RESUMO
Bothrops lanceolatus is an endemic Crotalidae species in Martinique, where approximately 30 cases of envenoming are managed yearly. Envenoming characteristics from Bothrops species include local tissue damage, systemic bleeding, and hemodynamic alterations. We hereby report a case of severe envenomation following B. lanceolatus snakebite to the right calf. Severe local manifestations developed progressively up to the lower limb despite adequate antivenom therapy. Systemic manifestations of venom also occurred, resulting in intensive care therapy. Surgery exploration revealed soft tissue necrosis, friability of the deep fascia, and myonecrosis. The patient needed multiple debridement procedures and fasciotomy of all leg compartments and anterior compartment of the thigh. Diagnosis of necrotizing fasciitis was confirmed by positive Aeromonas hydrophila blood cultures. This clinical case illustrates that major soft tissue infection, including necrotizing fasciitis may occur after snakebite. Abnormal coagulation tests should not delay surgical management, as severe envenoming is a life-threatening condition.
Assuntos
Bothrops , Gerenciamento Clínico , Fasciite Necrosante/etiologia , Fasciotomia , Mordeduras de Serpentes/cirurgia , Adulto , Aeromonas hydrophila/isolamento & purificação , Animais , Venenos de Crotalídeos/efeitos adversos , Desbridamento , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Humanos , Martinica , Coxa da Perna/patologia , Coxa da Perna/cirurgiaRESUMO
UNLABELLED: Gossypiboma imaging features are not well known and are often confused with soft tissue tumours. Publications on this topic mainly consist of case reports and small cohorts. Its appearance on various imaging modalities is not well defined. This led us to carry out a review of literature to determine specifically: (1) which imaging modalities should be used in cases of suspected gossypiboma, (2) what are the most common imaging findings that contribute to the diagnosis of gossypiboma. An exhaustive review of literature was carried out in June 2015 in the Medline, PubMed and Cochrane databases using the keywords "gossypiboma/textiloma/foreign body". We found 205 articles describing one or multiple cases of gossypiboma in various locations. Of these, the 32 articles that had imaging data were chosen - 16 for the limbs and 16 for other locations. The type of imaging carried out, description of the gossypiboma and circumstances of the discovery and occurrence were recorded. Descriptive statistics were generated to define the type of imaging used and the various findings. Imaging consisted of X-rays in 21/32 cases (66%), computed tomography (CT) in 14/32 cases (43%), magnetic resonance imaging (MRI) in 21/32 cases (65%) and ultrasonography in 14/32 cases (43%). On X-rays, bone involvement was found in 9/15 cases (60%); there was peripheral contrast product uptake on the CT scans in 9/14 cases (64%), a hypointense signal on T1-weighted sequences on MRI in 6/13 cases (46%) and lack of vascularisation in 8/13 cases (62%) and a acoustic shadow on ultrasonography in 9/14 cases (64%). In a patient presenting with a soft tissue lump and history of surgery, an imaging work-up including X-rays, ultrasonography and MRI must be performed. Bone involvement on X-rays, acoustic shadowing on ultrasonography and hypointense signal on T1-weighted MRI sequences with lack of vascularisation in combination with a history of surgery can bring up the possibility of gossypiboma. If there is a possibility of soft tissue tumour, the case should be discussed in a multidisciplinary meeting and a biopsy should be performed first. LEVEL OF EVIDENCE: IV - systematic analysis of published retrospective studies.
Assuntos
Diagnóstico por Imagem/métodos , Extremidades/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Diagnóstico Diferencial , HumanosRESUMO
BACKGROUND: Although fractures of the proximal femur (FPF) are supposedly less frequent in Black populations (studies of incidence are rare) the life expectancy in Africa is low, which could partially explain this notion. There is only one retrospective study on the incidence of FPF in the islands of the Caribbean, thus we performed an incidence study in the insular, circumscribed, 90% Afro-Caribbean population of Martinique. The goals of this study were: (1) to estimate the incidence of FPF; (2) and to prospectively describe the main characteristics. HYPOTHESIS: The incidence of fractures of the proximal femur in Martinique is lower than in Western countries. PATIENTS AND METHODS: The raw and standardized incidence ratio of FPF in relation to the world population was estimated based on data from the Medical Information System Program (Programme de médicalisation des systèmes d'information [PMSI]) for all of Martinique for a period of 4 years (January 1, 2010 to December 31, 2013). Characteristics were based on all patients over the age of 60 who presented to the Fort-de-France University Hospital (CHU) for a FPF between December 1, 2011 and April 31, 2012. Patients with light-skin phenotype, high-energy fractures and secondary fractures were excluded from the study. RESULTS: The standardized incidence ratio in relation to the world population was estimated (n=794) as 22.5/100,000 patient-years [20.6-24.4]: 22.6 and 22.4/100,000 in men and women respectively. The characteristics of eighty-seven patients (including 56 women), mean age 85.3 (±7.2) (62-100) years old were evaluated: 52 femoral neck fractures (60%) and 33 fractures of the greater trochanter (38%). The 2-month mortality rate was 21%, and 1/3 of the surviving patients could function independently. The risk of death increased in relation to the initial risk of moderate to severe dementia. DISCUSSION: The incidence of FPF in Martinique is lower than in Western countries and includes, as expected, an elderly, female population. Unlike a previous study performed in Guadeloupe, there was a majority of femoral neck fractures. A Caribbean multi-insular study is needed to confirm these results and to obtain precise data on bone density. LEVEL OF EVIDENCE: IV; descriptive prospective epidemiological study.
Assuntos
Fraturas do Colo Femoral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , População Negra , Doenças Ósseas Metabólicas/epidemiologia , Demência/epidemiologia , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Fraturas por Osteoporose/epidemiologia , Autonomia Pessoal , Estudos ProspectivosRESUMO
OBJECTIVES: We conducted a retrospective study to examine the optimal regimen of transfusion and whether preoperative transfusion is needed in patients with Sickle cell anaemia (SCA) undergoing a Total hip arthroplasty (THA). Then, we assessed the incidence of perioperative complications rates among patients assigned to different transfusion regimens to propose finally the safety transfusion protocol. BACKGROUND: Preoperative transfusions are usually given to reduce or prevent perioperative complications to SCA patients undergoing THA. There is no consensus however on the best regimen of transfusion. STUDY DESIGN AND METHODS: During the period of 2000 to 2010, 14 patients with SCA (sex-ratio 0.4) with a mean age of 36 years underwent 16 THA (primary or revision). Three groups were differentiated according preoperatively protocol transfusion. Group 1: exchange transfusion (EXT), group 2: simple transfusion (ST), group 3: no transfusion (NT). RESULTS: Overall, preoperative transfusion was performed in 43.7% of cases and complications rate was 50%. In the group 1 (EXT) including five patients (31%), severe complications occurred in four patients (80%). in the group 2, including two patients (12.5%), no complications were observed. In the group 3, including nine patients (56%), complications occurred in four procedures (44.5%), the half of them were haemolytic complications. CONCLUSION: Our results support the decision to transfuse, ST, preoperatively only if the patient is significantly below their steady-state haemoglobin (Hb) level. Transfusion can be used intraoperatively according Hb level and/or the blood loss volume. Exchange transfusion appeared mostly to be related to postoperative morbidity rates.
Assuntos
Anemia Falciforme/terapia , Artroplastia de Quadril/efeitos adversos , Transfusão de Eritrócitos/métodos , Transfusão Total/métodos , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Anemia Falciforme/complicações , Anemia Falciforme/cirurgia , Transfusão de Eritrócitos/efeitos adversos , Feminino , França , Humanos , Incidência , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Adulto JovemRESUMO
We report on a case of isolated lesser trochanter fracture, without associated trauma, secondary to pulmonary adenocarcinoma metastasis. Treatment consisted in resection-reconstruction by megaprosthesis. This form of isolated fracture is rare, and results from infiltration of the trochanteric area by a malignant tumoral process, which is usually metastatic.
Assuntos
Adenocarcinoma/secundário , Neoplasias Ósseas/secundário , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Adenocarcinoma/terapia , Neoplasias Ósseas/terapia , Terapia Combinada , Diagnóstico Diferencial , Prótese de Quadril , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
UNLABELLED: Femoral head fracture-dislocations (FHFD) are rare, while irreducible cases are even less frequent. Truly irreducible fractures such as the two cases in this report must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. Opinions vary on the surgical approach to be used once the hip is reduced and the fragment of the femoral head yet remains to be stabilized. Reports in the literature do not usually take into account the specificity of irreducible lesions, which in our opinion should be treated by the transgluteal approach (TGA) while reducible forms can be treated by the Hueter approach. The transgluteal approach with the patient in the lateral decubitus position provides a direct anterior view of the antero-infero-medial fracture site as well as dorsal access via the injuries occasioned to dorsal soft tissues by the posterolateral dislocation. A lag screw can be used with this approach, which is the only way to stabilize the ligament teres femoris attachment. LEVEL OF EVIDENCE: Level IV retrospective historical study.
Assuntos
Cabeça do Fêmur/lesões , Fixação Interna de Fraturas/métodos , Luxação do Quadril/cirurgia , Fraturas do Quadril/cirurgia , Adulto , Artroplastia de Quadril , Nádegas/cirurgia , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/etiologia , Necrose da Cabeça do Fêmur/cirurgia , Seguimentos , Consolidação da Fratura/fisiologia , Luxação do Quadril/diagnóstico por imagem , Fraturas do Quadril/diagnóstico por imagem , Humanos , Masculino , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Radiografia , ReoperaçãoRESUMO
We report clinical, radiological and histological findings following high tibial valgisation osteotomy (HTVO) using micro-macroporous biphasic calcium phosphate wedges fixed with a plate and locking screws. From 1999 to 2002, 43 knees were operated on and studied prospectively. All underwent clinical and radiological follow-up at days 1, 90, and 365 to evaluate consolidation and bone substitute interfaces. Additionally, biopsies were taken for histology at least 1 year after implantation from 10 patients who requested plate removal. Radiologically, consolidation was observed in 98% of cases. At 1 year, correction was unchanged in 95% of cases. Histological analysis revealed considerable MBCP resorption and bone ingrowth, both into the pores and replacing the bioceramic material. Polarised light microscopy confirmed normal bony architecture with trabecular and/or dense lamellar bone growth at the expense of the wedge implants. X-ray and micro-CT scan revealed a well organised and mineralised structure in the newly-formed bone. This study shows that using MBCP wedges in combination with orientable locking screws and a plate is a simple, safe and fast surgical technique for HTVO. The is the first study to examine the results by histological analysis, which confirmed good outcomes.
Assuntos
Substitutos Ósseos , Cerâmica , Articulação do Joelho/cirurgia , Osteotomia/instrumentação , Tíbia/cirurgia , Adolescente , Adulto , Idoso , Placas Ósseas , Parafusos Ósseos , Fosfatos de Cálcio/análise , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osseointegração , Osteotomia/métodos , Estudos Prospectivos , Radiografia , Tíbia/diagnóstico por imagem , Tíbia/ultraestruturaRESUMO
OBJECTIVE: No studies have been performed on cruising sailors who spend most of the year on offshore cruising sailboats. To gain a better understanding of this population, traumatic events occurring in this group of sailors were studied to define appropriate means of prevention. DESIGN, SETTING AND PATIENTS: Primary care data were collected prospectively using a questionnaire during in-depth interviews by one of the authors (FM) of 100 cruising sailboat crews that called at Martinique between December 2001 and May 2002. MAIN OUTCOME MEASUREMENTS: In total, 56 injuries were reported: 20 involved the upper limb, 20 the lower limb, and 7 the head and neck. There were also 19 burns, 11 of which were photoinduced and 8 accidental. There were 16 skin infections, 3 of which were complicated by arthritis. RESULTS: After analysis, we found that most of these injuries could be prevented if the following recommendations were applied. Wearing shoes would avoid foot injuries. A hatch cover would effectively protect from cranial trauma caused by the boom. To protect from the sun, a bimini top (cover to shield the cockpit) would be most effective. A windlass would avoid hand injuries and acute lower back pain. Lastly, meticulous wound care until complete healing would prevent the common complications of skin superinfections. CONCLUSIONS: Injuries to professional seafarers and ocean racers are well described, but the increasingly growing cruising sailor population has not been well studied. Development of easy and inexpensive worldwide network connection will allow better follow-up of this mobile population.
Assuntos
Traumatismos em Atletas/prevenção & controle , Navios , Esportes , Adulto , Traumatismos em Atletas/etiologia , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , TelemedicinaRESUMO
The authors report a case of a patient with paraparesis secondary to T5-T6 spondylodiscitis accompanied by a closely lying, well-formed pleural abscess. This rare association has previously been reported only twice in the literature. The technical difficulty of surgery for both the abscess and the compressive spondylodiscitis was resolved by the use of an enlarged posterior approach. This approach enabled evacuation of the pleural lesion, curettage of the disc space, interbody grafting, and spinal osteosynthesis in one stage.
RESUMO
PURPOSE OF THE STUDY: The aim of this radiological study was to evaluate the use of a biphasic ceramic wedge combined with plate fixation with locked adjustable screws for open wedge tibial osteotomy. MATERIAL AND METHODS: Twenty-six consecutive patients (27 knees) underwent surgery between December 1999 and March 2002 to establish a normal lower-limb axis. The series included 6 women and 20 men, mean age 50 years (16 right knees and 11 left knees). Partial weight-bearing with crutches was allowed on day 1. A standard radiological assessment was performed on day 1, 90, and 360 (plain AP and lateral stance films of the knee). A pangonogram was performed before surgery and at day 360. Presence of a lateral metaphyseal space, development of peripheral cortical bridges, and osteointegration of the bone substitute-bone interface were evaluated used to assess bone healing. The medial tibial angle between the line tangent to the tibial plateau and the anatomic axis of the tibia (beta) was evaluated to assess preservation of postoperative correction. The HKA angle was determined. RESULTS: Three patients were lost to follow-up and 23 patients (24 knees) were retained for analysis. At last follow-up, presence of peripheral cortical bridges and complete filling of the lateral metaphyseal space demonstrated bone healing in all patients. Good quality osteointegration was achieved since 21 knees did not present an interface between the bone substitute and native bone (homogeneous transition zone). The beta angle was unchanged for 23 knees. A normal axis was observed in patients (16 knees) postoperatively. DISCUSSION: Use of a biphasic ceramic wedge in combination with plate fixation with locked adjustable screws is a reliable option for open wedge tibial osteotomy. The bone substitute fills the gap well. Tolerance and integration are optimal. Bone healing is achieved. Plate fixation with protected weight bearing appears to be a solid assembly, maintaining these corrections.