[Benefit of the stabilization of long-bone fractures in polytraumatized patients]. / Beneficio de la estabilización de fracturas de huesos largos en politraumatizados.

INTRODUCTION: Early fracture fixation is increasingly common in medical practice, and femur shaft fractures are the perfect prototype of the lesion warranting early surgery in polytraumatized patients. Damage control orthopedics (DCO) is defined as the minimally-traumatic interventions intended to provide quick stabilization of orthopedic injuries to minimize the systemic inflammatory response. MATERIAL AND METHODS: By means of an evidence-based medicine tool (CAT) we approach the benefit of long-bone fracture stabilization in polytraumatized patients trying to answer a specific clinical question from a concrete situation: What is the evidence of the safety and benefit of early stabilization of long-bone fractures in polytraumatized patients? RESULTS: The patient group whose fractures were stabilized after 48 hours had more clinical complications, alterations of lung parameters and a longer hospital stay. There is no complete evidence showing that early stabilization of long bones in patients with moderate or severe head trauma worsens or improves the outcomes. CONCLUSIONS: Urgent fracture stabilization should be an adjuvant to resuscitation. Early fracture stabilization contributes to reducing the ICU stay, the incidence of acute respiratory distress syndrome (ARDS), multiple organ failure (MOF) and sepsis, thus improving patient survival.

Fractura-luxación central acetabular con migración intrapélvica de la cabeza femoral fracturada a nivel basicervical / Central acetabular fracture-dislocation with intra-pelvic migration of the fractured femoral head at the basicervical level

Se presenta un caso de fractura-luxación central acetabular con migración intrapélvica de la cabeza femoral que se encontraba fracturada a nivel basicervical. Esta asociación es poco frecuente afortunadamente. Existen pocos casos descritos en la literatura; suelen acompañarse de fracturas complejas de pelvis. El tratamiento consistió en la extracción de la cabeza femoral, la reconstrucción de la pared acetabular y la colocación de una prótesis total de cadera. La reconstrucción acetabular se realizó aprovechando los restos de la cabeza femoral. El resultado final tras 4 años de seguimiento se considera excelente

This is a case of a central acetabular fracture-dislocation with intrapelvic migration of the femoral head, which was fractured at the basicervical level. This is an infrequent combination of which very few cases are described in the literature. The ones that exist are often accompanied by complex pelvic fractures. In our case, treatment involved the extraction of the femoral head, the reconstruction of the acetabular wall and the implantation of a total hip prosthesis. For the acetabular reconstruction, fragments of the fractured femoral head were used. The final result after 4 years' follow-up is deemed excellent