RESUMEN
Seventy-three fractures of the femoral shaft (seventy patients) were randomized to treatment with interlocked nailing with either the Brooker-Wills femoral nail (thirty-nine fractures) or the Russell-Taylor femoral nail (thirty-four fractures). Sixty-one patients (sixty-four fractures) were prospectively followed from admission until healing of the fracture. Specific attention was paid to recording operative details, including technical difficulties associated with insertion of the nails. Technical difficulties were encountered in insertion of the proximal screw, distal screw, and nail, and in deployment of the fins. Insertion of the Russell-Taylor nail was associated with less technical difficulty, operative time, and estimated loss of blood. The two nails differ in their biomechanical properties, methods of fixation, and instrumentation. These differences did not affect the clinical outcome; the fractures in both groups of patients healed with excellent functional results.
Asunto(s)
Clavos Ortopédicos , Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/instrumentación , Fenómenos Biomecánicos , Fracturas del Fémur/diagnóstico por imagen , Estudios de Seguimiento , Fijación Interna de Fracturas/efectos adversos , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/etiología , Estudios Prospectivos , Radiografía , Ensayos Clínicos Controlados Aleatorios como Asunto , Reoperación , RotaciónRESUMEN
We describe the case of a patient who had a fracture through an ossified Achilles tendon, and we illustrate a second case. Such ossification is uncommon, occurring most often after trauma or surgery. A subsequent fracture has been reported previously in only eight patients.
Asunto(s)
Tendón Calcáneo/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Osificación Heterotópica/diagnóstico por imagen , Adulto , Humanos , Masculino , RadiografíaRESUMEN
Desmoid tumors are rare, being less than 0.03 per cent of all neoplasms. Because of scarcity of data and relatively small numbers of patients, optimal treatment remains controversial. In this report, our experience with 36 patients evaluated and treated from 1960 to 1987 is analyzed. The most common primary site was the wall of the chest (ten); eight tumors originated in the abdominal wall. Nine patients had a history of previous trauma, and eight of these were women. Thirty-two patients had wide local excision and two had amputations. Clear margins were obtained in only 22 patients despite an attempt at wide resection in all instances. With a mean follow-up period of 41 months and a median of 24 months, only one of 22 patients with negative histologic margins had recurrence of tumor. Among the 11 patients with positive margins, four received postoperative radiation therapy and two remain disease-free; of the seven remaining patients with positive margins, three had recurrences. One patient with unresectable disease was treated with tamoxifen with regression of tumor and remains alive 15 months later. These data suggest that the best treatment of desmoid tumors remains resection with a clear margin of normal tissue surrounding the tumor. Adjuvant radiotherapy did not appear to decrease the rate of local recurrence.
Asunto(s)
Fibroma/cirugía , Fibrosarcoma/cirugía , Análisis Actuarial , Adolescente , Adulto , Anciano , Niño , Preescolar , Diagnóstico Diferencial , Estudios de Evaluación como Asunto , Femenino , Fibroma/diagnóstico , Fibroma/terapia , Fibrosarcoma/diagnóstico , Fibrosarcoma/terapia , Estudios de Seguimiento , Humanos , Lactante , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Estudios RetrospectivosRESUMEN
Fifty femur fractures were treated with the Brooker-Wills intramedullary locking nail. The indications included subtrochanteric, subisthmal, segmental or comminuted acute fractures or nonunions, and intramedullary shortening procedures. Eighteen technical problems in 13 (26%) patients were encountered during insertion of the nail. The incidence of technical problems was high early in the series and in procedures done with the patient in the supine position. Adverse clinical results from technical errors occurred in two patients. Most technical errors seem avoidable with careful technique. The mean healing time was only 12.1 weeks and there were four nonunions (8%). One patient had a 10 degrees malunion, four patients had 1-2 cm of shortening, and there were two late device fractures. No patients had rotational malalignment or deep infections. The results and complication rate are comparable to those reported for other interlocking systems. The Brooker-Wills nail is useful for treatment of complex femur fractures and has been effective in preventing malrotation, angulation, and excessive shortening.
Asunto(s)
Clavos Ortopédicos , Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas/instrumentación , Adolescente , Adulto , Anciano , Femenino , Fracturas del Fémur/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Diseño de Prótesis , Radiografía , Factores de Tiempo , Cicatrización de HeridasRESUMEN
Numerous alternative types and sizes of implants for total hip arthroplasties are currently available. Two cases are reported in which the head size of the femoral component inserted was larger than the corresponding inner diameter of the acetabular cup. These are the first reported cases of this technical complication. The error can be avoided with careful preoperative planning and proper selection of implants. At 12- and 30-month follow-up evaluation, however, neither of these hips had dislocated or required revision. Immediate revision is not recommended, unless the hip dislocates or has symptomatic subluxations.
Asunto(s)
Prótesis de Cadera , Anciano , Femenino , Necrosis de la Cabeza Femoral/cirugía , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Falla de Prótesis , Radiografía , ReoperaciónRESUMEN
Treatment by in situ release, submuscular transposition, and anterior subcutaneous transposition have all been reported to produce satisfactory results for ulnar neuropathy secondary to the cubital tunnel syndrome. A prospective study was done to determine which preoperative clinical and electrical factors and surgical approaches in patients with ulnar nerve palsy at the elbow had the best results. The 32 patients had an average age of 50 years, had symptoms for an average of 15 months before surgery, and underwent postoperative follow-up for an average of 13 months. All patients with good results had no atrophy or preoperative fibrillations in the intrinsic muscles and had an obtainable evoked sensory potential. The change in motor conduction velocity did not correlate with good results. There was no significant difference in the results of the three surgical procedures. Eight of the 37 operations yielded good results, 19 patients showed an improvement, but 10 of the operations yielded poor results. Our results also indicated that surgical results could be predicted by proper patient selection through the assessment of the preoperative physical examination and electromyogram.