RESUMEN
The authors studied 10 consecutive patients with closed femoral shaft or supracondylar fractures who were nonambulatory and who were treated by reamed retrograde intramedullary nailing via an intercondylar notch approach. The study consisted of five women and five men with an average age of 60.7 years (range, 40-89 years). Six patients had spinal cord lesions, one had a brain injury, one had cerebral palsy, one had multiple sclerosis, and one had progressive myelopathy. Three fractures were supracondylar, and seven fractures involved the mid-distal diaphysis. The average time of surgery was 110 minutes (range, 70-225 minutes) with an average estimated blood loss of 288 mL (range, 150-400 mL). There were two postoperative deaths (at 15 days and 2 months, respectively) after the procedure that were attributable to pneumonia. The remaining eight patients were observed for an average of 13 months (range, 6-20 months) after surgery. All fractures healed as evaluated radiographically. Retrograde intramedullary nailing is a simple, safe, and effective alternative to nonoperative treatment for femoral shaft or supracondylar fractures in patients who are nonambulatory. Stabilization by this method allows fracture healing and rapid return of patients to their previous level of function. There were no nonunions, malunions, significant shortening, implant failure, or wound infections.
Asunto(s)
Personas con Discapacidad , Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas , Fracturas Cerradas/cirugía , Traumatismos de la Médula Espinal/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/diagnóstico por imagen , Estudios de Seguimiento , Fracturas Cerradas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Radiografía , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
Pubic ramus fracture nonunion is an unusual problem. Percutaneous retrograde superior pubic ramus medullary screw fixation was successfully used in two patients with prolonged symptomatic nonunions of the superior pubic ramus.
Asunto(s)
Tornillos Óseos , Fijación Intramedular de Fracturas/instrumentación , Fracturas no Consolidadas/cirugía , Hueso Púbico/lesiones , Accidentes por Caídas , Accidentes de Tránsito , Diseño de Equipo , Femenino , Estudios de Seguimiento , Fijación Intramedular de Fracturas/métodos , Curación de Fractura/fisiología , Fracturas no Consolidadas/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Percutaneous fixation of an unstable pelvic ring injury is becoming a popular method of pelvic stabilization. As posterior pelvic percutaneous techniques become more common, the possibility of iatrogenic complications increases. This case report describes an injury to the superior gluteal artery during percutaneous iliosacral screw insertion and the treatment of this potentially devastating injury.
Asunto(s)
Arterias/lesiones , Nalgas/irrigación sanguínea , Fijación Interna de Fracturas/efectos adversos , Fracturas Óseas/cirugía , Complicaciones Intraoperatorias/cirugía , Huesos Pélvicos/lesiones , Anciano , Arterias/cirugía , Tornillos Óseos/efectos adversos , Fijación Interna de Fracturas/instrumentación , Fracturas Óseas/diagnóstico por imagen , Humanos , Complicaciones Intraoperatorias/diagnóstico por imagen , Masculino , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The authors reviewed the use of chemotherapy and anterior/posterior spinal fusion without instrumentation to treat children with extensive spinal tuberculosis and kyphosis. Six children underwent anterior and posterior spinal fusion. All of the patients were followed until after maturity, except for 1 child who died of pulmonary tuberculosis 4 months after surgery and thus was excluded from the study. Preoperative kyphotic deformity averaged 100 degrees (range, 75 degrees-130 degrees). The average age at the time of surgery was 7.5 years (range, 4.7-10 years). Spinal involvement extended from 2 to 10 vertebral bodies (average, 7.6) and was limited to the thoracic region from T-2 to T-12. Preoperative, postoperative, and followup anterior/posterior and lateral standing radiographs were obtained. The kyphotic angle was measured from the lateral view. The surgical correction of preoperative kyphosis averaged 28.6 degrees (range, 20 degrees-45 degrees). One patient underwent repeat anterior fusion at 9 months for graft failure. At the time of followup, all grafts had fused and all patients were without pain. The average duration of followup was 12.8 years (range, 9.5-14.5 years). Complications secondary to chronic chemotherapy occurred in 2 children. Long-term followup revealed solid fusion, improvement of the kyphotic deformity, and good functional outcome in all 5 patients.
Asunto(s)
Antituberculosos/uso terapéutico , Cifosis/microbiología , Fusión Vertebral/métodos , Tuberculosis de la Columna Vertebral/cirugía , Niño , Preescolar , Terapia Combinada , Femenino , Peroné/trasplante , Estudios de Seguimiento , Humanos , Masculino , Radiografía , Resultado del Tratamiento , Tuberculosis de la Columna Vertebral/complicaciones , Tuberculosis de la Columna Vertebral/diagnóstico por imagenRESUMEN
A case report of a bilateral traumatic amputee who underwent a cross leg flap to preserve a knee disarticulation level amputation is presented. Salvage of amputated parts in the lower extremities to preserve stamp length provided our patient with better stability and decreased energy expenditure with ambulation.