RESUMO
BACKGROUND: Comminuted patellar fractures represent a challenging clinical problem. Treatment aims to restore the integrity of the extensor mechanism and the congruity of patellofemoral joint. Controversy exists regarding the ideal fixation method. Metallic constructs aiming to convert pulling forces on the anterior aspect of the patella into compression forces across the fracture site are the standard of care. More recently, low profile plates have been described in the management of comminuted patellar fractures. The aims of this study were to (1) develop a novel unstable patellar fracture model and (2) to compare biomechanically three different constructs for fixation comminuted patellar fractures. We hypothesized that an orthogonal biplanar disposition of the screws within an anteriorly placed locking plate provides the best biomechanical properties in the management of comminuted fractures. METHODS: Six-part complex AO 34-C3 patella fractures were simulated in 18 human cadaveric knees by means of osteotomies including comminution around the distal patellar pole. The specimens were randomly assigned to 3 fixation techniques (n â= â6) for either anterior plating, antero-lateral plating, or tension band wiring (TBW). Biomechanical testing was performed over 5000 cycles in active extension and passive flexion, followed by ultimate destructive quasi-static testing. Interfragmentary movements were captured by means of optical motion tracking. RESULTS: Displacement between the proximal and distal medial patella fragments was lower after anterior plating compared to both antero-lateral plating (P â= â0.084) and TBW (P â< â0.001). Moreover, displacement between the proximal and distal lateral fragments was significantly lower after anterior plating compared to both other techniques (P â≤ â0.032). In addition, it was significantly lower for antero-lateral plating versus TBW (P â< â0.001). Rotation around the medio-lateral axis between the proximal and distal medial fragments was significantly lower after anterior plating compared to TBW (P â= â0.017). CONCLUSIONS: Anterior mesh plating with biplanar placement of locking screws provides superior stability for fixation of comminuted patellar fractures when compared to both antero-lateral mesh plating and TBW. The latter is associated with considerably inferior performance.
RESUMO
Enhancing health research capacity in developing countries is a global health priority. Understanding the orthopedic burden of disease in Latin America will require close partnership between more-developed and less-developed countries. To this end, the Osteosynthesis and Trauma Care Foundation assembled a research consortium of Latin-American orthopedic leaders. Prior to the meeting, we surveyed attendees on perceived barriers to conducting research at their institutions. During the event, working groups discussed these barriers, developed strategies for addressing them, and planned future steps for collaboration. The participants established the need for global relationships that allow colleagues from Latin America to access to training and established investigational infrastructure of North American centers to address research questions relevant to their communities. As a result of the discussion, the International Orthopaedic Multicenter Study (INORMUS) in Fracture Care was initiated. Since then, an expanded international working group, Associación de Cirujanos Traumatológicos en las Americas (ACTUAR), has been created with the purpose of promoting increased global partnership for research capacity development.
RESUMO
Trece pacientes con fractura de húmero (diafisiaria o pseudoartrosis) fueron tratados con el nuevo sistema endomedular UHN (unreamed humeral nail) entre los meses de enero de 1997 y abril de 1998. Todos los clavos fueron implantados en forma retrógada obteniéndose éxito terapéutico en 85 por ciento de casos. Sólo dos pacientes presentaron complicaciones leves, uno con diastasis de los fragmentos y otro con mala alineación rotacional. Los resultados obtenidos muestran que la aplicación de está técnica ortopédica a la fractura de húmero permite mayor estabilidad al hueso y evita complicaciones neurológicas, además de que brinda recuperación precoz y reincorporación rápida a las actividades habituales
Assuntos
Humanos , Masculino , Feminino , Fraturas do Úmero , Complicações Pós-Operatórias , Medicina , VenezuelaRESUMO
En un grupo de 908 estudiantes regulares de la escuela "Fe y Alegria" del barrio Unión de Petare con edades entre los 7 y 12 años, descartando a aquellos que hubiesen recibido tratamiento quirurgico previo encontramos una prevalencia de Hernia Umbilical de 10,57 por ciento; siendo este resultado casi el doble del más alto encontrado en nuestra revisión de la literatura. Se realiza un análisis de las posibles causas y se realizan recomendaciones dirigidas al mejoramiento del programa de hiegiene escolar
