ABSTRACT
Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts. ADO poses difficulties during arthroplasty because of the increased chance for iatrogenic fractures due to sclerotic bone. ADO is divided into two types based on radiological findings, fracture risk, and osteoclast activity. These differences suggest less brittle bone in patients with ADO I compared to that of patients with ADO II, which suggests a smaller chance of preoperative fractures during cementless arthroplasty in ADO I compared with that in ADO II. A case of cementless total knee arthroplasty in a patient with ADO I is presented. Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced. Therefore, the differences between ADO I and ADO II may not be clinically relevant for an iatrogenic fracture during arthroplasty in patients with ADO.
Subject(s)
Adult , Female , Humans , Acetabulum/injuries , Arthroplasty, Replacement, Knee/adverse effects , Down Syndrome/complications , Femoral Fractures/etiology , Genes, Dominant , Iatrogenic Disease , Knee Joint/surgery , Osteoarthritis, Knee/complications , Osteopetrosis/complications , Periprosthetic Fractures/etiology , Tibial Fractures/etiologyABSTRACT
OBJETIVO: Avaliar o impacto da fratura na qualidade de vida dos pacientes. MÉTODO: Os pacientes foram submetidos a um protocolo de dados clínicos e epidemiológicos, a uma avaliação específica para fraturas da tíbia, o método de Johner e Wruhs, cujo dados foram analisados por um questionário genérico para avaliação da qualidade de vida, o SF-36, o qual foi aplicado pelos autores, com um mínimo de seis meses de pós-operatório. Estes instrumentos foram também estratificados com relação ao retorno ou não dos pacientes a todas as atividades que realizavam antes do acidente. RESULTADOS: Observou-se uma diminuição dos valores de avaliação do questionário SF-36 demonstrada estatisticamente (p<0,05) tanto pelo teste U de Mann-Whitney, entre os itens do SF-36 e retorno ou não às atividades prévias, como com relação ao resultado do SF36 estratificado para a avaliação clínica (Johner e Wruhs), por meio do teste de Kruskal-Wallis. CONCLUSÃO: De acordo com os critérios estabelecidos, e com base nos resultados obtidos, a fratura da tíbia, mesmo com uma boa evolução clínica, promoveu uma piora na qualidade de vida dos pacientes analisados.
OBJECTIVE: To evaluate the impact of tibial fractures on patient's quality of life. METHOD: All patients were evaluated by means of a protocol of clinical and epidemiological data. The Johner and Wruhs method was employed to evaluate tibial fractures and the results were compared to those of the SF-36 Health Survey, which was applied by the authors from the sixth month postoperatively. Those methods were applied considering the return of the patients or not to all the activities they used to perform before the accident. RESULTS: We found a statistical significance (p<0.05) showed by Mann- Whitney's U-test between the component of SF-36, and return or not to previous activities. Regarding the results of SF36 and clinical evaluation (Johner and Wruhs), on the Kruskal-Wallis' test, we also found significant correlation. CONCLUSION: According to the established criteria and based on the results, tibial fractures, even with favorable clinical outcomes, result in a diminished quality of life.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Fracture Fixation, Intramedullary , Fractures, Bone , Tibial Fractures/etiology , Tibial Fractures/rehabilitation , Quality of Life , Epidemiologic Methods , Hospitals, Public , Clinical Protocols/standards , Surveys and Questionnaires/standardsABSTRACT
Complex fractures of the tibial plateau are associated with considerable displacement of the articular surface together with either open wounds or severe soft tissue injury. Adequate Condition of the soft tissue is an important prerequisite before reconstruction of the tibial plateau. Conventional treatment by open reduction and internal fixation by plate and screws necessitates extensive dissection through compromised soft tissue with high rates of shin necrosis and infection. Twenty three patients with tibial plateau fractures having compromised soft tissue envelope were treated using the Ilizarov method with or without minimal internal fixation. There were nineteen male [82.6%] and four female [17.4%] patients with average age 39.4 years [range 22 to 65 years]. The mechanism of injury was road traffic accident in seventeen patients [73.9%], fall from height in five patients [21.7%] and one patient [4.4%] injured by wall collapse. Using the criteria of Honkonen and Jarvinen as regard functional results, fifteen patients [65.2%] were considered to have excellent results, six [26.1%] good and two [8.7%] fair. The Ilizarov method for treatment of tibial plateau fractures with or without minimal internal fixation is considered a mini invasive procedure with low morbidity for a fracture that would otherwise require an extensive dissection and internal fixation with plates and screws with further soft tissue compromise and high rate of complications
Subject(s)
Humans , Male , Female , Tibial Fractures/etiology , Ilizarov Technique , Soft Tissue Injuries , Fractures, Open/complications , Fractures, Open/surgery , Fracture Fixation, Internal , Internal Fixators , Bone Screws/adverse effects , Bone Plates/adverse effects , Fractures, Open/etiologyABSTRACT
Distal tibial fractures are becoming more and more common because of increased incidence of high velocity injuries. Outcome of such fractures is generally not satisfactory when associated with soft tissue injuries especially at the anteromedial aspect. Mechanism of injury varied between low and high energy injury, the aim of this work is assessment of treatment of a group of fracture distal tibia. Fifteen patients were assessed during the period of 2003 - 2005. All patients were classified as AO type A. All patients had anteromedial soft tissue injuries [e.g. severe abrasion, contused wound, swelling, ecchymosis and blisters]. Mode of treatment was wound debridement and open reduction and internal fixation of the fibula with pre- contoured plate and screws. Under fluoroscopic control, closed reduction of tibial fractures and indirect fixation by long transverse screws extended to the proximal and distal fragments of tibia through the fibular plate. All cases were done on the same day of injury. Of 15 patients, 12 fractures united with congruent ankle joint with average healing time [12-15 weeks], two patients had mild varus deformity and one had posterior sagging. Of all 15 patients no infection, no metal failure and no delayed union or non union were detected. Early ankle mobilization and non weight bearing started on the 2[nd] day of surgery. Full weight bearing was allowed only after bone consolidation of tibial and fibular fractures and not before removal of the long transverse tibial screws and its changing with short screws to fibula only. Limited internal screw fixation of the tibia through the fibular plate provides good alignment, articular congruence and avoids complications associated with other treatment options
Subject(s)
Humans , Male , Female , Bone Screws , Fracture Fixation , Postoperative Complications , Treatment Outcome , Tibial Fractures/etiology , Soft Tissue Injuries , Fracture Fixation, Internal , Blister , EcchymosisABSTRACT
Las fracturas de pilón tibial son infrecuentes (1 por ciento del miembro inferior), su correcta interpretación imagenológica y clasificación son dificultosas, son técnicamente demandantes para el cirujano debido a la complejidad de la cirugía y difíciles de manejar tanto en el pre como en el postoperatorio por la gran cantidad de complicaciones existentes en este tipo de fracturas. En este trabajo se realizó un estudio descriptivo de corte transversal en 24 pacientes con fractura de pilón tibial en un periodo de 2 años (febrero 2002 a enero 2004 incluido), con el objetivo de presentar nuestros resultados con diferentes metodologías terapéuticas, donde 16 pacientes fueron tratados quirúrgicamente y 7 en forma incruenta. De los primeros, 10 presentaron buenos resultados, 1 regular y 5 malos. De los segundos, 2 obtuvieron buenos resultados y 5 malos. Basándonos en la clasificación AO (Asociación de Osteosíntesis), el tratamiento fue diferente según el tipo de fractura, todas las A1, un caso B2 y un caso C3 se trataron con yeso inguinopédico; al resto se les realizó osteosíntesis. En 1 caso se tuvo que realizar amputación infrapatelar, siendo este caso excluido de la evaluación. Nuestros resultados se debieron a que es una patología poco frecuente, al tiempo de internación (promedio 46 días) y a la demora en la provisión de los implantes solicitados.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Young Adult , Middle Aged , Aged, 80 and over , Tibial Fractures/surgery , Tibial Fractures/etiology , Tibial Fractures/therapy , Fracture Fixation/methods , Fractures, Open , Casts, Surgical , Orthopedic Procedures/methods , Treatment OutcomeABSTRACT
El siguiente trabajo monográfico se realizó en el servicio de Ortopedia y Traumatología del Hospital Escuela Dr. Roberto Calderón Gutiérrez en el período de enero de 2003 a junio de 2005, donde se recopilaron un total de 32 pacientes que cumplieron con los requisitos adecuados de ingreso al estudio, el cual consistió en tratar las fracturas de tibia con clavo tipo ENCORE, obteniéndose que el grupo etáreo que prevaleció fue entre 20- 30 años de edad con un 62.5 por ciento. Apreciándose que el sexo masculino fue el que predominó, y los pacientes provenían en su mayoría de zona urbana, a su vez dichas fracturas fueron provocadas por lesiones de gran energia como accidentes automovilísticos y caídas. En lo correspondiente a la clasificación de la AO, se obtuvo un predominio del grupo A, donde prevaleió el subgrupo a2, y con mayor afectación del tercio medio. En cuanto a tiempo quirúrgico, se obtuvo un rango adecuado aun sin contar con intensificador de imagen, obteniéndose una estancia intrahospitalria menor de 5 días. En cuanto a la evolución del tratamiento de la fractura, se logró un buen resultado deel rango de movilidad de rodilla y tobillo; y se obtuvo datos de formación de callo óseo en la mayor parte de casos en el primer mes, consolidando en su mayoría a las 16 semanas de intervención, con bajo porcentaje de complicaciones...
Subject(s)
Fracture Fixation , Fractures, Closed , Tibial Fractures/classification , Tibial Fractures/epidemiology , Tibial Fractures/etiology , Tibial Fractures , NicaraguaABSTRACT
En el ámbito deportivo se producen múltiples lesiones por estrés en las extremidades inferiores, y la patología que presentamos es una de las mas frecuentes en pacientes jóvenes y niños que entrenan excesivamente. La clínica que presentan estos pacientes supone dolor y tirantez durante el ejercicio. En la etiología podrían estar implicadas las fibras de inserción de los músculos tibiales y sóleo (fibras de Sharpey), sin poder descartar la coexistencia de periostitis y miositis como cofactores. Con relativa frecuencia los "shin splints" se asocian a fracturas de estrés en diferentes estadíos que son también patología típica de sobreentrenamiento y pueden mostrar una semiología similar. La gammagrafía ósea en dos fases ha sido ampliamente descrita como una técnica de ayuda para el diagnóstico correcto y en consecuencia el buen manejo de este tipo de pacientes.
Subject(s)
Humans , Male , Adult , Running/injuries , Tibial Fractures , Fractures, Stress , Tibia/injuries , Sports , Exercise , Tibial Fractures/etiology , Cumulative Trauma Disorders , Athletic InjuriesABSTRACT
Twenty five patients with twenty six limbs that had ipsilateral femoral and tibial fractures were treated operatively. Road traffic injuries were the main causes of injuries. Twenty three cases were closed fractures femur and three cases were open grade I fractures. All femoral fractures were treated with closed unreamed nails. Closed tibial fractures were 21 cases and treated with unreamed nails for diaphyseal fractures and AO places for tibial plateau fractures. Five cases were open fractures tibiae: one was grade one, two were grade II and the last two were grade three. Open tibial fractures were treated with external fixators. The average follow-up was 30.1 months [range 24-51 monthg]. All femoral fractures united within 3-8 months with one case required additional bone graft operation. Twenty three tibiae united within 3 to 9 months. One tibia was infected and treated with removal of nail and external fixator and united after 11 months. The other two tibiae had multiple operations; one of them eventually united after 19 months and the last tibia still not united with infection. Full range of knee motion was found in 21 cases while 5 cases had limited knee motion. Nineteen ceases had no shortening, five cases had shortening less than two cm, and two cases had shortening 2-5 cm. One case had respiratory distress syndrome with showers of fat emboli and treated medically. The end results were nineteen cases with excellent results, five limbs with good results and two limbs with poor results
Subject(s)
Humans , Male , Female , Femoral Fractures/etiology , Tibial Fractures/surgery , Tibial Fractures/etiology , Follow-Up Studies , Treatment Outcome , Range of Motion, Articular , Knee Joint , Accidents, Traffic , External Fixators , Bone Plates , Bone Transplantation , Fracture FixationABSTRACT
Realizou-se um estudo experimental com 40 ratos da raça Lewis visando-se avaliar a influência do risedronato sódico na consolidação de fraturas em animais submetidos à dieta aprotéica e dieta protéica, divididos aleatoriamente em quatro grupos, com 10 animais em cada grupo, assim constituídos: grupo I, com dieta protéica, sem risedronato (grupo controle); grupo II, dieta protéica, com risedronato; grupo III, dieta aprotéica, sem risedrionato; grupo IV, dieta aprotéica, com risedronato. Os ratos foram submetidos a fraturas semelhantes, no 15º dia e à eutanásia no 43º dia do experimento. As variáveis analisadas incluíram a evolução ponderal, avaliação radiográfica, densitometria óssea, avaliação histomorfométrica do calo ósseo, dosagens sanguíneas de cálcio, fósforo, fosfatase alcalina, proteínas totais, albumina e osteocalcina. Concluiu-se que o risedronato exerceu influência positiva no processo de consolidação de fraturas em ratos nutridos e desnutridos, e aumentou a densidade mineral óssea. O risedronato ocasionou a formação de tecido ósseo maduro de melhor qualidade e morfologia.
Subject(s)
Animals , Male , Rats , Fracture Healing , Fracture Healing/physiology , Protein Deficiency/complications , Tibial Fractures/etiology , Calcium , OsteocalcinABSTRACT
Foram avaliados prontuários e radiografias de 179 pacientes com fratura de tíbia, sendo 120 expostas e 59 fechadas atendidos durante 4 anos em nosso Serviço. Dos pacientes, 132 eram do sexo masculino e 47 do sexo feminino,com idade entre 14 e 83 anos. Em 97 (54,18 por cento) pacientes, as fraturas ocorreram no terço médio. Cento e dois (56,8 por cento) pacientes apresentavam fragmento simples e 57 (31,38 por cento) tinham traços oblíquos. O tratamento com imobilização gessada foi realizado em 48 casos com fraturas fechadas e 38 com exposta, usando-se fixador externo seqüencial durante dias e em seguida imobilização gessada de 3 e 67, com osteossíntese através de placa e parafuso 5 e 12 e, exclusivamente, com fixador externo 2 e 3, respectivamente. Nas fraturas fechadas e expostas ocorreram 7 e 20 pseudartrose e 1 e 11 infecções. Constatamos com os dados obtidos, a validade dos estudos epidemiológicos, como contribuição para identificar melhor as características das lesões, tratamento e complicações e possibilitar o aprimoramento de condutas e aprendizado.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Tibial Fractures/surgery , Tibial Fractures/epidemiology , Tibial Fractures/etiologyABSTRACT
Se realizó un estudio descriptivo, logitudinal y prospectivo, en el Hospital Escuela Dr. Roberto Calderón Gutiérrez, en el período de enero- diciembre 1999, a 50 expedientes de pacientes atendidos y que fueron intervenidos quirúrgicamente por presentar fractura de tobillo. En el estudio se determino que 27 (45.6 porciento) corresponden al sexo femenino y 32 (54.4 porciento) al sexo masculino, en relación a la edad el sexo masculino presenta en los menores de 20 años 5.8 porciento, de 20- 29 años 8.4 porciento, de 30- 39 años 22 porciento y 40- 50 años, 13.5 porciento y mayores de 50 años 5.8 porciento y en el sexo femenino, las menores de 20 años 5.08 porciento, de 20- 29 años 13.5 porciento, de 30- 39 años 11.8 porciento, de 40- 49 años, 8.47 porciento y mayores de 50 años, 6.77 porciento. De los pacienters con fracturas de Tobillo, el 47.4 porciento corresponden a las Tipo B2, 169 porciento, a las de tipo B3, 8.47 porciento, a las de tipo B1. Las tipo A suman 13.48 porciento y las C 13.5 porciento. El tratamiento quirúrgico más utilizado fue el tornillo, usándose los maleolares 24 porciento, de cortical 23 porciento, transindesmal 17 porciento y de esponjosa 7.2 porciento, kirschnermas cerclaje 20 porciento, placa de media caña 5.4 porciento y el ligamento deltoideo
Subject(s)
Academic Dissertations as Topic , Fracture Fixation, Internal , Ligaments, Articular , Tibial Fractures/etiology , Tibial Fractures/surgery , NicaraguaABSTRACT
Se realizo un estudio para evaluar el manejo de pacientes con fijación IM (intramedular), según características de las fracturas de tibia e implante utilizado. Los implantes utilizados fueron clavos IM bloqueados tipo Gross Kempfe, clavo IM no bloqueado tipo Kuntscher Clásico y clavo IM de Lottes. Es importante hacer notar que el HEALF ha sido pionero como centro hospitalario público en la utilización de Técnicas de Fijación IM bloqueadas. Este materialha sido donado al Servicio de Ortopedia gracias a la gestión del Dr. Warren Pagel. Se evaluaron las características biológicas y sociales de los pacientes con fijación intramedular de tibia, así como la técnica e implante utilizado según eltipo de fractura. Para la evaluación de los resultados nos basamos en los criterios de Jhoners-Wursh. El estudio refleja que las características biológicas y sociales de nuestros pacientes son similares a la de estudios previos y que el resultado en el manejo de las fracturas de tibia con fijación intramedular es excelente en un 72.72 porciento de los casos lo cual es muy satisfactorio, pero se puede mejorar teniendo acceso a mayor variedad y set completos de implantes para cada patrón de fractura
Subject(s)
External Fixators/classification , Fracture Fixation, Intramedullary/classification , Prostheses and Implants , Tibial Fractures/classification , Tibial Fractures/etiology , Tibial Fractures/surgeryABSTRACT
El presente trabajo presenta un estudio descriptivo realizadó en pacientes mayores de 15 años, ingresados al Departamento de Ortopedía deL "HEODRA" durante 1998 y con seguimiento en consulta externa durante 1999. Encontrandose que los más afectados fueron los de la segunda y tercera década con 26.9 porciento y 31.8 porciento siendo el sexo masculino el que presentó mayor número de casos 84.6 porciento. La localización de las fracturas fue el tercio medio con 88.4 porciento, con respecto al trazo de fracturas el oblicuo fue el que presentó mayor porcentaje 50 porciento seguido del transverso. el tratamiento empleado fue el yeso inguinopédico más bota de sarmiento fue el más utilizado 65.3 porciento. Las complicaciones con mayor porcentaje fueron las infecciones oseas con 26 porciento e infecciones de partes blandas con 12 porciento
Subject(s)
Academic Dissertations as Topic , Multiple Trauma , Tibial Fractures/classification , Tibial Fractures/diagnosis , Tibial Fractures/etiologyABSTRACT
A case of hydatid cyst of the tibia, which manifested as a pathologic fracture is being reported. Pain and swelling of left lower limb with inability to bear the weight were the main features. Tender swelling was also noted at the upper and middle third of tibia. Open biopsy revealed the hydatid cyst wall and scolices of Echinococcus granulosus. Albendazole treatment was followed by curettage and bone grafting.
Subject(s)
Adult , Albendazole/therapeutic use , Biopsy , Bone Diseases/complications , Bone Transplantation , Combined Modality Therapy , Curettage , Echinococcosis/complications , Fractures, Spontaneous/etiology , Humans , Male , Tibia , Tibial Fractures/etiologyABSTRACT
Os autores relatam caso de paciente portador de púrpura trombocitopênica, com quadro infecciosos graves e freqüentes, que em algumas situaçöes complicaram-se com septiciemia e coagulopatia intravascular disseminada, apresentando fechamento prematuro das fises tibiais direta e esquerda, ao nível dos tornozelos. Foi feita revisäo bibliográfica a respeito, com discussäo da etiopatogenia do fechamento fisário prematuro
Subject(s)
Humans , Male , Adolescent , Tibial Fractures/etiology , Growth Plate/abnormalities , Purpura, Thrombocytopenic/complications , Ankle , Ankle/abnormalities , Disseminated Intravascular Coagulation/complications , Sepsis/complicationsABSTRACT
Descrevem-se três casos de "fratura de stress de tíbia", observando-se que as manifestaçöes clínicas precederam em mais de 30 dias o aparecimento das alteraçöes radiológicas compatíveis com fratura. É feita revisäo da literatura, citando-se os vários sítios ja encontrados de "fratura de stress"