RESUMEN
OBJECTIVE: Anatomic reconstruction of the posterior facet by primary stabilization of the calcaneal fracture with a locking nail. INDICATIONS: All intraarticular calcaneal fractures and unstable two-part fractures independent of the degree of closed/open soft tissue trauma. CONTRAINDICATIONS: High perioperative risk, soft tissue infection, beak fracture (type II fracture) and still open apophysis. SURGICAL TECHNIQUE: Anatomic reduction of the posterior facet using a sinus tarsi approach. Reduction and temporary fixation of the sustentacular, tuberosity, and anterior process fragments with 1.8-2.0 mm Kirschner wires. Thereafter, the C-Nail (calcaneus nail) is introduced with its guiding device stabilizing the sustentacular, tuberostity, and anterior process fragments through its three guiding arms with 6 or 7 locking screws. POSTOPERATIVE MANAGEMENT: Passive and active motion starts on postoperative day 2. Lymph drains help reduce swelling. Partial weightbearing with 20 kg for 6-8 weeks in the patient's own shoes is recommended. Xray controls are done at 4 and 8 weeks as well as after 6 and 12 months. RESULTS: A total of 107 calcaneal fractures treated with the C-Nail between 2011 and 2014 were evaluated according to the AOFAS score 6 months and 1 year after surgery. The measured values were on average 93.0 (range 65-100) points at 6 months and 94.1 (range 75-100) points 12 months after the surgery. Böhler's angle with initial traumatic values of 6.2° (-30 to +13°) improved postoperatively to 31.8°, after 3 months slightly decreased to 29.6°, and after 12 months to 28.3°. There were 2 cases of superficial wound necrosis (1.9 %) and 1 case a deep infection (0.93 %) with need of early C-Nail removal.
Asunto(s)
Fracturas de Tobillo/cirugía , Clavos Ortopédicos , Calcáneo/lesiones , Calcáneo/cirugía , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Adolescente , Fracturas de Tobillo/diagnóstico , Fracturas de Tobillo/diagnóstico por imagen , Calcáneo/diagnóstico por imagen , Femenino , Fijación Intramedular de Fracturas/rehabilitación , Humanos , Masculino , Resultado del TratamientoRESUMEN
The ideal treatment of displaced intra-articular calcaneal fractures is still controversially discussed. Because of the variable fracture patterns and the vulnerable soft tissue coverage an individual treatment concept is advisable. In order to minimize wound edge necrosis associated with extended lateral approaches, selected fractures may be treated percutaneously or in a less invasive manner while controlling joint reduction via a sinus tarsi approach. Fixation in these cases is achieved with screws, intramedullary locking nails or modified plates that are slid in subcutaneously. A thorough knowledge of the three dimensional calcaneal anatomy and open reduction maneuvers is a prerequisite for good results with less invasive techniques. Early functional follow-up treatment aims at early rehabilitation independent of the kind of fixation. Peripheral fractures of the talus and calcaneus frequently result from subluxation and dislocation at the subtalar and Chopart joints. They are still regularly overlooked and result in painful arthritis if left untreated. If an exact anatomical reduction of these intra-articular fractures is impossible, resection of small fragments is indicated.
Asunto(s)
Fracturas de Tobillo/cirugía , Calcáneo/lesiones , Calcáneo/cirugía , Fijación Interna de Fracturas/tendencias , Reducción Abierta/tendencias , Fracturas de Tobillo/diagnóstico por imagen , Calcáneo/diagnóstico por imagen , Terapia Combinada/instrumentación , Terapia Combinada/métodos , Terapia Combinada/tendencias , Medicina Basada en la Evidencia , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Humanos , Reducción Abierta/instrumentación , Reducción Abierta/métodos , Resultado del TratamientoAsunto(s)
Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Clavos Ortopédicos , Calcáneo/diagnóstico por imagen , Calcáneo/cirugía , Fijación Interna de Fracturas/instrumentación , Medicina Basada en la Evidencia , Fijación Interna de Fracturas/métodos , Humanos , Diseño de Prótesis , Resultado del TratamientoRESUMEN
BACKGROUND: Osteoporotic fractures of the ankle were observed three times more often in the year 2000 than in the year 1970 and it is predicted that this will increase another three times by the year 2030. The most important predictive values for ankle fractures in the elderly are smoking, multipharmacy and poor mobility. INJURY PATTERNS: Conservative treatment only seems to be successful in stable ankle fractures with good surrounding soft tissue. Pronation-abduction (PA) fractures most commonly affect elderly females and 90% of the cases present as the very unstable type III. Unstable fractures, such as PA type III, supination-eversion (SE) and pronation-eversion (PE) fractures type IV can be treated better by 2-stage open reduction internal fixation (ORIF). Because the PA type III fracture is often associated with dorsal dislocation of the foot it is proposed that this type should be classified as type IV, which needs urgent surgery to prevent further soft tissue damage. THERAPY: Recommended techniques are the K-wire cage or fibula-pro-tibia technique. Locking plates are also preferred for stable fracture fixation. According to the recommended preoperative computed tomography (CT) scan a Volkmann's fracture should be fixed through a posterolateral approach. The additional tibiotarsal internal transfixation should remain for 6-8 weeks after ORIF until it is changed to a protective lower leg cast after wound healing. An underlying osteoporosis should be diagnosed and inpatient treatment of this entity should be initiated by trauma surgeons whereby coordination training is also important. CONCLUSION: Due to the increasing number of ankle fractures in the elderly particularly in postmenopausal women with osteoporosis, the insufficient diagnostics and therapy of osteoporosis and because the number of these difficult to treat fractures will increase by a factor of 3 by 2030, special surgical techniques and particularly implants are necessary for unstable ankle fractures types PA III, SE IV and PE.
Asunto(s)
Fracturas de Tobillo/terapia , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Inestabilidad de la Articulación/prevención & control , Fracturas Osteoporóticas/terapia , Anciano , Anciano de 80 o más Años , Fracturas de Tobillo/complicaciones , Terapia Combinada , Femenino , Humanos , Inestabilidad de la Articulación/etiología , Masculino , Persona de Mediana Edad , Fracturas Osteoporóticas/complicacionesRESUMEN
OBJECTIVE: Anatomic reduction of displaced intra-articular calcaneal fractures with restoration of height, length, and axial alignment and reconstruction of the subtalar and calcaneocuboid joints. INDICATIONS: Displaced intra-articular calcaneal fractures with incongruity of the posterior facet of the subtalar joint, loss of height, and axial malalignment. CONTRAINDICATIONS: High perioperative risk, soft tissue infection, advanced peripheral arterial disease (stage III), neurogenic osteoarthropathy, poor patient compliance (e. g., substance abuse). SURGICAL TECHNIQUE: Extended lateral approach with the patient placed on the uninjured side. Reduction of the anatomic shape and joint surfaces according to the preoperative CT-based planning. Reduction of the medial wall and step-wise reconstruction of the posterior facet from medial to lateral. Reduction of the tuberosity and anterior process fragments to the posterior joint block and temporary fixation with Kirschner wires. Internal fixation with an anatomic lateral plate in a locking or nonlocking mode. Alternatively less invasive internal fixation with a calcaneus nail over a sinus tarsi approach for less severe fracture types. POSTOPERATIVE MANAGEMENT: The lower leg is immobilized in a brace until the wound is healed. Range of motion exercises of the ankle and subtalar joints are initiated on the second postoperative day. Patients are mobilized in their own shoe with partial weight bearing of 20 kg for 6-12 weeks depending on fracture severity and bone quality. RESULTS: Over a 4-year period, 163 patients with 184 displaced, intra-articular calcaneal fractures were treated with a lateral plate via an extended approach. In all, 102 patients with 116 fractures were followed for a mean of 8 years. A surgical revision was necessary in 4 cases (3.4%) of postoperative hematoma, 2 (1.7%) superficial and 5 (4.3%) deep infections. Of the latter, 2 patients needed a free flap for definite wound coverage, no calcanectomy or amputation was needed. Secondary subtalar fusion for symptomatic posttraumatic arthritis was performed in 9 cases (7.8%). At follow-up, the AOFAS Ankle/Hindfoot Score averaged 70.2, the Zwipp Score averaged 76.0, the German versions of the Foot Function Index and SF-36 physical component averaged 32.8 and 42.2, respectively. Scores were significantly lower with increasing fracture severity according to the Sanders and Zwipp classifications, bilateral fractures, open fractures, and with work-related injuries. With less invasive fixation using a calcaneal nail, superficial wound edge necrosis was seen in 2 of 75 cases (2.7%).
Asunto(s)
Fracturas de Tobillo/rehabilitación , Fracturas de Tobillo/cirugía , Calcáneo/lesiones , Calcáneo/cirugía , Fijación Interna de Fracturas/instrumentación , Fracturas Mal Unidas/cirugía , Osteotomía/métodos , Fracturas de Tobillo/diagnóstico , Tornillos Óseos , Hilos Ortopédicos , Calcáneo/diagnóstico por imagen , Terapia Combinada/instrumentación , Terapia Combinada/métodos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/rehabilitación , Curación de Fractura , Fracturas Mal Unidas/diagnóstico , Fracturas Mal Unidas/rehabilitación , Humanos , Osteotomía/rehabilitación , Radiografía , Resultado del TratamientoRESUMEN
Tendinosis of the Achilles tendon is a degenerative-reparative structural change of the tendon with microdefects, increases in cross-section due to cicatricial tendon regeneration, neoangiogenesis and reduction of elasticity. The previously used term tendinitis is only rarely used for the chronic form since signs of inflammation such as redness and hyperthermia or elevated levels of inflammatory parameters on laboratory testing are generally absent. Duplex sonography with visualization of the neovascularization has become a valuable supplement not only for diagnostics but also for therapy planning. The classic, conservative therapy for painful tendinosis consists of oral anti-inflammatory drugs, pain-adapted load reduction, raising the heel, stretching the calf musculature, and various physiotherapeutic interventions. When conservative treatment over a period of 4 - 6 months fails to produce any or non-adequate pain relief, an indication for surgical treatment should be considered. In the therapy for fresh ruptures of the Achilles tendon further developments in minimally invasive techniques have led to a worldwide paradigm change over the past 10 years. The decisive advantage of minimally invasive surgical techniques is the lower risk of wound infection as compared to the sutures of the open technique. When compared with conservative functional therapy the minimally invasive repair has the advantage of being less dependent on the compliance of the patient since, in the early phase of tendon healing the suture prevents a separation of the tendon ends upon controlled movements. However, not every patient with a ruptured Achilles tendon should be treated with a minimally invasive repair. Open tendon reconstruction and functional conservative therapy are still justified when the correct indication is given.
Asunto(s)
Tendón Calcáneo/lesiones , Modalidades de Fisioterapia , Procedimientos de Cirugía Plástica/métodos , Tendinopatía/diagnóstico , Tendinopatía/terapia , Traumatismos de los Tendones/diagnóstico , Traumatismos de los Tendones/terapia , Tendón Calcáneo/cirugía , Antiinflamatorios/uso terapéutico , Humanos , Rotura/diagnóstico , Rotura/terapiaRESUMEN
The open tendon suture is the most commonly used method of treatment for Achilles tendon rupture in Germany. Over the last decade the therapeutic spectrum of operative methods has been further enlarged by the development of new minimally invasive surgical techniques. Important criteria for planning treatment are the location and age of the rupture and comorbidities. For recent Achilles tendon ruptures minimally invasive suturing is indicated but for older ruptures a reconstruction often has to be carried out. The decisive disadvantage of an open tendon suture is the relatively high risk of infection. Using minimally invasive surgical techniques the frequency of postoperative infection could be significantly reduced. The suture methods without opening the ruptured region can be collectively grouped under the term percutaneous suture techniques and the minimally invasive methods with opening of the rupture region as combined open percutaneous techniques. Documented problems with the Ma-Griffith technique, such as injury of the sural nerve, low stability of the suture and insufficient adaption of the tendon stumps have been minimized by new minimally invasive operation techniques. Achilles tendon ruptures which nearly always arise without any external influence or accidents can have substantial psychological consequences regarding the integrity of one's own body especially for people actively engaged in sport. This aspect should be considered and accepted in particular during postoperative treatment.
Asunto(s)
Tendón Calcáneo/lesiones , Tendón Calcáneo/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Técnicas de Sutura , Traumatismos de los Tendones/cirugía , Humanos , Rotura/cirugíaRESUMEN
Cases of posttraumatic pes equinovarus after compartment syndrome have become more frequent in the last 3 decades because limb-saving procedures like compartment splitting, vascular repair, and microvascular free flaps have become well established in trauma surgery, thus reducing early below knee amputations. But if the deep flexor compartment is not split completely or if the muscles are crushed by direct trauma severe necrosis and subsequent muscle contractures result in a very severe clubfoot deformity. Metatarsalgia of fifth, fourth, and third metatarsal head even in well-fitted orthopaedic shoes occurs as well as painful bunions and fatigue fractures of the fifth metatarsal. Infected ulcers below the fifth/fourth metatarsal bone in a numb plantar sole often require head resection because of osteomyelitis.From 1994 to 2007 a total of 24 patients with severe pes equinovarus after compartment and/or postischemic syndrome were treated operatively. Only in 5 cases was a triple, Chopart, or Lisfranc arthrodesis necessary; 19 cases however could be treated only by soft tissue procedures like tenolysis, tendon lengthening, medial release of the scarred flexor retinacula and contracted capsules of the posterior ankle, subtalar and talonavicular joint to reorientate all axes of the foot. By temporary K-wire transfixation (6 weeks), initial external tibiotarsal transfixation of the foot (10 days), and additional tendon transfer for active foot elevation excellent and good long-term (5 years) results are achievable.The results according to the McKay Score are not significantly different regarding the triple arthrodesis group versus the pure soft tissue release group. Nevertheless, saving joints in the latter group seems to be very important.
Asunto(s)
Síndromes Compartimentales/cirugía , Deformidades Adquiridas del Pie/cirugía , Enfermedades del Pie/cirugía , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Adolescente , Humanos , Masculino , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Transfer of the flexor hallucis longus (FHL) tendon is a therapeutic option to replace a dysfunctional Achilles tendon in cases of rerupture with large defects, loss of the Achilles tendon after postoperative infection or severe tendinosis. MATERIALS AND METHODS: Between January 1994 and December 2005, 35 patients (5 female and 30 male, average age 47 years) were treated with 36 FHL transfers and 25 patients with 26 FHL transfers could be re-evaluated at a mean follow-up time of 79 months (range 20-133 months) after surgery. RESULTS: Of the 25 patients, 18 (72%) subjectively rated the result as excellent, 5 (20%) as good, and 1 patient (4%) each as fair and poor. According to the criteria of Trillat and Mournier-Kuhn, 18 patients (72%) were rated excellent, 4 (16%) good and 3 (12%) fair. The AOFAS ankle/hindfoot score at follow-up averaged 91 (range 13-100), the AOFAS forefoot score averaged 95 (range 24-100). CONCLUSIONS: FHL transfer to the Achilles tendon provides favorable results in cases of complicated cases with defects, infections or severe tendinosis after Achilles tendon rupture.
Asunto(s)
Tendón Calcáneo/lesiones , Tendón Calcáneo/cirugía , Traumatismos del Tobillo/cirugía , Transferencia Tendinosa/métodos , Traumatismos del Tobillo/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rotura/cirugía , Resultado del TratamientoRESUMEN
The age distribution of patients with distal radius fractures shows a clear predominance of patients over 60. In such patients fractures must be treated with due consideration for the general condition, accompanying illnesses, such as osteoporosis, and the often lesser ambitions concerning the function of the wrist joint. Three cases of patients over 70 years of age are presented: two of these patients were suffering from dementia and one, from multiple morbidities and poor general condition: In all three, severe osteitis of the distal radius developed after K-wire pinning to treat distal radius fractures. In two cases, the treatment culminated in radiocarpal arthrodesis, while in the third the definitive treatment was resection of the metaphysis of the distal radius. The presented cases indicate that in distal radius fracture patients who are affected by dementia or have a poor general condition K-wire pinning with protruding K-wires should not be regarded as the therapy of first choice.
Asunto(s)
Hilos Ortopédicos/efectos adversos , Demencia/complicaciones , Fijación Interna de Fracturas/métodos , Estado de Salud , Osteítis/cirugía , Fracturas del Radio/cirugía , Infección de la Herida Quirúrgica/cirugía , Traumatismos de la Muñeca/cirugía , Anciano de 80 o más Años , Artrodesis , Moldes Quirúrgicos , Comorbilidad , Fijadores Externos , Femenino , Humanos , Osteítis/diagnóstico por imagen , Osteotomía , Cuidados Posoperatorios , Radiografía , Fracturas del Radio/diagnóstico por imagen , Reoperación , Factores de Riesgo , Infección de la Herida Quirúrgica/diagnóstico por imagen , Cúbito/diagnóstico por imagen , Cúbito/cirugía , Traumatismos de la Muñeca/diagnóstico por imagenRESUMEN
Arthroplasty has become the most successful surgical procedure in developed countries. Replacement of severely damaged joints results in a substantial relief of pain, as the main symptom of osteoarthritis, in the majority of treated patients. With improved results in endoprosthetic surgery over the last decades, however, patients are increasingly undergoing the procedure to enhance their functional capacity and physical mobility. Especially younger patients, who cannot accept a restriction in their professional or sports activity, have become demanding candidates for surgery. This review summarizes the published results on shoulder, hip, knee, ankle and first metatarsophalangeal joint replacement in patients who are younger than 50 years of age. Mid- and long-term follow-up studies in this age group are evaluated in terms of prosthesis survival as well as functional improvement.
Asunto(s)
Artroplastia de Reemplazo , Osteoartritis/cirugía , Complicaciones Posoperatorias/etiología , Adulto , Análisis de Falla de Equipo , Estudios de Seguimiento , Humanos , Prótesis Articulares , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Diseño de Prótesis , Radiografía , Reoperación , Factores de RiesgoRESUMEN
BACKGROUND: The purpose of the present study was to investigate the influence of the radiological parameters on the functional outcome of patients with a fracture of the distal radius and to find out to which extent a deformity can be tolerated. PATIENTS AND METHODS: A total of 344 patients with an isolated fracture of the distal radius were treated during a 3-year period; 211 of them were evaluated at an average of 16 months after the accident according to the score of Gartland and Werley as modified by Sarmiento. Furthermore, we developed our own score for evaluating the influence of radiological parameters on the functional outcome. RESULTS: According to the AO classification, there were 20 patients with an A2, 71 an A3, 11 a B, 35 a C1, 44 a C2, and 30 a C3 fracture. Of 211 patients, 28 (13%) had a step-off in the articular surface of over 1 mm, resulting in a 24% reduction of the range of motion compared to the non-injured wrist (p<0.05). Patients with a radial shortening of more than 3 mm (n=12) had a 21% reduction of pro- and supination compared to the non-injured side (p<0.05). The radial tilt and the palmar inclination did not have a direct influence on the functional outcome. Patients treated with K-wire pinning and with an initial palmar inclination of less then -15 degrees had a significantly higher secondary loss of palmar inclination of 9 degrees compared to all others (p<0.05) at the final follow-up. CONCLUSION: The main radiological factors influencing the functional outcome of fractures of the distal radius are radial shortening and a step-off in the articular surface.
Asunto(s)
Evaluación de Resultado en la Atención de Salud/métodos , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/cirugía , Rango del Movimiento Articular , Recuperación de la Función , Adolescente , Adulto , Femenino , Alemania/epidemiología , Humanos , Masculino , Radiografía , Fracturas del Radio/epidemiología , Estadística como Asunto , Resultado del TratamientoRESUMEN
The etiology and mechanisms of Achilles, patellar and quadriceps tendon ruptures are very similar. Age dependent changes in tendon structure and disorders such gout, diabetes, rheumatic diseases and chronic renal failure are associated causes. The main mechanism of rupture is indirect trauma. Although clinical diagnosis is easy, ruptures are still frequently missed. Sonography is the main standard diagnostic tool. MRI is indicated only in special cases. Open operative repair is the most common treatment for quadriceps and patellar tendon ruptures. Treatment of Achilles tendon ruptures is moving towards an individualized choice of therapy. Percutaneous and other "minimally invasive" techniques will play an increasingly important role.
Asunto(s)
Tendón Calcáneo/lesiones , Ligamento Rotuliano/lesiones , Músculo Cuádriceps/lesiones , Tendinopatía/diagnóstico , Traumatismos de los Tendones , Tendón Calcáneo/anatomía & histología , Adolescente , Factores de Edad , Anciano , Fenómenos Biomecánicos , Humanos , Enfermedad Iatrogénica , Inestabilidad de la Articulación/etiología , Articulación de la Rodilla/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Aparatos Ortopédicos , Cuidados Posoperatorios , Radiografía , Procedimientos de Cirugía Plástica , Recurrencia , Factores de Riesgo , Rotura , Rotura Espontánea , Traumatismos de los Tendones/diagnóstico , Traumatismos de los Tendones/diagnóstico por imagen , Traumatismos de los Tendones/fisiopatología , Traumatismos de los Tendones/cirugía , Traumatismos de los Tendones/terapia , Ultrasonografía , Cicatrización de HeridasRESUMEN
BACKGROUND: The percutaneous technique for Achilles tendon repair with the Dresden instruments (pDI suture) was developed to minimize the typical problems of percutaneous Achilles tendon sutures. METHODS: From 1 January 2000 to 31 December 2003, the pDI suture was performed in 61 patients with 62 Achilles tendon ruptures. We reviewed 39 of 47 patients (83%) with 40 ruptured Achilles tendons who had undergone percutaneous repair at a minimal interval of 12 months after the operation. RESULTS: In this study we observed no sural nerve injuries. The rerupture rate was 2/62 or 3.2%. In one patient (1.6%) a superficial late infection occurred after tendon healing. Using the criteria of Trillat and Mounier-Kuhn, 62% of the results were very good and 30% good. The average AOFAS score was 96 (78-100) points; 78% of the patients assessed the result of treatment as very good and 20% as good. CONCLUSIONS: The percutaneous suture using the Dresden instruments is a minimally invasive operative treatment of Achilles tendon rupture resulting in nearly all very good and good subjective and clinical results. It combines a low rerupture and infection rate with a minimized risk of sural nerve injury.
Asunto(s)
Tendón Calcáneo/lesiones , Tendón Calcáneo/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Técnicas de Sutura/instrumentación , Traumatismos de los Tendones/cirugía , Análisis de Falla de Equipo , Estudios de Seguimiento , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Rotura , Nervio Sural/lesiones , Instrumentos Quirúrgicos , Técnicas de Sutura/efectos adversos , Suturas/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Early diagnosis and appropriate treatment of acute scapholunate dissociation (SLD) is crucial for obtaining a favorable result in fractures of the distal radius. The aim of this study was to determine the incidence of acute SLD in a prospective study and to differentiate this entity from chronic SLD. PATIENTS AND METHODS: A total of 120 patients with unilateral distal radius fractures were prospectively evaluated for SLD. Stress radiographs were obtained for all patients on the injured side after fixation of the distal radius fractures. In cases of SLD the unaffected side was examined to rule out chronic, bilateral SLD. RESULTS: Acute SLD was detected in 13 patients (11%), 11 (9.1%) of whom had stage 3 injury. Chronic SLD with bilateral asymptomatic instability was seen in three patients (2.5%). CONCLUSION: When treating fractures of the distal radius, acute SLD has to be ruled out and to be discriminated from chronic SLD. While acute SLD requires appropriate treatment, immediate treatment of chronic SLD is not indicated.
Asunto(s)
Inestabilidad de la Articulación/epidemiología , Inestabilidad de la Articulación/cirugía , Fracturas del Radio/epidemiología , Fracturas del Radio/cirugía , Hueso Escafoides/cirugía , Traumatismos de la Muñeca/epidemiología , Traumatismos de la Muñeca/cirugía , Enfermedad Aguda , Enfermedad Crónica , Comorbilidad , Femenino , Fijación de Fractura/métodos , Fijación de Fractura/estadística & datos numéricos , Curación de Fractura , Alemania/epidemiología , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Hueso Semilunar/diagnóstico por imagen , Hueso Semilunar/lesiones , Hueso Semilunar/cirugía , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Prevalencia , Pronóstico , Radiografía , Fracturas del Radio/diagnóstico por imagen , Medición de Riesgo/métodos , Factores de Riesgo , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/lesiones , Resultado del Tratamiento , Traumatismos de la Muñeca/diagnóstico por imagenRESUMEN
Thirty-five displaced fractures of the distal radius, classified by standard radiographs as extra-articular type A2 and A3 fractures according to the AO classification, were investigated before operative treatment by computed tomography. The comparative analysis surprisingly revealed an involvement of the articular surface of the distal radius in 57%. The intra-articular fractures were classified after CT as C1 in 15%, C2 in 65%, and C3 in 20%. The distal radioulnar joint was involved in 80% of the type C injuries and showed a dorsal subluxation in 17% of all cases. Similar to the results of type A2 and A3 fractures, type B and C fractures of the distal radius also may be underestimated in standard radiographs. This concerns important components such as the involvement of the radiocarpal joint surface and concomitant injuries of the distal radioulnar joint. Since joint congruency is an important predictor of outcome, CT scanning should be used more generously for planning and controlling surgical therapy.
Asunto(s)
Radiografía , Fracturas del Radio/diagnóstico por imagen , Tomografía Computarizada Espiral , Traumatismos de la Muñeca/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Hilos Ortopédicos , Errores Diagnósticos , Fijadores Externos , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Fracturas del Radio/clasificación , Fracturas del Radio/cirugía , Sensibilidad y Especificidad , Traumatismos de la Muñeca/clasificación , Traumatismos de la Muñeca/cirugíaRESUMEN
A randomised prospective study was carried out to compare non-bridging external fixation using a small A0 external fixator with percutaneous Kirschner wire fixation and plaster in the treatment of distal radial fractures (A2/A3 in the A0 classification). The study involved 40 patients, 20 in each group. The advantages of the non-bridging fixation are: (1) early functional therapy of the wrist, (2) simplified reduction of the fracture, and (3) considerable less restriction of wrist mobility in day-to-day situations. Although the final examination 6 months after treatment showed almost identical functional results, the patients treated with the external fixator benefited from the fact that use of the wrist was virtually free throughout the entire treatment period.
Asunto(s)
Fijadores Externos , Fracturas del Radio/cirugía , Traumatismos de la Muñeca/cirugía , Curación de Fractura/fisiología , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Prospectivos , Radiografía , Fracturas del Radio/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagenRESUMEN
Complete traumatic rupture of the tibialis posterior tendon is absolutely rare. From the scarce case reports in the medical literature a extreme pronation-abduction or pronation-external rotation mechanism according to the Lauge-Hansen classification can be presumed, leading to a malleolar fracture because of forced pronation, external rotation and dorsiflexion of the foot. With primary suture the prognosis is favorable. Traumatic dislocations, mostly with luxatio pedis sub talo, are treated by atraumatic reduction and refixation of the retinaculum. Again, the prognosis is favorable. Incomplete traumatic rupture of the tibialis posterior tendon with development of posttraumatic pes plano valgus, according to case reports and our own experience result from severe pronation-external rotation-soft tissue injuries as well as with pronation-abduction or pronation-external rotation-type ankle fractures. In these cases no macroscopic rupture of the tendon is evident, however occult interstitial micro-ruptures can occur because of excessive stretching, which can be determined histologically. If conservative measures fail, a modified Evans osteotomy to lengthen the lateral foot column is indicated. Degenerative complete and incomplete ruptures of the tibialis posterior tendon are predominantly seen in women more than 42 years old. Staging of this entity can be achieved with clinical tests (muscular force, external rotation), ultrasound, weight-bearing x-rays, CT and MRT. According to the degree of decompensation of tendon function, treatment consists of augmentation, modified Evans procedure or triple arthrodesis of the hind-foot.