RESUMO
The reconstruction of a large diaphyseal bone defect is a surgical challenge. Autologous bone grafts are usually insufficient to bridge the gap and allografts are prone to infection and may pose problems with internal fixation. Another solution is presented for the reconstruction of a large ulnar defect due to tumour resection, using the Ilizarov technique of segmental transport.
Assuntos
Neoplasias Ósseas/cirurgia , Dispositivos de Fixação Ortopédica , Ortopedia/métodos , Osteossarcoma/cirurgia , Ulna/cirurgia , Adolescente , Neoplasias Ósseas/diagnóstico , Humanos , Masculino , Osteossarcoma/diagnóstico , PeriósteoRESUMO
In a randomized prospective trial, treatment of extra-articular distal radial fractures by closed reduction and plaster application was compared with Kapandji-pinning. Closed reduction and plaster cast was used in 50 patients, Kapandji-pinning in 48 patients. According to the Cooney score, good and excellent results were found in the closed reduction and plaster cast group in 74%, compared with 75% in the Kapandji-pinning group. After measuring the maintenance of reduction as well as the functional outcome at 1 year follow-up, no statistically significant differences could be found between the two groups. We conclude that both techniques can be used in treating extra-articular fractures of the distal radius.
Assuntos
Moldes Cirúrgicos , Fixação Interna de Fraturas , Fraturas do Rádio/terapia , Pinos Ortopédicos , Feminino , Humanos , Imobilização , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
A prospective study was undertaken to determine the clinical importance of the different carpal instabilities following dorsally displaced distal radial fractures (Colles' type). All patients were followed for 1 year and a Cooney score and X-ray evaluation were done. Nine different carpal instabilities were evaluated. Only dissociative DISI and ulnar translocation showed significant clinical differences at 1 year follow-up. It is therefore recommended that a dissociative DISI, usually caused by scapholunate dissociation, should be treated by percutaneous pinning at the time of the initial treatment.
Assuntos
Fratura de Colles/fisiopatologia , Fratura de Colles/cirurgia , Instabilidade Articular/fisiopatologia , Articulação do Punho/fisiopatologia , Fratura de Colles/complicações , Humanos , Instabilidade Articular/complicações , Estudos ProspectivosRESUMO
In a prospective study we evaluated the results of 272 distal radial fractures by their involvement of the distal radioulnar joint. Impaired function following altered anatomy at the distal radius can be explained by dysfunction of the distal radioulnar joint. Ulnar styloid avulsions contribute to a poorer result because of their effect on distal radioulnar joint function.
Assuntos
Fratura de Colles/fisiopatologia , Fratura de Colles/cirurgia , Articulação do Punho/fisiopatologia , Antebraço/fisiopatologia , Humanos , Rotação , Resultado do TratamentoRESUMO
51 wrists of 30 embalmed cadavers have been used to perform an anatomical and radiological study relating cartilaginous and ligamentous lesions of the wrist with sex, age, ulnar variance (UV) and the state of the triangular fibrocartilage complex (TFCC) in an elderly population (mean 76.6 years). Two-thirds of all wrists (66%) showed cartilaginous lesions, mainly on the lunate (22, or 44%). The TFCC was perforated in 23 wrists (46%), and most were central degenerative perforations. Correlations were found between ulnar variance and TFCC thickness (P < 0.05) and ulnar variance and TFCC perforations (P < 0.05). A significant relation was observed between age and proximal row intercarpal ligamentous ruptures (P < 0.05) and between age and ulnar variance (P < 0.05). No statistical correlation was seen between ulnar variance and cartilaginous lesions on the lunate (P < 0.05) in this slightly ulnar negative population (mean-0.37 mm).
Assuntos
Cartilagem Articular/patologia , Ligamentos Articulares/patologia , Articulação do Punho/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Cadáver , Doenças das Cartilagens/epidemiologia , Doenças das Cartilagens/patologia , Feminino , Humanos , Incidência , Artropatias/epidemiologia , Artropatias/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Ruptura EspontâneaRESUMO
We evaluated ultrasound findings in developmental dislocation of the hip in relation to clinical signs, risk factors, and radiographic measurements. The ultrasound rating was determined according to the method of Graf. An ultrasound rating > IIa was considered abnormal. The risk factors corresponding best with an abnormal ultrasound were breech delivery (42.8%) and familial occurrence (21%). For the clinical findings, the risk factors corresponding best were abduction < 50 (42.5%) and asymmetric skinfolds in patients (26.4%). The radiographic evaluation showed more abnormal findings, but there was no statistical difference between the overall ultrasound and radiographic results.
Assuntos
Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/diagnóstico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Exame Físico , Radiografia , Fatores de Risco , UltrassonografiaRESUMO
The results of open subacromial decompression (OSD) were compared with arthroscopic subacromial decompression (ASD) after 1 year in 32 subjects (4 bilateral), and the correlation between the two shoulder rating scales for impingement was documented. Patients were evaluated clinically on the modified University of California at Los Angeles (UCLA) shoulder rating scale, and Constant scale. Scapular position and rotation were evaluated as well as a rotation and abduction shoulder strength test using the Cybex II dynamometer. No parameters revealed significant differences between the groups, except for the UCLA score which indicated an advantage for the ASD group (p = 0.046). The OSD group scored 24.5 (5.45) on the UCLA scale and 73.8 (18.9) on the Constant scale, whereas the ASD group scored 28.3 (5.6) and 80.8 (16.4). To study the correlation between both scales, the Pearson correlation product-moment coefficient was calculated and a high correlation (r = 0.81) obtained. Less mobility was found in the operated arm for all parameters, with the exception of glenohumeral abduction in both groups and passive elevation in the OSD group. Only in the OSD group did the scapula in the operated extremity show more abduction of the inferior angle of the scapula. Weaker abduction strength in the operated side was found in the ASD group, whereas in the OSD group there was significantly less adduction and external rotation strength at 180 degrees/s en 240 degrees/s. We conclude that after one year the open group tends to catch up with the arthroscopic patients and that the main benefits after arthroscopic surgery as described in literature are more evident in the shorter period.
Assuntos
Descompressão Cirúrgica/métodos , Síndrome de Colisão do Ombro/cirurgia , Adulto , Idoso , Artroscopia , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estatísticas não ParamétricasRESUMO
This report comprises a follow-up of 39 patients after simple excision and 16 patients after Silastic replacement of the radial head for displaced comminuted fractures. Prostheses were used when similar fractures were associated with an unstable elbow. The excision group was followed up for 6.1 years on average, and the replacement group for 5.7 years. The objective result after simple excision was good in 55% of cases, fair in 26% and poor in 19%. The results in the replacement group were only 13% good, 38% fair, 37% poor and in 12% the prostheses had to be removed.
Assuntos
Próteses e Implantes , Fraturas do Rádio/cirurgia , Elastômeros de Silicone , Atividades Cotidianas , Adolescente , Adulto , Idoso , Articulação do Cotovelo , Feminino , Seguimentos , Força da Mão , Humanos , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/complicações , ReoperaçãoRESUMO
The authors describe a case with a closed posterior elbow dislocation associated with a distal radial fracture and complete transsection of the brachial artery. The patient had a pulseless distal upper extremity and immediate gross swelling of the elbow and forearm. As closed reduction was not possible, open reduction had to be performed through an anteromedial approach to the elbow. End-to-end suture of the brachial artery was successful. After fasciotomy and internal fixation of the distal radial fracture, the elbow was stabilized with an external fixator spanning the elbow joint. After two years, despite good function of the elbow, restoration of the hand function is not optimal owing to persistent motor deficit of the ulnar nerve.
Assuntos
Artéria Braquial/lesões , Lesões no Cotovelo , Luxações Articulares/complicações , Fraturas do Rádio/complicações , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Fixadores Externos , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/fisiopatologia , Luxações Articulares/cirurgia , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Ruptura , Técnicas de Sutura , Resultado do TratamentoRESUMO
Clenched fist injuries or human bite-fight wounds are the result of an impact of the fist with the opponent's teeth, with perforation of the skin and joint. Severe septic arthritis of the third metacarpal joint of the dominant hand often occurs. The consequences, medical and legal, on the long run are important.
Assuntos
Infecções Bacterianas/diagnóstico , Mordeduras Humanas/diagnóstico , Traumatismos da Mão/diagnóstico , Articulação Metacarpofalângica/lesões , Metacarpo/lesões , Pele/lesões , Adolescente , Adulto , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/cirurgia , Artrite Reativa/diagnóstico , Artrite Reativa/cirurgia , Infecções Bacterianas/cirurgia , Mordeduras Humanas/microbiologia , Mordeduras Humanas/cirurgia , Desbridamento , Procedimentos Cirúrgicos Dermatológicos , Drenagem , Seguimentos , Traumatismos da Mão/microbiologia , Traumatismos da Mão/cirurgia , Humanos , Masculino , Articulação Metacarpofalângica/cirurgia , Metacarpo/cirurgia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/cirurgia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/cirurgia , SupuraçãoRESUMO
Complex posttraumatic conditions in the proximal femur can be difficult to treat because of severe bone loss. A possible solution to this problem is the Wagner prosthesis. The results of 23 replacements in 22 patients are described. They were satisfactory in most cases for the given preoperative status. Using the Merle d'Aubigné scoring system, 17 results were good, while 6 were fair or poor, mostly related to problems in immediate mobilization due to the general condition of the patient.
Assuntos
Fraturas do Fêmur/cirurgia , Prótese de Quadril , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Falha de Prótese , Radiografia , ReoperaçãoRESUMO
High-pressure injuries to the finger are often under-estimated. Nevertheless, early diagnosis and debridement are absolute requirements to save the finger and to restore function. Delayed diagnosis may lead to severe infection and often ends in amputation.
Assuntos
Traumatismos dos Dedos/etiologia , Ferimentos Perfurantes/etiologia , Adulto , Amputação Cirúrgica , Desbridamento , Traumatismos dos Dedos/cirurgia , Humanos , Masculino , Óleos , PressãoRESUMO
Osteoid osteoma is a benign tumor frequently situated around the knee. It should therefore be considered as a possible cause of atraumatic knee pain in young adults. The mean interval from onset of symptoms to diagnosis is 14 months. Clinical symptoms are the most reliable diagnostic factors. Block resection is the treatment of choice. A retrospective study of 10 patients is presented.
Assuntos
Neoplasias Ósseas/fisiopatologia , Neoplasias Femorais/fisiopatologia , Osteoma Osteoide/fisiopatologia , Dor/etiologia , Adolescente , Adulto , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Diagnóstico Diferencial , Feminino , Neoplasias Femorais/diagnóstico , Neoplasias Femorais/cirurgia , Humanos , Joelho , Masculino , Osteoma Osteoide/diagnóstico , Osteoma Osteoide/cirurgiaRESUMO
In a retrospective study 33 fractures of the dens were analyzed. Nonoperative treatment was successful in types I and III, but unsuccessful in 48.5% of type II fractures. In addition to the poor outcome factors of Schatzker, the classification of Roy-Camille is a valuable prognostic factor.
Assuntos
Processo Odontoide/lesões , Fraturas da Coluna Vertebral/terapia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Processo Odontoide/diagnóstico por imagem , Prognóstico , Radiografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/cirurgiaRESUMO
This is a report of an additional case of transverse fracture of the lunate with marked displacement, requiring open reduction and osteosynthesis. The lunate became necrotic with all features of Kienböck's disease.
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Osso Semilunar/lesões , Pinos Ortopédicos , Criança , Fraturas Ósseas/cirurgia , Humanos , Ligamentos Articulares/lesões , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Masculino , Radiografia , RupturaRESUMO
The authors review the treatment of fractures of the distal radius, based on their experience and from data in the literature. The choice of a treatment for any given fracture must take into account first of all the stability of the fracture. The best results are achieved in stable fractures. Only minimally displaced distal radius fractures can be treated functionally. However, a plaster cast for one week is indicated for the comfort of the patient. In displaced but stable fractures both closed reduction and percutaneous fixation are indicated. In case of closed reduction, the plaster cast should be applied for 5 to 6 weeks with an above-elbow cast for 3 weeks. Percutaneous fixation gives the best results in extraarticular fractures in younger patients. Because of its simplicity however, it should not be ignored in the elderly osteoporotic patients. In the authors' experience, both techniques were only used for extraarticular fractures. Good and excellent results were found in the closed reduction and plaster cast group in 74% of the patients; the Kapandji technique gave 75% good and excellent results. These results are in line with other findings which show that, for simple fracture types, the Kapandji technique and closed reduction seem to give similar results. External fixation is widely used for intra-articular comminuted fractures. Dynamic external fixation does not show any advantage over static devices. Additional K-wires or bone grafting may be necessary. External fixation gives superior results to plate and screw fixation. Internal fixation should be reserved for fractures with ventral comminution or severe displacement with unacceptable reduction by closed or minimally invasive techniques.
Assuntos
Fixadores Externos , Fixação de Fratura/métodos , Fraturas Fechadas/terapia , Fixadores Internos , Fraturas do Rádio/terapia , Adolescente , Adulto , Idoso , Pinos Ortopédicos , Moldes Cirúrgicos , Criança , Humanos , Pessoa de Meia-IdadeRESUMO
Dislocations of the distal radio-ulnar joint (DRUJ) can be isolated or combined with fractures. Cases of DRUJ dislocations have been described with Galleazi fractures, open radius and ulna fractures and intraarticular fractures of the distal radius. We report a case of a volar DRUJ dislocation combined with a transstyloid radio-carpal dislocation. Because of severe instability of the wrist, open reduction of the radial styloid combined with an open reduction of the dislocated DRUJ is advised.
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Luxações Articulares/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Adulto , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/complicações , Luxações Articulares/cirurgia , Masculino , Radiografia , Traumatismos do Punho/cirurgiaRESUMO
A case of both an os trigonum and a soleus tertius anomaly is presented in a patient with chronic posteromedial ankle pain. A resection of the os trigonum was performed, with complete relief of symptoms. The diagnosis and therapy are discussed, and the literature is reviewed.
Assuntos
Músculos/anormalidades , Tálus/anormalidades , Adulto , Humanos , Perna (Membro) , Imageamento por Ressonância Magnética , Masculino , Cintilografia , Tálus/patologia , Tálus/cirurgiaRESUMO
Failure of internal fixation in hip fractures can lead to difficult problems, especially in elderly patients. At the intertrochanteric or subtrochanteric level a prosthesis with diaphyseal support is one of the solutions to this problem. In 12 patients an endoprosthesis was performed for failed internal fixation. The mean age at the time of initial fracture fixation was 79 years (range: 61 to 94 years). The mean time from initial fracture fixation to failure and salvage by an endoprosthesis was 6 months (range: 5 days to 19 months). Eleven patients could be reviewed clinically and radiographically after a mean follow-up time of 32 months (range: 4 months to 7 years). The functional results were satisfactory considering the age of the patients. The current series shows that endoprosthesis might be considered as a valuable method in the salvage treatment of failed internal fixation of a subtrochanteric or intertrochanteric hip fracture.
Assuntos
Fraturas do Quadril/cirurgia , Prótese de Quadril , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Placas Ósseas , Feminino , Consolidação da Fratura , Fraturas do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Reoperação , Falha de TratamentoRESUMO
Sixty-seven Monteggia lesions occurring in adults were reviewed. A follow-up of 1 to 14 years revealed that 53.7% had good to excellent results and 46.3% had results which were fair or poor. All fractures were treated with open reduction and internal fixation. Complications were encountered in 29 cases or 43%. Delayed bone healing in 10 cases and the persistent dislocation of the radial head in 7 cases were noted. Excellent or good results were seen in type III and I, according to Bado's classification; fair or poor results in type IV and II. The results are less good when the olecranon process is fractured, especially in type Ia fractures. The overall result of this injury is abysmal. To improve the outcomes, the authors recommend dorsal plating of the ulnar fracture, avoidance of early resection of the radial head and immediate mobilization of the elbow.