RESUMO
Operative fixation of acetabular fractures involving the quadrilateral surface presents a challenging clinical scenario. Classically, quadrilateral plate buttress was achieved via the use of a "seven" plate. More recently, the use of an anatomic, pre-contoured design has been gaining popularity due to its pre-contoured shape and larger footprint, allowing for a wider quadrilateral plate buttress. The current study presents using a stainless steel locking calcaneal plate to obtain similar surface area coverage as the modern pre-contoured quadrilateral plate, but at a lower cost.Level of evidence IV.
Assuntos
Acetábulo , Placas Ósseas , Fixação Interna de Fraturas , Fraturas Ósseas , Complicações Pós-Operatórias/prevenção & controle , Acetábulo/diagnóstico por imagem , Acetábulo/lesões , Acetábulo/cirurgia , Adulto , Fenômenos Biomecânicos , Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/reabilitação , Consolidação da Fratura , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Aço Inoxidável/farmacologia , Resultado do TratamentoRESUMO
The use of adjunct plate fixation is known to be a useful reduction aid during intramedullary nailing of the proximal tibia. We have expanded the indications beyond aiding the reduction and now use these plates as an adjunct to intramedullary nailing during the healing period. Specific indications include diaphyseal tibial fractures with severe bone loss/comminution and segmental tibial fractures with or without intraarticular extension. We believe the adjunctive permanent plate fixation technique may offer a treatment solution in these selected situations with the added benefit of immediate weight bearing.
Assuntos
Placas Ósseas , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Adulto , Terapia Combinada/instrumentação , Terapia Combinada/métodos , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Radiografia , Resultado do TratamentoRESUMO
Treatment of subtrochanteric fracture remains a challenge, but evolution of strategy has allowed for reliable results with low complications. Although several fixation options exist, reamed, antegrade intramedullary nailing (IMN) has evolved as the standard of care. Cognizant effort to achieve anatomic reduction before IMN passage allows for desired outcomes. Several reduction techniques can be used to overcome the deforming forces present in the proximal femur to allow for proper IMN placement. The purpose of this article is to review the tips, tricks, and pitfalls to avoid in the treatment of subtrochanteric femur fractures with IMN.
Assuntos
Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/cirurgia , Pinos Ortopédicos , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Quadril/diagnóstico por imagem , Humanos , RadiografiaRESUMO
OBJECTIVES: The purpose of this study was to determine significant factors that may impact the postoperative differences in femoral version (DFV) and differences in femoral length (DFL) between the fixed and uninjured sides after intramedullary nailing (IMN) secondary to gunshot wounds. DESIGN: Retrospective data registry study. SETTING: Academic level I trauma center. PATIENTS: Over a 10-year period, 417 patients underwent IMN of a diaphyseal femur fracture (OTA/AO 32A-C). Of these, 57 patients sustained fractures caused by gunshots and had a postoperative computed tomographic scanogram. MAIN OUTCOME MEASURES: DFV and DFL. The effect of the following variables on DFV and DFL were determined through univariate and stepwise multivariate regression analyses: age, sex, body mass index, trauma fellowship-trained versus nontrauma surgeon, daytime versus nighttime surgery, antegrade versus retrograde nail insertion, use of traction, type of operating table, and AO and Winquist classifications. RESULTS: The mean postoperative DFV for all patients was 8.62 degrees (±6.67 degrees). Postoperative DFV greater than 15 degrees was found in 12.3% of all patients. After IMN, no significant differences in DFV were found with increasing complexity of AO/OTA or Winquist fracture classification. None of the aforementioned independent variables were significantly predictive of postoperative DFV in univariate or multivariate analyses. The mean postoperative DFL for all patients was 5.25 mm (±4.36 mm). In a multivariate model, classification as Winquist type 3 or 4 was weakly (adjusted R = 0.075) but significantly predictive of less DFL than categorization as type 1 or 2 (P = 0.027). CONCLUSIONS: Although gunshot-associated femur fractures may present surgical challenges for treatment through IMN, acceptable femoral rotation and length are obtainable regardless of the fracture complexity or a variety of demographic and surgically-related variables. LEVEL OF EVIDENCE: Prognostic level II.