RESUMO
The treatment of Gustilo-Anderson type III open femoral fracture with large segmental bone defect remains a challenge for orthopedic trauma surgeons. The aims of management are first to prevent the risk of infection and then to reconstruct the bone loss with correct alignment and length. The induced membrane technique (or Masquelet technique) was initially described for tibia nonunion but became over the years an established procedure to treat any kind of large bone defect. The case of a 22-year old male who sustained an open femoral shaft fracture with a circumferential 7-cm bone defect after a car accident is presented. Given the critical size of the bone loss, we chose to manage this patient using a modified-Masquelet technique, in which we stabilized the fracture by an intramedullary femoral nail and filled only the lateral side of the defect with a cement spacer. He went on to have a full and successful union of his fracture 16-weeks after the second stage surgery. The final functional outcomes were excellent allowing the patient to resume all activities without restriction.
RESUMO
Articular fractures of the distal humerus are rare, and even rarer are fractures involving the trochlea and capitellum in a single fragment, with no associated comminution. These fractures are classified as 2a according to the Dubberley classification and are rarely described in the literature. Two cases of Dubberley 2a fractures were treated at our hospital. The first case, involving a 68-year-old patient, was treated with a medial and a lateral approach, combined with posteroanterior fixation using 3 Herbert screws. In the 2nd case, a 16-year-old male was treated with a single lateral approach, permitting fixation with two Herbert screws. One of the two screws is inserted into the bone at the edge of the cartilage, with an anteroposterior trajectory that leaves the cartilage intact. We opted mainly for posteroanterior screw fixation in subchondral bone, which is less damaging to articular cartilage and soft tissues and has already demonstrated its reliability. No associated lesions were found, and no complications were encountered. Results were excellent, with Mayo Elbow Performance Index (MEPI) scores of 95 and 100 respectively. Herbert screw fixation therefore appears to be an option of choice for these fractures, although comparative studies are needed to evaluate the different treatments available.
RESUMO
We report a case of anterior thigh compartment syndrome, which occurred after man's thigh was bruised after flipping repeatedly over his bike and being hit by the frame of the bike nearly at around 6 pm. The next day at 1:30 am, he was admitted to the hospital. The initial presentation was a hematoma, and the patient was kept in bed with local cooling. The compartment syndrome of the thigh (CST) diagnosis was made around 6:00 pm when the level of pain was interpreted as disproportionate to the treated lesion; anterior compartment pressure measure was 84 mmHg. A compartment fasciotomy was performed. It is difficult to diagnose a CST in case of muscular contusion as the latter causes symptoms that are similar to CST. A conservative treatment without fasciotomy was carried out by several authors, especially in sportsmen showing a CST following contusion. This conservative treatment implies close monitoring of intramuscular pressures and adjuvant measures (bed rest, holding the thigh at the heart level and oxygenotherapy).
Assuntos
Síndrome do Compartimento Anterior/etiologia , Síndrome do Compartimento Anterior/cirurgia , Fasciotomia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgia , Adulto , Síndrome do Compartimento Anterior/diagnóstico , Humanos , Escala de Gravidade do Ferimento , Masculino , Doenças Raras , Coxa da Perna/cirurgia , Resultado do Tratamento , Ferimentos não Penetrantes/diagnósticoRESUMO
Our aim, through a comparative study of two populations, one European and the other Afro-Caribbean, was to find out whether there were differences in radiographic measurements of femoral diaphyseal canal diameter, thickness of the medial and lateral cortex, and global diaphyseal diameter. We studied the nailed femurs of adult males in a population of 54 Europeans and 52 Afro-Caribbeans. Both populations were comparable in terms of age, height and weight. The measurements were taken with a ruler on the narrowest area of the hourglass, the isthmus, on an antero-posterior radiograph. The diameter of the femoral canal was classified into three intervals: <13 mm, 13-14 mm and >14 mm. The femoral canal diameter was significantly larger in the European patients, 14.3 (11-19) versus 13.4 (11-15.6), while the thickness of the lateral cortex was significantly larger in the Afro-Caribbean patients, 8.50 (6-12) versus 7.72 (5.4-11.5). Patient distribution according to the intervals was different in both groups: 59% of the Afro-Caribbeans were in the average interval versus 24.1% of the Europeans. For nearly 53.7% of the Europeans, the diameter of the femoral canal fell in the last interval versus 15.4% of the Afro-Caribbeans. The fact that the femoral canal is narrower in the Afro-Caribbean population may be linked to a thicker lateral cortex. The diameters of the nails used were larger in the European population, 12.6 mm (10-15) versus 12.1 mm (11-14) in the Afro-Caribbean population. The global diameters of both populations' femurs were similar (28.9 mm for the European sample vs. 29 mm). The present study may have an impact on the implants used in the orthopedic surgery (intramedullary nailing, arthroplasty implants). The range of usable implants must be complete and there must be precise pre-operative planning. A study of computed tomography scans could complement our measurements.