RESUMEN
INTRODUCTION: Trochanteric fractures are commonly stabilized either by intramedullary nailing or plate and screw fixation after reduction on the orthopaedic surgical table under radiological guidance. HYPOTHESIS: Closed trochanteric fracture anatomic reduction is difficult in the transversal plane. OBJECTIVES: The objective of this prospective study was to assess the rotational malalignment induced after reduction and osteosynthesis of trochanteric fractures. PATIENTS AND METHODS: Prospective study including 40 patients (mean age, 78 years; range, 51-90 years) operated for a trochanteric fracture between January 2007 and September 2008. Fourteen fractures were treated using DHS™ (Synthes™) plate and screw fixation and 26 with intramedullary nailing (trochanteric nail™, Stryker™). All these patients underwent postoperative CT of the pelvis during their hospitalization with measurement of anteversion of the operated and healthy femoral necks at the posterior condyles. The evaluation criterion was whether or not there was malalignment greater than 15° on the operated side compared to the healthy side. RESULTS: The mean anteversion was 14.2° for the healthy side and 23° for the operated side. The mean rotational malalignment was 15.3°. Forty percent of the rotational malalignments were greater than 15°, with a majority of cases showing excess internal rotation (35%) of the distal fragment. CONCLUSION AND DISCUSSION: The rate of internal rotational malalignment of the distal fragment greater than 15° was high (40% of this series). This should encourage surgeons to reduce the excess internal rotation that tends to be attributed to the distal fragment during preoperative reduction of these fractures. LEVEL OF EVIDENCE: Level III. Prospective diagnostic study with no control group.
Asunto(s)
Desviación Ósea/etiología , Placas Óseas , Tornillos Óseos , Fijación Interna de Fracturas , Fijación Intramedular de Fracturas , Fracturas Cerradas/cirugía , Fracturas de Cadera/cirugía , Complicaciones Posoperatorias/etiología , Anomalía Torsional/etiología , Anciano , Anciano de 80 o más Años , Desviación Ósea/diagnóstico por imagen , Femenino , Curación de Fractura/fisiología , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Prospectivos , Tomografía Computarizada por Rayos X , Anomalía Torsional/diagnóstico por imagenRESUMEN
We report three cases of extensive thrombosis of the inferior vena cava after insertion of a temporary cava filter in patients with hypercoagulable state. The indication of implantation of a temporary cava filter in these kinds of patients have to be questioned. A primary implantation of a definite filter should be preferred.
Asunto(s)
Trombosis/etiología , Filtros de Vena Cava/efectos adversos , Vena Cava Inferior , Adolescente , Adulto , Humanos , Masculino , Factores de RiesgoRESUMEN
We report two cases of osteoid osteoma of the acetabulum associated with severe chronic synovitis. The diagnosis is difficult and usually delayed because the acetabulum is a rare site for this tumor and clinical signs are nonspecific. Computed tomography (CT) scanning is the best diagnostic technique. An intraarticular surgical approach allows complete resection, but one case required spongy bone grafts. Postoperative results are excellent.
Asunto(s)
Acetábulo/diagnóstico por imagen , Neoplasias Óseas/diagnóstico por imagen , Osteoma Osteoide/diagnóstico por imagen , Acetábulo/cirugía , Adolescente , Neoplasias Óseas/complicaciones , Neoplasias Óseas/cirugía , Enfermedad Crónica , Femenino , Humanos , Masculino , Osteoma Osteoide/complicaciones , Osteoma Osteoide/cirugía , Cintigrafía , Sinovitis/complicaciones , Sinovitis/diagnóstico por imagen , Tecnecio , Tomografía Computarizada por Rayos XRESUMEN
It is about an unique case of an intra-articular osteoid osteoma, located in the back of the acetabulum in a 14 years old girl. Synovitis made clinical and radiological appearances very suggestive of an arthritis. Diagnosis was recalled in the view of biological negativity, the notion of nocturnal pains, reduced by aspirin, and especially radiological features with densification of the back of the acetabulum. Scintigraphy revealed hyperfixation located in the back of the acetabulum and scanner showed a picture, in the same place, buldging towards the joint, suggestive of the osteoid osteoma. The operation, made by anterior approach with anterior dislocation of the hip, allowed the "in bloc" resection of an osseus piece whose immediate radiographic examination confirmed that the whole osteoma was removed. A synovial biopsy was also performed. The pathologist confirmed the diagnosis and showed a reactional synovitis within the soft tissues. Pain disappeared as soon as the waking up. This case report is interesting because: this localization is very exceptional, the reactional synovitis was evocating of an arthritis, the iconography is absolutely complete, a review of publications is done for this subject.