الملخص
ANTECEDENTES El peroné flotante tras un traumatismo de alta energía es una entidad muy poco frecuente. Este es el primer reporte de caso asociado a luxación del tendón bicipital. OBJETIVO Presentar un caso de peroné flotante tras luxación divergente de tobillo asociado a luxación peronea proximal. MATERIALES Y MÉTODOS Mujer de 17 añ que, tras accidente de tráfico, sufrió caída y presentó dolor y deformidad del tobillo izquierdo, junto con dolor e impotencia funcional de la rodilla ipsilateral. En las radiografías, se apreció una luxación pura divergente del tobillo izquierdo de tipo IV. Se realizó reducción cerrada en urgencias. El estudio se complementó con una resonancia magnética que mostró una rotura completa de la sindesmosis y del ligamento deltoideo, así como una fractura no desplazada de la meseta tibial externa, junto con un desgarro de la cápsula tibioperonea proximal y desprendimiento completo del ligamento lateral externo y del tendón bicipital desde su inserción en la cabeza del peroné. Se realizó reanclaje de la sindesmosis y del ligamento deltoideo, así como del ligamento lateral externo y del tendón bicipital mediante anclajes óseos metálicos y reducción de peroné tanto proximal como distalmente, mediante sistema de sutura tipo botón. Se inmovilizó con férula cruropédica por cuatro semanas. RESULTADOS La paciente presentó recuperación completa de la fuerza a los cinco meses de seguimiento, con movilidad completa del tobillo y de la rodilla. CONCLUSIÓN El peroné flotante es muy poco frecuente; sólo se ha descrito un caso en la literatura. Implica la disrupción de la articulación tibioperonea proximal y distal, lo que puede provocar inestabilidad en la rodilla y en el tobillo. Por tanto, ante un traumatismo de alta energía en el tobillo, es necesaria la exploración minuciosa de la rodilla ipsilateral.
BACKGROUND Floating fibula after high-energy trauma is a very uncommon entity. The present is the first report of a case associated with avulsion of the bicipital tendon. PURPOSE To present a case of floating fibula after divergent ankle dislocation associated with proximal peroneal dislocation. MATERIALS AND METHODOS A 17-year-old woman who fell after a traffic accident and presented pain and deformity of the left ankle with pain and functional impotence in the ipsilateral knee. The radiographs showed a pure divergent type-IV left-ankle dislocation. Closed reduction was performed in the emergency room. The study was complemented with a magnetic resonance imaging scan which showed complete rupture of the syndesmosis and the deltoid ligament, as well as a non-displaced fracture of the external tibial plateau together with a tear of the proximal tibiofibular capsule and complete detachment of the external lateral ligament and bicipital tendon from its insertion in the peroneal head. The syndesmosis and deltoid ligament were reanchored, as well as the external lateral ligament and the bicipital tendon, using metallic bone anchors and fibula reduction both proximally and distally, using a suture-button system. The patient was immobilized with a long-leg splint for four weeks. RESULTS The patient presented complete recovery of strength at five months of follow-up. CONCLUSSION Floating fibula is a rare entity, with only one case described in the literature. It involves a disruption of the proximal and distal tibiofibular joint, which can lead to knee and ankle instability. Therefore, in cases of high-energy trauma to the ankle, a careful examination of the ipsilateral knee is necessary.
الموضوعات
Humans , Female , Adult , Ankle Injuries/surgery , Ankle Injuries/diagnostic imaging , Fibula/injuries , Magnetic Resonance Imaging , Treatment Outcome , Orthopedic Proceduresالملخص
RESUMEN Cronobacter sakazakii es una bacteria Gram negativa que pertenece a un grupo emergente de patógenos oportunistas de la familia de los Enterococos, que causa infecciones nosocomiales. Afecta típicamente a los recién nacidos de bajo peso; puede causar graves infecciones como meningitis, sepsis o enterocolitis necrotizante, potencialmente mortales, aunque la gran mayoría de las infecciones se producen en pacientes ancianos, en los que son mucho más leves. Se reporta el primer caso confirmado de infección de herida quirúrgica en España causada por C. sakazakii en un adulto inmunocompetente(AU)
ABSTRACT Cronobacter sakazakii is a Gram negative bacterium that belongs to an emerging group of opportunistic pathogens of the Enterococci family, which causes nosocomial infections. It typically affects low birth weight newborns. It can cause serious infections such as meningitis, sepsis, or life-threatening necrotizing enterocolitis, although the vast majority of infections occur in elderly patients, where they are much milder. We report the first confirmed case of surgical wound infection in Spain, caused by C. sakazakii in an immunocompetent adult(AU)
الموضوعات
Humans , Male , Aged , Surgical Wound Infection/etiology , Enterobacteriaceae Infections/etiology , Fractures, Bone/surgery , Fibula/injuries , Open Fracture Reduction/adverse effectsالملخص
Introducción: El tétanos es una enfermedad infecciosa prevenible que puede causar la muerte. Las manifestaciones clínicas son debidas a una potente toxina secretada por el Clostridiumtetani, un bacilo Gram positivo que penetra a través de pérdidas de continuidad de la piel, independientemente del tamaño de la herida. Objetivo: Presentar la evolución clínica de una paciente residente en una zona rural en Latacunga, Cotopaxi, Ecuador. Desarrollo: Paciente sin antecedentes de inmunización previa que acudió a sala de emergencias por fractura cerrada de tibia y peroné en miembro inferior izquierdo como secuela de un accidente de tránsito. El diagnóstico clínico de tétanos generalizado se basó en la aparición al noveno día del trauma de disfagia, trismus, rigidez nucal y posteriormente contracturas generalizadas con opistóstono, parada cardiorrespiratoria y disfunción autonómica. Con una prolongada estadía hospitalaria de 82 días, recibió anestesia en críticas condiciones durante 15 ocasiones, sufrió complicaciones graves y amenazantes para la vida que requirió la permanencia durante 46 días en sala de cuidados intensivos. Conclusiones: Este caso enfatiza la amenaza permanente del tétanos en este entorno, así como la necesidad de implementar esquemas de inmunización de una forma más abarcadora y constante(AU)
Introduction: Tetanus is a preventable infectious disease that can cause death. The clinical manifestations are due to a powerful toxin secreted by Clostridiumtetani, a Gram-positive bacillus that penetrates through losses of skin continuity, regardless of the wound's size. Objective: To present the clinical evolution of a female patient living in a rural area in Latacunga, Cotopaxi, Ecuador. Development: Patient with no history of previous immunization who went to the emergency room due to a closed fracture of the tibia and the fibula in the left lower limb as a result of a traffic accident. The clinical diagnosis of generalized tetanus was based on the appearance on the ninth day of dysphagia´s trauma, trismus, nuchal rigidity, and later on: generalized contractures with opistho-tonus, cardiorespiratory arrest, and autonomic dysfunction. With a prolonged hospital stay of 82 days, she received anesthesia under critical conditions in 15 occasions, and suffered serious complications. She remained for 46 days in the intensive care unit. Conclusions: This case emphasizes the permanent threat of tetanus in this environment, as well as the need to implement immunization schemes in a more comprehensive and constant manner(AU)
الموضوعات
Humans , Female , Middle Aged , Tibial Fractures/complications , Fibula/injuries , Fractures, Closed/complications , Tetanus/complications , Tetanus/therapyالملخص
Introducción: La incidencia de lesiones intraarticulares asociadas a lesiones sindesmales tibioperoneas, y los resultados funcionales y objetivos (imagenológicos) del tratamiento de las misma con asistencia artroscópica. Material y Métodos: En el período de agosto del 2013 al mismo mes del 2016 fueron tratados quirúrgicamente 21 pacientes (12 hombres y 9 mujeres) con lesiones sindesmales aisladas o con fracturas de tobillo: Weber tipo C, Weber tipo B y Maisonneuve. Como primer paso se realizó la artroscopia anterior de tobillo, para confirmar lesiones inestables y tratar las lesiones asociadas. Luego de la reducción, tratamiento de la fractura y lesión ligamentaria, se realizó un nuevo tiempo artroscópico para constatar la reducción de la misma. Todos los pacientes se evaluó la reducción con radiografías y tomografías axial computada pre y postoperatoria inmediata. Todos los pacientes fueron evaluados con los scores de AOFAS y VAS preoperatorios y a los 16 meses. Resultados: Todos los pacientes mejoraron los valores del score de AOFAS con un promedio preoperatorio de 27, a 90 postoperatorio, Vas preoperatorio de ocho y postoperatorio de uno. Las reducciones se consideraron aceptables con un desplazamiento de hasta 2 mm. en la tomografía postoperatoria y en un solo caso fue inaceptable. En el 47,6% de los casos,a detectó patología intraarticular, que pudo ser resuelta artroscópicamente. Conclusión: La artroscopia evidenció una incidencia de lesiones intraarticulares cercana al 50%, todos los casos mostraron resultados funcionales satisfactorios y solo un caso mostro una mala reducción, que no requirió ningún tratamiento accesorio. Nivel de evidencia: IV. Tipo de estudio: Serie de casos
Objective: The objective of the study was to determine 1) the incidence of intra-articular injuries associated with syndesmal tibiofibular lesions, 2) the functional and objective (imaging) results of the same treatment with arthroscopic assistance. Material and Methods: From August 2013 to August of 2016, 21 patients (12 men and 9 women) with isolated syndesmal lesions or with ankle fractures were treated surgically: Weber type C, Weber type B and Maisonneueve. Average age of 32 years. The same surgical team performed the surgeries; the first step was the anterior ankle arthroscopy, to confirm unstable injuries and treat the associated injuries. After the reduction, treatment of the fracture and ligament injury, a new arthroscopic time was performed to verify the reduction of the same. Average arthroscopy time was 8 min. All patients were evaluated with X-rays and computed axial tomography immediately before and after surgery to evaluate the reduction, score of Aofas and Vas before surgery and at 16 months. Results: All patients improved the values of Aofas score for a preoperative average of 27, postoperative of 90; Vas preoperative of eight and postoperative of one. Reductions were considered acceptable with up to 2 mm. displacement in the postoperative tomography and in only one case was unacceptable. In 47.6% of cases, intra-articular pathology was detected, which could be solved arthroscopically. Conclusion: Arthroscopy showed an incidence of intraarticular injuries close to 50%, all cases showed satisfactory functional results and only one case showed a poor reduction, which did not require any accessory treatment. Level of evidence: IV. Type of study: Case series
الموضوعات
Arthroscopy/methods , Tibial Fractures , Ankle Injuries/surgery , Fibula/injuries , Acute Disease , Incidence , Treatment Outcomeالملخص
Introducción: La reducción y la osteosíntesis de las fracturas de tobillo permiten una recuperación precoz. Sin embargo, clásicamente, no se permite la carga del peso durante casi seis semanas. El objetivo de este estudio es analizar si la carga inmediata del peso en pacientes con fracturas de peroné produce complicaciones y desplazamientos secundarios. Materiales y Métodos: Se estudió a 21 pacientes con fracturas de tipo AO 44B1 operados, a quienes se les indicó carga inmediata. Se analizó su evolución clínica y radiológica. El seguimiento fue superior a tres meses. Resultados: La carga del peso con protección con bota walker ocurrió, en promedio, a los dos días. El puntaje de la AOFAS para tobillo a los tres meses de la cirugía fue de 99. El tiempo promedio para el retorno a la actividad laboral fue de 2.1 meses y de 2.95 meses para la actividad deportiva. Conclusiones: Los pacientes con fracturas de tipo AO 44B1 de baja energía, tratados mediante reducción y osteosíntesis, pueden realizar carga del peso precoz, sin riesgo de desplazamientos secundarios. La carga precoz junto a la movilización temprana logra una muy buena evolución clínica, y no incide en un mayor índice de complicaciones.
Introduction: Reduction and fixation of ankle fractures allow early recovery. However, typically the weight load is not allowed for about 6 weeks. The aim of this study is to analyze if immediate weight bearing in patients with fibula fractures produces complications and/or secondary displacement. Methods: Twenty-one patients with AO type 44B1 operated fractures were analyzed, and immediate loading was indicated. Clinical and radiographic outcomes were evaluated. Follow-up was >3 months. Results: Weight load with a walker boot protection occurred, on average, at day 2. The AOFAS ankle score averaged 99 points three months after surgery. Patients returned to work at 2.1 months and to the previous sporting activity at 2.95 months, on average. Conclusions: Patients with low-energy AO type 44B1 fractures, treated by reduction and osteosynthesis, can support early weight load without risk of secondary movements. Early loading with early mobilization has a very good clinical outcome, and it does not induce a higher rate of complications.
الموضوعات
Fracture Fixation, Internal/methods , Fibula/surgery , Fibula/injuries , Weight-Bearing , Ankle Injuries/surgery , Follow-Up Studies , Time Factors , Treatment Outcomeالملخص
Describir los resultados obtenidos con el enclavado endomedular acerrojado en pacientes con fractura del tercio distal de la tibia. Materiales y Métodos: Se incluyeron pacientes con fracturas desplazadas del tercio distal de la tibia, tratadas con clavo endomedular. La muestra incluyó 35 pacientes. El tiempo de seguimiento posoperatorio fue de 29.2 meses. Se evaluaron el tiempo de consolidación, la consolidación viciosa y las complicaciones. Los resultados funcionales se determinaron con el puntaje de la AOFAS. Resultados: De los 35 pacientes con fractura del tercio distal de la tibia (24 de tipo A y 11 de tipo B de la clasificación AO), en todos, se logró la consolidación de la fractura. El tiempo promedio de consolidación fue de 17.2 semanas (rango 11-26). No se halló diferencia estadística (p = 0,201) en el tiempo de consolidación entre las fracturas asociadas con fracturas del peroné tratadas (13 semanas) o no tratadas (17 semanas). El puntaje de la AOFAS fue 86. Conclusión: Se plantea el enclavado endomedular con múltiples cerrojos distales como una buena alternativa de tratamiento para las fracturas de la tibia distal AO de tipo A o B, con bajo porcentaje de complicaciones y un alto índice de consolidación. Nivel de Evidencia: IV...
To describe the results obtained with intramedullary nailing in patients with distal third tibia fracture. Methods: Patients with displaced fractures of the distal tibia treated with intramedullary nailing were included. The sample comprised 35 patients. The follow-up was 29.2 months. Time of consolidation, malunion and complications were evaluated. Functional results were described according to the AOFAS score. Results: All patients with a distal third tibia fracture (24 type A and 11 type B) presented fracture healing. The average time to union was 17.2 weeks (range 11-26). There was no difference (p = 0.201) in the time to union between fractures associated with treated or untreated fibula fractures (13 and 17 weeks, respectively). The AOFAS score was 86 points. Conclusion: Intramedullary nailing with multiple distal locks is a good alternative treatment for AO types A or B distal tibia fractures, with a low complication rate and a high rate of consolidation. Level of Evidence: IV...
الموضوعات
Adult , Fracture Fixation, Intramedullary/methods , Tibial Fractures/surgery , Tibial Fractures , Fibula/injuries , Ankle Injuries/surgery , Follow-Up Studies , Treatment Outcomeالملخص
A 30-year-old male was involved in a car accident. Radiographs revealed a depressed marginal fracture of the medial tibial plateau and an avulsion fracture of the fibular head. Magnetic resonance imaging showed avulsion fracture of Gerdy's tubercle, injury to the posterior cruciate ligament (PCL), posterior horn of the medial meniscus, and the attachments of the lateral collateral ligament and the biceps femoris tendon. The depressed fracture of the medial tibial plateau was elevated and stabilized using a cannulated screw and washer. The injured lateral and posterolateral corner (PLC) structures were repaired and augmented by PLC reconstruction. However, the avulsion fracture of Gerdy's tubercle was not fixed because it was minimally displaced and the torn PCL was also not repaired or reconstructed. We present a unique case of pure varus injury to the knee joint. This case contributes to our understanding of the mechanism of knee injury and provides insight regarding appropriate treatment plans for this type of injury.
الموضوعات
Adult , Humans , Male , Fibula/injuries , Knee Injuries/complications , Multiple Trauma/complications , Tibial Fractures/complicationsالملخص
OBJECTIVES: The purpose is to study the effects of hyperbaric oxygen therapy and autologous platelet concentrates in healing the fibula bone of rabbits after induced fractures. METHODS: A total of 128 male New Zealand albino rabbits, between 6-8 months old, were subjected to a total osteotomy of the proximal portion of the right fibula. After surgery, the animals were divided into four groups (n = 32 each): control group, in which animals were subjected to osteotomy; autologous platelet concentrate group, in which animals were subjected to osteotomy and autologous platelet concentrate applied at the fracture site; hyperbaric oxygen group, in which animals were subjected to osteotomy and 9 consecutive daily hyperbaric oxygen therapy sessions; and autologous platelet concentrate and hyperbaric oxygen group, in which animals were subjected to osteotomy, autologous platelet concentrate applied at the fracture site, and 9 consecutive daily hyperbaric oxygen therapy sessions. Each group was divided into 4 subgroups according to a pre-determined euthanasia time points: 2, 4, 6, and 8 weeks postoperative. After euthanasia at a specific time point, the fibula containing the osseous callus was prepared histologically and stained with hematoxylin and eosin or picrosirius red. RESULTS: Autologous platelet concentrates and hyperbaric oxygen therapy, applied together or separately, increased the rate of bone healing compared with the control group. CONCLUSION: Hyperbaric oxygen therapy and autologous platelet concentrate combined increased the rate of bone healing in this experimental model. .
الموضوعات
Animals , Male , Rabbits , Fracture Healing , Fibula/injuries , Fractures, Bone/therapy , Hyperbaric Oxygenation/methods , Platelet-Rich Plasma , Collagen/analysis , Combined Modality Therapy/methods , Disease Models, Animal , Fractures, Bone/physiopathology , Osteotomy , Reproducibility of Results , Time Factors , Treatment Outcomeالملخص
O objetivo deste estudo foi compreender o significado de conviver com fixação externa por fratura exposta grau III em membros inferiores, sob o olhar do paciente. Os dados foram coletados com seis adultos jovens que faziam tratamento ambulatorial ortopédico, em um hospital público da cidade de São Paulo, por meio de entrevista semiestruturada com questões abertas, entre junho e agosto de 2010. Na busca do significado desta vivência, mantivemos uma atitude fenomenológica na análise, o que propiciou desvelar o fenômeno "buscar viver apesar de se sentir preso em uma gaiola". Os pacientes apontam que é o desejo pessoal e apoio de outras pessoas que propiciam a reorganização de suas vidas, apesar dos inúmeros desafios que precisam superar para adaptarem-se ao fixador acoplado ao seu corpo, do medo que sentem em relação ao futuro e das dúvidas quanto ao tratamento.
The present study is aimed to understand the meaning of living with an external fixation device forgrade III open fractures of the lower limbs from the perspective of the patient.The data were collected with six young adults who were under going out patient orthopedic treatment in a public hospital in the city of SãoPaulo, through semi-structured interviews with open questions, between Juneand August 2010. Seeking to understand the meaning of this experience,we have maintained a phenomenological attitude during the analysis, which made it possible to reveal the phenomenon"try to live in spiteof feeling trapped in a cage." Patients said that their personal desire and support from others helped them reorganize their lives, despite the several challenges they had to overcome to adapt to the fastener attached to their body and the fear of the future and doubts about the success of treatment.
El objetivo de este estudio fue comprender el significado de vivir con fijación externa para las fracturas abiertas de grado III de los miembros inferiores bajo la mirada del paciente. Los datos fueron recogidos con seis jóvenes adultos que no habían recibido tratamiento ortopédico de ambulatorio en un hospital público en la ciudad de SãoPaulo, a través de entrevistas semi estructuradas con preguntas abiertas,entre junio y agosto de 2010. En búsqueda del significado de esta experiencia que hemos mantenido una actitud de análisis fenomenológico, lo que llevó a revelar el fenómeno"tratan de vivir a pesarde sentirse atrapado en una jaula." Los pacientes indican que es el deseo y el apoyo de otros que están a favor de la reorganización de la vida personal, apesar de los numerosos desafíos que se deben superar para adaptarse a la sujeción acoplada a su cuerpo,el miedo que sienten sobre el futuro y las dudas en el tratamiento.
الموضوعات
Adult , Female , Humans , Male , Body Image , External Fixators , Fractures, Bone/psychology , Fractures, Open/psychology , Ilizarov Technique/psychology , Leg Injuries/psychology , Patients/psychology , Quality of Life , Accidents, Traffic , Acetabulum/injuries , Body Dysmorphic Disorders/etiology , Body Dysmorphic Disorders/psychology , Emotions , Femoral Fractures/psychology , Femoral Fractures/surgery , Fibula/injuries , Fractures, Bone/surgery , Fractures, Open/classification , Fractures, Open/surgery , Ilizarov Technique/instrumentation , Interpersonal Relations , Leg Injuries/surgery , Patient Acceptance of Health Care , Severity of Illness Index , Social Support , Tibial Fractures/psychology , Tibial Fractures/surgeryالملخص
OBJECTIVE@#To investigate the characteristics of forensic clinical identification on common peroneal nerve injury in traffic accident.@*METHODS@#Eight cases of common peroneal nerve injury in traffic accidents were analyzed, including general condition of the wounded, the way of injury, the imaging results, the EMG results, and the degree of injury, etc.@*RESULTS@#In 8 cases, 2 cases of complete common peroneal nerve injury were determined to grade 9 (disability degree) and 6 cases of partial common peroneal nerve injury were determined to grade 10 (disability degree).@*CONCLUSION@#By comparison, the disability degree of complete common peroneal nerve injury is higher than that of partial common peroneal nerve injury. The forensic clinical identification of common peroneal nerve should be made with synthetical consideration of medical history, symptoms, and auxiliary examinations.
الموضوعات
Adult , Female , Humans , Male , Middle Aged , Accidents, Traffic , Age Distribution , Disability Evaluation , Expert Testimony , Fibula/injuries , Fractures, Bone/physiopathology , Leg Injuries/physiopathology , Peroneal Nerve/physiopathology , Peroneal Neuropathies/physiopathology , Radiography , Trauma Severity Indicesالملخص
OBJETIVO: Comparar os resultados da fixação ou não da fíbula no tratamento das fraturas do terço distal da tíbia, com haste intramedular e placa em ponte. MÉTODOS: Foram 47 fraturas em 47 pacientes, sendo que em 21 pacientes foi utilizada a haste intramedular bloqueada não fresada e em 26 a placa em ponte (placa de compressão dinâmica larga ou estreita) pela técnica minimamente invasiva. Todas as fraturas da fíbula se encontravam no mesmo nível ou abaixo da fratura da tíbia. RESULTADOS: No grupo tratado com fixação da fíbula, a média do tempo de consolidação foi de 14,6 semanas. No grupo tratado sem fixação da fíbula, a média do tempo de consolidação foi de 14,3 semanas. No grupo de pacientes tratados com fixação da fíbula observou-se uma proporção de desvio angular em varo (6,3 por cento) significativamente menor que o subgrupo sem fixação de fíbula (32,3 por cento), e com desvio angular em valgo (62,5 por cento) significativamente maior que o grupo sem fixação de fíbula (32,3 por cento). CONCLUSÃO: Os benefícios da fixação da fíbula permanecem ainda controversos quando ocorrem fraturas associadas com a tíbia. Em relação à consolidação, não houve diferença significativa entre os grupos.
OBJECTIVE: To compare the results of fibula fixation (or not fixation) in the treatment of fractures located in the distal third part of the tibia, by using intramedullary nailing and bridge plate. METHOD: 47 fractures in 47 patients were studied. Twenty-one patients were treated with non-reammed, interlocking intramedullary nailing, and 26 patients were treated with wide or narrow dynamic compressional plates (using a minimally invasive technique). All of the fibula fractures are located at the same level or below the tibia fractures. RESULTS: in the group of patients treated with fibula fixation, the average healing time was 14.6 weeks. In the group of patients treated without fibula fixation, the average healing time was 14.3 weeks. In the group of patients treated with fibula fixation it was observed a significantly smaller proportion of valgus angular deviation (6.3 percent) than in the group of patients treated without fibula fixation (32.3 percent). CONCLUSIONS: The benefits of fibula fixation still keeping controversial when tibial fractures are associates. Regarding fracture healing, there was no significant difference between the studied fracture groups.
الموضوعات
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged, 80 and over , Fracture Fixation , Fracture Fixation, Internal , Fibula/injuries , Tibial Fracturesالملخص
Fat embolism syndrome (FES) remains a diagnostic challenge for physicians. It is commonly as associated with fractures of long bones and it is a major source of morbidity and mortality inpatients with multiple injuries. Overall mortality is between 5-15 percent in all studies. These facts motivate us to present the case of a young woman suffering bone fractures in both legs during the earthquake in Chile on February 27, 2010. She presented a FES 72 hours later. It is important to understand this syndrome, as it can be confused with other serious diseases that require different management. We should be able to have a high FES suspicion in the appropriate context, in as much as an early diagnosis, and treatment may improve the prognosis of this severe condition.
El síndrome de embolia grasa (SEG) sigue siendo un reto diagnóstico para los médicos. Se asocia fundamentalmente en fracturas de los huesos largos y es una importante fuente de morbilidad y mortalidad en pacientes politraumatizados. La mortalidad general se encuentra entre el 5 a 15 por ciento en todos los estudios. Esto nos motiva a presentar el caso de una mujer joven que 72 horas después de fracturas sufridas durante el terremoto ocurrido en Chile el 27 de febrero del 2010, presentó un SEG. Es importante conocer este síndrome, ya que se puede confundir con otras patologías graves que requieren un manejo distinto y al tener una alta sospecha en el contexto adecuado, se permite un diagnóstico oportuno, tratamiento precoz y mejorar el pronóstico.
الموضوعات
Humans , Adult , Female , Dyspnea/etiology , Embolism, Fat/etiology , Embolism, Fat , Fractures, Bone/complications , Diagnosis, Differential , Embolism, Fat/therapy , Hydrocortisone/therapeutic use , Natural Disasters , Oxygen Inhalation Therapy , Pulmonary Embolism , Fibula/injuries , Radiography, Thoracic , Tomography, X-Ray Computed , Tibia/injuriesالملخص
En los últimos años los accidentes de tránsito sufridos por los trabajadores mientras llevan a cabo su jornada laboral, han aumentado en número y severidad. En el presente trabajo se estudiaron los accidentes de tránsito que fueron valorados como riesgo laboral en la Sección de Medicina del Trabajo durante los años 2006-2007 (total de casos evaluados por esta causa 121). Obteniéndose del mismo una caracterización del trabajador afectado, siendo este, de sexo masculino, entre 30 y los 49 años, chofer o mensajero motorizado. Además se logró determinar que la mayoría de las lesiones presentadas por estos trabajadores correspondió con fracturas de los miembros inferiores (tibia y peroné) y con traumatismo craneoencefálicos, resultando como secuelas más destacadas el dolor residual y la limitación funcional, por lo que se les otorgó una incapacidad temporal y permanente acorde con la severidad de sus secuelas...
الموضوعات
Middle Aged , Accidents, Traffic , Insurance, Disability , Occupational Medicine , Fibula/injuries , Tibial Fractures , Brain Injuries, Traumatic/etiology , Wounds and Injuries , Costa Ricaالملخص
OBJETIVO: Avaliar a eficácia de um centrifugado osteogênico de medula óssea em estimular a consolidação de osteotomias da fíbula em coelhos. MÉTODOS: Foram utilizados dez coelhos machos adultos da raça Nova Zelândia albino. Realizou-se uma osteotomia transversa médio-diafisária da fíbula direita, seguida da adição local de uma esponja de colágeno absorvível embebida em um centrifugado osteogênico, obtido pela centrifugação de aspirado de medula óssea do osso ilíaco ipsilateral. A fíbula esquerda foi utilizada como controle, sendo feita a mesma osteotomia, porém neste caso adicionando-se somente a esponja de colágeno absorvível. Após quatro semanas os animais foram sacrificados para estudo dos calos ósseos formados. Os critérios de avaliação foram a mensuração da densidade mineral utilizando-se a densitometria óssea com DEXA, do volume do calo com tomografia computadorizada multi-slice e dos tecidos formados por meio de histomorfometria. RESULTADOS: A utilização do centrifugado osteogênico resultou em um aumento médio na densidade mineral óssea dos calos de 40,3 por cento e da quantidade relativa de tecido ósseo de 9,4 por cento, sem aumento significativo nas quantidades relativas de cartilagem ou fibrose nem no volume do calo ósseo. CONCLUSÃO: A administração do centrifugado osteogênico de medula óssea utilizado neste estudo favoreceu a consolidação óssea de osteotomias experimentais em coelhos.
OBJECTIVE: The purpose of this study was to evaluate the efficacy of a centrifuged osteogenic bone marrow aspirate to stimulate healing in rabbit fibular osteotomies. METHODS: Ten white New Zealand rabbits were used. A transverse medial diaphyseal fibular osteotomy was performed on the right fibula, where an absorbable collagen sponge embedded in osteogenic centrifuged bone marrow aspirate, obtained from the ipsilateral iliac bone, was inserted. The left fibula was used as the control group, where the collagen absorbable sponge was inserted without the osteogenic centrifuged aspirate. The rabbits were sacrificed four weeks after surgery to evaluate bone callus formation. Analyses of results were performed with DEXA bone densitometry to evaluate callus mineral mass, multislice computed tomography to evaluate callus volume and histomorphometry to evaluate the relative rate of tissue formation. RESULTS: The employment of centrifuged osteogenic bone-marrow aspirate resulted in a 40.3 percent, increase of callus bone mineral mass and increased relative quantity of bone tissue formation by 9.4 percent, without a significant increase in the relative quantities of cartilage, fibrous tissue, or in callus volume. CONCLUSIONS: This study shows that the centrifuged osteogenic bone marrow aspirate was able to improve the healing of experimental fibular osteotomies in rabbits.
الموضوعات
Animals , Male , Rabbits , Bone Marrow Cells , Bone Transplantation , Fracture Healing , Fibula/injuries , Osteotomy , Densitometryالملخص
OBJETIVOS: Este trabalho avaliou o potencial osteogênico de enxertos de periósteo livre associado a uma membrana de colágeno. MÉTODOS: Vinte ratos albinos Wistar com idade média de 100 dias foram submetidos à cirurgia para criação de um defeito ósseo de 2,5 a 3,0 mm de comprimento na diáfise das fíbulas. Após 30 dias os animais foram então divididos em dois grupos: Grupo I recebeu o implante de periósteo associado à membrana de colágeno e Grupo II, somente a membrana de colágeno. Os animais foram radiografados antes do implante de periósteo e 15 ou 30 dias após o mesmo. RESULTADOS: Os resultados mostraram que o enxerto de periósteo livre associado à membrana de colágeno não foi eficiente no processo de reparo do defeito ósseo. CONCLUSÃO: Sugere-se que enxertos periosteais não vascularizados não apresentam potencial para formar novo osso. O fato de o enxerto ter sido implantado 30 dias após a criação do defeito ósseo interferiu negativamente no processo de osteogênese.
OBJECTIVE: The present study evaluated the osteogenic potential of free periosteum graft in combination with collagen membranes. METHODS: Twenty white Wistar rats aged 100 days underwent surgery to create a bone defect measuring 2.5-3.0 mm in length in the diaphysis of the fibula. After thirty days, the animals were divided into two groups. Group I received periosteum along with a collagen membrane, while Group II received only a collagen membrane. The animals were X-rayed before the implant surgery and 15 or 30 days post-operation. RESULTS: The results demonstrated that free periosteum graft in combination with collagen membranes was not efficient in the repair of bone defects. CONCLUSION: We suggest that nonvascularized periosteal grafts do not show potential to form new bone, and that making the implant 30 days after the creation of the bone defect may have interfered negatively in osteogenic process.
الموضوعات
Animals , Female , Rats , Bone Regeneration , Fibula/injuries , Membranes , Osteogenesis , Prostheses and Implants , Tibia/injuries , Tibia , Collagen , Periosteum , Rats, Wistarالملخص
A luxação traumática isolada da articulação tibiofibular proximal é rara. Esta lesão pode não ser reconhecida ou diagnosticada no atendimento inicial. A ausência de suspeita clínica pode causar problemas para o diagnóstico. O diagnóstico necessita de história precisa do mecanismo e sintomas da lesão, avaliação clínica e radiográfica adequada de ambos joelhos. Casos não reconhecidos são fonte de alterações crônicas. O tratamento é feito por redução fechada e imobilização ou, em casos irredutíveis ou instáveis, redução aberta com fixação interna temporária. Um caso raro de luxação tibiofibular proximal isolada em um jogador de basquetebol é relatado para ilustrar essa lesão.
The isolated traumatic dislocation of the proximal tibiofibular joint is rare. The injury could go unrecognized or be misdiagnosed at the initial presentation. Lack of clinical suspicion can cause diagnostic problems. The diagnosis requires accurate history of the mechanism and symptoms of the injury, and adequate clinical and radiographic evaluation of the both knees. Overlooked injuries are a source of potentially chronic changes. The treatment is closed reduction and immobilization or, in case of a failed or unstable reduction, open reduction with temporary internal fixation. A rare case of acute isolated anterolateral dislocation of the proximal tibiofibular joint in a basketball player was described to illustrate this injury.
الموضوعات
Humans , Male , Adult , Basketball , Fibula/injuries , Knee Dislocation/classification , Knee Dislocation , Knee Dislocation/therapyالملخص
Los tumores óseos primitivos son neoplasias que se originan en el hueso, siendo los mas comunes en la infancia el osteosarcoma y el sarcoma de Ewing (aproximadamente 5% del total), aparecen en la segunda década de la vida son excepcionales antes de los 5 años de edad y es mas frecuente en el sexo masculino. Se presenta el caso de un escolar masculino de 6 años que inició enfermedad actual de 25 días de evolución caracterizada por dolor de fuerte intensidad a nivel de miembro inferior izquierdo que no mejora con la administración de analgésicos, posteriormente presenta aumento de volumen, e imposibilidad para la marcha. Asimetria de miembros inferiores dada por aumento de volumen de pierna izquierda con respecto a la derecha con 3 cm. de diferencia, dolorosa a la movilización. Rx de miembro inferior izquierdo: Levantamiento del periostio en tercio medio de peroné izquierdo. RMN de miembro inferior izquierdo se evidencia LOE en diáfisis de peroné izquierdo con infiltración de masa muscular. Se realizó exéresis del TU y tejidos adyacentes. La biopsia confirma el diagnóstico de sarcoma de Ewing con compromiso de partes blandas adyacentes y bordes libres de resección ósea libres de neoplasia. Recibió quimioterapia adyuvante. Finalizó tratamiento en Octubre del 2007. Actualmente Vivo sin enfermedad con excelente evolución pos-tratamiento y en seguimiento. El Sarcoma de Ewing es poco frecuente en menores de 10 años de edad, el pronóstico depende del tamaño, localización, metástasis al diagnóstico, niveles de LDH y respuesta a la quimioterapia inicial, debe individualizarse el tratamiento con el fin de lograr control local y erradicación de la enfermedad residual.
الموضوعات
Humans , Male , Child , Bone Neoplasms/surgery , Bone Neoplasms/pathology , Bone Neoplasms/drug therapy , Osteosarcoma , Fibula/anatomy & histology , Fibula/injuries , Biopsy/methods , Sarcoma, Ewing/surgery , Sarcoma, Ewing/pathology , Sarcoma, Ewing/drug therapy , Leg Injuries/etiologyالملخص
BACKGROUND: We wanted to report on stress fracture of the proximal fibula and to suggest the pathomechanism of this fracture. METHODS: Between April 2004 through April 2005, the military recruits who complained of leg pain during the 6 weeks basic training in the Republic of Korea Marine Corps education and training group were evaluated according to their clinical manifestations and plain radiographs. RESULTS: Twelve recruits of 635 recruits who complained leg pain were diagnosed as having fibular stress fracture. Eleven cases (10 recruits) appeared at the junction of the proximal and middle 1/3 of the fibula and 2 cases (2 recruits) were in the middle 1/3 of the fibula, as assessed radiologically. Tenderness was the most reliable clinical manifestation. All the fractures occurred after repetitive walking or jumping in a squatting position. Conservative treatments that included bed rest, immobilization and non-steroidal anti-inflammatory drugs administration according to the symptom severity were satisfactory. CONCLUSIONS: Proximal fibular stress fracture is not rare in military recruits. The shearing force on the proximal fibula and the repetitive stress by walking or jumping in a squatting position contribute to the stress fracture of the proximal fibula.
الموضوعات
Humans , Male , Young Adult , Fibula/injuries , Fractures, Stress/etiology , Military Personnel , Physical Exertion , Republic of Korea , Resistance Training/adverse effectsالملخص
Introduccion: Las fracturas de tobillo en los pacientes de edad avanzada con osteoporosis o fracturas conminutas presentan mayor riesgo de perdida de reduccion posoperatoria. Las placas con estabilidad angular son una alternativa para las fracturas con deficit de calidad osea y representan una nueva opcion terapeutica.El objetivo de este trabajo es evaluar en forma retrospectiva los resultados a mediano plazo de un grupo de pacientes mayores de 55 años con fractura de tobillo tratados con placas con estabilidad angular. Materiales y metodos: Se analizaron los resultados clínicos y radiológicos en una serie de 11 pacientes con fractura de tobillo tratadas con placas de estabilidad angulardebido a la presencia de osteoporosis o conminucionfracturaria. Resultados: El seguimiento promedio fue de 11,4 meses (rango 3-30). Todas las fracturas se consolidaron con reduccion anatomica en siete casos, buena en tres y regular en una. No existio perdida de reduccion en ninguna. El puntaje AOFAS de retropie y tobillo fue 84,8/100 (DE ± 13). De acuerdo con los criterios de Marsch ningun paciente presento cambios artrosicos severos, solo en cinco hubo cambios leves. Se diagnostico osteoporosis en seis casos mediante densitometria osea. Conclusiones: En nuestra serie la osteosintesis de perone con placa LCP presento buenos resultados clinicos y radiologicos a mediano plazo y represento una alternativa para las tecnicas habituales.
الموضوعات
Middle Aged , Fracture Fixation, Internal/methods , Fractures, Comminuted , Fibula/surgery , Fibula/injuries , Fibula , Osteoporosis , Bone Plates , Ankle Injuries/surgery , Follow-Up Studies , Treatment Outcomeالملخص
El tumor óseo de células gigantes es generalmente benigno, raro, grande, solitario agresivo localmente; denominado así por las células que lo constituyen las cuales son del tipo de los osteoclastos multinucleados, de ahí su otro nombre osteoclastoma. La experiencia acumulada evidencia que estos afectan en el adulto a la epífisis y metafisis, pero en los adolescentes solo afecta las zonas proximales confinadas por las placas de crecimiento. La mayoría de estos tumores aparecen en la zona periférica de la rodilla en mas de un 50 por ciento de los casos. Se reporta como síntoma mas evidente el dolor periarticular que es el estímulo que lleva a la consulta. Es considerado una neoplasia traicionera ya que histológicamente no hay diferencia entre osteoclastoma benigno y el infrecuente osteoclastoma maligno complicando el tratamiento. Existen características radiológicas que orientan al diagnóstico como la expansión excesiva de la cáscara perióstica a nivel epi-metafisiario; siendo el método gold standard de diagnóstico la RMN, donde podemos diferenciar características macroscópicas especificas del tumor; es importante tener en cuenta el rastro óseo (Survey, gammagrafía), ya que se han reportado casos de tumores multicentricos generalmente entre 2 y 3 focos neoplásicos distintos. Según su patogenia se ha establecido una gradación actual dada por la sinergia clinicoradiopatológica como elemento predictivo pero que no aporta significancia a la hora del tratamiento. Anteriormente se manejaban estas neoplasias conservadoramente, en la actualidad el tratamiento se inclina a la resección total en bloque buscando la curación total con posterior reemplazo con injerto o implante; ya que el tratamiento local mediante curetaje reporta una gran tasa de recidivas alrededor de un 50 por ciento. El uso de radioterapia en esta patología esta proscrito por la prevalencia de degeneración sarcomatosa. Presentación del caso: se presenta el caso de una paciente femenina de 17 años.