RESUMO
Stress fractures of the tarsal navicular do not heal predictably with conservative treatment, so we recommend operation if the fracture remains symptomatic, and radiographs show wide separation of a complete fracture, extension of an incomplete fracture, delayed healing, or a medullary cyst. An autologous bone graft is inserted after en-bloc resection of the fracture surfaces. It is important that the fracture is fully exposed to its distal limits before the graft is inserted. We have grafted 19 fractures in 18 patients. Six fractures were complete, 12 incomplete and one had a residual medullary cyst. Of the 15 patients with adequate follow-up, 12 had been able to return to a pre-injury level of activity by five to 12 months.
Assuntos
Transtornos Traumáticos Cumulativos/cirurgia , Fraturas não Consolidadas/cirurgia , Ossos do Tarso/lesões , Adolescente , Adulto , Transplante Ósseo , Transtornos Traumáticos Cumulativos/diagnóstico por imagem , Transtornos Traumáticos Cumulativos/patologia , Feminino , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/patologia , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Radiografia , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/patologia , Ossos do Tarso/cirurgiaAssuntos
Emblemas e Insígnias , Pediatria , Sociedades Médicas , Austrália , Genealogia e Heráldica , Pediatria/educaçãoRESUMO
One in six patients receiving renal transplants has orthopaedic problems. Osteoporosis with accompanying fractures is common, as is avascular necrosis of the hips, knees, and other bones. Immunosuppressive therapy with steroids is implicated and its mode of action discussed. No means of prophylasix is known. If treated conservatively, aseptic necrosis of bone is much more disabling than is commonly believed as judged by the critical assessment technique of Charnley. The authors therefore recommend that a surgical approach should be adopted whenever possible.
