controversial topics in the management of displaced supracondylar humerus fractures in children.

The aim of our study was to review the literature looking for the up to date information regarding these controversial topics. An electronic literature search was performed using the Medline/PubMed database. A closed reduction attempt should always be done first. It is more important to engage both columns as well as divergence of the pins no matter whatever configuration is applied. Time to surgery seems to be not an important factor to increase the risk of complications as well as open reduction rate. Usually neurological injuries present a spontaneous recovery. If there is absent pulse, we should follow the algorithm associated with the perfusion of the hand.

HIV-infected children vaccination coverage and safety in a Western European cohort: a retrospective study.

Since the implementation of highly active antiretroviral therapy in HIV-infected children, response to scheduled vaccines may determinate future morbidity and mortality. The aims of this study have been to describe the current vaccine coverage, vaccine safety and concordance with vaccine recommendations of the 68 HIV-infected children and adolescents followed up in our Unit. Forty-four percent of the children received at least one dose of the oral polio vaccine (OPV). Only 9.1% needed and received a second set of hepatitis B virus immunization because of low vaccine response. Only 14.7% were vaccinated against varicella. Coverages of 82.3% and 100% have been reached with the 23-valent and the 7-valent pneumococcal vaccines, respectively. Meningococcal conjugated vaccine uptake was moderate (80.8%). Influenza annual vaccination coverage was poor: only 22.7% had well-documented yearly vaccines. In our experience, vaccine coverage is lower in those vaccines administered in primary care centres compared with the immunizations given at the hospital. OPV administration did not cause any adverse effect in the children or in their families. Vaccine coverage in HIV-infected children was suboptimal.