[Experience in the management of open pelvic fractures at the Mexican Red Cross Trauma Center]. / Experiencia en el manejo de fracturas expuestas de pelvis en el Centro de Trauma Cruz Roja Mexicana.

A prospective, descriptive study was conducted at the Trauma and Orthopedics Service from January 1st, 2006 to January 1st, 2009; all patients with a diagnosis of open pelvic fracture were included. A total of 112 patients with pelvic fracture were seen at the Emergency Room; 12 of them with an open pelvic fracture; 75% were males, most of them ages 31 to 45 years of age; they were stabilized with a circular pelvic binder and external fixators with a V technique; a gastrointestinal bypass with colostomy was performed; 3 patients died within the first few hours due to hypovolemic shock, 5 survived a mean of 25 days and died due to other causes, and four patients were discharged alive. These lesions have a mortality rate of 66.66%; mediate mortality resulting from massive bleeding occurred in 25% and survival was 33.33%. The most frequent fractures (39.28%) according to the Tile classification were type C, which are the most unstable ones; according to the Bircher-Hargrove classification, most cases were type C, which are the most severe lesions and involve a high mortality rate and risk of contamination; it is therefore important to perform a gastrointestinal bypass and an emergency colostomy as part of the initial patient management.

[Clinical and functional assessment in the treatment of os calcis fractures. Open and closed reduction]. / Evaluación clínica y funcional en el tratamiento de fracturas de calcáneo. Reducción cerrada y abierta.

In this prospective, longitudinal, comparative, observational study 15 patients with 17 fractures were reviewed from September 1st 2006 to December 31st 2007 and followed-up by the outpatient service at 4, 8, 12, 16 and 20 weeks and at one year. All patients were assessed with the Maryland functional scale. These fractures were more frequent among males, 94%, and mean age was 35 years. The main cause was falls from a height of more than 2 meters. The left side was the most frequently involved (59%). Fractures were classified according to Sanders tomography classification system. Open reduction and internal fixation were performed with a specialized os calcis plate in 7 cases; 5 were treated with closed reduction and internal fixation with a cannulated screw, and 5 with a long leg cast device. The most common complication was wound dehiscence that occurred in 10% of the cases. The assessment with the Maryland scale was done at 20 weeks with the following results: 4 excellent (23.5%), 3 good (17.6%), 6 fair (35.3%), and 4 poor (23.5%). The objective of this paper was to make a clinical and functional comparison among the 3 treatment modalities in patients with os calcis fracture.

[Treatment of shaft fractures in children with elastic titanium nails]. / Tratamiento de fracturas diafisiarias en niños con clavos elásticos de titanio.

UNLABELLED: According to the statistics, long bone fractures in children are caused by high-energy mechanisms and they are the most frequent ones in the orthopedic practice. The advantage of reducing these fractures with elastic titanium nails and three buttress points is that neither the blood supply nor the physis are injured. MATERIAL AND METHODS: Twenty-seven patients ages 5-15 years of age were analyzed. They presented at the Emergency Service, Polanco Red Cross Orthopedics and Trauma Hospital, between July 1st 2006 and July 1st 2007. RESULTS: The sample size was 27 patients, the highest incidence occurred at 10 years of age, the forearm was the most frequent location, and the treatment of choice was closed surgery. Only one complication occurred, fractures healed before 8 weeks and rehabilitation started before 9 weeks. All of them had permissible angulations and 4 patients had a 2 mm shortening. The use of elastic titanium nails is an effective method to treat long bone fractures, it results in minimal angulations and few complications, and allows patients to promptly resume their activities.

[Bilateral quadriceps rupture in a patient with osteogenesis imperfecta. A case report]. / Ruptura bilateral de cuadríceps en un paciente con osteogénesis imperfecta. Reporte de caso.

We present the case of a 24-year-old patient with bilateral quadriceps rupture and history of type I congenital osteogenesis imperfecta diagnosed clinically and with ultrasound. Bilateral quadriceps tenoplasty was performed with an anterior approach and without any complications. The patient was discharged with bilateral neoprene knee-guards. The sutures were removed at the 21-day follow-up visit, rehabilitation was started at six weeks and the patient was doing well at the 2- and 3-month follow-up visits. Timely management and early rehabilitation contribute to decrease the risk of sequelae despite the poor functional prognosis.

[Amputation as a treatment for complications on a traumatic dislocations of the knee. Case report]. / Amputación como tratamiento de complicaciones de la luxación traumática de rodilla. Presentación de un caso.

INTRODUCTION: Vascular lesion associated with knee dislocation represents a common and potentially devastating complication. A delay in revascularization that exceeds 8 hours can lead to amputation of the extremity. Therefore it is mandatory to do an immediate examination and an effective diagnosis to rule out this complication. CASE REPORT: A 19-year-old male was struck by a motor vehicle and caused traumatic dislocation of the left knee as observed on X-rays. The knee was reduced immediately. At 12 hours, the patient presented edema on the extremity and was then stabilized with external fixators. On the third day the patient developed a compartmental syndrome and artery obstruction, and required fasciotomies and revascularization of the popliteal artery. Twenty four hours later, again the artery was obstructed, conducing to supracondylar amputation. DISCUSSION: The purpose of this article is to show that a knee dislocation, with vascular complications, may lead to extremity amputation as a drastic treatment. It is important to emphasize that vigilance of vascular permeability has to be followed every 2-3 hours, for at least 72 hours after the injury, and assisted with Doppler study. And if needed, at the moment when a pulse abnormality is detected an arteriography study must be realized.

[Damage control in long bones and pelvis in the Mexican Red Cross Trauma Center]. / Control de daños en fracturas de huesos largos y pelvis en el Centro de Trauma Cruz Roja Mexicana.

Multiple injured patients account for some of the biggest and most complex problems a trauma surgeon has to face in his daily routine; thus, applying orthopedic damage control (DCO) is important. Multiple injured patients treated at the Medical Red Cross Medical Trauma Center were reviewed, in the period comprised between June 2006 and July 2007. One-hundred cases with long bone and pelvis fractures, ranging between 10 and 75 years old, 21 women (21%) and 79 men (79%); the most common trauma mechanism was patients falling from a height above 2 meters (33%). The most frequently affected bone was the femur with 43 fractures AO32B. The most common open fracture was that of the tibia the (18 IIIB AO 42B). Six amputations were carried out, most commonly CDO used was external fixation (44), cases of fat embolism (2) deceased (3). The results were satisfactory with the usage of DCO.