RESUMO
Bilateral Posterior Fracture Dislocation (BPFD) of the shoulder is an uncommon but not rare presentation. We describe etiology, diagnostics, treatments and outcome and give a historic review and with a current approach of this pathology. We reviewed 55 cases (110 shoulders), mostly men (49/55), with a mean age of 49.2 years, mean follow up 21.9 months, mean delay until diagnose of 12.7 days (0-112 days), with a seizure as the cause in 80.0% . Other causes are electrocution, trauma or other. If the mechanism is not clear an epileptic insult should be considered the cause until proven otherwise. Closed reduction or mini open reduction is common in the more dated literature, but gives a overall good outcome. Arthroplasty is the prefered method in the more recent literature. Autografts from the shoulder treated with arthroplasty can be used to reconstruct the articular surface of the contralateral shoulder. High index of suspicion is important and a CT is most important diagnostic tool.
Assuntos
Artroplastia , Redução Fechada , Fratura-Luxação , Redução Aberta , Convulsões , Fraturas do Ombro , Artroplastia/efeitos adversos , Artroplastia/métodos , Artroplastia/estatística & dados numéricos , Redução Fechada/efeitos adversos , Redução Fechada/métodos , Redução Fechada/estatística & dados numéricos , Diagnóstico Tardio/estatística & dados numéricos , Traumatismos por Eletricidade/complicações , Feminino , Fratura-Luxação/diagnóstico , Fratura-Luxação/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta/efeitos adversos , Redução Aberta/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos , Convulsões/complicações , Convulsões/diagnóstico , Fraturas do Ombro/diagnóstico , Fraturas do Ombro/etiologia , Fraturas do Ombro/cirurgia , Tomografia Computadorizada por Raios X/métodos , Transplante Autólogo/métodos , Transplante Autólogo/estatística & dados numéricos , Ferimentos e Lesões/complicaçõesRESUMO
INTRODUCTION: Distal tibial fractures are uncommon, but they result in poor overall outcome. The objective of this study was to assess functional outcome and general health status after the treatment of distal tibial fractures and identify factors that affect these outcome measures. PATIENTS AND METHODS: A retrospective cohort study including 118 AO type 43 distal tibial fractures in 116 patients was conducted. With regard to articular involvement, fractures were classified as either simple (A1-B2, n=70) or complex (B3-C3, n=48). Twenty relevant demographic and operative variables were studied. Functional outcome, quality of life and pain were assessed using the Foot Function Index (FFI) and AOFAS ankle score, physical and mental SF-36, and Visual Analog Scale (VAS) questionnaires, respectively. RESULTS: Over 75% of patients experienced noteworthy loss of ankle function. The general health status assessment showed markedly affected quality of life with more than two-third of all responding patients suffering from pain every day. In fact, complex fractures and increased complication rate were associated with worse functional outcome, whereas prolonged time to definite surgery affected both functional outcome and general health status significantly. CONCLUSIONS: Complex distal tibial fractures were associated with poor functional outcome scores and delayed (-staged) surgery has been shown to prevent postoperative soft tissue problems. However, soft tissue injury associated with distal tibial fractures itself affected both the postoperative functional outcome and general health status as well. This should contribute to the understanding of treatment and outcome of distal tibial fractures. LEVEL OF EVIDENCE: 3.
