ABSTRACT
Subtrochanteric fractures in children are rare events that occur in only 4% of all femur fractures; most injuries occur as a result of high-energy trauma, being young male patients the most affected. The management of this type of injury is controversial; there are many forms of treatment, including the use of plaster spica 90-90, closed reduction and use of elastic or rigid intramedullary nails, open reduction and plate placement, and the use of external fixators. Most suggest that for children under 10 a nonoperative approach should be preferred and that older ones should be managed surgically, but it is between six and 12-year-olds that most of the controversy exists. In this article, we present the management of this entity with a proximal fracture plate using a minimally invasive technique.
Las fracturas subtrocantéricas en niños son eventos poco frecuentes que se presentan en solo 4% de todas las fracturas de fémur; la mayoría de las lesiones ocurren como resultado de traumas de alta energía, siendo el paciente joven de sexo masculino el más afectado. El manejo de este tipo de lesión es controversial; existen muchas modalidades de tratamiento, como el uso de espica de yeso en 90-90, reducción cerrada y uso de clavos elásticos o rígidos endomedulares, reducción abierta y fijación con placas y, finalmente, el uso de fijadores externos. La mayoría proponen que para niños menores de 10 años, se debe preferir el manejo no quirúrgico y en mayores, el manejo quirúrgico, pero la discusión se produce entre los seis y 12 años de edad, en donde está la mayor parte de la polémica. En la actualidad, en el Hospital Universitario de Santander, tratamos este tipo de fracturas mediante técnica de mínima incisión con placa autobloqueada para fémur proximal en niños, con buenos resultados.
Subject(s)
Femoral Fractures , Fracture Fixation, Intramedullary , Hip Fractures , Minimally Invasive Surgical Procedures , Bone Nails , Bone Plates , Child , Femoral Fractures/surgery , Hip Fractures/surgery , Humans , MaleABSTRACT
Subtrochanteric fractures in children are rare events, occur in only 4% of all femur fractures, most injuries occur as a result of high energy trauma, being young males patient the most affected. The management of this type of injury is controversial, there are many forms of treatment, including the use of plaster spica 90-90, closed reduction and use of elastic or rigid intramedullary nails, open reduction and plate placement and external fixators. Most suggest that children under 10 should be preferred non-operative and for older than 12 surgical management is indicated, but the discussion is between 6 and 12 years old. Through this article we present the treatment of such entity with a proximal fracture plate using a minimally invasive technique.
Las fracturas subtrocantéricas en niños son eventos poco frecuentes que se presentan en sólo 4% de todas las fracturas de fémur, la mayoría de lesiones ocurren como resultado de traumas de alta energía, siendo el paciente joven de sexo masculino el más afectado. El manejo de este tipo de lesión es controversial, existen muchas modalidades de tratamiento como el uso de espica de yeso en 90-90, reducción cerrada y uso de clavos elásticos o rígidos endomedulares, reducción abierta y fijación con placas y finalmente, el uso de fijadores externos. La mayoría propone que para niños menores de 10 años debe preferirse el manejo no quirúrgico y en mayores el manejo quirúrgico, pero la discusión se produce entre los 6 y 12 años de edad, período en el que radica la mayor parte de la polémica. En la actualidad tratamos este tipo de fracturas en el hospital universitario mediante técnica de mínima incisión con placa autobloqueada para fémur proximal en niños con buenos resultados.
Subject(s)
Femoral Fractures , Fracture Fixation, Intramedullary , Hip Fractures , Bone Nails , Bone Plates , Child , External Fixators , Femoral Fractures/surgery , Hip Fractures/surgery , Humans , Male , Treatment OutcomeABSTRACT
Femoral head chondroblastoma is an infrequent tumor, accounting for approximately 1-2% of benign bone tumors. It occurs more frequently in young male patients. It's most frequent locations include the proximal humerus, proximal femur, distal femur and proximal tibia. The femoral head is the third most frequent site of this tumor. There is no specific treatment for this entity; reported treatments range from acetabular osteotomies and osteochondral grafts, to vascularized fibular grafts, all of them with good results. However, this tumor is clinically unpredictable if left untreated. We report a case managed with osteochondral graft and followed-up for three years after the surgical procedure.
Subject(s)
Chondroblastoma/surgery , Femoral Neoplasms/surgery , Femur Head , Adolescent , Allografts , Bone Transplantation , Cartilage/transplantation , Humans , MaleABSTRACT
The induced membrane technique was first described by Masquelet in 1986. It was initially used for the reconstruction of long bone shaft defects, particularly of the femur and tibia. The technique consists of two stages. During the first stage a membrane is induced to provide support to the grafts and supply growth factors that contribute to provide a favorable receiving bed for the future graft. During the second stage the poly-methyl-methacrylate spacer is removed and replaced with bone grafts, usually harvested from the iliac crest. Given that this technique has proven good results, it started to be used at other bone sites. We present herein the case of a patient with a large bone defect in the midfoot in whom the Masquelet technique was used with iliac crest grafts. Arthrodesis with a distal radius plate was performed to improve medial column stability, with favorable clinical and functional results.
