RESUMEN
BACKGROUND: Patients with injuries to multiple organs or organ systems are in a serious risk of shock, multiorgan failure and death. Although there are scoring systems available to assess the extent of polytrauma and guide the prognosis, their usefulness is limited by their considerably subjective nature. As the production of nitric oxide (NO) by many cell types is elevated in tissue injury, we hypothesized that serum concentration of NO (and its oxidation products, NOx) represents a suitable marker of polytrauma correlating with prognosis. We wanted to prove that nitric oxide could serve as an indicator for severity of injury in polytrauma. METHODS: We measured serum NOx and standard biochemical parameters in 93 patients with various degrees of polytrauma, 15 patients with minor injuries and 20 healthy volunteers. RESULTS: On admission, serum NOx was higher in patients with moderate polytrauma than both in controls and patients with minor injury, and it was even higher in patients with severe polytrauma. Surprisingly, NOx on admission was normal in the group of patients that required cardiopulmonary resuscitation or died within 48 hours after admission. In the groups, where it was elevated on admission, serum NOx dropped to normal values within 12 hours. Blood lactate levels on admission were elevated in proportion to the severity of subsequent clinical course. CONCLUSION: Elevated serum NOx and blood lactate in patients with polytrauma are markers of serious clinical course, while normal NOx combined with a very high lactate may signal a fatal prognosis (Fig. 4, Ref. 8).
Asunto(s)
Insuficiencia Multiorgánica/diagnóstico , Traumatismo Múltiple , Óxido Nítrico/sangre , Choque Traumático/diagnóstico , Adulto , Biomarcadores/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Traumatismo Múltiple/sangre , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/fisiopatología , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Choque Traumático/etiología , Índices de Gravedad del TraumaRESUMEN
AIM OF THE STUDY: The aim of this study is to assess treatment outcomes of diaphyseal radial and ulnar fractures using angle- stable LCP device (Synthes, Svýcarsko), compared to ForeSight intramedullary nailing (Smith&Nephew, USA). MATERIAL AND METHODS: The prospective study included 80 patients with 115 forearm fractures, assigned to two equal groups, based on the fixation method. The group included 53 males and 27 females, the mean age was 36.6 years of age (range 18-77). the mean folow up period was 18 months (range 12-32 months). The patients were repetitevely x-rayed and their functional assessment was performed at the same time. Furthermore, treatment- related complications were also evaluated. RESULTS: Two cases of prolonged healing were recorded in the LCP device treatment group. Four cases of prolonged healing were recorded in the intramedullary nailing group, which healed within 18 months and did not require reoperation. The mean fracture healing time was 20.5 weeks (range 9-80 weeks) in the group with intramedullary nailing, and 19.0 weeks (range 12-46 weeks) in the LCP group. No significat differences in surgery time, healing time, postoperative pain scores or final 1-year functional outcomes were detected between the both treatment groups. Statistically significant prolonged healing was demonstrated in the intramedullary nailing group in cases, where fragment dislocation exceeded 3 mm, compared to a group of patients with anatomical repositioning and dislocation of less than 2 mm (p = 0.015; Anova). No cases of deep infections were recorded. Complications, recorded in the intramedullary nailing group, included the following: partial migration of securing nails in two subjects and incomplete synostosis in two subjects. Complications, recorded in the LCP device group, included: early re-fracturing in the original fracture location in a single subject (3 weeks after extraction). DISCUSSION: The results correspond with outcomes of other recent studies. Although open repositioning and internal fixation is considered a standard treatment method in forearm diaphyseal fractures, recently changing opinion on the use of nails in this indication is apparent. Considering ongoing improvements of these implants, the trend of nailing should be more widely accepted. CONCLUSION: Although their concept of fracture fixation is different, the both implants appear indicated for the management of forearm diaphyseal fractures.
Asunto(s)
Fijación Interna de Fracturas/instrumentación , Fijación Intramedular de Fracturas , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugía , Adolescente , Adulto , Anciano , Diáfisis/diagnóstico por imagen , Diáfisis/lesiones , Diáfisis/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Cúbito/diagnóstico por imagen , Adulto JovenRESUMEN
AIM OF THE STUDY: The aim of this retrospective study is to evaluate the results after treating diaphyseal fractures of the radius and ulna with an interlocking intramedullary nail. MATERIALS AND METHODS: Between 2001 and 2005, 78 patients with 118 fractures were treated using the ForeSight intramedullary nail (Smith & Nephew, Memphis, USA). The average patient age was 37.02 years. In the postoperative period, early and late complications were evaluated through radiological and functional methods. The average period of follow-up was 25 months (range: 12-58 months). RESULTS: The average length of time to demonstrated bone healing was 14.2 weeks. Four cases of prolonged healing were observed. Pseudo-arthrosis formation did not occur. Assessment of function according to Anderson gave the following results: full range of movement in 88.6% of patients; mild restriction of movement in 10.1%; severe restriction of movement in 1.3% of patients. The implanted material was extracted from 27 patients. Refractures did not occur. Postoperative complications included: 1 superficial infection, 3 cases of incomplete radio-ulnar synostosis; one case of compartment syndrome. CONCLUSIONS: Upon comparing the techniques of using plates with those of nailing in the treatment of forearm fractures, we have achieved comparable results with nailing. We therefore regard it as advantageous, in particular for treating open, serial and grossly comminuted fractures of the forearm bones.
Asunto(s)
Clavos Ortopédicos , Diáfisis/cirugía , Fijación Intramedular de Fracturas , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Diáfisis/diagnóstico por imagen , Diáfisis/lesiones , Femenino , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Radiografía , Fracturas del Radio/diagnóstico por imagen , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Resultado del Tratamiento , Fracturas del Cúbito/diagnóstico por imagenRESUMEN
PURPOSE OF THE STUDY: The aim of the study was to compare the results of revision surgery in diaphyseal fractures of the ulna and radius treated by intra-medullary interlocking nailing or plate osteosynthesis. MATERIAL AND METHODS: The group included 36 patients who, in the period from 2000 to 2005, were treated with the use of the intra-medullary ForeSight nail system (Smith & Nephew, USA) or a small, 3.5 mm auto-compression plate (different manufacturers). Pseudoarthrosis developed in 25 patients and recurrent fractures were found in 11 patients (six of these suffered fractures along the original fracture line after minimal trauma and five showed a recurrent fracture at the site of screw tunnels). The average age of the patients was 37.3 years. The average period between injury and revision surgery was 16 months (range, 4 to 32 months). The follow-up included examination for early and late complications and the evaluation of X-ray findings and functional outcomes. RESULTS: The average follow-up was 21 months (range, 12 to 36 months). For revision surgery, an intra-medullary nail was used in 28 and a plate in 8 patients. The average operative time was 85 min (range, 30 to 180 min). Radiographic union was achieved by 6 months in 30, by 12 months in three and by 18 months in three patients. The average fusion time in the 30 patients healing by 6 months (nailing, 23x, 7x plate osteosynthesis) was 16.05 weeks. The range of motion in the wrist, forearm and elbow was evaluated by the Anderson method. The outcomes were excellent, good and satisfactory in 11, 15 and 10 patients, respectively. Poor results or wrist or elbow stiffness were not recorded. Pain was recorded at rest and in activity, taking requirements for analgesic therapy into account. After revision surgery, 22 patients were free from pain, 10 reported occasional pain during activity and four experienced pain at rest. None of the patients required permanent analgesic therapy. CONCLUSIONS: The results of our study show the effectiveness of plate and nailing techniques in revision forearm surgery. The corrective procedure must be chosen with regard to the type of pseudoarthrosis, and individual therapy respecting the principles of stable osteosynthesis is necessary. A differentiated operative approach, infection control and stimulation of bony union also play important roles.
Asunto(s)
Fijación Interna de Fracturas , Fijación Intramedular de Fracturas , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugía , Adulto , Anciano , Diáfisis , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/efectos adversos , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , ReoperaciónRESUMEN
In this report the first experience with callus distraction lengthening using the intramedullary kinetic nail is described. This was performed on a left tibia with a total shortening of 34 mm. The distraction phase lasted 36 days and the rate of distraction was 0.95 mm per day. The full weight-bearing of the treated lower extremity was allowed at 12 weeks after surgery. Complete consolidation of the callus was achieved at 112 days and the consolidation index was 3.21 days/mm. No serious complications were recorded during the post-operative period. At 12 months after surgery, the patient showed a full range of motion in the knee, his ankle range of motion was S 15-0-35, and he achieved an excellent functional outcome on evaluation by Paley's classification.
Asunto(s)
Callo Óseo/cirugía , Fijación Intramedular de Fracturas , Osteogénesis por Distracción , Tibia/cirugía , Fracturas de la Tibia/cirugía , Adulto , Peroné/lesiones , Peroné/cirugía , Fracturas Óseas/cirugía , Fracturas Abiertas/cirugía , Humanos , Masculino , Fracturas de la Tibia/complicacionesRESUMEN
PURPOSE OF THE STUDY: The management of intracapsular femoral neck fractures remains an unsolved issue of the present-day trauma surgery of the musculoskeletal system. These fractures are conventionally treated with the use of spongious screws or a dynamic hip screw combined with an antirotational spongious screw. The aim of this study was to evaluate the outcomes of surgical therapy using a different type of implant (proximal femoral nail) for intracapsular femoral neck fractures. MATERIAL: From January 2000 to March 2004, intracapsular fractures were treated with the use of a proximal femoral nail in 70 patients. In this retrospective study, 56 patients (28 men and 28 women) were evaluated at a minimum of 12 months after surgery. The average follow-up was 22.4 months. According to the AO classification, the fractures were categorized as 31- B1 in 20, 31-B2 in 12 and 31-B3 in 24 patients. METHODS: The implant used was a bi-axial proximal femoral nail (Targon PF, B. Braun Aesculap, Germany) inserted by the standard surgical procedure. RESULTS: In 33.3 % of the patients the operative stabilization was performed early, within 6 hours of injury, in 51.8 % the operation was carried out within 24 hours, and 14.3 % of the patients underwent surgery later than 24 hours after injury. At one year after injury, fracture union without complications was recorded in 45 patients (80 %). Complications included avascular necrosis of the femoral head in seven patients (12.5 %), pseudoarthrosis in two patients (3.6 %) and other serious complications in two patients (3.6 %). Reoperations were indicated in five patients, and these underwent total hip replacement. No refracture occurred in the vicinity of the implant. No or little pain after the implantation procedure, as assessed at 12 months and later, was reported by 83 % of the patients. The patients in whom fracture union was achieved without complications were allowed to walk with full weight-bearing at 13.8, 16.4 and 20.4 weeks, when their injury was 31-B1, 31-B2 and 31-B3, respectively. CONCLUSIONS: Our results show that the bi-axial proximal femoral nail (Targon PF, B. Braun Aesculap, Germany) is useful for management of intracapsular femoral head fractures because of the following advantages: it eliminates the risk of lateral protrusion of the implant, it allows for even distribution of weight bearing and thus reduces the risk of pseudoarthrosis development, it has a low probability of the sliding screw getting jammed.
Asunto(s)
Clavos Ortopédicos , Fracturas del Cuello Femoral/cirugía , Fijación Interna de Fracturas/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Cuello Femoral/diagnóstico por imagen , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
INTRODUCTION: The objective of the research is the assessment of the way and results of a case-series of treatment of gunshot wounds and to remain of the requirement of complete wound treatment in peace time. MATERIALS AND METHODS: During the period from 1997 to 2006, we treated 60 patients who had penetrating gunshot wounds. The case series included 12 female and 48 male patients ranging in ages from 18 to 71 years (average age 37 years). Weapons that caused injuries included pistol (33), rifle (5), assault rifle AK-47 (1), air gun (9), firecrackers (2), and unknown weapons (10). We assessed outcomes of different therapeutic approaches by monitoring early and late postoperative complications and by total recovery time. RESULTS: Two patients died within the first 24 hours; no other patients die after the first 24 hours of initiation of treatment. Thirty-nine patients were hospitalized with hospital stays ranging from 1 to 40 days (average length of stay 13.2 days). Total recovery time varied from 3 to 330 days averaging 65.7 days until full recovery and ability to work. Fifteen patients had bone injury, eight of which needed osteosyntesis. Four patients received external fixators, two were treated by titanium intramedullar nail, and two by transfixation with Kirchner wire eighteen patients (30%) had secondary sutures. Perioperative complications were osteomyelitis (two patients), pseudoarthrosis of upper extremity proximal phalange (one patient) and non-lethal pulmonary embolism (one patient). CONCLUSION: Standard treatment of penetrating gunshot wounds should consist of primary and prompt detailed debridement, sufficient fasciotomy, and complete drainage of the wound.
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Heridas por Arma de Fuego/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Balística Forense , Humanos , Masculino , Persona de Mediana Edad , Cicatrización de Heridas , Heridas por Arma de Fuego/patologíaRESUMEN
INTRODUCTION: The objective of our study is evaluation of clinical and radiological results of dislocated proximal humeral fractures, treated by direct, angular stabile, antegrade and interlocking implants Targon PH (Aesculap, Tuttlingen, Germany). METHODS: We evaluated 102 patients (76 female and 26 male), average age was 67.3 years (26-87 years). The standard nail was used in 73 cases; the long one was used in 29 cases. We interpreted functional results (Constant's score and relative Constant's score), radiological results and postoperative complications. RESULTS: Constant's score achieved average 51.3 points--3 weeks after operation, 67.4 points--after 6 months and 75.8 points--after 1 year. Value of the relative Constant's score was 59.3%, 75.9% and 83.5%. We have found trend to the poorer functional outcomes in all complicated four-part fractures; especially in cases with disarticulation. The complete bone healing was reached in: 63.7% up to 3 months, 95.1% up to 6 months and 99% up to 1 year. We detected lecase of the pseudoarthrosis. We had 37 complications in our 102 patients group in the first year after operation. The migration of the proximal fixation screws was most frequent complication--12 patients. Eight times the humeral head aseptic necrosis appeared (5x partial, 3x complete), 3 times redislocation of tuberculum maius was found. We made reoperation 2 times by Phillos plate (1x for pseudoarthrosis, 1x for broken screws). CONCLUSIONS: Targon PH is intramedullary nail stabilisation of proximal humeral fractures by angular stabile, antegrade, interlocking system. We consider it for mini-invasive technique that provides high stability in osteoporotic bone and allows immediate postoperative shoulder mobilisation.
Asunto(s)
Clavos Ortopédicos , Fijación Intramedular de Fracturas/métodos , Fracturas del Hombro/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/instrumentación , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Complicaciones PosoperatoriasRESUMEN
A common problem in management of polytrauma - a simultaneous injury to more than one organ or organ system, at least one of them lethal without intervention - is a discrepancy between a relatively good initial state and a serious subsequent development. Since nitric oxide (NO) is produced in high quantities during tissue injury, we assumed that serum levels of NO (and its oxidation products, NOx) might serve as a prognostic marker of polytrauma severity. However, we found recently that NOx was increased in polytrauma, but not in the most severe cases. The present study was undertaken to test the hypothesis that serum NOx is reduced in severe polytrauma by concomitant overproduction of reactive oxygen species (ROS). Polytrauma was induced in rats under anesthesia by bilateral fracture of femurs and tibiae plus incision of the right liver lobe through laparotomy. Serum NOx was measured by chemiluminescence after hot acidic reduction. The role of ROS was assessed by treatment with an antioxidant, N-acetyl-L-cysteine (NAC). Experimental polytrauma elevated NOx from 11.0+/-0.7 to 23.8+/-4.5 ppb. This was completely prevented by NAC treatment (9.1+/-2.2 ppb). Serum NOx is elevated in severe polytrauma, and this is not reduced by ROS. On the contrary, ROS are necessary for the NOx elevation, probably because ROS produced by inflammatory cells activated by the polytrauma induce massive NO production.
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Radicales Libres/sangre , Traumatismo Múltiple/sangre , Óxido Nítrico/sangre , Especies Reactivas de Oxígeno/sangre , Animales , Antioxidantes/farmacología , Antioxidantes/uso terapéutico , Biomarcadores/sangre , Radicales Libres/antagonistas & inhibidores , Masculino , Traumatismo Múltiple/tratamiento farmacológico , Óxido Nítrico/antagonistas & inhibidores , Ratas , Ratas Wistar , Especies Reactivas de Oxígeno/antagonistas & inhibidoresRESUMEN
INTRODUCTION: The aim of this study is to evaluate the results after treating diaphyseal fractures of the forearm with an inter-locking intramedullary nail. METHODS: Between 2003 and 2005, 45 patients with 68 fractures were treated using the ForeSight intramedullary nail (Smith&Nephew, Memphis, USA). The average patient age was 34.12 years. In the postoperative period, early and late complications were evaluated through radiological and functional methods. RESULTS: The average length of time to demonstrated bone healing was 13.2 weeks. 3 cases of prolonged healing were observed, and pseudoarthrosis formation did not occur. Assessment of function according to Anderson gave the following results: full range of movement in 86.9% of patients; mild restriction of movement in 10.9%; and severe restriction of movement in 2.2% of patients. Postoperative complications included: I superficial infection, 2 cases of incomplete radioulnar synostosis; and one case of compartment syndrome. CONCLUSIONS: Upon comparing the techniques of using plates with those of nailing in the treatment of forearm fractures, we have achieved comparable results with nailing, and we therefore regard it as advantageous foremost for treating open, serial and grossly comminuted fractures of the forearm bones.
Asunto(s)
Clavos Ortopédicos , Fijación Intramedular de Fracturas , Fracturas del Radio/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Diáfisis/lesiones , Diáfisis/cirugía , Femenino , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Fracturas del Cúbito/cirugíaRESUMEN
The authors present an account on the use of Jurasz' operation for drainage of an abscess of the omental bursa after a piercing injury of the abdomen within a relatively short interval after development of this complication.
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Absceso/cirugía , Drenaje/métodos , Epiplón , Enfermedades Peritoneales/cirugía , Traumatismos Abdominales/complicaciones , Absceso/etiología , Adulto , Humanos , Masculino , Enfermedades Peritoneales/etiología , Heridas Punzantes/complicacionesRESUMEN
A healthy, right-handed 34-year-old man was injured by repeated direct blows delivered to his left upper arm with a baseball bat. These blows led to a posterior dislocation of the elbow joint, associated with fractures of the radial head and the coronoid process. There was bone loss on the fractured joint surface of the olecranon, with simultaneous ipsilateral trauma to the ulna. The correct surgical approach in the case of such fractures is still the subject of some controversy. The treatment can have serious complications. The results of treatment are often poor, especially because of persisting instability and stiffness of the elbow following a long period of immobilisation. Few studies have been concentrated on this topic up to now. We report on the functional and radiological results 24 months after the treatment of this rare, open "shock triad in the elbow."
Asunto(s)
Lesiones de Codo , Fijación Interna de Fracturas/métodos , Fracturas Conminutas/cirugía , Fracturas Abiertas/cirugía , Luxaciones Articulares/cirugía , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugía , Adulto , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Estudios de Seguimiento , Fijación Intramedular de Fracturas/métodos , Curación de Fractura/fisiología , Fracturas Conminutas/diagnóstico por imagen , Fracturas Abiertas/diagnóstico por imagen , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Cúbito/diagnóstico por imagenRESUMEN
BACKGROUND: Intracapsular fractures of the femoral neck are mostly treated using individual cancellous screws or a dynamic hip screw in combination with anti-rotational cancellous screws. The goal of this study was to evaluate the possibility of using proximal femoral nails for the surgical stabilisation of intracapsular fractures of the femoral neck. METHODS: A total of 58 patients (30 male, 28 female) were evaluated in a retrospective study after a minimum postoperative follow-up of 24 months. The average length of time after surgery was 33.1 months. According to the AO classification, the following numbers of type 31B intracapsular fractures of the femoral neck were included in the study: by number, 20 cases of type 31B1, 12 cases of type 31B2 and 26 cases of 31B3. The biaxial proximal femoral nail (Targon PF, B. Braun, Aesculap(R), Germany) was the tested implant and was inserted using standard surgical techniques. RESULTS: No complications in healing were noted in 48 patients (82.8% of the study group) 2 years following injury. The most frequent complication found was avascular necrosis of the head in seven patients (12.1%). Pseudoarthrosis formation was seen in two patients (3.4%), and other severe peroperative complications were observed in two other patients (3.4%). Reoperations were indicated in five patients, all of whom received a total hip endoprosthesis. We did not observe any refracture in the area of the implant. After 12 months 83% of the patients stated that they felt no or little pain. CONCLUSION: The results of our study have proven that the Targon PF biaxial proximal femoral nail may be used in treating intracapsular fractures of the femoral neck.