RÉSUMÉ
PURPOSE: To analyze the cause and treatment method of humerus nonunions which were initially treated by operation. The causes of nonunion were analyzed according to the initial treatment method. We report upon treatment options. MATERIALS AND METHODS: We reviewed 15 cases of humerus nonunion, which were initially treated surgically (7 cases of dynamic compression plate, 4 of Ender nail, 3 of interlocking intramedullary nail, 1 of K-wire) from January 1992 to January 2001. RESULTS: The causes of nonunion were determined to be as follows ; inadequate internal fixation or technical failure (9 cases), postoperatively applied improper external immobilization (5 cases), inadequate choice of implant (1 case). We treated the nonunion as follows; dynamic compression plate and bone graft in 11 cases, intramedullary nailing with small plate augumentation and bone graft in two, maintenance of initial nail with small plate augumentation and bone graft in two. All cases had bone union at an average of 15.9 weeks without complications, such as osteomyelitis, radial nerve palsy, or joint stiffness. CONCLUSION: Plate fixation is considered to be superior to intramedullary fixation in the treatment of nonunion. However, cases that received interlocking intramedullary nailing can be treated easily with small plate augumentation and bone graft without initial nail removal.
Sujet(s)
Ostéosynthese intramedullaire , Humérus , Immobilisation , Articulations , Ostéomyélite , Paralysie , Nerf radial , TransplantsRÉSUMÉ
BACKGROUND : Treatment of a severe burn injury with total parenteral nutrition can produce bacterial translocation to mesenteric lymph nodes through the intestinal mucosa due to permeability changes. Early enteral feeding will help to restore the mucosal barrier function. Certain nutrients may have a beneficial effect on bacterial translocation and gut immunity. METHODS : We choose the glutamine and korean cabbage as dietary factors to study the beneficial effect on gut immunity of feeding different dietary formulations of low amino acid concentrated total parenteral nutritional fluids in burned rats. Forty-eight (48) male pathogen-free Sprague-Dowley rats were allocated in 4 groups(group A, control chow diet and water ad libitum; group B, oral TPN diet; group C, oral TPN diet supplemented with 2% glutamine; and group D, oral TPN diet supplemented with korean cabbage). All groups, except control group A, recieved 40% total body surface area, full-thickness burn injury. Group A received sham burn injury. Bacterial translocation to mesenteric lymph nodes, the cecal bacterial population level, the intestinal mucosal protein content, and the total IgA of the intestinal luminal washing fluid were measured and light-microscope changes of the small intestine were observed in the rats on the 4th and the 7th days after corresponding diet intake. RESULTS : The incidence of bacterial translocation in the oral TPN diet group B was reduced signifi cantly compared with control group A and glutamine supplemented group C on 4th day postburn (p< 0.05) The cecal bacterial population level of control group A showed significant lower values, compared with the other groups, in total aerobic (on 4th day p<0.01, on 7th day p<0.01) and gram-negative enterics species (on 4th day p<0.01, on 7th day p<0.05). The mucosal protein amount per cm of length of intestine was decreased slightly in groups B, C, and D, compared with the control group A, but without statistical significance, on the 7th day postburn. The total (serum and secretary) IgA per cm of length of intestine was increased significantly in the glutamine-supplemented group C and the cabbage- sup plemented group D on the 7th day postburn, compared with the oral TPN group B (p<0.05). However,there was no corresponding decrease in the bacterial translocation ratio or the cecal bacterial population level. Histologic observations on the 4th and the 7th days of glutamine-supplemented group C & cabbage- supplemented group D revealed increases in the villous height, and the numbers of villous cells and goblet cells, compared with the oral TPN group B. A slight desquamation of the villous cells was observed in the cabbage-supplemented group on the 7th day. CONCLUSION : In summary, early enteral feeding is not sufficient to avoid bacterial translocation. Certain nutritional factors such as glutamine are helpful in overcoming the bacterial translocation in burned rats. Korean cabbage was beneficial became promoted an IgA increase in the intestine without a direct effect on the bacterial translocation.
Sujet(s)
Animaux , Humains , Mâle , Rats , Translocation bactérienne , Surface corporelle , Brassica , Brûlures , Régime alimentaire , Nutrition entérale , Aliment formulé , Glutamine , Cellules caliciformes , Immunoglobuline A , Incidence , Muqueuse intestinale , Intestin grêle , Intestins , Noeuds lymphatiques , Nutrition parentérale totale , Perméabilité , Phénobarbital , EauRÉSUMÉ
High-voltage electrical burns are associated with deep muscle injuries. A hidden, deep muscle injury has no specific clinical manifestations, and undetected muscle injury sometimes leads to septisemia or major amputations. From January to December 1996, 52 burned patients were admitted to the burn center. We evaluated their laboratory findings and the results of diagnostic tools. The items of study were urine, EKG, CK-MB, CPK, LDH, SGOT, SGPT, PYP scanning, Plethysmography, and arteriography. The presence of myoglobinuria and the increase in SGOT and SGPT two weeks after the injury were related to the extent of the burns. The PYP scanning was a very sensitive and useful tool for detecting hidden muscle injuries. The arteriographic findings were unsatisfactory for deciding the amputation level. The PCR findings converting to obstructive type were helpful in predicting possibile amputations.