RESUMO
CASE: A 35-year-old female patient presented with an exposed forefoot fracture with bone and dermal loss after a vehicular accident. There was a bone defect at the level of the second toe and the third metatarsal. She was treated by second toe resection and second metatarsal transfer to augment the third metatarsal diaphysis ray (nonvascularized, without any soft-tissue envelope) and a microsurgical forearm flap. CONCLUSION: As one option among the reconstruction techniques available for a metatarsal segmental defect, metatarsal transfer associated with a fasciocutaneous radial forearm flap proved to be effective in this patient.
Assuntos
Transplante Ósseo/métodos , Traumatismos do Pé/cirurgia , Fraturas Cominutivas/cirurgia , Fraturas Expostas/cirurgia , Retalhos Cirúrgicos , Adulto , Amputação Cirúrgica , Fios Ortopédicos , Desbridamento , Feminino , Traumatismos do Pé/diagnóstico por imagem , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Expostas/diagnóstico por imagem , Humanos , RadiografiaRESUMO
La luxación erecta expuesta de hombro es una asociación lesional de muy baja frecuencia en la edad pediátrica. Son más frecuentes las lesiones fisarias y epifisarias que las luxaciones y lesiones ligamentarias. Esto es debido a la presencia de un tejido óseo con gran poder de deformidad elástica y un periostio grueso. Presentamos un caso clínico de un paciente de 11 años de edad que sufrió una luxación erecta expuesta de hombro derecho, producto de una caída de 1 metro y medio de altura. El tratamiento consistió en una limpieza quirúrgica de urgencia, reducción gleno humeral y antibioticoterapia empírica, penicinila 400.000 UI/kg/día fraccionado cada 6 hs y gentamicina 3mg/Kg/día fraccionada cada 8 h por 10 días, inmovilización por 3 semanas con cabestrillo seguido de rehabilitación, y un follow up de 2 años al final del cual el paciente no presento secuelas funcionales en la articulación glenohumeral derecha.
The exposed erect dislocation of the shoulder is a very low frequency lesion association in the pediatric age. The physical and epiphyseal lesions are more frequent than the dislocations and ligament injuries. This is due to the presence of a bone tissue with great elastic deformity power and a thick periosteum. We present a clinical case of an 11-year-old patient who suffered an exposed erect dislocation of the right shoulder, due to a fall of 1 meter and a half high. The treatment consisted of emergency surgical cleaning, humeral gleno reduction and empirical antibiotic therapy, penicinila 400,000 IU/kg/day divided every 6 hours and gentamicin 3mg/Kg/day divided every 8 hours for 10 days, immobilization for 3 weeks with a sling followed by rehabilitation, and a follow-up of 2 years at the end of which the patient did not present functional sequelae in the right glenohumeral joint.
A luxação ereta exposta do ombro é uma associação de lesão de freqüência muito baixa na idade pediátrica. As lesões físicas e epifisárias são mais freqüentes que as luxações e lesões ligamentares. Isto é devido à presença de um tecido ósseo com grande poder de deformidade elástica e um periósteo espesso. Apresentamos um caso clínico de um paciente de 11 anos de idade que sofreu uma luxação ereta exposta do ombro direito, devido a uma queda de 1 metro e meio de altura. O tratamento consistiu em limpeza cirúrgica de emergência, redução de gleno umeral e antibioticoterapia empírica, penicinila 400.000 UI / kg / dia dividida a cada 6 horas e gentamicina 3mg / Kg / dia dividida a cada 8 horas por 10 dias, imobilização por 3 semanas com tipóia seguida de reabilitação e seguimento de 2 anos no final dos quais o paciente não apresentava sequela funcional na articulação glenoumeral direita.
Assuntos
Humanos , Masculino , Criança , Luxação do Ombro/cirurgia , Luxação do Ombro/reabilitação , Luxação do Ombro/diagnóstico por imagem , Fraturas Expostas/cirurgia , Fraturas Expostas/reabilitação , Fraturas Expostas/diagnóstico por imagem , Penicilinas/administração & dosagem , Luxação do Ombro/tratamento farmacológico , Restrição Física , Gentamicinas/administração & dosagem , Seguimentos , Terapia por Exercício , Redução Fechada , Antibacterianos/administração & dosagemRESUMO
Surgical management of lower extremity malunions and acute fractures in the setting of lower extremity deformities presents a unique challenge for orthopaedic surgeons. The objective of this study was to evaluate the outcomes of using the clamshell osteotomy in patients with acute fractures involving a malunion or deformity. A retrospective review of the cases performed by various orthopaedic traumatologists at 4 different trauma centers was performed to identify cases using the clamshell osteotomy from January 2012 to January 2016. Nine clamshell osteotomy cases were identified, 4 presenting fractures in the setting of previous malunions. All osteotomies healed within 15 months (average 6.8 ± 4.4 SD). In this multicenter case series, we demonstrate that using clamshell osteotomies can result in excellent outcomes for permitting intramedullary nailing of acute fractures in patients with lower extremity deformity.
Assuntos
Fixação Intramedular de Fraturas/efeitos adversos , Consolidação da Fratura/fisiologia , Fraturas Expostas/cirurgia , Fraturas não Consolidadas/cirurgia , Traumatismos da Perna/cirurgia , Osteotomia/métodos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos de Coortes , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Fraturas Expostas/diagnóstico por imagem , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Tomografia Computadorizada por Raios X/métodos , Centros de TraumatologiaRESUMO
Fracture-dislocations of the talus are one of the most complex injuries involving the foot and ankle. These injuries are often accompanied by additional traumatic orthopedic injuries, avascular necrosis, and infection. When approaching limb reconstruction and salvage, the overall prognosis and functionality of the limb are key factors to consider. In the present report, we draw attention to the importance of a multidisciplinary team approach for formulating a treatment plan that incorporates the talar injury and associated injuries or pathologic features. We also reviewed the published data related to avascular necrosis of the talus, open talar fracture management, and treatment outcomes.
Assuntos
Traumatismos do Tornozelo/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Expostas/cirurgia , Osteonecrose/cirurgia , Tálus/lesões , Acidentes de Trânsito , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Parafusos Ósseos , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/cirurgia , Fraturas Expostas/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/cirurgia , Osteonecrose/diagnóstico por imagem , Osteonecrose/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Reoperação , Medição de Risco , Tálus/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Background: The objective of this study was to review the outcomes of patients who underwent one-bone forearm (OBF) reconstruction. Methods: A retrospective review of patients who underwent OBF surgery between 1994 and 2014 was undertaken. Patient demographics, etiology, associated injuries, number of surgeries prior to OBF surgery, surgical details, and postoperative information were collected. A telephone interview was conducted at final follow-up, including a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, a 10-point scoring system used by Peterson et al, and a series of questions concerning pain and patient satisfaction. Results: There were 6 males and 2 females with a mean age of 44 years (range, 20-66 years). All patients had traumatic etiology, with 6 having open wounds and 2 having closed wounds. All patients had union with a mean follow-up of 83.6 months (range, 16-218 months). The mean pain score was 3 (range, 0-8), of which 3 were painless (score 0). The mean QuickDASH score was 39 (range, 7-75), and 4 patients had good or excellent results according to the 10-point score system used by Peterson et al. All patients were satisfied with the result. Five of 8 had complications related to soft tissues that were residual from their prior injuries and surgeries. One patient had post healing fracture requiring revision fixation and 1 had a postoperative infection requiring parenteral antibiotics. Conclusions: OBF surgery is an effective salvage procedure for complicated forearm instability, particularly after trauma. While union rates are high, complications are typically related to pain and soft tissue secondary to the previous injury and reconstructive procedures.
Assuntos
Traumatismos do Antebraço/cirurgia , Instabilidade Articular/cirurgia , Adulto , Idoso , Transplante Ósseo/efeitos adversos , Transplante Ósseo/métodos , Feminino , Traumatismos do Antebraço/diagnóstico por imagem , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/cirurgia , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/cirurgia , Humanos , Instabilidade Articular/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Radiografia , Estudos Retrospectivos , Terapia de Salvação/efeitos adversos , Terapia de Salvação/métodos , Resultado do Tratamento , Adulto JovemRESUMO
The current study aimed to select suitable remedies for seawater immersion-complicated open-knee joint fracture by exploring the effects of different treatment methods. Forty adult rabbits weighing 2.20 ± 0.25 kg were divided equally into internal fracture fixation group (A), seawater-immersed group with primary internal fixation (B), seawater-immersed group with secondary internal fixation (C), and seawater-immersed group with external fixation (D), using the random-digit table method. Open-femoral internal condylar fracture models were established. Group A was left untreated for 2 h, whereas the other three groups were subjected to seawater immersion for 2 h. Afterwards, groups A and B underwent debridement and steel plate and screw internal fixation. Group C underwent debridement and external fixation, which was followed by secondary steel plate and screw internal fixation after the wound healed. Group D underwent transarticular arthrodesis. Wound infection, joint functional rehabilitation, and radiological and histopathological changes in fracture healing in each group were assessed. The results showed that delayed internal fixation effectively reduces the infection rate of seawater immersion-complicated open fracture and benefits joint function rehabilitation.
Assuntos
Fraturas Expostas/cirurgia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Água do Mar/efeitos adversos , Animais , Modelos Animais de Doenças , Feminino , Fixação de Fratura , Fraturas Expostas/complicações , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/reabilitação , Traumatismos do Joelho/complicações , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/reabilitação , Masculino , Coelhos , Radiografia , Resultado do Tratamento , Cicatrização , Infecção dos Ferimentos/etiologiaRESUMO
BACKGROUND: We conducted a study evaluating the clinical and radiologic results of the open tibial shaft fractures using an external fixator as definitive treatment. METHODS: Clinical, observational, descriptive, prospective and longitudinal study. Forty-six patients were included, 40 males (87%) and 6 females (13%), whose age was 31.02 +/- 14.62 years; the time elapsed from the accident to admission in the Emergency Room was 1-16 hours, with a mean of 5.1 +/- 3.35 hours. Ten patients (21.74%) had a Gustilo grade I open fracture, and 36 patients (78.26%) a Gustilo grade II fracture. They were also classified according to the AO classification, with the following resulting groups: 13 (28.9%) patients were A3, 12 (26.1%) were B3, 8 (17.4%) B1, 8 (17.4%) were B2, and 5 (10.9%) were A2. The dynamization of the fixator was done at a mean of 11.56 +/- 1.10 weeks. RESULTS: Forty-three patients had healing at 23.51 +/- 3.62 weeks; Gustilo I fractures healed at 22.8 +/- 3.5 weeks; Gustilo II fractures at 23.7 +/- 3.7 weeks, with a P value of 0.48. In 3 patients (6.53%), due to absence of healing, the external fixator was exchanged for an intramedullary nail with a bone graft, with healing occurring at 18 weeks. Six infections (13%) were reported at the nail insertion site; angulations ranged from 0 degrees to 8 degrees, which is tolerable. CONCLUSIONS: This fixator is safe in properly selected patients, since the few complications that occurred are similar to other reports using different internal fixation methods.
Assuntos
Fixadores Externos , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Expostas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Fraturas da Tíbia/diagnóstico por imagem , Adulto JovemRESUMO
Minimally invasive plate osteosynthesis (MIPO) has been advocated as a safe approach to humeral shaft fracture management. We evaluated the reproducibility of this technique in a regional hospital. Thirty-five patients underwent MIPO of humerus shaft fractures. Fifteen patients had an open fracture, six a preoperative radial nerve palsy, and nine a concomitant thoracic, musculoskeletal or vascular injury. At an average 12-month follow-up, 91% of fractures healed after a mean of 12 weeks (range, 8-16). Two infections occurred. Final alignment averaged 4° of varus (range, 5° of valgus to 20° of varus). Active elbow ROM averaged 114° (range, 60-135°) and was less than 100° in nine elbows. Five of six preoperative radial nerve injuries recovered spontaneously. Healing and infection rates in this study are consistent with those reported in the literature. Lower elbow ROM and higher fracture angulation at healing were nevertheless found. MIPO is technically demanding and requires adequate intraoperative imaging and surgical experience in order to obtain adequate fracture alignment. Brachialis muscle scarring and inadequate postoperative rehabilitation may be involved in limited elbow range of motion.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/cirurgia , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/cirurgia , Paralisia/complicações , Paralisia/diagnóstico por imagem , Paralisia/cirurgia , Complicações Pós-Operatórias/etiologia , Neuropatia Radial/complicações , Neuropatia Radial/diagnóstico por imagem , Neuropatia Radial/cirurgia , Radiografia , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Adulto JovemRESUMO
Tibial pilon fractures are difficult to manage because of their severity. These injuries are frequently open and contaminated, with marked comminution of the articular surface and metaphysis. The results of open reduction and internal fixation are dependent on the severity of the initial injury and the quality and stability of the reduction. The literature reports numerous complication rates associated with open reduction and internal fixation of pilon fractures. The Ilizarov technique of external fixation has fewer complications, and allows restoration of joint surfaces, reconstruction of length, and alignment of the extremity while maintaining a sufficient range of joint motion. Two cases of pilon fractures in which the Ilizarov method was utilized are reported, along with a review of the literature.
Assuntos
Fraturas Expostas/cirurgia , Técnica de Ilizarov , Fraturas da Tíbia/cirurgia , Fraturas Expostas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas da Tíbia/diagnóstico por imagemRESUMO
Two cases of ipsilateral open fracture of the femur and tibia treated using the dynamic ASIF-BM tubular external fixator are described. Results were very good, with short periods of occupational disability. These cases support primary stable osteosynthesis of these simultaneous fractures and the value of dynamic axial external fixation as a definitive treatment of open fractures of the femur and tibia shaft, either isolated or simultaneous.