RESUMO
BACKGROUND: Trauma to the elbow is a common cause of joint stiffness that might require surgical release. Release of the stiff elbow can be done by open or arthroscopic approach. There is no high-level evidence for the best surgical treatment modality for post-traumatic elbow stiffness. The objective of this article was to review current available literature of studies reporting on open or arthroscopic release of post-traumatic elbow stiffness. METHODS: A comprehensive literature search was performed. All titles and abstracts of potentially relevant studies were reviewed, with a set of predefined inclusion and exclusion criteria. After the initial assessment for inclusion, 2 authors extracted data independently from the included articles. RESULTS: Thirty articles were included, with an overall enrolment of 798 patients. No randomized controlled trials were retrieved. The first article was published in 1989 and the most recent in 2012. There were 4 different kinds of treatment modalities identified from the included studies: 1) open arthrolysis; 2) arthroscopic arthrolysis; 3) open arthrolysis with external fixation; and 4) open arthrolysis with distraction arthroplasty. The gain in range of motion was 51°, 40°, 88°, and 56° for groups 1-4, respectively. The average percentage of complications was 23, 5, 73, and 58 for groups 1-4, respectively. CONCLUSION: Current literature is not sufficient enough to draw firm statistically based conclusions. However, as the amount of complications seems to rise with the extent of the surgical procedure, we would advise to treat as less invasive as possible (grade C).
Assuntos
Lesões no Cotovelo , Artropatias/cirurgia , Artroscopia , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Humanos , Artropatias/etiologia , Artropatias/fisiopatologia , Amplitude de Movimento ArticularRESUMO
Injuries to the tarsometatarsal joint are infrequent and the presentation varies. The radiologic evaluation can be difficult, and injuries are missed initially in up to one third of cases. A 60-year-old female sports instructor presented to the emergency department with a Lisfranc fracture dislocation of the foot as result of an indirect trauma. The patient attended to a hospital the day she sustained the injury, where the Lisfranc fracture was missed. At our hospital, the patient underwent immediate restoration of the dislocation. Because of swelling, internal fixation was applied 2 weeks later. Postoperatively, the patient was mobilized in a non-weight-bearing plaster cast for 6 weeks, continued by progressive weight-bearing in a walker. The fixation screws were removed 3 months after surgery. Lisfranc fractures are rare injuries and can be missed at first sight. Careful clinical examination and radiographs in 3 different planes are required to identify the injury. Computed tomography might be helpful when the findings from the above-mentioned examinations are inconclusive. Operative treatment, including anatomic reduction and fixation, is required in almost all cases to achieve the best satisfactory result. Long-term complications include secondary arthritis and foot deformities, which can be treated by foot ortheses or arthrodesis.
Assuntos
Erros de Diagnóstico , Fraturas Ósseas/diagnóstico , Fraturas Fechadas/diagnóstico , Articulações Tarsianas/lesões , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Fraturas Fechadas/cirurgia , Humanos , Pessoa de Meia-Idade , Articulações Tarsianas/diagnóstico por imagem , Articulações Tarsianas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
CASE: We present a case of a 56-year-old man who sustained a basal cervical periprosthetic fracture around a well-fixed metal-on-metal hip resurfacing arthroplasty (MoMHRA). Although several fixation methods have been described, there seems to be no consensus about the optimal fixation method for fractures around MoMHRAs. This fracture could be regarded as a Vancouver type-B1 or -C periprosthetic fracture, so we successfully treated our patient in a standard way with a dynamic hip screw (DHS) and one cannulated hip screw. CONCLUSION: We describe DHS fixation as a successful treatment option for periprosthetic hip fractures around well-fixed MoMHRA.