RESUMO

Epiphyseal fractures of the metatarsal head are a rare entity specially as an isolated injury and is rarely seen in patients with skeletal immaturity. Due lack of documentation for this type of fracture, the treatment of choice is uncertain. The purpose of the present study is to present two cases and treatment of epiphyseal fracture of the second metatarsal head, to our knowledge there are no publications for this injury.

Las fracturas epifisarias de la cabeza metatarsiana son una entidad poco frecuente, principalmente cuando se presentan de forma aislada y en raras ocasiones se ven en pacientes con inmadurez esquelética. Debido a la escasez de documentación para este tipo de fractura, el tratamiento de elección es incierto. El motivo del presente estudio es presentar dos casos de fractura epifisaria de la cabeza del segundo metatarsiano y su tratamiento, ya que para nuestro conocimiento no hay publicaciones al respecto.

Assuntos

RESUMO

Introducción: Las fracturas del metatarso son las lesiones traumáticas más comunes del pie, y las del primer metatarsiano son las cuartas en frecuencia. El tratamiento funcional de las fracturas metatarsianas consiste en el apoyo efectivo y precoz, sin inmovilización del miembro. Objetivo: Comparar la efectividad del tratamiento funcional en las fracturas del primer metatarsiano con los tratamientos convencionales Métodos: Se realizó un estudio analítico, observacional, retrospectivo, de casos y controles, en 102 fracturas del primer metatarsiano durante un período de ocho años. La muestra incluyó a pacientes de ambos sexos, entre 16 y 65 años de edad. Se comparó el tratamiento funcional con los tratamientos ortopédico y quirúrgico. Las fracturas fueron clasificadas según su localización, recomendación terapéutica y tratamiento efectuado. Los resultados fueron evaluados en función de la duración de la incapacidad temporal y las complicaciones. Resultados: 48 fracturas fueron tratadas con el método funcional y 41 mediante descarga e inmovilización. Los 13 pacientes con criterio de indicación quirúrgica fueron intervenidos mediante reducción y osteosíntesis. Se obtuvo una menor duración de la incapacidad y menos complicaciones con el tratamiento funcional que con los tratamientos convencionales. Conclusiones: En los últimos años ha aumentado la tendencia a tratar las fracturas metatarsianas de manera conservadora y muchos autores recomiendan el método funcional como tratamiento de elección. Este proporciona una curación más temprana y ocasiona menos complicaciones que los tratamientos convencionales(AU)

Introduction: Metatarsal fractures are the most common traumatic injuries of the foot, and those of the first metatarsal are the fourth in frequency. The functional treatment of metatarsal fractures consists of effective and early support, without limb immobilization. Objective: To compare the effectiveness of functional treatment in fractures of the first metatarsal with conventional treatments. Methods: An analytical, observational, retrospective, case-control study was conducted on 102 first metatarsal fractures over a period of eight years. The sample included patients of both sexes, between 16 and 65 years of age. Functional treatment was compared with orthopedic and surgical treatments. The fractures were classified according to location, therapeutic recommendation and treatment. The results were evaluated according to the duration of the temporary incapacity and the complications. Results: Forty eight fractures were treated with the functional method and 41 by offloading and immobilization. The thirteen patients with surgical indication criteria were operated by reduction and osteosynthesis. A shorter duration of disability and fewer complications were achieved with functional treatment than with conventional treatments. Conclusions: In recent years, the tendency to treat metatarsal fractures conservatively has increased and many authors recommend the functional method as the treatment of choice. This provides earlier healing and causes fewer complications than conventional treatments(AU)

Assuntos

RESUMO

Background: The metacarpal/metatarsophalangeal joints, as well as the suspensory apparatus, are usually affected by injuries, due to the intense physical demand during sports and great range of motion, predisposing to degenerative processes,trauma and rupture of the suspensory apparatus. In this case, arthrodesis is the main technique indicated. Such surgicaltechniques have a poor prognosis due to post-surgical complications, such as implant infection. Therefore, the study ofprocedures that promote better joint stabilization is important, with reduced surgical time and tissue exposure, decreasingsignificantly the chance of infection and other possible complications.Case: A 5-year-old male horse was referred to the hospital with a history of trauma and a lacerating wound in the metatarsalplantar region of the left hindlimb. The animal presented grade IV (I-V) claudication of the left hindlimb with hyperextension of the metatarsophalangeal joint and significant pain on palpation, evidencing the rupture of the superficial, deep digitalflexor tendons and suspensory ligament of the fetlock. The initial surgical treatment was performed using the arthrodesistechnique described by [16]. The intramedullary nail was used with fixation of the plate on the plantar face of the first phalanx together with a single plate fused to the pin, adjusted according to size of the first phalanx, 13 mm thick x 15 cm long,forming an angle between 120º and 140º. Twenty-four h after surgery, there was a simple spiral diaphyseal fracture (typeA), in the middle third of the third metatarsal bone in the region of the proximal end, due to the lever held by the short nailagainst the diaphysis cortex. To treat the complication, an intramedullary 316 L surgical steel rod 13 mm thick x 21 cm longwas used, filling the entire spinal canal. The nail had three holes at the proximal end and two holes at the distal end...(AU)

Assuntos

RESUMO

BACKGROUND: Zone 1 fractures of the proximal fifth metatarsal are usually treated nonsurgically using some type of immobilization. The aim of this study was to compare clinical and functional outcomes, time to return to prior activity levels, and rate of bone healing when using a hard-soled shoe (HSS) vs a controlled ankle motion (CAM)-walker boot (CWB). METHODS: Seventy-two consecutive patients with zone 1 fractures of the fifth metatarsal base were treated conservatively with either an HSS or CWB by 2 different providers. We included 57 women and 15 men, average age of 41.3 (range, 16-88) years. Radiographic findings, visual analog scale (VAS) for pain, and American Orthopaedic Ankle & Foot Society (AOFAS) midfoot score were assessed. Patients were followed at 4, 8, 10, 12, and 24 weeks or until asymptomatic and able to return to prior level of activities. Statistical analysis was performed using Mann-Whitney U, Fisher exact, and chi-square tests. P values <.05 were considered significant. RESULTS: Age and gender distributions were similar in both groups (P = .23 and P = .57). Patients had similar VAS and AOFAS scores after 8 (P = .34 and P = .83) and 12 (P = .87 and P = .79) weeks. Average time for bone healing was significantly faster using the CWB (7.2 weeks) when compared to the HSS (8.6 weeks) (P < .001). The average time to return to prior level of activities was similar in both groups (8.3 weeks for CWB and 9.7 weeks for HSS) (P = .11). Fracture displacement was equal in both groups, with a mean of 1.9 mm of displacement in patients using the HSS, and a mean of 1.6 mm in those using the CWB (P = .26). CONCLUSION: Zone 1 fractures of the proximal fifth metatarsal can be treated conservatively with either a hard-soled shoe or a CAM-walker boot. Even though patients treated in the CAM-walker boot demonstrated earlier signs of complete healing, similar clinical and functional results were achieved with both treatments. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Assuntos

RESUMO

Background: The metacarpal/metatarsophalangeal joints, as well as the suspensory apparatus, are usually affected by injuries, due to the intense physical demand during sports and great range of motion, predisposing to degenerative processes,trauma and rupture of the suspensory apparatus. In this case, arthrodesis is the main technique indicated. Such surgicaltechniques have a poor prognosis due to post-surgical complications, such as implant infection. Therefore, the study ofprocedures that promote better joint stabilization is important, with reduced surgical time and tissue exposure, decreasingsignificantly the chance of infection and other possible complications.Case: A 5-year-old male horse was referred to the hospital with a history of trauma and a lacerating wound in the metatarsalplantar region of the left hindlimb. The animal presented grade IV (I-V) claudication of the left hindlimb with hyperextension of the metatarsophalangeal joint and significant pain on palpation, evidencing the rupture of the superficial, deep digitalflexor tendons and suspensory ligament of the fetlock. The initial surgical treatment was performed using the arthrodesistechnique described by [16]. The intramedullary nail was used with fixation of the plate on the plantar face of the first phalanx together with a single plate fused to the pin, adjusted according to size of the first phalanx, 13 mm thick x 15 cm long,forming an angle between 120º and 140º. Twenty-four h after surgery, there was a simple spiral diaphyseal fracture (typeA), in the middle third of the third metatarsal bone in the region of the proximal end, due to the lever held by the short nailagainst the diaphysis cortex. To treat the complication, an intramedullary 316 L surgical steel rod 13 mm thick x 21 cm longwas used, filling the entire spinal canal. The nail had three holes at the proximal end and two holes at the distal end...

Assuntos

RESUMO

Introdução: as lesões no complexo articular de Lisfranc ocorrem devido a trauma direto ou indireto, no qual forças de torção ou axiais são transmitidas ao pé. Os modelos cadavéricos são úteis para avaliar padrões de lesões e modelos de fixação, mas frequentemente a quantidade de deslocamento articular após a lesão torna-se um limitador. O objetivo deste estudo foi testar um modelo cadavérico que inclui carga axial, flexão plantar do pé e movimentos de pronação-supinação, recriando diástase óssea semelhante ao observado em lesões sutis de Lisfranc na prática clínica. Nossa hipótese é de que a aplicação do movimento de pronação e supinação em um modelo cadavérico produziria deslocamentos ósseos confiáveis e mensuráveis. Métodos: foram utilizadas 24 amostras cadavéricas frescas congeladas amputadas abaixo do nível do joelho. Os ossos cuneiformes medial e intermédio, o primeiro e o segundo metatarsos, foram marcados. Uma lesão ligamentar completa foi realizada entre os cuneiformes medial e intermédio e entre o cuneiforme medial e o segundo metatarso em 12 amostras (grupo 1) e adicionou-se a lesão dos ligamentos entre o primeiro metatarso e o cuneiforme medial e entre o segundo metatarso e o cuneiforme intermédio em 12 amostras correspondentes (grupo 2). Pronação e supinação do pé, além de uma carga axial de 400 N, foram aplicadas às amostras, utilizando-se o Instrom Testing Machine. Um digitalizador tridimensional (3D) foi utilizado para medir as distâncias entre os ossos. Resultados: para o grupo de lesão parcial (grupo 1), as distâncias referentes aos ossos nos quais os ligamentos foram seccionados apresentaram aumento na condição lesionada tanto em pronação quanto em supinação, como esperado. Em relação à distância entre o cuneiforme intermédio e o primeiro metatarso e entre o primeiro e o segundo metatarsos, observou-se diminuição na condição lesionada em pronação e aumento em supinação. Para o grupo de lesão completa (grupo 2), as distâncias referentes aos locais de secção dos ligamentos apresentaram aumento na condição lesionada tanto em pronação quanto em supinação, como esperado. No tocante à distância entre o cuneiforme intermédio e o primeiro metatarso e entre o primeiro e o segundo metatarsos, verificou-se o mesmo padrão de comportamento das lesões parciais. Conclusão: o modelo biomecânico cadavérico para lesões do complexo articular de Lisfranc desenvolvido neste estudo simula o mecanismo de estresse clínico da lesão e o tipo de lesão mais comum, exibe variações de distâncias fidedignas e mensuráveis e foi desenvolvido para permitir o teste do tratamento da lesão sem interferência nos dispositivos de aferição, podendo se constituir em excelente método para a comparação de técnicas de fixação das lesões ligamentares tarsometatarsais.

Introduction: Lesions in the Lisfranc joint complex occur due to direct or indirect trauma, where a torsional or axial force is transmitted to the foot. Cadaveric models are a useful way to assess injury patterns and fixation models, but a frequent limitation is the amount of joint dislocation after injury. The aim of this study was to test a cadaveric model that includes axial load, plantar flexion of the foot and pronation-supination movement, recreating bone diastasis similar to that observed in subtle Lisfranc lesions in clinical practice. Our hypothesis is that the application of pronation and supination motion in a cadaveric model would produce reliable and measurable bone displacements. Methods: Twenty-four fresh frozen cadaveric leg samples were used. The medial (C1) and intermediate (C2) cuneiform bones, the first (M1) and second (M2) metatarsal bones were marked. A complete ligament injury was performed between C1-C2 and C1-M2 in 12 samples (Group 1) and between C1-C2, C1-M2, C1-M1 and C2-M2 in 12 corresponding samples (Group 2). Foot pronation and supination, in addition to an axial load of 400 N, were applied to the samples. A 3D scanner was used to measure the distances between the bones. Results: For the partial lesion group (Group 1), in which the ligaments between C1-C2 and C1-M2 were injured, these distances increased in the injured condition in both pronation and supination, as expected. Regarding the distance C2-M1 and M1-M2, there was a decrease in the injured condition in pronation and an increase in supination. For the complete lesion group (Group 2), in which the ligaments between C1-C2, C1-M2, C1-M1, and C2-M2 were injured, these distances increased in injured condition both in pronation and supination, as expected. Regarding the behavior of distances C2-M1 and M1-M2, the same behavior pattern was observed as in partial injuries. Conclusion: The cadaveric biomechanical model for Lisfranc joint complex injuries developed in this study simulates the mechanism of clinical stress of the lesion and the most common type of lesion, exhibits reliable and measurable distances, and allows lesion treatment without compromise, being, possibly, an excellent method for comparing tarsometatarsal ligament injury fixation methods.

Assuntos

RESUMO

PURPOSE: To investigate the effect of intermittent vibration at different intervals on bone fracture healing and optimize the vibration interval. METHODS: Ninety sheep were randomized to receive no treatment (the control group), incision only (the sham control group), internal fixation with or without metatarsal fracture (the internal fixation group), and continuous vibration in addition to internal fixation of metatarsal fracture, or intermittent vibration at 1, 2, 3, 5, 7 and 17-day interval in addition to internal fixation of metatarsal fracture (the vibration group). Vibration was done at frequency F=35 Hz, acceleration a=0.25g, 15 min each time 2 weeks after bone fracture. Bone healing was evaluated by micro-CT scan, bone microstructure and mechanical compression of finite element simulation. RESULTS: Intermittent vibration at 7-day interval significantly improved bone fracture healing grade. However, no significant changes on microstructure parameters and mechanical properties were observed among sheep receiving vibration at different intervals. CONCLUSIONS: Clinical healing effects should be the top concern. Quantitative analyses of bone microstructure and of finite element mechanics on the process of fracture healing need to be further investigated.

Assuntos

RESUMO

Abstract Purpose: To investigate the effect of intermittent vibration at different intervals on bone fracture healing and optimize the vibration interval. Methods: Ninety sheep were randomized to receive no treatment (the control group), incision only (the sham control group), internal fixation with or without metatarsal fracture (the internal fixation group), and continuous vibration in addition to internal fixation of metatarsal fracture, or intermittent vibration at 1, 2, 3, 5, 7 and 17-day interval in addition to internal fixation of metatarsal fracture (the vibration group). Vibration was done at frequency F=35 Hz, acceleration a=0.25g, 15 min each time 2 weeks after bone fracture. Bone healing was evaluated by micro-CT scan, bone microstructure and mechanical compression of finite element simulation. Results: Intermittent vibration at 7-day interval significantly improved bone fracture healing grade. However, no significant changes on microstructure parameters and mechanical properties were observed among sheep receiving vibration at different intervals. Conclusions: Clinical healing effects should be the top concern. Quantitative analyses of bone microstructure and of finite element mechanics on the process of fracture healing need to be further investigated.

Assuntos

RESUMO

Kounis syndrome represents the concurrence of acute coronary syndromes or anginal pain with allergic, hypersensitivity, and anaphylactoid reactions that are increasingly found in clinical practice. We present a case of a young woman who experienced attacks of dyspnea, hypoxemia, and hypotension during and after spinal anesthesia. Based on the pattern of clinical symptoms and laboratory findings, she was retrospectively diagnosed with Kounis syndrome, even though no apparent trigger of hypersensitivity was found.

Assuntos

Assuntos