RESUMO
An unusual case of anterolateral fracture-dislocation of the lumbosacral junction is reported, and seven additional cases from the literature are discussed. The mechanism of injury is forced hyperflexion and shear. The prevalence of neurologic involvement is high, as is the number of fractures of the adjacent spinal elements and the occurrence of disk fragments in the spinal canal. The value of plain radiography and computed tomography in diagnosis and planning treatment is illustrated.
Assuntos
Luxações Articulares/diagnóstico por imagem , Vértebras Lombares/lesões , Sacro/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adulto , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Twenty-five patients with aseptic nonunion of the humeral shaft, treated by a combined therapeutic procedure, are reported. The initial treatment of these 21 closed and four open fractures had been nonoperative in 21 patients and surgical in four. Seven further open procedures had been performed in four of these patients, also undergoing failure. The time period between the fracture and our treatment averaged 13 months (range, 6-46 months). A uniform therapeutic protocol, consisting of decortication, internal fixation with a broad, straight DCP ASIF plate and autologous cancellous bone grafting, was performed in all cases, supplemented with the use of surgical cement in one. Radiologic healing was achieved primarily in 24 patients in periods averaging 6 months and after renewal of the protocol in one patient. Followup averaged 35 months (range, 8-69 months): results were good in 21 patients.
Assuntos
Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Fraturas do Úmero/cirurgia , Adolescente , Adulto , Idoso , Placas Ósseas , Transplante Ósseo , Feminino , Fraturas Fechadas/diagnóstico por imagem , Fraturas Fechadas/cirurgia , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/cirurgia , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Fraturas do Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , RadiografiaRESUMO
Fifteen patients with large segmental necrosis of the tibia with deep infection, following open fractures, were treated according to the Burri-Papineau protocol. After radical debridement, the segmental bone defects averaged 8.4 (5-15) cm. Necrectomy, external fixation, and open cancellous grafting, in a two-stage procedure, gave infection control in 14 cases and bone healing in 12. Additional procedures, i.e., plating and posterolateral bone grafting, provided union in another 2 cases. One patient underwent amputation. Functional results in the other 14, after a follow-up averaging 4 years, were good in 9 cases, fair in 3, and poor in 2.