Asunto(s)
Clavos Ortopédicos , Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fijación Intramedular de Fracturas/métodos , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Resultado del TratamientoRESUMEN
Maquet osteotomy can be associated with an unacceptably high incidence of wound complications that may be as high as 37%. A consecutive series of 42 Maquet osteotomies has been performed between 1990 and 2002 by a single surgeon without a single wound problem or infection and this series is the subject of this report. The use of an anterolateral incision reduces the damage to the major lymphatics minimising the risk of wound oedema. Identification and preservation of the feeding musculocutaneous vessels on the lateral and medial sides facilitates extensive but safe mobilisation of the skin flaps permitting an easy closure over a substantially elevated tibial tubercle. The use of an anterolateral incision with knowledge of the blood supply of the leg has eliminated the wound complications associated with the standard anteromedial incision reported previously in the literature. This approach, preserving the blood supply and lymphatic drainage, avoids skin necrosis and wound dehiscence, obviates any requirement for plastic surgical procedures such as releasing incisions or skin grafts and minimises the risk of infection and osteomyelitis.
Asunto(s)
Osteotomía/métodos , Tibia/cirugía , Cicatrización de Heridas , Adulto , Anciano , Femenino , Humanos , Artropatías/cirugía , Articulación de la Rodilla/cirugía , Pierna/anatomía & histología , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Piel/irrigación sanguíneaRESUMEN
A retrospective review of fractures occurring around the femoral component of total hip replacements was performed using patient notes and X rays. Between 1996 and 2002, 12 patients with total hip replacement had fixation of their periprosthetic femoral shaft fracture with carbon fibre plates. The mean patient age was 76 years (range 57-94). With regard to fracture type (Johansson Classification), three were Type 2 and nine were Type 3. In 11 cases the average time to union was 4 months (range 3-6). There was one non-union leading to implant failure. This was subsequently treated with a revision arthroplasty. There were no other significant complications. Although designed to fit the supracondylar region of the femur, we had no difficulty in applying the plate over the trochanteric region. Our results indicate that carbon fibre plates are effective in the management of femoral periprosthetic fractures in the elderly and this may be related to the unique properties of the plate.
