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1.
Bone Joint J ; 103-B(4): 769-774, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789468

RESUMO

AIMS: Complex fractures of the femur and tibia with associated severe soft tissue injury are often devastating for the individual. The aim of this study was to describe the two-year patient-reported outcomes of patients in a civilian population who sustained a complex fracture of the femur or tibia with a Mangled Extremity Severity Score (MESS) of ≥ 7, whereby the score ranges from 2 (lowest severity) to 11 (highest severity). METHODS: Patients aged ≥ 16 years with a fractured femur or tibia and a MESS of ≥ 7 were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (January 2007 to December 2018). Cases were grouped into surgical amputation or limb salvage. Descriptive analysis were used to examine return to work rates, three-level EuroQol five-dimension questionnaire (EQ-5D-3L), and Glasgow Outcome Scale-Extended (GOS-E) outcomes at 12 and 24 months post-injury. RESULTS: In all, 111 patients were included: 90 (81%) patients who underwent salvage and 21 (19%) patients with surgical amputation. The mean age of patients was 45.8 years (SD 15.8), 93 (84%) were male, 37 (33%) were involved in motor vehicle collisions, and the mean MESS score was 8.2 (SD 1.4). Two-year outcomes in the cohort were poor: six (7%) patients achieved a GOS-E good recovery, the mean EQ-5D-3L summary score was 0.52 (SD 0.27), and 17 (20%) patients had returned to work. CONCLUSION: A small proportion of patients with severe lower limb injury (MESS ≥ 7) achieved a good level of function 24 months post-injury. Further follow-up is needed to better understand the long-term trajectory of these patients, including delayed amputation, hospital readmissions, and healthcare utilization. Cite this article: Bone Joint J 2021;103-B(4):769-774.


Assuntos
Fraturas do Fêmur/cirurgia , Escala de Gravidade do Ferimento , Traumatismos da Perna/cirurgia , Fraturas da Tíbia/cirurgia , Amputação , Feminino , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Sistema de Registros , Vitória
2.
Orthop Clin North Am ; 52(2): 111-121, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33752832

RESUMO

Periarticular fractures of the lower extremity can be difficult injuries to stabilize effectively. Modern advances in technique and implant design now allow many of these fractures to be fixed with an extreme intramedullary nail. When nailing is not possible, less invasive plating through percutaneous incisions is a reliable option. The decision to perform extreme nailing is multifactorial and is based on the fracture pattern, the condition of the soft tissues, the medical condition of the patient, and the importance of earlier or immediate weightbearing.


Assuntos
Fêmur/lesões , Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Fixadores Internos , Fraturas da Tíbia/cirurgia , Fixação Intramedular de Fraturas/métodos , Humanos
3.
Acta Chir Orthop Traumatol Cech ; 88(1): 45-49, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-33764867

RESUMO

PURPOSE OF THE STUDY The term toddler's fracture was first coined by J. S. Dunbar in 1964 as a nondisplaced fracture of the distal tibia in children aged 9 months to 3 years. Over time, many other authors extended this definition as to the location as well as age range. The purpose of this paper is to provide a comprehensive overview of the existing studies focusing on the topic of toddler's fractures, to compare individual diagnostic and therapeutic approaches, and to specify the term toddler's fracture. Also, a group of patients with this diagnosis is presented, treated at our department. MATERIAL AND METHODS A retrospective study of a group of patients treated at the Department of Paediatric and Trauma Surgery, 3rd Faculty of Medicine, Charles University in the period from 1. 1. 2012 to 2. 8. 2017. The defined age range of patients was 9 months up to 3 years. The most frequent type of skeletal injury at this age was identified. Also, the etiology of injuries, the method and duration of fixation were examined. Moreover, an overview of foreign articles, with a focus on diagnosis and therapeutic approach is presented. RESULTS In the respective five-year period, a total of 15,679 children with a skeletal injury were treated at the Department of Paediatric and Trauma Surgery, of whom 57 patients at the age of a toddler (9 months to 3 years of age) sustained a nondisplaced distal tibial metaphyseal fracture (0.4%). In addition, 147 patients were treated for nondisplaced fracture of the first metatarsal base (0.9%) - in 98 of whom it was a torus fracture, in 49 patients the fracture line extended into the physis; therefore, it concerned the Salter-Harris type II separation of epiphysis. The group included only one patient with a nondisplaced calcaneal fracture. DISCUSSION Despite differences in the definition as to the location and age of patients, the toddler's fractures can always be defined as nondisplaced, and in many cases, they are difficult to diagnose based on the initial X-rays. Crucial for a differential diagnosis is to distinguish them from osteomyelitis, synovitis of the hip joint, or a tumour. In case of unclear history, also the Child Abuse and Neglect syndrome shall be considered. When any of the aforementioned diagnoses is suspected, methods with a higher diagnostic yield (but in case of computed tomography and scintigraphy also with a higher burden) - ultrasound, CT or scintigraphy - can be used. CONCLUSIONS We recommend that the term "toddler's fracture" is used for nondisplaced fractures of the distal third of the tibia with respect to the original criteria proposed by Dunbar. We consider as an option to include in this group also the first metatarsal fractures due to their frequency in this age group, provided that the stated conditions are met. Key words: toddler's fracture, tibial fractures, toddlerhood, diagnosis, treatment.


Assuntos
Fraturas da Tíbia , Criança , Pré-Escolar , Humanos , Lactente , Radiografia , Estudos Retrospectivos , Tíbia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Ultrassonografia
4.
Zhongguo Gu Shang ; 34(2): 148-52, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33666002

RESUMO

OBJECTIVE: To explore clinical effect of bridge-link combined fixation system(BCFS) in treating open middle and lower tibial fractures by external fixation. METHODS: From October 2016 to September 2017, 11 patients with open middle and lower tibial fractures were treated with BCFS by external fixation, including 7 males and 4 females aged from 23 to 65 years old with an average of 44.2 years old;the course of disease ranged from 7 to 10 days. All fractures were open, middle and lower tibiofibular fractures. According to AO classification, 5 patients were type A, 5 patients were type B, and 1 patient was type C. All fractures were classified as typeⅡaccording to Gustilo-Anderson classification. The time of fracture healing, postoperative complications were observed, Johner-Wruhs standard were used to evaluate clinical effect. RESULTS: All patients were followed up from 7 to 13 months with an average of 10.1 months. Fracture healing time ranged from 4 to 8 months with an average of 6.2 months. The removal time of BCFS ranged from 5 to 11 months with an average of 7.8 months. No screws loosening and BCFS breakage occurred after operation, while 1 patient occurred infection of proximal and distal tibia after operation which was healed by anti-inflammatory treatment and dressing change. According to Johner-Wruhs standard, 8 patients were excellent and 3 patients good at the latest follow-up. CONCLUSION: BCFS could be used to treat open middle and lower tibial fractures by external fixation, which had features of small size, flexible use, solid and elastic fixation. It could not effectively reduce tissue injury and promote fracture healing, but also have advantages of less postoperative complications and better recovery of limb function.


Assuntos
Fraturas Expostas , Fraturas da Tíbia , Adulto , Idoso , Placas Ósseas , Fixadores Externos , Feminino , Fixação de Fratura , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
6.
Medicine (Baltimore) ; 100(7): e24791, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607836

RESUMO

RATIONALE: Despite significant advances in surgical techniques and implants, the clinical outcome of high-energy pilon fractures remains unsatisfactory, which continues to represent numerous challenges for orthopedic trauma surgeons. PATIENT CONCERNS: A 62-year-old man injured his right ankle after falling from a 3 m high place. There were no open wounds or other complications. DIAGNOSES: According to the X-ray and CT scans, the patient was diagnosed with pilon fracture (type AO-43-C2) and lateral malleolus fracture of the right limb. INTERVENTIONS: The patient was initially treated with calcaneal traction upon admission to a primary hospital. Five days after the injury, the patient underwent open reduction and internal fixation (ORIF) of the fracture and vacuum sealing drainage (VSD) for wound closure. OUTCOMES: The patient presented to our hospital on the 9th day after the first ORIF operation because of critical ischemia of the affected foot and distal lower leg. Blood circulation did not improve after a series of salvage treatments, and below-knee amputation was ultimately performed. LESSONS: This is a rare case of complete ischemic necrosis following ORIF surgery of a closed pilon fracture due to iatrogenic damage. Standardized treatment that strictly follows the guidelines, instructions, or expert consensus should be promoted in this kind of complicated pilon fracture.


Assuntos
Amputação/métodos , Fraturas do Tornozelo/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Redução Aberta/efeitos adversos , Fraturas da Tíbia/cirurgia , Angiografia Digital , Fraturas do Tornozelo/complicações , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Lesões dos Tecidos Moles/etiologia , Fraturas da Tíbia/complicações , Lesões do Sistema Vascular/etiologia
7.
Bone Joint J ; 103-B(2): 294-298, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517721

RESUMO

AIMS: The aim of this study was to determine the immediate post-fixation stability of a distal tibial fracture fixed with an intramedullary nail using a biomechanical model. This was used as a surrogate for immediate weight-bearing postoperatively. The goal was to help inform postoperative protocols. METHODS: A biomechanical model of distal metaphyseal tibial fractures was created using a fourth-generation composite bone model. Three fracture patterns were tested: spiral, oblique, and multifragmented. Each fracture extended to within 4 cm to 5 cm of the plafond. The models were nearly-anatomically reduced and stabilized with an intramedullary nail and three distal locking screws. Cyclic loading was performed to simulate normal gait. Loading was completed in compression at 3,000 N at 1 Hz for a total of 70,000 cycles. Displacement (shortening, coronal and sagittal angulation) was measured at regular intervals. RESULTS: The spiral and oblique fracture patterns withstood simulated weight-bearing with minimal displacement. The multifragmented model had early implant failure with breaking of the distal locking screws. The spiral fracture model shortened by a mean of 0.3 mm (SD 0.2), and developed a mean coronal angulation of 2.0° (SD 1.9°) and a mean sagittal angulation of 1.2° (SD 1.1°). On average, 88% of the shortening, 74% of the change in coronal alignment, and 75% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. The oblique fracture model shortened by a mean of 0.2 mm (SD 0.1) and developed a mean coronal angulation of 2.4° (SD 1.6°) and a mean sagittal angulation of 2.6° (SD 1.4°). On average, 44% of the shortening, 39% of the change in coronal alignment, and 79% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. CONCLUSION: For spiral and oblique fracture patterns, simulated weight-bearing resulted in a clinically acceptable degree of displacement. Most displacement occurred early in the test period, and the rate of displacement decreased over time. Based on this model, we offer evidence that early weight-bearing appears safe for well reduced oblique and spiral fractures, but not in multifragmented patterns that have poor bone contact. Cite this article: Bone Joint J 2021;103-B(2):294-298.


Assuntos
Deambulação Precoce , Fixação Intramedular de Fraturas/métodos , Cuidados Pós-Operatórios/métodos , Fraturas da Tíbia/cirurgia , Fenômenos Biomecânicos , Pinos Ortopédicos , Parafusos Ósseos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/reabilitação , Humanos , Modelos Anatômicos , Tíbia/lesões , Tíbia/fisiologia , Tíbia/cirurgia , Fraturas da Tíbia/reabilitação , Suporte de Carga
8.
Bone Joint J ; 103-B(2): 279-285, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517738

RESUMO

AIMS: Pin-site infection remains a significant problem for patients treated by external fixation. A randomized trial was undertaken to compare the weekly use of alcoholic chlorhexidine (CHX) for pin-site care with an emollient skin preparation in patients with a tibial fracture treated with a circular frame. METHODS: Patients were randomized to use either 0.5% CHX or Dermol (DML) 500 emollient pin-site care. A skin biopsy was taken from the tibia during surgery to measure the dermal and epidermal thickness and capillary, macrophage, and T-cell counts per high-powered field. The pH and hydration of the skin were measured preoperatively, at follow-up, and if pin-site infection occurred. Pin-site infection was defined using a validated clinical system. RESULTS: Out of 116 patients who were enrolled in the study, 23 patients (40%) in the CHX group and 26 (44%) in the DML group had at least one bad or ugly pin-site infection. This difference was not statistically significant (p = 0.71). There was no significant relationship between pH or hydration of the skin and pin-site infection. The epidermal thickness was found to be significantly greater in patients who had a pin-site infection compared with those who did not (p = 0.01). Skin irritation requiring a change of treatment occurred in four patients (7%) using CHX, and none using DML. CONCLUSION: We found no significant difference in the incidence of pin-site infection between the CHX and DML treatment groups. Dermol appeared to offer a small but significant advantage in terms of tolerability. We did not find a significant association between patient or treatment related factors and pin-site infection. It is therefore difficult to make specific recommendations based upon these results. The use of either cleaning agent appears to be appropriate. Cite this article: Bone Joint J 2021;103-B(2):279-285.


Assuntos
Pinos Ortopédicos/efeitos adversos , Emolientes/uso terapêutico , Fixadores Externos/efeitos adversos , Fixação de Fratura/instrumentação , Cuidados Pós-Operatórios/métodos , Infecções Relacionadas à Prótese/prevenção & controle , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos Locais/uso terapêutico , Clorexidina/uso terapêutico , Feminino , Seguimentos , Fixação de Fratura/métodos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/epidemiologia , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
9.
BMC Surg ; 21(1): 95, 2021 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-33612116

RESUMO

BACKGROUND: The hexapod external fixator (HEF) is increasingly used for high-energy tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the HEF for definitive management in patients with high-energy tibial shaft fractures. METHODS: The study was conducted on 34 patients with tibial shaft fractures who were admitted or referred to our institution and consented to HEF treatment from Jan 2016 to June 2019, including 27 males and 7 females with a mean age of 39 years (range 18 to 65 years). Patients' clinical and radiological data, and the final clinical outcomes at a minimum of 12 months follow-up were collected and retrospectively analyzed. All complications were documented according to Paley's classification. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit. RESULTS: All patients remained in the HEF for a mean of 26 weeks (range 15 to 52 weeks) and acquired complete bone union. The satisfactory alignment was achieved in all patients, and all the patients were able to perform daily activities with no difficulty at the last clinical visit. Complications included pin tract infection (44%), delayed union (6%), nonunion (3%), and joint stiffness (3%). The ASAMI bony result was excellent in 31 patients and good in 3. The ASAMI functional result was excellent in 27 patients, good in 6, and fair in 1. CONCLUSIONS: Definitive management using the hexapod external fixator is an alternative and effective method for high-energy tibial shaft fractures, including technical advantages of early trauma-control, the versatility of achieving excellent alignment, and the continuity of device until bone union.


Assuntos
Fixadores Externos , Fraturas da Tíbia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
10.
Unfallchirurg ; 124(3): 212-221, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33580301

RESUMO

The anterolateral tibial rim with the anterior tibial tubercle (Tubercule de Tillaux-Chaput) serves as an insertion site of the anterior inferior tibiofibular ligament (AITFL). It can also be termed the anterior malleolus or fourth malleolus. Fractures of the anterolateral tibial rim typically result from an external rotation or abduction mechanism of the talus within the ankle mortise. They are frequently overlooked in plain radiographs. Computed tomography (CT) is needed for an exact visualization of the fracture anatomy and treatment planning. A total of three main types can be differentiated: (1) extra-articular avulsion fracture of the AITFL, (2) fracture of the anterolateral distal tibia with involvement of the joint and tibial incisura and (3) impaction fracture of the anterolateral tibial plafond. Surgical fixation of displaced anterolateral distal tibial fractures aims at bone-to-bone stabilization of the anterior syndesmosis, restoration of the tibial incisura for the distal fibula and joint surface. Displaced extra-articular avulsion fractures (type 1) are fixed with a suture anchor or transosseal suture. Larger fragments involving the tibial incisura and plafond (type 2) are mostly fixed with screws. Impression fractures of the anterolateral tibial plafond (type 3) necessitate elevation with restoration of the joint surface, bone grafting of the impaction zone as needed and anterior buttress plating. Only a few studies have reported the treatment results of anterolateral tibial rim fractures in adults. Conservative treatment of dislocated fragments reportedly leads to non-union and malposition of the distal fibula with incongruence of the ankle mortise requiring revision. Impaction fractures (type 3) can lead to secondary avascular necrosis of the anterolateral tibial plafond.


Assuntos
Fraturas do Tornozelo , Ligamentos Laterais do Tornozelo , Fraturas da Tíbia , Adulto , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Fíbula , Fixação Interna de Fraturas , Humanos , Tíbia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia
11.
Instr Course Lect ; 70: 121-138, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438908

RESUMO

Tibial plafond fractures include a wide spectrum of injuries that show their complexity. Soft-tissue injury in tibial plafond fractures is much more important than bony injury. Commonly, a staged treatment, that is, temporary external fixation followed by definitive surgery when the soft tissue is ready, is performed. Knowledge of multiple surgical approaches is a prerequisite for open reduction and internal fixation of tibial plafond fractures because of the large variation of fracture patterns.


Assuntos
Lesões dos Tecidos Moles , Fraturas da Tíbia , Fixação de Fratura/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Consolidação da Fratura , Humanos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
12.
Instr Course Lect ; 70: 399-414, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438924

RESUMO

As the number of pediatric and adolescent patients participating in sports continues to increase, so too does the incidence of anterior cruciate ligament (ACL) tears in this population. There is increasing research on pediatric and adolescent ACL tears; hundreds of articles on the topic have been published in the past few years alone. It is important to highlight the most pertinent information in the past decade. In discussing pediatric ACL tears, it is also important to review tibial spine fractures. These injuries are rightfully grouped together because tibial spine fractures often occur with a mechanism of injury similar to that of ACL tears, but typically in a younger age group. Because management is different, understanding the similarities and differences between the two pathologies is important. Recent updates on the epidemiology, diagnosis, management, and outcomes of both pediatric ACL tears and tibial spine fractures need to be reviewed.


Assuntos
Lesões do Ligamento Cruzado Anterior , Fraturas da Coluna Vertebral , Fraturas da Tíbia , Lesões do Menisco Tibial , Adolescente , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Criança , Humanos , Articulação do Joelho , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/epidemiologia , Fraturas da Tíbia/cirurgia
14.
Injury ; 52(3): 402-406, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33341244

RESUMO

BACKGROUND: COVID-19 has created huge pressures on healthcare systems. The ongoing provision of major trauma services during this time has proved challenging. We report our experience of managing open lower limb fractures (oLLFs) during the pandemic in a London major trauma centre (MTC). METHODS: This was a prospective study of all open lower limb fractures presenting to our unit over the initial 48 days of UK government lockdown - 24th March till 10th May 2020. Results were compared to the same time period in 2019 retrospectively. Epidemiological data, mechanism, Gustilo-Anderson (G-A) severity grading, time to initial debridement and definitive coverage were analysed. RESULTS: There was a 64% reduction in emergency department (ED) attendances (25,264 vs 9042). There was an 18% reduction in oLLFs (22 vs 18). Approximately three-quarters of injuries were in males across both cohorts (77% vs 78%) and tended to occur in younger patients (median age, 37 vs 35). Road-traffic-accidents (RTAs) were the most common injury mechanism in both 2019 and lockdown, but a rise in jumpers from height was seen in the latter. A similar pattern of G-A severities were seen, however only 3 injuries during lockdown required major soft tissue reconstruction. There was no significant difference in times taken for initial debridement (p = 0.72786) or definitive wound coverage (p = 0.16152). A greater proportion of independent operating was seen during lockdown between orthopaedics and plastic surgery. CONCLUSIONS: Despite government lockdown measures, oLLFs still placed significant burden on our MTC. Notwithstanding significant staffing alterations and theatre pressures, we have been able to ensure these lower limb emergencies remain a surgical priority and have managed to utilise resources appropriately.


Assuntos
Fraturas do Fêmur/cirurgia , Traumatismos do Pé/cirurgia , Fraturas Expostas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desbridamento/métodos , Feminino , Fraturas do Fêmur/epidemiologia , Traumatismos do Pé/epidemiologia , Fraturas Expostas/epidemiologia , Retalhos de Tecido Biológico , Humanos , Tempo de Internação , Londres , Masculino , Pessoa de Meia-Idade , Retalho Perfurante , Cirurgia Plástica , Retalhos Cirúrgicos , Fraturas da Tíbia/epidemiologia , Fatores de Tempo , Centros de Traumatologia , Técnicas de Fechamento de Ferimentos , Adulto Jovem
15.
Medicine (Baltimore) ; 99(50): e23704, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327361

RESUMO

RATIONALE: Floating ankle is a rare traumatic condition characterized by a combination of tibial and ipsilateral foot fractures, with the ankle remaining intact. It is usually caused by high-energy trauma and also presents with serious soft tissue damage. Its treatment is mainly restricted to external fixation, which results in poor outcomes. We present a patient with a floating ankle who underwent staged treatment and achieved full internal fixation, subsequently returning to normal activity. PATIENT CONCERNS: A 26 year- old man had an accident with an reel machine and sustained an open fracture on his right lower extremity. DIAGNOSES: Digital radiograph demonstrated a distal tibial fracture, fibular fracture, and multiple metatarsal fractures, which fulfilled the criteria for a floating ankle. INTERVENTIONS: Initial ankle-spanning external fixation was performed. After 21 days, the patient underwent open reduction and internal fixation on his first and fifth metatarsals, and K-wire fixation on his fourth metatarsal. The external fixator was replaced by plaster fixation. Seven days later, the patient underwent internal fixation of his leg, open reduction and internal fixation with plating was applied of the fibular fracture, and minimally invasive plate osteosynthesis of the tibial fracture. OUTCOMES: At 1-year follow-up, bone union was identified by digital radiograph; after 2 years, his ankle function had fully recovered, and he resumed his normal activities. LESSONS: In the staged treatment protocol of the floating ankle, temporary external fixation provided traction and immobilization of the skeletal and soft tissues. Secondary internal fixation maintained the reduction and alignment and allowed early exercise, which is critical to the prognosis of a floating ankle.


Assuntos
Traumatismos do Tornozelo/cirurgia , Ossos do Pé/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Adulto , Placas Ósseas , Fios Ortopédicos , Ossos do Pé/lesões , Humanos , Masculino , Amplitude de Movimento Articular
17.
PLoS One ; 15(12): e0244557, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378331

RESUMO

BACKGROUND: The supplemental screw technique was introduced for salvage of lateral hinge fracture in medial open-wedge high tibial osteotomy (owHTO). The efficacy of its use in protection of lateral hinge fracture and corresponding biomechanical behaviors remained unclear. The current study was aimed to clarify if a supplemental screw can provide better protection to lateral hinge in biomechanical perspective. MATERIALS: An in vitro biomechanical test was conducted. Tibial sawbones, commercial owHTO plates and a cannulated screw were utilized for preparing the intact, owHTO, and owHTO with cannulated screw insertion specimens. A "staircase" dynamic load protocol was adopted for axial compressive test with increasing load levels to determine structural strength and durability by using a material testing system, while a motion capture system was applied for determining the dynamic changes in varus angle and posterior slope of the tibia plateau with various specimen preparation conditions. RESULTS: Type II lateral hinge fracture were the major failure pattern in all specimens prepared with owHTO. The insertion of a supplemental cannulated screw in medial owHTO specimens reinforced structural stability and durability in dynamic cyclic loading tests: the compressive stiffness increased to 58.9-62.2% of an intact specimen, whereas the owHTO specimens provided only 23.7-29.2% of stiffness of an intact specimen. In view of tibial plateau alignment, the insertion of a supplemental screw improved the structural deficiency caused by owHTO, and reduced the posterior slope increase and excessive varus deformity by 81.8% and 83.2%, respectively. CONCLUSION: The current study revealed that supplemental screw insertion is a simple and effective technique to improve the structural stability and durability in medial owHTO.


Assuntos
Osteotomia/instrumentação , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Fenômenos Biomecânicos , Parafusos Ósseos , Humanos , Modelos Biológicos , Tíbia/fisiopatologia , Fraturas da Tíbia/fisiopatologia
18.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1248-1252, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063488

RESUMO

Objective: To explore the effectiveness of simple Ilizarov ring external fixation technique in treatment of tibial plateau fractures complicated with osteofascial compartment syndrome. Methods: Between September 2013 and March 2017, 30 patients with tibial plateau fractures complicated with osteofascial compartment syndrome were treated with simple Ilizarov ring external fixation technique. There were 23 males and 7 females, with an average age of 34.4 years (range, 23-43 years). The injuries were caused by traffic accident in 12 cases, by falling from height in 4 cases, by falling in 8 cases, and by a crashing object in 6 cases. The time from injury to admission was 1-12 hours (mean, 4.8 hours). According to the Schatzker classification, there was 1 case of type Ⅱ, 3 cases of type Ⅲ, 10 cases of type Ⅳ, 7 cases of type Ⅴ, and 9 cases of type Ⅵ. All patients underwent fasciotomy due to osteofascial compartment syndrome; the interval between fasciotomy and operation was 10-15 days (mean, 12.5 days). Knee Society Score (KSS) and Ilizarov Method Research and Application Association (ASAMI) protocol were used to evaluate knee function. Results: The operation time was 110-155 minutes (mean, 123.1 minutes); the intraoperative blood loss was 100-500 mL (mean, 245 mL); the postoperative hospital stay was 3-5 days (mean, 3.8 days). All patients were followed up 20-24 weeks (mean, 22.7 weeks). Except for 2 patients with signs of needle tract infection, no other complication occurred. X-ray films showed that the fractures healed, and the healing time was 10-20 weeks (mean, 14.6 weeks). At last follow-up, the KSS clinical score was 70- 95 with an average of 87.5; the functional score was 70-90 with an average of 79.0. According to ASAMI protocol evaluation, the effectiveness was rated as excellent in 24 cases, good in 3 cases, fair in 2 cases, and poor in 1 case. Conclusion: For tibial plateau fractures complicated with osteofascial compartment syndrome, simple Ilizarov ring external fixation technique can basically restore joint function and has fewer complications. It is a relatively safe and effective treatment method.


Assuntos
Síndromes Compartimentais , Técnica de Ilizarov , Fraturas da Tíbia , Adulto , Placas Ósseas , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Fraturas da Tíbia/complicações , Fraturas da Tíbia/cirurgia , Adulto Jovem
19.
Oper Orthop Traumatol ; 32(5): 421-432, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32945938

RESUMO

OBJECTIVE OF SURGERY: Joint-spanning transfixation of the ankle joint aims at mostly temporary retention of the reduction, i.e. restoring length and axial alignment and stabilization of the ankle mortise in highly unstable fractures around the ankle and under critical soft tissue conditions. In selected cases, external fixation serves as an additional stabilization also following completed internal fixation or the fracture can be treated in the external fixator. The goal of surgery is to allow quick soft tissue recovery, prevention of redislocation and stabilization of the ankle and adjacent structures. INDICATIONS: a) Fractures of the tibial pilon; b) very distal, extra-articular lower leg fractures (without the option for pin positioning in the distal fragment); c) highly unstable malleolar fractures with tendency to subluxation and dislocation fractures; d) critical soft tissue conditions around the ankle; e) dislocation fractures of the talus, Chopart and Lisfranc joints (if necessary with additional transarticular transfixation). CONTRAINDICATIONS: Missing consent to surgery by the conscious patient, life-threatening general condition by other prioritized injuries. SURGICAL TECHNIQUE: Percutaneous pin placement of the appropriate caliber into so-called safe zones of the tibia, metatarsus and calcaneus, as needed. Additional transfixation of the Chopart and Lisfranc joints with K­wires as needed. Fixation of the struts with the foot in a neutral position. Besides consideration of biomechanical principles, pin placement must be done in anticipation of the definitive stabilization and future approaches respecting the anatomical structures while achieving maximum stability and soft tissue protection. POSTOPERATIVE MANAGEMENT: Following initial transfixation, elevation of the injured leg for soft tissue protection, local cooling and bed rest are indicated. In cases of compartment syndrome and open fractures with temporary soft tissue coverage, second look surgery after 24-72 h is mandatory. For exact fracture analysis and optimal planning of the definitive surgical strategy, the indications for CT imaging should be generously considered. The timing of definitive care depends on the local soft tissue status and the overall condition of the patient. RESULTS: The presence of a dislocation at the time of the accident represents a negative prognostic factor for ankle fractures. Higher rates of posttraumatic arthrosis are also found in pilon fractures and trimalleolar fractures, direct cartilage damage and rupture of the syndesmosis. In cases of anatomic reconstruction of the mortice and ankle joint congruence, good to excellent results can be achieved in 75-89%.


Assuntos
Traumatismos do Tornozelo , Fixadores Externos , Tornozelo , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo , Seguimentos , Fixação Interna de Fraturas , Humanos , Radiografia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
20.
PLoS One ; 15(9): e0232911, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941429

RESUMO

Peer-reviewed published studies on tibial plateau fractures treated with either open reduction with internal fixation (ORIF) or circular external fixation were reviewed to compare functional, radiological outcomes, postoperative complications, and reoperation rates between the two methods. A systematic search of various databases including Medline, Cochrane Controlled Register of Trials (CENTRAL), ScienceDirect, and Google Scholar from inception until June 2019 was performed. 17 studies with 1168 participants were included in the review. Most of the studies (76%) were retrospective in nature and had low or unclear bias risks. Incidence of total infection (Odds ratio [OR], 2.58; 95% CI, 1.33-5.02) and malunions (OR, 2.56; 95% CI, 1.12-5.84) were higher and length of hospital stay was shorter in patients treated with circular external fixator (Mean difference [MD], -6.1; 95% CI, -11.1--1.19). There were no differences in the incidence of secondary osteoarthritis (OR, 1.49; 95% CI, 0.92-2.42), range of motion (MD, 2.28; 95% CI, -11.27-15.82) non-union (OR, 1.44; 95% CI, 0.14-14.27) and reoperation rates (OR, 1.84; 95% CI, 0.90-3.78) between the two groups. Results from this investigation suggest that circular fixation may offer some advantages over ORIF such as a shortened length of hospital stay and early return to preinjury activities. Definitive clinical recommendations cannot be made as it also presents higher rates of postoperative complications than ORIF.


Assuntos
Fixação de Fratura/métodos , Fraturas Mal-Unidas/epidemiologia , Osteoartrite/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Criança , Fixadores Externos/efeitos adversos , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/instrumentação , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Amplitude de Movimento Articular , Reoperação/estatística & dados numéricos , Fraturas da Tíbia/terapia
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