Enclavado retrógrado en fractura tibial / Retrograde nailing in a tibial fracture

Se describe un caso de fractura abierta de tibia grado iiia con gran conminución y pérdida distal de stock óseo ( cm) con total afectación de la superficie articular tibial y gran inestabilidad de la articulación peroneo-astragalina. El tratamiento realizado consintió en practicar una exhaustiva limpieza, colocándose un enclavado fresado retrógrado calcáneo-astrágalo-tibial con bloqueos proximales y distales, además de una aguja de Kirschner peroneo-astragalina. Se consiguió el cierre primario de la piel. A las 3 semanas se procedió al aporte de injerto óseo autólogo de cresta ilíaca rellenando el defecto óseo, a la reimpactación del clavo endomedular que estaba protuido distalmente y a la dinamización distal. Se consiguió la consolidación del defecto óseo en 16 semanas. Actualmente, el paciente deambula sin dolor con la artrodesis tibio-astragalina consolidada (AU)

We describe a case of a severely comminuted type iiia open tibial fracture, with distal loss of bone stock (7 cm), total involvement of the tibial joint surface, and severe instability of the fibular-talar joint. The treatment performed consisted of thorough cleansing, placing a retrograde reamed calcaneal-talar-tibial nail with proximal and distal blockage, as well as a fibular-talar Kirschner nail. Primary closure of the skin was achieved. After 3 weeks, an autologous iliac crest bone graft was performed to fill the bone defect, and the endomedullary nail, which had protruded distally was reimpacted and dynamized distally. The bone defect was eventually consolidated after 16 weeks. Currently, the patient can walk without pain the tibial-astragal arthrodesis is consolidated (AU)

[Retrograde nailing in a tibial fracture]. / Enclavado retrógrado en fractura tibial.

We describe a case of a severely comminuted type iiia open tibial fracture, with distal loss of bone stock (7 cm), total involvement of the tibial joint surface, and severe instability of the fibular-talar joint. The treatment performed consisted of thorough cleansing, placing a retrograde reamed calcaneal-talar-tibial nail with proximal and distal blockage, as well as a fibular-talar Kirschner nail. Primary closure of the skin was achieved. After 3 weeks, an autologous iliac crest bone graft was performed to fill the bone defect, and the endomedullary nail, which had protruded distally was reimpacted and dynamized distally. The bone defect was eventually consolidated after 16 weeks. Currently, the patient can walk without pain the tibial-astragal arthrodesis is consolidated.

External fixation and secondary intramedullary nailing of open tibial fractures. A randomised, prospective trial.

We performed a prospective, randomised trial in 39 patients with open tibial fractures treated initially by external fixation to compare cast immobilisation (group A) and intramedullary nailing (group B) as a sequential protocol planned from the onset of treatment. The results showed that group B achieved faster union (p < 0.05) than group A with less malunion or shortening and a greater range of movement. Patients treated by intramedullary nailing required fewer radiographs and outpatient visits (p = 0.0015) and had a more predictable and rapid return to full function. We feel that these severe fractures are better treated by delayed intramedullary nailing and that this has an acceptable rate of complications.

Treatment of radial head fractures using a fibrin adhesive seal. A review of 15 cases.

Since 1986 we have treated 15 patients with fractures of the head of the radius limited to one or two fragments (Mason type II) by open reduction and internal fixation with the Fibrin Adhesive System. At a mean follow-up of over two years, all but one of the results were excellent. This method is recommended for the treatment of selected fractures of the radial head followed by early mobilisation.

Stabilization of the lower thoracic and lumbar spine with the internal spinal skeletal fixation system and a cross-linkage system. First results of treatment.

Since 1986, 19 patients with 21 fractures of the thoracic and lumbar spine have been treated with the AO Internal Spinal Skeletal System. Of these fractures, 17 were burst fractures, 2 were seatbelt fractures and 2 were fracture-dislocations. All the patients in the series had a minimum follow-up of 12 months. There were 4 important losses of correction and two deep infections. In the majority of patients the postoperative reduction deteriorated during follow-up. The addition of 1 or 2 DTT appears to give the system more stability.