RESUMO
We performed a prospective, randomised trial in 39 patients with open tibial fractures treated initially by external fixation to compare cast immobilisation (group A) and intramedullary nailing (group B) as a sequential protocol planned from the onset of treatment. The results showed that group B achieved faster union (p < 0.05) than group A with less malunion or shortening and a greater range of movement. Patients treated by intramedullary nailing required fewer radiographs and outpatient visits (p = 0.0015) and had a more predictable and rapid return to full function. We feel that these severe fractures are better treated by delayed intramedullary nailing and that this has an acceptable rate of complications.
Assuntos
Fixadores Externos , Fixação Intramedular de Fraturas , Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Adulto , Moldes Cirúrgicos , Emergências , Feminino , Fraturas Expostas/diagnóstico por imagem , Fraturas não Consolidadas/epidemiologia , Humanos , Masculino , Estudos Prospectivos , Radiografia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Fraturas da Tíbia/diagnóstico por imagem , Resultado do TratamentoRESUMO
Since 1986 we have treated 15 patients with fractures of the head of the radius limited to one or two fragments (Mason type II) by open reduction and internal fixation with the Fibrin Adhesive System. At a mean follow-up of over two years, all but one of the results were excellent. This method is recommended for the treatment of selected fractures of the radial head followed by early mobilisation.
Assuntos
Adesivo Tecidual de Fibrina , Fraturas do Rádio/terapia , Adolescente , Adulto , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/cirurgiaRESUMO
Since 1986, 19 patients with 21 fractures of the thoracic and lumbar spine have been treated with the AO Internal Spinal Skeletal System. Of these fractures, 17 were burst fractures, 2 were seatbelt fractures and 2 were fracture-dislocations. All the patients in the series had a minimum follow-up of 12 months. There were 4 important losses of correction and two deep infections. In the majority of patients the postoperative reduction deteriorated during follow-up. The addition of 1 or 2 DTT appears to give the system more stability.
Assuntos
Fixadores Internos , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagemRESUMO
We describe a case of a severely comminuted type iiia open tibial fracture, with distal loss of bone stock (7 cm), total involvement of the tibial joint surface, and severe instability of the fibular-talar joint. The treatment performed consisted of thorough cleansing, placing a retrograde reamed calcaneal-talar-tibial nail with proximal and distal blockage, as well as a fibular-talar Kirschner nail. Primary closure of the skin was achieved. After 3 weeks, an autologous iliac crest bone graft was performed to fill the bone defect, and the endomedullary nail, which had protruded distally was reimpacted and dynamized distally. The bone defect was eventually consolidated after 16 weeks. Currently, the patient can walk without pain the tibial-astragal arthrodesis is consolidated.