RESUMEN
We studied prospectively 30 patients who had a Mitchell's osteotomy secured by either a suture followed by immobilisation in a plaster boot for six weeks, or by a cortical screw with early mobilisation. The mean time for return to social activities after fixation by a screw was 2.9 weeks and to work 4.9 weeks, which was significantly earlier than those who had stabilisation by a suture (5.7 and 8.7 weeks, respectively; p < 0.001). Use of a screw also produced a higher degree of patient satisfaction at six weeks, and an earlier return to wearing normal footwear. The improvement in forefoot scores was significantly greater after fixation by a screw at six weeks (p = 0.036) and three months (p = 0.024). At one year, two screws had been removed because of pain at the site of the screw head. Internal fixation of Mitchell's osteotomy by a screw allows the safe early mobilisation of patients and reduces the time required for convalescence.
Asunto(s)
Tornillos Óseos , Hallux Valgus/cirugía , Osteotomía/métodos , Técnicas de Sutura , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
We reviewed all ankle fractures over a 6-year period and selected those with greater than 33 per cent subluxation of the talus to assess the early management and the incidence of skin complications. A total of 60 fractures were identified; none were reduced as an emergency procedure on admission to the accident department and seven developed ischaemic necrosis over the medial skin incision. We suggest that early reduction in the accident and emergency department may help to prevent this complication.
Asunto(s)
Traumatismos del Tobillo/terapia , Luxaciones Articulares/terapia , Fracturas de la Tibia/terapia , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Manipulación Ortopédica , Persona de Mediana Edad , Necrosis , Piel/patología , Factores de TiempoRESUMEN
We present the results of a prospective study in which 32 "Performance" total knee replacements were implanted with a mean follow-up period of 6.5 years. Survival analysis showed 89% survival at 7 years. Of those knees that survived to follow-up 80% were pain free or had mild pain when climbing stairs and only 1 knee was unable to flex beyond 100 degrees. Eighty-six percent of patients were able to walk unlimited distances and all knees had a statistically significant improvement in the knee evaluation scores at follow-up. There was no evidence of loosening or migration in the surviving knees.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/instrumentación , Prótesis de la Rodilla/normas , Osteoartritis de la Rodilla/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Prótesis de la Rodilla/efectos adversos , Tablas de Vida , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/fisiopatología , Dolor/etiología , Estudios Prospectivos , Falla de Prótesis , Rango del Movimiento Articular , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Twenty-seven patients, with eight femoral and 20 tibial fractures, were treated with the Marchetti/Vincenzi flexible intramedullary nail between March 1993 and May 1994 in a District General Hospital. Clinical and radiological reviews were performed on all patients except for one who died. There was a high complication rate in both groups (63.5 per cent femoral and 43 per cent tibial). Particularly common was coronal mal-alignment. Other complications included non-union, external rotation, and fracture shortening with proximal migration of the nail. These data suggest that flexible intramedullary nails do not give adequate stability to either femoral or tibial fractures. We believe they should not be used in the lower limb without external support or delayed weight bearing.