RESUMO
INTRODUCTION: Intra-articular distal radial fractures in young subjects occur in severe trauma. Articular reduction needs to be anatomical. We report four cases with the particularity of having a 90° or 180° rotated lunate fossa. Our goal is to bring out the positive aspects of surgical procedure by volar medial approach and to assess long-term functionnal and radiological results. MATERIAL AND METHODS: Our study focused on four men whose average age was 27 (age range from 19 to 43). The fractures were type IV according to Melone's classification. The associated lesions included: one fracture of the base of the ulnar styloid, one fracture of the distal quarter of the ulnar diaphysis and one scapho-lunate diastasis. We used a volar medial approach between the flexors tendons and the ulnar bundle in order to pin the fragment of lunate fossa. The rest of the radial epiphysis was pinned after a 5mm skin incision. In two cases, this pinning was complemented with a brachial-antebrachial-palmar cast and in the other two cases with an external fixator. RESULTS: The follow-up period averaged 68.8 (18 to 115) months, all the patients were clinically examined through antero-posterior, lateral and dynamic X-rays. The objective results assessed according to Green and O'Brien's criteria, later modified by Cooney, were as follows: two very good, one good, one average. The X-rays showed consolidated fractures. According to Knirk and Jupiter's classification of arthritis, we had three grades 0, one of which showed a subchondral sclerosis of the lunate fossa, and one grade 3. DISCUSSION AND CONCLUSION: Imaging with simple radiographs is not sufficient and needs to be complemented with CT scan. Our approach allows for direct access to the fragment of the lunate fossa and easier visualization of the distal radioulnar, compared to Henry's approach, thereby avoiding excessive traction of the median nerve. TYPE D'ÉTUDE: Niveau IV.
Assuntos
Fratura de Colles/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Osso Semilunar/cirurgia , Placa Palmar/cirurgia , Fraturas da Ulna/cirurgia , Adulto , Fratura de Colles/diagnóstico por imagem , Fixadores Externos , Seguimentos , Consolidação da Fratura , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/lesões , Masculino , Placa Palmar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fraturas da Ulna/diagnóstico por imagemRESUMO
We describe the case of an original insertion and course of the abductor digiti minimi muscle on the medial part of the palmaris longus tendon. The anomalous muscle was only present on the left side. Various studies have reported the frequency of anomalous muscles in approximately 22 to 35% of hands and it was in majority an anomalous abductor digiti minimi muscle. The knowledge of this original insertion is important because it can sometimes be correlated with ulnar nerve compression at Guyon's canal. But Guyon's canal syndrome is less common than carpal tunnel syndrome, and the incidence of ulnar nerve compression in relation with anomalous muscle is approximately 2.9% of cases. It is possible to diagnose the anomalous muscle through ultrasound or MRI. This variation should be taken into consideration by surgeons during surgical procedures for ulnar nerve decompression at Guyon's canal and when performing anteromedial approach to the wrist between flexors tendons and ulnar bundle.
Assuntos
Mãos/anatomia & histologia , Músculo Esquelético/anatomia & histologia , Síndromes de Compressão do Nervo Ulnar/etiologia , Punho/anatomia & histologia , Cadáver , Mãos/embriologia , Humanos , Complicações Intraoperatórias/prevenção & controle , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/embriologia , Síndromes de Compressão do Nervo Ulnar/diagnóstico por imagem , Síndromes de Compressão do Nervo Ulnar/patologia , Síndromes de Compressão do Nervo Ulnar/cirurgia , Ultrassonografia , Punho/embriologiaRESUMO
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
The management of combined loss of skin coverage and bone substance in the lower third of the leg is problematic. A recommended sequential strategy associates removal of infected tissue and coverage followed by treatment of the bone defect. We report a technique without microsurgery, using Masquelet's induced membrane technique to manage the bone loss, associated to bone transport and coverage by a fasciocutaneous flap with distal pedicle. In a patient presenting with a 10 cm defect with bone exposure, this 2-step procedure allowed consolidation at 7 months without functional sequelae; the fixator was kept in place for 9 months. Neither microsurgery nor cancellous bone graft was required. Using a spacer to induce a membrane facilitated bone transport and distal consolidation.
Assuntos
Fraturas Expostas/cirurgia , Procedimentos Ortopédicos/métodos , Fraturas da Tíbia/cirurgia , Adulto , Desbridamento , Fixadores Externos , Humanos , Técnica de Ilizarov , Masculino , Membranas ArtificiaisRESUMO
Centipede bites occurring in tropical countries are rare, however vigilance must be exercised during activities in the open air and dwellings should be checked in the event of rain. The bite is very painful and can be accompanied by generalised signs. An initial wound disinfection and a check of antitetanus vaccination status is all that is usually needed to ensure an uneventful outcome. There are however, rare cases where local toxicity and a bacterial super-infection, often with Gram+ cocci, can lead to a cellulitis or even necrotizing fasciitis of the hand. The diagnosis of a centipede bite can be made by the double marks made by the fangs. Wound debridement and antibiotics led to a good outcome in both our cases.
Assuntos
Braço , Artrópodes , Mordeduras e Picadas/complicações , Celulite (Flegmão)/microbiologia , Fasciite Necrosante/microbiologia , Infecções Estafilocócicas/etiologia , Adolescente , Idoso de 80 Anos ou mais , Animais , Feminino , Humanos , MasculinoRESUMO
The authors report a case of bilateral C4-C5 facet fracture dislocation associated with a severe sprain underlying C5-C6, which had occurred during an traffic accident. The diagnosis of severe sprain was raised on the 55 th day. The injury mechanism is studied. Contiguous multilevel injuries of the lower cervical spine should be suspected in case of high-energy trauma. MRI can provide an exhaust if diagnosis of possible multilevel injuries. After fixation of the obvious lesion, intraoperative dynamic fluoroscopy must be performed to demonstrate any instability in another area.
Assuntos
Traumatismos da Coluna Vertebral/diagnóstico , Acidentes de Trânsito , Adolescente , Artrodese , Placas Ósseas , Vértebras Cervicais/patologia , Fluoroscopia , Fixação de Fratura , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/patologia , Imageamento por Ressonância Magnética , Masculino , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/patologia , Traumatismos da Coluna Vertebral/patologia , Entorses e Distensões/diagnóstico , Entorses e Distensões/patologia , Tomografia Computadorizada por Raios XRESUMO
We report a case of anterior thigh compartment syndrome (TCS), which occurred after a closed femoral fracture internal fixation using an intramedullary rod. A 20 ml ropivacaine hydrochloride single-injection femoral block had preceded general anaesthesia to conduct the surgical procedure. The compartment syndrome diagnosis was made the morning after surgery when the level of pain was interpreted as disproportionate to the treated lesion; in addition, compartment pressure measure had increased to 54 mmHg. A compartment fasciotomy was performed. Diagnostic delays have previously been observed and attributed to nerve blocks in cases of tibial fracture. This patient's report raises the question of whether a femoral block may be responsible for delays in diagnosing compartment syndrome, although no series have been published of such occurrences in large numbers. When nerve blocks are used, they should be more analgesic than anaesthetic. Careful patient monitoring remains important.
Assuntos
Síndromes Compartimentais/etiologia , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Bloqueio Nervoso/efeitos adversos , Coxa da Perna/lesões , Acidentes de Trânsito , Adulto , Amidas/administração & dosagem , Anestésicos Locais/administração & dosagem , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/cirurgia , Diagnóstico Diferencial , Humanos , Medição da Dor , Ropivacaina , Coxa da Perna/cirurgia , Adulto JovemRESUMO
We report the case of a fracture of the glenoid, Goss-Ideberg type II, associated with an inferior dislocation of the shoulder, a combination that has not to our knowledge been previously reported. The injury had occurred after a fall of three metres. The radiological assessment included an anteroposterior view and a CT scan that guided the surgical approach by indicating that the fragment of the glenoid cavity was especially dorsal. We carried out a preoperative MRI to eliminate the possibility of a rotator cuff tear being present. The surgical treatment was carried out with the patient in lateral decubitus position and restored normal function to the shoulder.
Assuntos
Fraturas Ósseas/complicações , Luxações Articulares/complicações , Traumatismo Múltiplo , Escápula/lesões , Articulação do Ombro , Fraturas Ósseas/classificação , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/cirurgiaRESUMO
We report a case of acute carpal tunnel syndrome caused by prolonged compression. A 40-year-old man was admitted for an acute carpal tunnel syndrome secondary to direct compression of the wrist which was blocked in supination under his thorax for ten hours during a period of alcoholic coma. Total sensorial anesthesia of the median nerve territory was noted. The emergency procedure consisted in simple opening of the carpal tunnel without nerve exploration due to the risk of bacterial contamination resulting from skin lesions, devascularization and postoperative fibrosis. Initially, the skin on the volar aspect of the wrist had the aspect of a second degree burn. The patient recovered nerve function the next day and the skin wound healed within 15 days. The patient was seen at consultation at 13 months and exhibited complete recovery of wrist and hand motion with normal thumb opposition and no signs of sensorial or motor deficit. The retinaculum of the flexor system must be opened to guarantee full nervous recovery.
Assuntos
Intoxicação Alcoólica/complicações , Síndrome do Túnel Carpal/etiologia , Doença Aguda , Adulto , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/cirurgia , Coma/induzido quimicamente , Coma/complicações , Seguimentos , Humanos , Masculino , Nervo Mediano/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do TratamentoRESUMO
We report three cases of complete traumatic tibialis posterior tendon rupture which occurred after ankle fracture. Diagnosis was established at surgery. Repair of the non-degenerative tendon was achieved during the procedure for osteosynthesis of the malleolar fracture. Fractures healed a few months after surgery. The posterior tibialis muscle tendon functioned plantar arch was normal, except in one patient with multiple injuries who died in intensive care thirteen days after the accident. Although exceptional, injury of the tibialis posterior tendon should not be overlooked after ankle fracture. These injuries become apparent only at surgery for the malleolar fracture since pain hinders clinical examination. Primary suture best guarantees a good functional outcome. Residual pain, deficit in active inversion of the foot, modified medial longitudinal arch, or progression to planovalgus are retrospective diagnostic signs.