Determining the Borderline Anatomical Parameters for Better Functional Outcome of Colles Fracture: A Prospective Study / Determinação dos parâmetros anatômicos limítrofes para melhor desfecho funcional da fratura de Colles: Um estudo prospectivo

Abstract Objective The treatment of Colles fracture can deform the wrist. Some studies claim the resulting deformity rarely hinders daily activities, whereas others report the opposite; thus, anatomical reduction is desirable. Our objective was to analyze the anatomical and functional results of Colles fracture to find out the values of individual parameters corresponding to the best functional outcome. Methods The present prospective study included 70 elderly patients with Colles fracture. All patients were managed conservatively. The anatomical parameters were evaluated by measuring dorsal angulation, radial inclination, and radial height, and they were assessed as per Stewart et al. The functional result was assessed by the Mayo wrist score. The results were analyzed using the chi-squared test of association, and a p-value < 0.001 was considered statistically significant and to examine strengths of associations; we computed odds ratios (ORs) with 95% confidence intervals (CI). Results Excellent and good results were obtained in 68.5% of the cases anatomically and 78.5% functionally, which was statistically significant (p= 0.0009). Out of the three anatomical parameter dorsal angulation < 10° and loss of radial inclination < 9° showed statistically significant association with functional results (p= 0.0006), but loss of radial height < 6 mm did not (p= 0.0568), which became significant when loss of radial height was kept < 4 mm (p= 0.00062). Conclusion Fractures with anatomical reduction have better functional results. The acceptable borderline anatomical parameters for obtaining excellent or good functional results are dorsal angulation < 10°, loss of radial inclination < 9°, and loss of radial height < 4 mm.

Resumo Objetivo O tratamento da fratura de Colles pode deformar o pulso. Alguns estudos afirmam que essa deformidade raramente dificulta as atividades diárias, enquanto outros relatam o contrário; assim, a redução anatômica é desejável. Nosso objetivo foi analisar os resultados anatômicos e funcionais da fratura de Colles para descobrir os valores de parâmetros individuais correspondentes ao melhor desfecho funcional. Métodos Este estudo prospectivo incluiu 70 pacientes idosos com fratura de Colles. Todos os pacientes foram tratados de forma conservativa. Os parâmetros anatômicos foram a angulação dorsal, a inclinação radial e a altura radial, avaliados de acordo com Stewart et al. O resultado funcional foi avaliado segundo a tabela de pontuação de pulso Mayo. Os resultados foram analisados por meio do teste de associação do qui-quadrado, considerando o valor de p< 0,001 estatisticamente significativo. A força das associações foi analisada por razões de possibilidades com intervalos de confiança de 95%. Resultados Excelentes e bons resultados anatômicos e funcionais foram obtidos em 68,5% e 78,5% dos casos, respectivamente, com diferença estatística significativa (p= 0,0009). Dos três parâmetros anatômicos, a angulação dorsal inferior a 10° e a perda da inclinação radial inferior a 9° apresentaram associação estatisticamente significativa com os resultados funcionais (p= 0,0006), mas não a perda de altura radial inferior a 6 mm (p= 0,0568); no entanto, a perda da altura radial inferior a 4 mm foi associada de forma significativa aos desfechos funcionais (p= 0,00062). Conclusão As fraturas com redução anatômica apresentam melhores desfechos funcionais. Os parâmetros anatômicos limítrofes aceitáveis para a obtenção de resultados funcionais excelentes ou bons são angulação dorsal inferior a 10°, perda da inclinação radial inferior a 9° e perda da altura radial inferior a 4 mm.

Vertebrectomia total e estabilização com pinos e polimetilmetacrilato como tratamento para luxação entre vértebras torácicas em cão ­ relato de caso / Total vertebrectomy and stabilization with pins and polymethylmethacrylate as treatment for thoracic vertebral luxation in a dog - case report

As lesões decorrentes de atropelamento são as principais causas de fraturas e luxações vertebrais, ocasionando graus variáveis de injúrias vertebrais e medulares. O presente trabalho tem como objetivo relatar a ocorrência de lesão traumática em coluna vertebral de cão sem raça definida, com quatro anos de idade, resultando em luxação T11-12, com exposição de T11 e secção medular, estando o paciente paraplégico, com sinais de lesão em neurônio motor superior e ausência de nocicepção profunda em membros pélvicos. O tratamento de escolha foi a vertebrectomia de T11, associada ao alinhamento de T10-12 com introdução de pinos e fixação com polimetilmetacrilato (PMMA) associado à ceftriaxona. Em decorrência de lesão na pleura parietal no trans-cirúrgico, optou-se pela toracostomia para introdução de tubo torácico, o qual permaneceu no paciente por quatro dias. No pós-operatório, o paciente apresentou recuperação satisfatória, sendo recomendado aos tutores a confecção de cadeira de rodas a fim de facilitar sua locomoção. A técnica mostrou-se satisfatória para minimizar as infecções passíveis de ocorrência em fraturas expostas, bem como melhorar a qualidade de vida do paciente, evitando-se dores crônicas.

Injuries resulting from being run over are the leading causes of vertebral fractures and dislocations, causing varying vertebral and spinal injuries. The present study aims to report the occurrence of traumatic injury to the spine of a mixed breed dog, aged four years, resulting in a T11-12 dislocation, with T11 exposure and spinal section, with the patient showing paraplegia, signs of an upper motor neuron lesion and absence of deep nociception in pelvic limbs. The treatment of choice was T11 vertebrectomy, associated with the alignment of T10-12 with the introduction of pins and fixation with polymethylmethacrylate (PMMA) associated with ceftriaxone. Due to a lesion in the parietal pleura during the surgery, thoracostomy was chosen to introduce a chest tube, which remained in the patient for four days. In the postoperative period, the patient presented a satisfactory recovery, and it was recommended that tutors make a wheelchair to facilitate their mobility. The technique proved to be satisfactory for minimizing infections that could occur in open fractures and improving the patient's quality of life, avoiding chronic pain.

Luxo-fractura humeral conminuta con preservacion de la cabeza. Reporte de caso / Conminuted fracture of the humerus managed with head preservation. Case report

La incidencia de las fracturas de la cabeza humeral es aproximadamente del 6% de todas las fracturas con mayor afectación a las mujeres quienes tienen tres veces más probabilidad de presentar este tipo de fracturas que los hombres. Las fracturas de humero proximal que involucren tres o más fragmentos representan un alto riesgo y altas tasas de necrosis de la cabeza humeral. El objetivo de este reporte de caso es mostrar el éxito de la reconstrucción en una luxo fractura de humero proximal compleja con preservación de la cabeza. Paciente masculino de 35 años de edad quien sufre luxo fractura multifragmentada de la cabeza del húmero Neer IV y fractura de platillos tibiales schatzker IV por accidente de tránsito en motocicleta. Con una evolución favorable y satisfactoria.

The incidence of humeral head fractures is approximately 6% of all fractures with greater involvement in women who are three times more likely to have this type of fracture than men. Proximal humerus fractures involving three or more fragments represent a high risk and high rates of humeral head necrosis. The objective of this case report is to show the success of the reconstruction in a complex proximal humerus luxofracture with preservation of the head. Herein we present a 35-year-old male patient with a multifragmented luxofracture of the humerus head (Neer IV) and fracture of the tibial plateau Schatzker IV due to motorcycle traffic accident with a favorable and satisfactory evolution.

Iliofemoral technique modification using an anchor screw as treatment of canine traumatic hip luxation - case report / [Modificação da técnica de sutura iliofemoral com uso de parafuso âncora no tratamento da luxação coxofemoral traumática em cães - relato de caso]

Twelve dogs with traumatic hip luxation were selected for surgical intervention with a modified iliofemoral suture technique using an anchor screw to substitute the passage of suture material through a perforated tunnel in the ilium. Six procedures were performed with non-absorbable suture and other six with absorbable suture materials. These cases were evaluated at 15, 30, 60, and 90 days after surgery by performing an ambulation analysis and palpation of the joint. In all cases, there was a return of partial and total limb support in an average of 3 and 19 postoperative, respectively. The fixation strategy of the suture material in the ilium using an anchor screw proved to be efficient with a smaller surgical approach and lesser surgical difficulty, maintaining joint congruence in acute as chronic luxation cases. The use of absorbable and non-absorbable sutures had excellent clinical results, but there was a subjective superiority of the first ones, once 4 dogs of the non-absorbable group presented some discomfort during the postoperative palpation of the joint, 90 days after surgery.(AU)

Doze cães com luxação coxofemoral traumática foram submetidos à intervenção cirúrgica de sutura iliofemoral modificada com uso de parafuso âncora substituindo a passagem de fio através de túnel perfurado no ílio. Seis procedimentos foram realizados com fio não absorvível, e outros seis com fio absorvível. Os casos foram avaliados aos 15, 30, 60 e 90 dias após a cirurgia, por meio de análise de deambulação e palpação articular. Em todos os casos, houve retorno de suporte parcial e total do peso no membro operado, em média, aos três e 19 dias de pós-operatório, respectivamente. A estratégia de fixação do fio de sutura no ílio com parafuso âncora se mostrou eficaz, permitindo uma abordagem cirúrgica menos invasiva, com menor dificuldade na execução, garantindo manutenção da congruência articular tanto em quadros de luxação aguda como crônica. O uso de fio absorvível e não absorvível teve bons resultados clínicos, porém houve uma superioridade subjetiva do primeiro, uma vez que quatro pacientes do grupo fio inabsorvível mostraram desconforto à palpação da articulação aos 90 dias após a cirurgia.(AU)

Luxación inveterada del semilunar / Inveterate Lunate Dislocation

RESUMEN Las fracturas-luxaciones carpianas son lesiones poco frecuentes que ocurren tras traumatismos de alta energía y que, inicialmente, muchas veces pasan desapercibidas. Se presenta un paciente de 32 años de edad, masculino, que había sido atendido seis semanas antes en la consulta de trauma tras caer de una altura aproximada de 6 metros. Se diagnosticó luxación aislada del semilunar y se le realizó carpectomía parcial. La evolución fue satisfactoria, el paciente se incorporó a su vida social activa a las 16 semanas del acto operatorio. Tras un año de evolución presentó dolor leve y ocasional(AU)

ABSTRACT Carpal fracture-dislocations are rare injuries that occur after high-energy trauma and that, initially, often go unnoticed. A case of a 32-year-old male patient is reported, he had been treated six weeks earlier in the trauma clinic after falling from a six meter height approximately. An isolated lunate dislocation was diagnosed and partial carpectomy was performed. The evolution was satisfactory, the patient joined his active social life 16 weeks after the operation. After a year of evolution, he showed mild and occasional pain(AU)

Luxación palmar divergente del escafoides y semilunar: reporte de caso / Palmar divergent dislocation of the scaphoid and lunate: case report

Reportamos el caso de un hombre de 61 años de edad quien presentó una luxación palmar divergente del escafoides y semilunar de la muñeca derecha secundario a trauma por caída de una escalera en su casa, quien fue atendido a las 24 horas del accidente, se le realizó una resección de los dos huesos (desvascularizados completamente), y se redujo el hueso grande en la fosa semilunar del radio más reparación de la cápsula articular y los ligamentos palmares radiocarpales. Al control del primer año el resultado ha sido satisfactorio, con un buen desempeño de su actividad laboral, y con una congruencia de la articulacion radio hueso grande y estabilidad completa de la muñeca. Nivel de Evidencia: IV

We report the case of a 61-year-old man who presented a Palmar divergent dislocation of the scaphoid and lunate of the right wrist secondary to trauma due to the fall of a ladder in his house, who was seen 24hours after the accident, he underwent a resection of the two bones (completely devascularized), and the Capitate bone was reduced in the lunate fossa of the radius by adding a repair of the joint capsule and the radiocarpal palmar ligaments. After the first year of follow up the result has been broadly satisfactory, with good performance of his working activity, and with a congruence of the Radial-Capitate joint with complete stability of the wrist. Evidence Level: IV

Fracturas de epitróclea: serie de casos en un hospital pediátrico / Medial epicondyle fractures: clinical cases a pediatric hospital

Resumen Las fracturas de la epitróclea representan el 11 al 20% de las lesiones en codo en población pediátrica y aproximadamente el 50% se asocia a luxación en el codo, siendo la incarceración menos frecuente. El objetivo del trabajo es describir los resultados funcionales de una serie de pacientes con fractura de epitróclea. Se realizó un estudio observacional descriptivo y retrospectivo de pacientes pediátricos con fracturas de epitróclea, atendidos en un hospital pediátrico. Se revisaron las historias clínicas y los datos fueron analizados en Excel. El estudio fue aprobado por el comité de ética del hospital. Se tomaron 42 casos de los cuales 39 cumplieron con los criterios de inclusión. La edad media fue 11.3 años (4-16 años). El 77% fueron operados y la fractura se asoció a luxación del codo en el 25.6%. El 7.6% de los casos tuvieron neuroapraxia de nervio cubital con recuperación espontánea. La fractura de la epitróclea se observa en población pediátrica involucrada en actividades de alto rendimiento. Puede ocurrir falla en diagnóstico debido a la compleja osificación del codo y también a la superposición de imagen de la epitróclea con la tróclea humeral. Se asocia con luxación del codo entre un 25 a 50% de los casos. El tratamiento de esta fractura es ortopédico o quirúrgico. Las tasas de consolidación en ambos tratamientos son similares.

Abstract Medial epicondyle fractures represent 11-20% of elbow injuries in the pediatric population. Approximately 50% is associated with dislocation in the elbow. Incarceration is less frequent. The objective of this study is to describe the functional results of a cases of patients with medial epicondyle fracture and to review the subject. It is a descriptive and retrospective observational study of pediatric patients with medial epicondyle fracture, attended in a pediatric hospital. The medical records were reviewed and the data were analyzed in an Excel table. The study was approved by the hospital ethics committee. 39 of 42 cases, met the inclusion criteria. The average age was 11.3 years (4-16 years). 77% were operated and the fracture was associated with dislocation of the elbow in 25.6%. The 7.6% of the cases had ulnar nerve neuroapraxia that they recovered spontaneously. The medial epicondyle fracture is observed in the pediatric population involved in high performance activities. Subdiagnosis can occur due to the complex ossification of the elbow and also to the superimposition of the medial epicondyle image with the humeral trochlea. It is associated with dislocation of the elbow between 25 to 50% of cases. The treatment of this fracture is orthopedic or surgical. The consolidation rates in both treatments are similar.

Trans-scaphoid perilunate fracture dislocation beyond Mayfield stage IV: a case report on a new classification proposal / Fratura luxação transescafoperissemilunar além do estágio IV de Mayfield. Estudo preliminar. Proposta de nova classificação: relato de caso

ABSTRACT This report and review of the literature aims to recognize the complete enucleation beyond stage IV of the classification proposed by Mayfield. The addition of a fifth category is proposed, added for complete ligament injuries that lead to nonexistent circulation for the radiolunate ligament, preventing surgical reconstruction, thus influencing surgical treatment.

RESUMO Esse relato e revisão na literatura tem como objetivo reconhecer a enucleação total além do estágio IV da classificação proposta por Mayfield. Propõe-se a adição de uma quinta categoria, para lesões ligamentares completas que levam a uma circulação inexistente do ligamento radiolunar, impedem a reconstrução cirúrgica e influenciam, assim, o tratamento cirúrgico.

Presentación inusual de una fractura-luxación peritalar / Unusual presentation of a peritalar fracture dislocation

Una luxación peritalar implica la ruptura simultánea de las articulaciones talocalcánea y talonavicular. Es relativamente poco frecuente y representa aproximadamente del 1% al 1,5% de todas las lesiones traumáticas del pie. La luxación medial es la más frecuente (alrededor del 80% de los casos comunicados). Las luxaciones peritalares laterales son menos frecuentes (17%) y las posteriores (2,5%) y anteriores son raras (1%). Aproximadamente el 55% del subtipo medial y el 72% del subtipo lateral se asocian con fracturas. Se presenta el caso de una mujer de 36 años que sufrió un traumatismo indirecto practicando kitesurf al caerse de la tabla tratando de evitar un accidente. Sufrió una luxación peritalar lateral con fracturas de escafoides tarsiano, calcáneo y peroné asociadas. A los tres días, se intentó una reducción cerrada y a los seis días, se realizó la cirugía. Se recomienda un diagnóstico precoz de las luxaciones peritalares y un rápido reconocimiento de las fracturas asociadas e infrecuentes, con el fin de evitar complicaciones frecuentes. Nivel de Evidencia: IV

A peritalar dislocation involves simultaneous disruption of the talocalcaneal and talonavicular joints. It is relatively uncommon and account for approximately 1% to 1.5% of all traumatic foot injuries. Medial dislocation is the most frequent type accounting for approximately 80% of reported cases. Lateral peritalar dislocations are less common (17%), and posterior (2.5%) and anterior dislocations are rare (1%). Approximately 55% of medial and 72% of lateral subtypes are associated with fractures. We report the case of a 36-year-old woman who suffered an indirect traumatism during kitesurf practice, after falling from the kite-board trying to avoid an accident. She presented a lateral peritalar dislocation with associated navicular, calcaneal and fibular fractures. A closed reduction was attempted three days from trauma. Six days after the lesion, surgery was performed. We recommend an early diagnosis of peritalar dislocations and a correct recognition of infrequent fractures to avoid usual complications. Level of Evidence: IV

Luxofractura tarsometatarsiana asociada a luxación mediotarsiana y subastragalina / Fracture-luxation tarsométatarsienne associée à luxation médiotarsienne et sous-astragalienne / Tarsometatarsian luxofracture associated with midtarsal dislocation and subastragalina

Las lesiones del pie son difíciles de tratar por la complejidad anatómica de la región y por su infraestimación diagnóstica y terapéutica. Por lo general, se producen por traumas de alta energía. Se presenta un paciente del sexo masculino, blanco, de 56 años de edad, que llegó al cuerpo de guardia de emergencia con múltiples traumas producto de un accidente automovilístico. Se diagnosticó una luxofractura tarsometatarsiana asociada a luxación mediotarsiana y luxación subastragalina. Con criterio de tratamiento quirúrgico de urgencia fue llevado al salón de operaciones y se le realizó la reducción cerrada de la articulación mediotarsiana y subastragalina, y la estabilización con clavo de Steimann. La evolución fue satisfactoria tras el tratamiento quirúrgico(AU)

Foot injuries are difficult to treat due to the anatomical complexity of the region and the diagnostic and therapeutic underestimation. Generally, high-energy trauma produced this kind of injuries. We present a 56 year-old, white, male patient, who arrived at the emergency room with multiple traumas resulting from a car accident. The diagnosis was a tarsometatarsal luxo-fracture associated with midtarsal dislocation and subtalar dislocation. He underwent an emergency surgical treatment to closed reduce of the midtarsal and subtalar joint, and stabilization was achieve with Steinmann Pins. The evolution was satisfactory after the surgical treatment(AU)

Les lésions du pied sont difficiles à traiter due à la complexité anatomique de cette région et à leur faible estimation diagnostique et thérapeutique. En général, ces lésions résultent des traumatismes à haute énergie. Le cas d'un patient âgé de 56 ans, blanc, arrivé au service d'urgence avec plusieurs traumatismes causés dans un accident de route, est présenté. Une fracture-luxation tarsométatarsienne, associée à une luxation médiotarsienne et une luxation sous-astragalienne, a été diagnostiquée. Répondant à un critère d'urgence chirurgicale, il a subi une réduction fermée de l'articulation médiotarsienne et sous-astragalienne et une stabilisation par clou de Steinmann. Son évolution a été satisfaisante après ce geste chirurgical(AU)

Evaluación funcional y radiológica del tratamiento quirúrgico de la luxación acromioclavicular, mediante técnica Phemister modificada vs técnica 4 suturas / Functional and radiological assessment of the surgical treatment of the acromioclavicular luxation, by means of modified technique Phemister vs technical 4 sutures

INTRODUCCIÓN: La lesión de la articulación acromio clavicular es una de las más frecuentes, quizás por su posición subcutánea y la relativa escasez de músculos que la protegen. Generalmente se producen en eventos deportivos, pero también son comunes en accidentes o traumas de alto impacto. Se producen por un mecanismo indirecto, generalmente al caer de costado sobre el hombro, aplicándose una fuerza lateral en el acromion. OBJETIVO: Determinar los resultados funcionales y radiológicos en pacientes sometidos a tratamiento quirúrgico de luxación acromio-clavicular con técnica Phemister modificada vs técnica 4 suturas. MATERIAL Y MÉTODOS: Estudio serie de casos. Se estudiaron 59 pacientes de ambos sexos de 20 a 70 años de edad, internados en el servicio de Traumatología y Ortopedia del Hospital Obrero Nº 1, durante el periodo del 1° de enero al 31 de diciembre del año 2013. Se realizó la valoración funcional (Test de Imatani) y radiológica de 55 pacientes operados con la técnica de Phemister modificada y de 4 pacientes operados con la técnica 4 suturas. RESULTADOS: Los pacientes operados con la técnica de Phemister modificada obtuvieron los resultados funcionales: 40.0% excelente, 38.2% bueno, 18.2% aceptable y 3.6% pobre; y radiológicos: 87.3% aceptable, 10.9% pobre y 1.9% recidiva. Y los pacientes operados con la técnica 4 suturas obtuvieron resultados funcionales: 75.0% excelente, 25.0% bueno, 0.0% aceptable y 0.0% pobre; y radiológicos: 100% aceptable. CONCLUSIÓN: Se observa una superioridad de la técnica 4 lazadas respecto a la técnica Phemister modificada, en lo que respecta tanto a los resultados funcionales como los radiológicos.

INTRODUCTION: The injury of the clavicular acromion joint is one of the most frequent, perhaps because of its subcutaneous position and the relative scarcity of the muscles that protect it. They usually occur at sporting events, but they are also common in accidents or high impact traumas. They are produced by an indirect mechanism, usually by falling sideways on the shoulder, applying a lateral forcé in the acromion. OBJECTIVE: Determining the functional and radiological results in patients submitted to surgical treatment of luxation clavicular acromion with engineering modified Phemister vs technical 4 sutures. MATERIAL AND METHODS: Case series study. 59 patients were studied of both sexes from 20 to 70 years of age, inpatients in the service of Traumatology and Orthopedic of the Hospital Obrero No 1, over the course of the 1 one belonging to January to December 31 the year 2013. The functional (Imatani's Test) and radiological assessment of 55 patients operated on with the modified technique of Phemister and of 4 patients operated on with the technique accomplished 4 sutures itself. RESULTS: The patients operated on with the modified technique of Phemister obtained the functional results: 40,0 % excellent, 38,2 % good, 18,2 % acceptable and 3,6 % poor; And radiological: 87,3 % acceptable, 10,9 % poor and 1,9 % relapsing. And the patients operated on with the technique 4 sutures obtained functional results: 75,0 % excellent, 25,0 % good, 0,0 % acceptable and 0,0 % poor; And radiological: 100 % acceptable. CONCLUSIONS: It is observed a superiority of the technique 4 linked in relation to the modified Phemister technique, with respect to the functional and radiological results.

Luxo-fractura de Chopart / Fracture-luxation de l'articulation de Chopart / Chopart luxo-fracture

La articulación de Chopart o transversa del tarso está constituida por la articulación calcaneocuboidea y la astragaloescafoidea. Las lesiones que ocurren en estas articulaciones se conocen como luxo-fractura de Chopart y son extremadamente raras. Entre las causas más frecuentes se encuentran los accidentes en motocicletas y las caídas de altura. El tratamiento es la reducción anatómica y fijación estable. La necrosis avascular del astrágalo, así como la artritis postraumática son las complicaciones más temidas. Con este trabajo se pretende describir la conducta y evolución perioperatoria de dos pacientes con luxo-fractura de Chopart, atendidos en el Servicio de Urgencias del Hospital Militar Central Dr Luis Díaz Soto. Fueron diagnosticados tempranamente y se les realizó reducción abierta más fijación interna con una recuperación en los primeros tres meses. La baja prevalencia de la luxo-fractura de Chopart requiere un diagnóstico adecuado y correcto para lograr un buen resultado clínico(AU)

The Chopart joint or transverse tarsus is constituted by the calcaneocuboid and the astragaloescafoidea joints. The injuries that occur in these joints are known as Chopart luxo-fracture and are extremely rare. Motorcycle accidents and falls from heights are among the most frequent causes of Chopart luxo-fractures. The treatment is the anatomical reduction and stable fixation. The avascular necrosis of the talus, as well as post-traumatic arthritis are the most feared complications. This paper aims to describe the behavior and perioperative evolution of two patients with Chopart luxo-fracture, treated in the Emergency Service at Dr Luis Díaz Soto Central Military Hospital. They were early diagnosed and underwent open reduction and internal fixation. They recovered in the first three months. The low prevalence of Chopart luxo-fracture requires adequate and correct diagnosis to achieve good clinical results(AU)

L'articulation de Chopart, ou médio-tarsienne, est constituée de deux articulations distinctes: l'articulation calcanéo-cuboïdienne et l'articulation astragalo-scaphoïdienne. Les lésions produites dans ces articulations sont connues comme des fractures-luxations de l'articulation de Chopart, et sont assez rares. Parmi les causes les plus fréquentes, on peut trouver les accidents du trafic (surtout, de moto) et les chutes de haut. Le traitement consiste généralement à une réduction anatomique et une fixation stable. La nécrose avasculaire de l'astragale et l'arthrite post-traumatique sont les complications les plus souvent à craindre. Le but de ce travail est de décrire le comportement et l'évolution péri-opératoire de deux patients atteints d'une fracture-luxation de l'articulation de Chopart, et traités au service d'urgence de l'hôpital militaire Dr Luis Díaz Soto. Ils sont rapidement diagnostiqués, et traités par réduction ouverte et fixation interne. Leur récupération est réussie en trois mois. La faible prévalence de la fracture-luxation de l'articulation de Chopart exige un diagnostic précis pour atteindre de bons résultats cliniques(AU)

Fractura luxación de Lisfranc en un paciente con enfermedad de Hansen. Presentación de caso / Lisfranc fracture-dislocation in a patient with Hansen´s Disease. Case presentation

Introducción: Las lesiones de la articulación de Lisfranc se producen por traumas de alta energía; pero cuando se presentan en pacientes con enfermedad de Hansen y daño del sistema nervioso periférico, los traumas repetitivos de pequeña intensidad pueden conducir a este tipo de lesión. Objetivo: Presentar un caso interesante dada la asociación en un paciente con Hansen de una lesión de Lisfranc causado por un trauma de baja energía. Presentación de caso: Paciente de 64 años de edad fototipo V, con antecedentes de Hansen Lepromatoso, que por traumas repetitivos de baja intensidad y un proceso séptico sobreañadido, presentó fractura-luxación de Lisfranc del tipo divergente, se comentan los antecedentes, el cuadro clínico, los exámenes laboratorio, ultrasonidos, estudio radiológico y el tratamiento impuesto. Conclusiones: La discapacidad en manos y pies por trastornos neurológicos en pacientes con lepra lepromatosa de más de 5 años de evolución es bastante frecuente, pero asociado a luxofractura de Lisfranc de tipo divergente, por trauma de baja intensidad, no lo es, ya que este tipo de lesión normalmente se produce por traumas de alta energía(AU)

Introduction: Lisfranc joint lesions are produced by high energy traumas, but when they present in patients with Hansen´s disease and damage to the peripheral nervous system, the low intensity repeated traumas can lead to this type of lesion. Objective: To present an interesting case, given a particular association on a patient with Hansen´s disease and a Lisfranc lesion, caused by a low energy trauma. Case presentation: 64 years old Phototype V patient with antecedents of lepromatous Hansen´s disease who presented Lisfranc fracture-dislocation of a divergent type after low intensity repeated traumas, and a septic superadded process. The antecedents, clinical picture, laboratory tests, ultrasounds, radiological study, and the treatment indicated are all analyzed. Conclusions: Disability in hands and feet due to neurological disorders in patients with lepromatous leprosy of more than 5 years of evolution is very frequent, but it is not so frequent when associated to a Lisfranc fracture-dislocation of a divergent type due to low intensity trauma, because this type of lesion is normally caused by high energy traumas(AU)

Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches? / Deslocamentos facetários cervicais traumáticos: abordagem anterior, posterior ou combinada?

ABSTRACT Surgical treatment is well accepted for patients with traumatic cervical facet joint dislocations (CFD), but there is uncertainty over which approach is better: anterior, posterior or combined. We performed a systematic literature review to evaluate the indications for anterior and posterior approaches in the management of CFD. Anterior approaches can restore cervical lordosis, and cause less postoperative pain and less wound problems. Posterior approaches are useful for direct reduction of locked facet joints and provide stronger fixation from a biomechanical point of view. Combined approaches can be used in more complex cases. Although both anterior and posterior approaches can be used interchangeably, there are some patients who may benefit from one of them over the other, as discussed in this review. Surgeons who treat cervical spine trauma should be able to perform both procedures as well as combined approaches to adequately manage CFD and improve patients’ final outcomes.

RESUMO O tratamento dos deslocamentos facetários cervicais traumáticos (DFC) é preferencialmente cirúrgico, conforme a literatura pertinente, mas há dúvidas quanto a melhor forma de abordagem da coluna: anterior, posterior ou combinada. Realizamos revisão sistemática para avaliar as indicações da abordagem anterior e da posterior nos DFC. A abordagem anterior permite restaurar a lordose cervical, com menor dor no pós-operatório e menos problemas relacionados a ferida cirúrgica. A abordagem posterior permite redução direta dos deslocamentos, bem como pode resultar em uma fixação biomecanicamente mais robusta. Acessos combinados são usados em casos complexos. Embora ambas possam ser usadas, há alguns pacientes que possivelmente se beneficiem preferencialmente de uma abordagem ao invés da outra, como discutido no presente manuscrito. Cirurgiões de coluna devem ser habilitados a realizar ambos os procedimentos para melhor os resultados do tratamento dos DFC.

Fractura de cuña intermedia asociada a lesión de Llisfranc y escafoides tarsiano. Sustitución con injerto autólogo. Reporte de un caso / Intermedia Wedge fracture associated with Lisfranc injury and tarsal scaphoid. Substitution with autologous graft. A case report

La fractura-luxación de Lisfranc, es poco frecuente (0,2% de todas las fracturas) y pasa inadvertida; la ausencia de tratamiento puede originar una deformidad de pie plano valgo con gran incapacidad y artrosis postraumática. Las fracturas de la cuñas, generalmente están asociadas a otras lesiones, el tratamiento quirúrgico se reserva a determinados casos, y su sustitución está poco documentada en la bibliografía; en las fracturas del cuerpo del navicular es importante su correcto tratamiento por formar parte de la coxa pedis. Se presenta el caso de un paciente que sufrió traumatismo del pie derecho con afectación de las cuñas y pérdida de la integridad ósea de la cuña intermedia(AU)

The Lisfranc fracture-dislocation, are uncommon (0.2% of all fractures) go unnoticed, no treatment can cause a valgus flatfoot deformity with great disability and posttraumatic osteoarthritis (1). Fractures wedge are usually associated with other injuries, surgical treatment is reserved, for certain cases, and replacing this poorly documented in the literature, in fractures of the navicular body is important proper treatment to be part of the pedis coxa. Report the case patient who suffered trauma to the right foot, with an affectation wedges with loss of bone integrity of the intermediate wedge(AU)

Trauma complexo da mão parte II: lesão óssea, amputação e reimplante, perda de substância dos dedos, lesão da polpa digital e lesão ungueal / Complex trauma of the hand, part II: bone injury, amputation and replantation, loss of fi nger substance, digital pulp injury and nail injury

O trauma da mão representa uma das lesões que com maior frequência pode deixar sequelas funcionais importantes. A idade mais afetada é a economicamente ativa. Valorizamos o conhecimento adequado do primeiro atendimento e do manejo das lesões mais frequentes na mão traumatizada. Nesta segunda parte, serão abordados os fundamentos e conceitos considerados como essenciais na lesão óssea, amputações e reimplantes, perda de substância na mão, lesão da polpa digital e do complexo ungueal. Procuramos orientar a conduta dos médicos nas diversas situações clínico-cirúrgicas para diminuir o grau de complicações e sequelas (AU)

Hand trauma is one of the injuries that can most often leave important functional sequelae. The most affected age group is economically active people. We appreciate proper knowledge of the initial treatment and management of the most common injuries in the traumatized hand. In this second part we address the fundamentals and concepts considered essential in bone injury, amputation and replantation, loss of substance in the hand, and injuries of digital pulp and ungual complex. We aim to guide the conduct of physicians in different clinical and surgical situations to reduce the degree of complications and sequelae (AU)

Evaluación del manejo quirúrgico en la luxación acromioclavicular grado iii en el hospital obrero n° 2 c n s / Evaluation of surgical management in grade III acromioclavicular dislocation in the workers' hospital n ° 2 cns

Entre Enero 1998 a Abril 2004, en un periodo de 6 años y 4 meses, en el servicio de Ortopedia y Traumatología del hospital Obrero N°2 de la C.N.S, se realizó un estudio de tipo retrospectivo longitudinal en 21 casos con diagnóstico clínico - radiológico de Luxación Acromioclavicular Grado III (LAC III), los cuales son tratados quirúrgicamente Existen una variedad de tratamientos quirurgicos para el manejo de la LAC III, por lo que vemos la necesidad de analizar objetivamente los resultados obtenidos y tratar de estandarizar su manejo para beneficio de los pacientes. La incidencia de la lesión fue 12 (57%) para el lado derecho, y 9 (43%) para el lado izquierdo, 11 (52%) de los pacientes el mecanismo de lesión fue por caída de altura, y en los otros 10 (47%) pacientes el mecanismo de lesión fue caída de vehículo de dos ruedas. Más frecuente en varones con 18(85 %) casos, y en mujeres con 3(14%) casos, y una relación de incidencia de 6:1, con una edad mínima de 26 años y una máxima de 71 años, obteniéndose un promedio de 44.9 años . Los resultados fueron evaluados mediante la escala clínico-radiología de la UCLA modificada; Correspondiendo para el Grupo A (Bueno 55%, Regular 44%), Grupo B (Excelente 60%, Bueno 40%), Grupo C (Bueno 43%, Regular 29%, Malo 29%). De las tres técnicas quirúrgicas los resultados más alentadores son los del Grupo B por las ventajas mencionadas, se debe recalcar que se requiere un amplio conocimiento de la anatomía local para evitar complicaciones.

Between January 1998 and April 2004, (in a 6 year 4 month period), in the Orthopedic and Traumatology service at the Obrero Hospital N°2 that belongs to the C.N.S., a longitudinal retrospective study was done, in 21 cases with clinical - radiology diagnose of Acromioclavicular Dislocation III degree (LAC III), that went throught surgical treatment. There is a Wide variety of surgical treatments to handle the LAC III, therefore, we saw the need to analyze the results we obtained and to try to design a protocol to manage it in order to benefit our patients. The incidence was 12 (57%) for the right side and 9 (43%) for the left side. In 11 patients the mechanism of the injury was a fall from height and in the other 10 (47%) patients the mechanism of injury was a fall from a two-wheeled vehicle. The results were evaluated using the clinical-radiology modified scale from de UCLA, obtaining for Group A (Good 55%, Average 44%), for Group B (Excellent 60%, Good 40%,), and for Group C (Good 43%, Average 29%, Poor 29%). From the three surgical techniques described the most encouraging results were for Group B because of the advantages we discussed. We must emphasize the need to know the local anatomy in order to avoid complications.