RESUMO
INTRODUCTION: Lateral malleolus non-union can cause pain and loss of function. Standard treatment involves open approach with debridement, bone-grafting and plate stabilisation, with published surgical site infection rates to 17%. To minimise the risk of soft tissue complications and allow early mobilisation, we describe a technique for percutaneous cannulated screw stabilisation. MATERIALS AND METHODS: Retrospective case review for all percutaneous lateral malleolus non-union stabilisation procedures undertaken in our hospital between 2011 and 2017 was performed. Fracture union was diagnosed by resolution of pain and swelling, with a return to full weight-bearing mobilisation and two-view radiographs consistent with union. RESULTS: Twelve cases were reviewed. All fractures united. There was one superficial wound infection treated with oral antibiotics, and one early case with drill-piece fracture requiring conversion to open procedure with plate stabilisation. CONCLUSION: We believe this to be the first report of percutaneous stabilisation for non-union of lateral malleolus fractures. We demonstrate this to be a safe and effective technique.
Assuntos
Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/fisiopatologia , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Dor Pós-Operatória/cirurgia , Adulto , Fraturas do Tornozelo/complicações , Fraturas do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Desbridamento , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Progression of slipped capital femoral epiphysis following in situ screw fixation typically occurs through loosening of the screw in the metaphysis. Epiphyseal migration off the screw due to physeal growth is rare. We report epiphyseal migration off bilateral screws in a child undergoing thyroid replacement therapy. Patients with mild and moderate slipped capital femoral epiphysis and endocrine disease should be followed-up with radiographs taken at intervals which reflect the rate of growth. Fixation should be revised if the tip of the screw approaches the physis and initial fixation with two screws may be considered.
Assuntos
Epífises/crescimento & desenvolvimento , Colo do Fêmur/crescimento & desenvolvimento , Hipotireoidismo/complicações , Complicações Pós-Operatórias/fisiopatologia , Escorregamento das Epífises Proximais do Fêmur/complicações , Escorregamento das Epífises Proximais do Fêmur/cirurgia , Adolescente , Parafusos Ósseos , Progressão da Doença , Epífises/efeitos dos fármacos , Colo do Fêmur/efeitos dos fármacos , Humanos , Hipotireoidismo/tratamento farmacológico , Masculino , Complicações Pós-Operatórias/cirurgia , Reoperação , Tiroxina/uso terapêuticoRESUMO
This study tests the null hypothesis that there is no difference between sciatic nerve block (SNB) and periarticular anesthetic infiltration (PI) as adjuncts to femoral nerve blockade (FNB) in total knee arthroplasty in terms of postoperative opioid requirements. Fifty-two patients undergoing total knee arthroplasty were randomized to receive either (a) combined FNB-SNB or (b) combined FNB-PI. Average morphine consumption in the first 24 (20 vs 23 mg) and 48 hours (26 vs 33 mg) showed no significant difference. Visual Analogue Scale scores, knee flexion (60° vs 67.5°) and extension lag (0° vs 5°) were comparable. Anesthetic time, surgical time, and length of hospital stay (5.5 vs 6 days) were similar. This study showed no significant difference between the 2 groups. The PI offers a practical and potentially safer alternative to SNB.
