Treatment of Extensive Soft Tissue Injury with Polypropylene Prosthesis: A Case Study.

Injuries with exposure of soft tissue are frequent in orthopaedics. Innovative therapies using prosthesis as an auxiliary material to treat this type of injury are under development, aiming to overcome applicability and execution limitations of myocutaneous flap techniques. Figueiredo's technique uses a polypropylene prosthesis extracted from sterile saline to treat trauma at the fingertip. It is an alternative technique with a high success rate, reproducible, low cost and easy to apply. This article reports a case of foot injury with exposure of soft tissue treated with a treatment similar to Figueiredo's technique. The patient was admitted with a large and contaminated skin wound, muscle damage, tendon exposure, cuboid fracture and bone loss. Initially, debridement was performed. After 72 hours, a polypropylene prosthesis extracted from a sterile saline bottle was implanted and subsequently replaced after 60 days. After 76 days, the prosthesis was removed. There was no infection. 8 months later, there was total healing by second intention. The patient's motor and sensory functions were preserved. This case study shows that Figueiredo's technique can also be employed in more extensive injuries, representing an alternative to using myocutaneous flaps. The polypropylene prosthesis is extremely affordable, which enables resolution of cases in a greater number of services. This technique still offers the best aesthetic result and does not compromise other body regions.

Capitate and Hamate Fracture. Case Study.

Capitate and hamate fractures are infrequent injuries and are uncommon in isolation. A capitate fracture is usually associated with a scaphoid fracture. The primary mechanism of injury is a fall with the wrist in hyperextension. Other possible ways for capitate fractures are axial down trauma of the third metacarpal and direct trauma. Hamate fractures have a 2% incidence among carpal bone fractures, probably due to underreporting. They can occur on the hamate body or the hamulus or hook. Combined capitate and hamate fractures are uncommon and relevant studies, especially case reports, are scarce. We present a case report of a combined capitate and hamate fracture in a 44-year-old patient who suffered a direct trauma to the back of the hand during a fall. Following a clinical suspicion based on history and physical examination, radiographic and computed tomography (CT) studies were crucial for elucidating the case and proposed treatment, which involved ensuring absolute stability and performing an open reduction, using interfragmentary compression, with the Herbert bone screw implanted in each bone. After the surgical procedure, the patient wore a forearm plaster cast splint for four weeks. A satisfactory outcome was obtained in three months, with a complete range of motion and preserved force compared to the contralateral hand.