RESUMO
PURPOSE OF THE STUDY: Fracture of lateral process of the talus is an uncommon injury, fracture of the posteromedial tubercle of the talus is quite rare, and association of the two lesions is not reported previously. We report a case of an associated fracture of posteromedial tubercle an lateral process of the talus. PATIENT AND METHODS: The mechanism of injury was forced ankle dorsiflexion and pronation, this mechanism was responsible of an avulsion of the posteromedial tubercle by the postero talotibial ligament and a fracture of lateral process by compression between the lateral malleolus and the calcaneus. RESULTS: Conventional radiographs permitted the diagnosis of the lateral process fracture but the fracture of the posteromedial tubercle was showed only on CT scans. DISCUSSION: The fracture of the posteromedial tubercle was treated by internal fixation, through a posteromedial approach. At 12 months follow-up the patient was able to walk without pain and radiographic result was excellent (no avascular necrosis of the tubercle and no Arthrosis of subtalar joint).
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Tálus/diagnóstico por imagem , Tálus/lesões , Tomografia Computadorizada por Raios X , Adulto , Humanos , MasculinoRESUMO
PURPOSE OF THE STUDY: The purpose of this study was to analyse the results of tibial intramedullary nailing using an unreamed "Universal Elastic Bundle Nail". MATERIAL AND METHODS: Forty-three intramedullary nailing of tibial shaft were done in 43 patients with recents fractures, from May 1993 and May 1996. There were 36 males and 7 females. The average age was 31.5 years (range 17-68 years). Thirty-three were injured in a traffic accident (20 motorcycles, 5 pedestrians and 8 car passengers), seven were injured in a home accident (fall) and three had a sport injury. There were 13 open fractures according to Gustilo: 5 grade I, 7 grade II and one grade III B. Eight fractures involved the proximal metaphyseal part of the tibia, 16 the distal metaphyseal part and 14 the tibial shaft; in five cases there were segmental fractures. According to AO classification there were: 10 fractures type A, 24 fractures type B and 9 fractures type C (5 segmental fractures). In 5 cases there were associated femoral fractures: three ipsilaterals and two controlaterals. All were treated in the same time: four by UEBN device and one by AO's nail. All the patients with type B and C fractures were positioned on a Maquet table with a boot traction or transcalcaneal pin traction (in the distal fractures). The nail was introduced after closed reduction through a vertical transpatellar tendon incision, without reaming procedure. RESULTS: Forty one fractures healed after an average time of 96 days (60-120). In 11 open fractures bone union occurred after 98 days (85-120). The distal fractures healed after a mean time of 86 days (60-120), proximal fractures in 123 days and mid shaft fractures in 98 days. In type A fractures bone union occurred after an average time of 68 days, while bone union occurred after a mean time of 100 days in type B and C fractures. Two patients with an open proximal type B fracture, had a delayed union: both healed after proximal screws removal. Two fractures healed with a valgus angulaton 5 degrees and 10 degrees. No infection, no loss of reduction and no bundle migration has been noted. DISCUSSION: The Marchetti-Vicenzi's nail (UEBN) permitted a stable fixation in tibial fractures. The use of this unreamed nailing coupled with an automatic distal locking in the metaphyseal cancellous bone, reduced operative time and shortened X Ray's radiation exposure. At the follow-up fracture healing occurred in 41 cases 95.3 p. 100 at four months. Two delayed union occurred after four months, the two cases were open fractures grade II. All the two cases healed after secondary procedure without any loss of function. Malunion occurred in two patients (in only one case there was a major valgus angulation 10 degrees), the two cases were related to technical error. We had no cases of infection or leg shortening or bundle migration in the ankle joint. CONCLUSION: We believe that Universal Elastic Bundle Nail allows a stable and safety fixation in open or closed tibial fractures without pseudarthrosis and without infection (in our series).
Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/instrumentação , Fraturas da Tíbia/cirurgia , Acidentes , Adolescente , Adulto , Idoso , Traumatismos em Atletas/complicações , Fenômenos Biomecânicos , Elasticidade , Desenho de Equipamento , Feminino , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas da Tíbia/classificação , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/etiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Grade III open tibial fractures often require long hospitialized and many operations. They always leave unsightly scars and functional results are sometimes very poor. We wanted to establish a predictive score for use in all cases to help us to decide if amputation would give a better result or not. We devised a "PLD" scoring system with a maximum of twenty points, comprising data that concern the patient (0 to 4), the lesions (0 to 14) and the delay of bone coverage(0 to 2). Patient outcome was quantitatively scored by assessing the function (15 points) and the quality of life (professional, sport and leisure, social and psychologic, 15 points). Twenty-seven cases of grade III open tibial fracture were reviewed for this study. Traffic accidents (23 cases) were very frequent. For each case, the total hospital stay and the type and the number of interventions were noted. PLD scores were calculated at emergency and after one month. Final outcome was evaluated at the latest patients follow-up. Results showed that if the PLD score in emergency or at one month was < 5, the final resut was good or excellent (>25) for more than 80 percent of patients. If the score at one month was < 5, the result was judged poor (<20) in more than half the cases. If the PLD score in emergency or at one month was o 20, all such cases required an amputation in emergency or at a later stage. (AU)