RESUMEN

OBJECTIVE: This study aimed to present the mid-term clinical and radiographic outcomes of patients with perilunate injuries treated with open reduction and internal fixation (ORIF). METHODS: Patients who underwent ORIF due to perilunate injuries from 2004 to 2015 were retrospectively reviewed. Surgery was mostly performed using a standard dorsal approach. Each injury was graded as per Mayfield staging. At the final follow-up, pain intensity was evaluated using a 10-cm visual analog scale (VAS). Wrist and elbow range of motion, handgrip and pinch strength, Modified Mayo Wrist Scores, and the disabilities of the arm, shoulder, and hand (DASH) scores were measured. On plain radiographic examination, the scapholunate (SL) angle, SL interval, carpal height, and continuity of Gilula arcs were evaluated. The presence of arthritis was also assessed using the Herzberg classification. RESULTS: In total, 26 male patients (27 wrists) who met the inclusion criteria were included in the study. The mean age was 40 years (range: 20-58); the mean follow-up was 45 months (range: 16-96). Most of the injuries were fracture-dislocations (n=20; 71.4%). According to Mayfield staging, 7 wrists were grade 3, and 20 wrists were grade 4. According to Herzberg staging, 11 (40.7%) patients were stage 2a. The mean VAS was 2.3 (range: 0-5) at rest and 3.3 (range: 0-7) during activity. The mean wrist flexion and extension were 50° (range: 21-80°; 73.5% of the unaffected side) and 45.1° (range: 20-74°; 70.9% of the unaffected side), respectively. The mean radial and ulnar deviation were 14.6° (range: 6-25°; 63.6% of the unaffected side) and 22.3° (range: 5-40°; 64.7% of the unaffected side), respectively. Grip and pinch strength were 57.6 kg (range: 15-106; 65.5% of the unaffected side) and 18.6 kg (range: 8-28; 78.2% of the unaffected side), respectively. The mean Mayo score was 63.3 (range: 20-90), and the DASH score was 24.1±25.2. The mean SL angle was 61.6° (range: 40-83). There was 1 wrist with a pathological SL interval, 11 wrists with dorsal intercalated segmental instability, and 3 wrists with fractures of the Gilula arcs. The mean carpal height was within the normal range. CONCLUSION: In the treatment of perilunate injuries, satisfactory clinical and radiographic outcomes can be expected from ORIF at mid-term follow-up. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Asunto(s)

Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Hueso Semilunar , Radiografía , Traumatismos de la Muñeca/cirugía , Articulación de la Muñeca , Adulto , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Fuerza de la Mano , Humanos , Hueso Semilunar/diagnóstico por imagen , Hueso Semilunar/lesiones , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Radiografía/métodos , Radiografía/estadística & datos numéricos , Rango del Movimiento Articular , Estudios Retrospectivos , Articulación de la Muñeca/fisiopatología , Articulación de la Muñeca/cirugía

RESUMEN

OBJECTIVE: The aim of the present study was to determine the effect of topical and systemic tranexamic acid (TXA) on fracture healing in a rat surgical model. METHODS: We created standard, right-sided, open, diaphyseal femoral fractures with intramedullary Kirschner wire fixation in 48 male rats and divided them into three groups: a topical TXA (10 mg/kg) group, a systemic TXA (10 mg/kg) group, and a control group. Fracture healing was evaluated radiographically and histologically after early (week 2) and late (week 4) postoperative sacrifice. RESULTS: The radiological scores differed significantly among the all groups (p=0.001), as did the week 2 and 4 scores (p=0.003 and p=0.010, respectively). Radiologically, the topical TXA group exhibited better bone healing at both 2 (p=0.001) and 4 (p=0.007) weeks than the control group, and the systemic group showed better healing at both 2 (p=0.027) and 4 (p=0.023) weeks than the control TXA group. Moreover, bone healing was better in the group treated with topical rather than systemic TXA on radiological examinations performed at 2 (p=0.001) and 4 (p=0.007) weeks postoperatively (p=0.001 and p=0.007, respectively). Histologically, the groups differed significantly (p=0.001). The histological scores differed significantly among the all groups (p=0.001). At 2 weeks, the topical TXA group exhibited significantly better bone healing than the control group (p=0.001). CONCLUSION: Our results suggested that topical application of TXA in fracture patients may accelerate healing, whereas systemic administration may adversely affect healing.

Asunto(s)

Administración Tópica , Fracturas del Fémur , Curación de Fractura/efectos de los fármacos , Ácido Tranexámico/administración & dosificación , Animales , Antifibrinolíticos/administración & dosificación , Pérdida de Sangre Quirúrgica/prevención & control , Vías de Administración de Medicamentos , Fracturas del Fémur/tratamiento farmacológico , Fracturas del Fémur/cirugía , Periodo Posoperatorio , Radiografía/métodos , Ratas , Resultado del Tratamiento

RESUMEN

INTRODUCTION: Hoffa fractures are rare injuries and usually involve the lateral condyle. There are few published studies of large series of isolated coronal plane fractures of the femoral condyle. The aim of the study to determine the long-term functional outcomes and complications in surgically treated Hoffa fractures. PATIENTS AND METHODS: A retrospective review was made of 13 consecutive patients who were treated surgically for an isolated coronal plane fracture of the distal femur posterior condyle. The patients were evaluated with physical examination, PA and lateral radiographs and CT at the final follow-up examination. Functional outcome was evaluated with the OXFORD knee scoring system and Knee Society Score (KSS). Pain at rest and in activity was assessed using a Visual Analog Scale (VAS). RESULTS: The patients comprised 11 males and 2 females with an average age at surgery of 27.5 years. The mean follow-up period was 93 months (range, 62-134 months). Mean time to fracture healing was 10 weeks (range, 8-12 weeks). The mean ROM was determined as 110°, mean KSS 78,4 and mean Oxford knee score 38,2. The mean KSS was 66,5 for medial Hoffa fracture patients and it was 83,8 for lateral Hoffa fracture patients. The mean Oxford knee score was 33,2 for medial Hoffa fracture patients and it was 40,4 for lateral Hoffa fracture patients. The mean VAS at rest and in activity was 1,1 and 2,9, respectively. Osteoarthritis was seen in 7 (54%) patients and avascular necrosis in 2 (15.4%). Varus instability was determined in 1 patient and valgus instability in 1 patient. CONCLUSION: Hoffa fractures may easily be overlooked if the radiological examination is not made carefully. Screw fixation was seen to provide enough biomechanical stability until the fracture healed. Arthrosis is a frequent long-term complication which worsens the functional results. Medial Hoffa fractures tend to have worse functional results than lateral Hoffa fractures. LEVEL OF EVIDENCE: Therapeutic Level IV retrospective case series.

Asunto(s)

Fracturas del Fémur/cirugía , Fijación Interna de Fracturas , Curación de Fractura/fisiología , Fracturas Intraarticulares/cirugía , Rango del Movimiento Articular/fisiología , Adulto , Placas Óseas , Tornillos Óseos , Femenino , Fracturas del Fémur/fisiopatología , Fijación Interna de Fracturas/rehabilitación , Humanos , Fracturas Intraarticulares/fisiopatología , Masculino , Pronóstico , Radiografía , Estudios Retrospectivos , Resultado del Tratamiento , Escala Visual Analógica , Adulto Joven

RESUMEN

BACKGROUND: Corticosteroid injection used to be the treatment of choice for lateral epicondylitis. Most injections are performed blindly. In the blinded technique, it could be difficult to determine the exact pathological localisation. The purpose of this single-blinded, randomised controlled clinical study was to compare the clinical therapeutic effects of blinded and USG-guided corticosteroid injection therapy in lateral epicondylitis. PATIENTS AND METHODS: Forty patients with chronic lateral epicondylitis were included in this clinical trial. The patients were randomly allocated to blinded group or USG-guided injection group according to a computer-generated randomisation list. All blinded injections were administered by an orthopaedic surgeon and all ultrasound-guided injections were made by a radiologist experienced in this technique. All patients were injected under aseptic conditions using 40 mg/2 mL methylprednisolone acetate. The outcomes of both treatments were assessed by an independent assessor at pre-injection, then at 6-week and 3- and 6-month follow-up assessments. The assessor evaluated the q-DASH, VAS, and grip strength scores. RESULTS: No statistically significant difference was determined between the groups in respect of the Q-DASH and grip strength scores preoperatively and at 6 weeks and 3 and 6 months post-injection. No statistically significant difference was determined between the groups in respect of the VAS scores preoperatively and at 6 weeks and 6 months. No systemic or local complications were reported during the treatment. CONCLUSION: There was no statistically significant difference compared to the blinded injection technique, and the mean score differences between the groups are of no clinical relevance.

Asunto(s)

Codo/diagnóstico por imagen , Inyecciones/métodos , Metilprednisolona/administración & dosificación , Codo de Tenista/tratamiento farmacológico , Ultrasonografía/métodos , Adulto , Femenino , Glucocorticoides/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento

RESUMEN

BACKGROUND: The present objective was to retrospectively evaluate factors affecting functional outcome of multipart proximal humeral fracture treated with fixation or hemiarthroplasty. METHODS: Included were 58 patients (19 women, 39 men; average age: 51.04 years; range 22-78 years) who underwent surgery for Neer type III or IV proximal humeral fractures between 2007 and 2012. All participants attended follow-up of at least 2 years. A total of 35 patients underwent open reduction and anatomical plate fixation; 23 underwent partial shoulder replacement. Patients were evaluated according to Constant-Murley shoulder scoring at final follow-up examination. Evaluated impacts on functional outcome included age, gender, American Society of Anesthesiologists (ASA) Physical Status classification, trauma energy, type of fracture, and time to surgery. RESULTS: Mean follow-up duration was 47.25±13.29 (25-76) months. Mean Constant-Murley score was 58.65±18.62 (65.77±18.67 for the fixation group, 47.82±12.52 for the hemiarthroplasty group; p=0.001). When impact of independent variables on functional scores was assessed, ASA score and type of fracture were found to significantly affect functional outcome in the fixation group, and trauma energy was found to significantly affect functional outcome in the hemiarthroplasty group. Complications were detected in 20 patients (34.5%) upon final examination, 14 of whom (70%) had rotator cuff deficiency. DISCUSSION: Though improved functional results may be obtained using plate fixation in the surgical treatment of multipart proximal humeral fractures, the high rates of rotator cuff failure associated with both surgical methods should be considered.

Asunto(s)

Placas Óseas , Evaluación de Resultado en la Atención de Salud , Fracturas del Hombro/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Hemiartroplastia , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Estudios Retrospectivos , Articulación del Hombro , Resultado del Tratamiento , Turquía

RESUMEN

BACKGROUND/AIM: Ankaferd blood stopper (ABS) is a mixture of certain ratios of 5 different plant roots (Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum, and Urtica dioica). The aim of this study is to evaluate the histopathological effects of ABS on articular cartilage in vitro. MATERIALS AND METHODS: Twenty-one albino Sprague Dawley rats were randomly allocated to 3 groups: 0.1 mL of saline was injected in the first group, 0.1 mL of ABS was injected in the second group, and 0.1 mL of blood and 0.1 mL of ABS were injected in the third group. One month later all rats were sacrificed. Specimens were obtained for histopathological evaluation. RESULTS: Significant results were detected in the groups with respect to International Cartilage Repair Society and synovial proliferation scores (P < 0.05 and P < 0.01). According to inflammatory cell infiltration and fibrin formation scores, there was no significant difference between group 1 and group 2 (P < 0.01), although there was significant difference between group 3 and the other groups (P > 0.05). CONCLUSION: ABS and hemarthrosis had toxic effects on knee cartilage. The side effects were increased with the combination of hemarthrosis and ABS. As a result, ABS had unexpected effects on experimental hemarthrosis.

Asunto(s)

Extractos Vegetales/farmacología , Animales , Glycyrrhiza , Hemostáticos , Ratas , Ratas Sprague-Dawley , Ratas Wistar

RESUMEN

BACKGROUND: Treatment of the distal tibial fractures are challenging due to the limited soft tissue, subcutaneous location and poor vascularity. In this control-matched study, it was aimed to compare the traditional open reduction and internal fixation with minimal invasive plating (MIPO). We hypothesized that superior results may be achieved with MIPO technique. METHODS: 22 patients treated with traditional open reduction and internal fixation were matched with 22 patients treated with closed reduction and MIPO on the basis of age (±3), gender, and fracture pattern (AO classification). Evaluation was assed according to the wound problems, the American Orthopaedic Foot and Ankle surgery (AOFAS) scoring, radiological union, malunion, delayed union, hospitalisation time, time from injury to surgery, and operation time. RESULTS: There was no significant difference in the distribution of AO/OTA classification, age, gender, AOFAS score, time from injury to operation, follow-up, bone union time, delayed union, malunion and infection (p>0.05). The operation time was significantly longer in the open group than in the MIPO group: 69.59±7.21 min. for the ORIF, and 61.14±5.61 for the MIPO group (p<0.01).The hospitalisation time was significantly longer in the open group than in the MIPO group: 7.64±4.71 days for the MIPO, and 10.18±4.32 days for the ORIF group (p<0.05). CONCLUSION: MIPO technique can be beneficial for the treatment of distal tibia AO/OTA A and B type fractures with reduced hospital stay, cost-effectiveness, and infection rate.

Asunto(s)

Fracturas de la Tibia/cirugía , Adulto , Fracturas de Tobillo , Placas Óseas , Estudios de Casos y Controles , Femenino , Fijación Interna de Fracturas/métodos , Humanos , Tiempo de Internación , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Reducción Abierta/métodos , Tempo Operativo , Resultado del Tratamiento

RESUMEN

OBJECTIVE: The purpose of this study was to compare pedicle screw fixation (PSF) with hybrid instrumentation (HI) in cases of adolescent idiopathic scoliosis (AIS). METHODS: Thirty-eight patients with AIS who underwent PSF (n=19) or HI (n=19) between 2001 and 2011 were retrospectively reviewed. Patients had similar age at surgery and similar number of fused vertebrae. Operative time, intraoperative blood loss, and postoperative complications were compared between the 2 groups. Spinal radiographs for apical vertebral translation, global coronal balance, major curve Cobb angle, global sagittal balance, thoracic kyphosis, and lumbar lordosis were measured in all patients preoperatively and at 2-year follow-up; the results were then compared between the 2 groups. Postoperative correction was calculated for all patients and compared between the 2 groups. RESULTS: The average time of surgery ofthe PSF group was significantly longer than that of the HI group (p<0.05). The amount of bleeding of the PSF group was significantly higher than the HI group (p<0.01). No statistically significant difference was found between the groups in respect to the development of complications (p>0.05). Both the major curve Cobb angle and the global sagittal balance showed greater improvement in the PSF group compared to the HI group (p<0.01). Postoperative correction was better in the PSF group than the HI group. CONCLUSION: The PSF system provided better improvement than the HI system in major curve Cobb angle and global sagittal balance, and postoperative correction was better in the PSF group than the HI group.

Asunto(s)

Fijadores Internos , Lordosis/diagnóstico por imagen , Tornillos Pediculares , Complicaciones Posoperatorias , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Adolescente , Pérdida de Sangre Quirúrgica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Radiografía , Estudios Retrospectivos , Fusión Vertebral/métodos , Vértebras Torácicas/cirugía , Resultado del Tratamiento , Turquía , Adulto Joven

RESUMEN

INTRODUCTION: In this retrospective study, the impact of age, amputation level and the cause of amputation were examined using the Hospital Anxiety and Depression Scale (HADS) and Medicare K scores of amputees with unilateral lower-limb amputation. MATERIALS AND METHODS: In total, 135 patients with unilateral transfemoral (TF) or (TT) transtibial amputations were examined. All data were collected using questionnaires that were either self-administered or administered during an interview. The HADS was developed as a self-reporting questionnaire to detect adverse anxiety and depressive status. K code is used to describe the functional abilities of amputees. RESULTS: The mean age at the time of surgery was 52.79 ± 13.08 years. The mean time since amputation was 59.20 ± 24.41 months for TT, and 60.89 ± 22.09 months for TF amputation. The HADS-A scores of the transfemoral amputation group were determined as significantly high compared to those of the transtibial group (p < 0.05). The K index of the group aged 35 years and below was significantly higher than that of the other groups (p 0.002, p 0.001, p < 0.01). CONCLUSION: The data show higher HADS-A scores with traumatic transfemoral amputation. Therefore, adequate psychiatric evaluation and rehabilitation should be applied to all amputees, especially in cases of young, traumatic, transfemoral amputations. LEVEL OF EVIDENCE: Level 3, retrospective comparative cohort study.

Asunto(s)

Amputación Quirúrgica/métodos , Amputación Traumática/psicología , Trastorno Depresivo/etiología , Adulto , Factores de Edad , Anciano , Amputación Quirúrgica/psicología , Miembros Artificiales/psicología , Femenino , Fémur/cirugía , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Prótesis e Implantes , Estudios Retrospectivos , Autoinforme , Tibia/cirugía , Resultado del Tratamiento

RESUMEN

BACKGROUND: The aim of the present study was to assess the degree of apical vertebral rotation values in Adolescent Idiopathic Scoliosis (AIS) that were obtained on CT scans, and to analyze the influence of patient position (supine versus prone) on the degree of rotation. METHODS: The study included 50 apical vertebra rotation measurements of 34 patients with Type 1A and Type 3C curvature according to the Lenke classification. CT imaging was applied to the patients in supine and prone positions to measure the apical vertebral rotation (AVR). The average AVR angles were measured using the Aaro-Dahlborn method and the results were compared. RESULTS: No significant differences were found between the vertebral rotation measured in the prone and supine positions for the Lenke 1A subgroup and the Lenke 3C thoracic group (p = 0.848; p = 0.659, respectively). In the Lenke 3C lumbar group, however, the vertebral rotation in the supine position was found to be significantly lesser than that in the prone position (difference -1.40° ± 1.79°, p = 0.007). CONCLUSION: The assessment of the apical vertebra rotation is crucial in AIS. Even though the vertebral rotation in the supine position was found to be significantly lesser than that in the prone position, CT imaging in a prone position could not be considered clinically more relevant than the CT images in a supine position as there was less than 3° difference.

Asunto(s)

Posición Prona , Escoliosis/diagnóstico por imagen , Columna Vertebral/diagnóstico por imagen , Posición Supina , Adolescente , Femenino , Humanos , Masculino , Estudios Prospectivos , Rotación , Escoliosis/clasificación , Tomografía Computarizada Espiral , Adulto Joven

RESUMEN

OBJECTIVE: The aim of the study was to determine the amount of radiation exposure in the orthopedic operating theater, to show that the radiation dose was decreased with distance from the tube, and to inform personnel about protective measures. METHODS: Ionised radiation was measured in the orthopedic operating theater where fluoroscopy was used between 18 February 2014 and 02 June 2014. Four dosimeters were placed at the head and foot of the operating table and at 200 cm from those areas at a height of 60 cm vertical to the floor. RESULTS: At the end of 104 days, the total values were determined as 90.5 mrem at the foot of the table, 68.17 mrem at the head of the table, 7.5 mrem at 200 cm from the foot of the table, and 5.17 mrem at 200 cm from the head of the table. A significant decrease was observed in the values determined at a distance from the radiation source. CONCLUSION: The rate of radiation determined in the dosimeters decreased when distance from the radiation source increased. During the use of fluoroscopy in orthopedic surgery, the wearing of lead aprons, neck protectors, and glasses, in addition to maintaining a distance from the tube, will reduce the radiation exposure of individuals.

Asunto(s)

Fluoroscopía/efectos adversos , Exposición Profesional/análisis , Quirófanos , Dosis de Radiación , Exposición a la Radiación/análisis , Humanos , Procedimientos Ortopédicos , Protección Radiológica , Medición de Riesgo

RESUMEN

BACKGROUND: This study aimed to conduct a clinical and radiological analysis of treatment results in Schatzker type I and type II tibial plateau fractures and investigate the effect of Body Mass Index on these results. METHODS: A total of 64 patients (44 male [68.8%], 20 female [31.3%]; mean age 21-80; range 45.05±13.47 years) undergoing surgery for Schatzker type I and type II tibial plateau fractures were included into the study. Clinical and radiological results were evaluated according to Rasmussen scores. During evaluation, BMI of the patients was reported. The effects of obesity on these clinical and radiological results were further evaluated. RESULTS: In Schatzker type II cases, there was an indirect 48.4% statistically significant relation (p<0.01) between Rasmussen Clinical scores and age. DISCUSSION: In Type II fractures, the results of obese patients were found to be worse when compared to patients with normal weight. While obesity is not a problem which can be overcome in a short time interval, close follow-up and careful rehabilitation are essential to achieve good results in this group of patients.

Asunto(s)

Obesidad , Fracturas de la Tibia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fijación Interna de Fracturas/métodos , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular , Recuperación de la Función , Fracturas de la Tibia/diagnóstico por imagen , Resultado del Tratamiento , Adulto Joven

RESUMEN

PURPOSE: One of the important factors in a successful arthroplasty is component alignment. The primary objective of this study was to determine whether the fibular shaft reference technique is beneficial for the tibial component position on the postoperative plain radiograph after total knee arthroplasty. METHODS: A total of 42 patients between 2009 and 2011 were analysed retrospectively. The surgeon prepared the tibia using an extramedullary cutting guide and set the posterior tibial slope with respect to the fibular reference rod. In the postoperative radiographic measurements, a true anteroposterior and lateral radiograph of the lower leg covering the whole length of the tibia was used. RESULTS: Five patients were excluded as they did not meet the inclusion criteria, four patients were excluded due to improper radiographs and the study group was reduced to 33 patients and 35 knees. The mean preoperative tibiofibular angle was 2.1° ± 0.8°. The mean postoperative tibial sagittal angle measurements were 83.3° ± 1.4° (81°-86°). 33 (94 %) Knees gained the desired tibial sagittal angle within the desired alignment (5° ± 3°). The mean postoperative tibial coronal angle was 89.3° ± 1.5°. The tibial component coronal angle of two knees was more than 3 alignment from the neutral mechanical axis. CONCLUSION: The major clinical relevance of the technique described in the present study is cost-effectiveness, and it does not require any extra time or surgical equipment. This method can be used as an alternative choice for bulky extremities which is a cause of malalignment of the components. LEVEL OF EVIDENCE: Retrospective case series, Level IV.

Asunto(s)

Artroplastia de Reemplazo de Rodilla/métodos , Peroné/diagnóstico por imagen , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/cirugía , Anciano , Femenino , Peroné/cirugía , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Radiografía , Estudios Retrospectivos , Tibia/diagnóstico por imagen , Tibia/cirugía

RESUMEN

Treatment of chronic osteomyelitis of the long bones is challenging due to infection and bone resection. The aim of this case presentation is to report an alternative method for chronic osteomyelitis of the femur. We aimed to provide acute and rapid shortening at the resected site, and lengthening from the metaphyseal bone of a 22-year-old male patient who applied with pain and discharge in the right thigh due to chronic osteomyelitis, and who had undergone three surgical procedures previously. A two-stage treatment was planned. At the first stage, bone resection, antibiotic-impregnated cement rod, and external fixator were applied. At the second stage, intramedullary femoral nail was applied, compression was continued to achieve the docking side in the resection area, and lengthening was performed to eliminate shortness. At the final follow-up, excellent bone and functional scores were obtained. The distraction-compression technique described here can provide successful results in the treatment of chronic osteomyelitis of the long bones.

Asunto(s)

Antibacterianos/administración & dosificación , Cementos para Huesos/uso terapéutico , Osteogénesis por Distracción , Osteomielitis/terapia , Clavos Ortopédicos , Enfermedad Crónica , Fijadores Externos , Fémur/cirugía , Humanos , Masculino , Resultado del Tratamiento , Adulto Joven

RESUMEN

OBJECTIVE: The aim of this study was to evaluate the effect of BMI on clinical and radiological outcomes of pilon fractures. We hypothesized that obese patients, defined as having a BMI of 30 or higher, would not have worse functional and radiological outcome compared to non-obese patients. METHODS: This study retrospectively reviewed 42 patients (33 males and 9 females; mean age: 42.67±12.29 years, range: 18 to 67 years) who sustained tibial pilon fractures between January 2008 and May 2011. Each patient's postoperative course, including the incidence of postoperative complications, and the length of hospital stay was determined from medical charts. At the final follow-up, clinical assessment was made according to the AOFAS score and radiological evaluation was made according to the Kellgren-Lawrence classification. RESULTS: Twenty-nine patients had low-energy trauma, while 13 had high-energy trauma. Mean BMI was 28.96±4.86 kg/m2. There were 18 obese patients and 24 non-obese patients. Mean AOFAS score at the final follow-up was 68.36±20.71. The average follow-up time was 30.0±11.48 months. Superficial infection in the obese group occurred at a statistically significantly higher rate (p<0.05). Operation and hospitalization times occurred at a significantly higher rate in the obese group (p=0.001 and p= 0.041, respectively). CONCLUSION: Body mass index does not affect the clinical and radiological outcomes of tibial pilon fractures, with the exception of superficial infection. Obese patients could be treated as non-obese patients with close monitoring of the wound.

Asunto(s)

Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Índice de Masa Corporal , Fijación Interna de Fracturas/métodos , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Adulto , Anciano , Clavos Ortopédicos , Placas Óseas , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/efectos adversos , Curación de Fractura/fisiología , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Radiografía , Rango del Movimiento Articular/fisiología , Recuperación de la Función/fisiología , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Resultado del Tratamiento , Adulto Joven

RESUMEN

BACKGROUND: Treatment of tibial nonunion with bone loss is extremely difficult. A variety of techniques have been described, but each has shortcomings, in particular prolonged external fixation time as well as serious complications such as nonunion and infection. Accordingly, we developed a technique that seeks to reduce these complications by using a circular external fixator in addition to an intramedullary nail to achieve union, limb lengthening, and stability of the regenerated segment. DESCRIPTION OF TECHNIQUE: First, the pseudoarthrosis area is resected, and acute compression is continued until bone contact at the docking site was achieved. Then primary grafting is applied to the docking site using a graft harvested from the patient's iliac bone, and the predrilled nail holes localized on the middle segment of the tibia are locked with a free-hand technique. Finally, lengthening is performed to overcome the leg-length discrepancy with an external fixator. METHODS: Between 2008 and 2011, this technique was used to treat five patients with tibial nonunion with bone loss. All patients were available for a minimum of a 14-month followup (mean, 30 months; range, 14-58 months). General indications for the procedure were age older than 16 years, tibial nonunion with bone loss, and the absence of any psychiatric disorder. We evaluated external fixation time, external fixation index (defined as the duration of external fixation in months divided by the total amount of bone transported and/or the amount of lengthening in centimeters), and time to union on plain radiographs, clinical results using the Paley bone and functional assessment scores, and postoperative complications from chart review. RESULTS: The external fixation time was 4 months (range, 3-5 months), and the average external fixation index was 0.4 months/cm. The mean time to bone union was 4.6 months (range, 3.5-5.5 months). All angles were determined to be in the normal range. No patients developed refracture or malalignment either on the docking site or the osteotomy site. Paley bone evaluation results were excellent in all five patients, and Paley functional results were excellent in four and good in one. We observed 10 pin-site infections as minor complications, and one patient was left with a residual equinus deformity of 5° as a major complication according to the Paley classification. CONCLUSIONS: Our technique combining acute shortening and distraction osteogenesis had promising results for the treatment of tibial nonunion with bone loss in a small group of patients. However, future studies directly comparing available approaches to this difficult problem are required. Because this problem is uncommon, these studies will almost certainly require the cooperation of multiple large participating centers. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Asunto(s)

Clavos Ortopédicos , Fijadores Externos , Fijación Intramedular de Fracturas/instrumentación , Fracturas no Consolidadas/cirugía , Osteogénesis por Distracción/instrumentación , Seudoartrosis/cirugía , Tibia/cirugía , Fracturas de la Tibia/cirugía , Adulto , Trasplante Óseo , Descompresión Quirúrgica , Fijación Intramedular de Fracturas/efectos adversos , Curación de Fractura , Fracturas no Consolidadas/diagnóstico , Humanos , Ilion/trasplante , Masculino , Persona de Mediana Edad , Osteogénesis por Distracción/efectos adversos , Osteotomía , Diseño de Prótesis , Seudoartrosis/diagnóstico , Radiografía , Tibia/diagnóstico por imagen , Tibia/lesiones , Fracturas de la Tibia/diagnóstico , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

AIM: In the treatment protocol of fractures of the fifth metacarpal, closed reduction and immobilization is generally recommended. This study aimed to compare the radiological and functional results of short-arm plaster cast and a forearm U-splint. PATIENTS AND METHODS: Between January 2011 and June 2012, the study comprised a total of 122 cases with 64 (52.4%) in the cast group and 58 (47.6%) in the splint group. The cases were 92 (75.4%) males and 30 (24.6%) females with a mean age of 30.56 ± 12.27 years (range 10-66 years). Two groups were formed according to the surgical treatment plans of the two surgeons who were to follow up the patients. RESULTS: No statistically significant difference was found between the groups in terms of age, duration of the cast or splint and follow-up period (p > 0.05). The grip strength of Group A was determined as 90.38 ± 1.77% of the healthy side and Group B as 90.58 ± 1.65%. No statistically significant difference was seen between the groups in respect of grip strength (p > 0.05). The degree of dorsal angulation pre-application, post-application and after removal of the groups showed no statistically significant difference between the groups (p > 0.05). CONCLUSION: No superiority was seen in the clinical and radiological results of the two different treatment protocols applied to fractures of the fifth metacarpal. However, when the complications created by a plaster cast and pressure wounds are taken into consideration, the application of a short-arm U-splint can be said to be a better option.

Asunto(s)

Moldes Quirúrgicos , Fracturas Óseas/terapia , Inmovilización/métodos , Huesos del Metacarpo/diagnóstico por imagen , Huesos del Metacarpo/fisiopatología , Aparatos Ortopédicos , Adolescente , Adulto , Anciano , Moldes Quirúrgicos/efectos adversos , Niño , Femenino , Curación de Fractura , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/fisiopatología , Fuerza de la Mano , Humanos , Masculino , Huesos del Metacarpo/lesiones , Persona de Mediana Edad , Úlcera por Presión/etiología , Radiografía , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven

RESUMEN

INTRODUCTION: Adolescent idiopathic scoliosis and epilepsy are pathologies rarely seen together. In this study we report an AIS case we operated in which epilepsy was seen post operatively. We want to emphasize the items one should pay attention in such cases. PRESENTATION OF CASE: In a 14-year-old girl with AIS and concomitant syringomyelia and spondylolisthesis, posterior deformity correction and fusion were performed. After stabilization the patient was discharged on the 10th day of discharge epileptic seizure appeared. DISCUSSION: In scoliosis surgery, the mechanic stress and bleeding caused by the operation itself can cause neurological problems due to primary nervous system injury. The operation and bleeding during and after the operation, pulmonary and cardiac functional instability, metabolic imbalance can be the causes of epileptic seizures. CONCLUSION: Epilepsy seen after a major surgery like scoliosis surgery, can be either as a result of central nervous system origined vascular and hypoxic problems or metabolic. In our case we concluded that massive hemorrhage must have induced epilepsy. In neurologic consultations the case was considered as an incidental epileptic picture.