RESUMO
We present a technique of osteosynthesis of proximal humeral fractures using Kirschner wires, assembled in an elastic manner. We report 29 patients (mean age, 68 years) with types II, III and V fractures, according to Neer's classification, treated with closed or open (seldom) reduction and percutaneous pinning. The pin placement was antegrade: the wires started on the epiphysis and aimed at the diaphysis, with the proximal ends fixed with an external clamp and the distal ends crossed and laying on the endosteal surface. Patients were evaluated with the Constant-Murley scale at the end of treatment. Radiological and clinical outcome was satisfactory in all but one patient, in whom the closed reduction was insufficient. Percutaneous elastic pinning is an effective treatment of proximal humeral fractures. If necessary, it should be associated with open reduction.
RESUMO
The surgical management of clinical spinal instability is for many aspects controversial since the lack of a precise clinical and instrumental definition of instability complicates the implementation of a therapeutic protocol. Both the indications and the surgical procedure are not always well defined. Some of the most common surgical techniques used in the most frequent causes of instability of the lumbar spine: fractures, degenerative disease and spondylolisthesis, are described.
Assuntos
Instabilidade Articular/cirurgia , Vértebras Lombares/cirurgia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Humanos , Instabilidade Articular/etiologia , Doenças da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Espondilolistese/complicações , Espondilolistese/cirurgiaRESUMO
With the advances in diagnostic and surgical procedures, for degenerative disease of the lumbar spine an aggressive therapeutic approach is more frequently indicated. The available surgical procedures are numerous and in continuing evolution. Most common surgical procedures used in major degenerative disease of the lumbar spine as disk herniation and stenosis are described. Indications, results and complications associated to these procedures are also illustrated.
