RESUMEN
Between 1990 to 1993, 21 patients with tibial plateau or proximal tibial fractures resulting from high-energy trauma were treated with the Monticelli-Spinelli external fixator. There were 13 men and 8 women (mean age, 45.2 years; range, 26 to 78). There were a total of 5 type A, 2 type B, and 14 type C fractures, using the Arbeitsgemeinschaft Fur Osteosynthesefragen (AO) classification system. Immediate postoperative reductions were good or excellent, according to strict radiographic criteria, in 16 of 21 patients. All patients obtained at least 90 degrees of knee flexion, and only one patient lost more than 5 degrees of full extension. Complications included seven superficial pin-tract infections and one deep vein thrombosis with resultant pulmonary embolism. Nineteen patients were available for follow-up (mean, 14 months). Clinically, 13 patients had satisfactory results where good or excellent radiographic reductions were maintained, knee extension was within 5 degrees of full, flexion was > or = 90 degrees, with < or = 5 degrees valgus/varus angulation. Six patients had unsatisfactory results, not meeting the above criteria. The Monticelli-Spinelli external fixator is a much-needed tool in the treatment of high-energy tibial plateau fractures that are not amenable to more extensive surgical procedures because of the associated soft-tissue injuries.
Asunto(s)
Fijación de Fractura/instrumentación , Fracturas de la Tibia/terapia , Adulto , Anciano , Femenino , Fijación de Fractura/métodos , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
From April 1990 to August 1994, the GSH supracondylar intramedullary nail (Smith & Nephew/Richards, Memphis, Tennessee) was used to treat 23 supracondylar femur fractures in 22 patients. Nineteen of the 23 fractures were highly comminuted and intra-articular. Fifteen patients with 16 fractures were followed up to healing or declaration of nonunion for an average of 10 months. All fractures were treated with direct reduction through a median parapatellar incision. Fixation of the intercondylar fractures was with 6.5-mm cannulated screws, and the GSH nail was then inserted between the screws to secure the articular segment to the shaft. Fifteen of the 16 fractures healed (94%) with excellent and good results at an average of 3.3 months. Initial postoperative fracture reduction was maintained in all patients until union, as shown by follow-up radiographs. Thirteen of the 16 patients were treated with immediate continuous passive motion of the knee. Average knee range-of-motion was 109 degrees. Complications included 1 nonunion, 1 delayed union, 1 hardware failure secondary to premature full weight-bearing, and 1 patient with impingement of the nail in the intercondylar notch. This impingement resolved with removal of the nail after fracture healing. The GSH supracondylar intramedullary nail is an excellent alternative for the treatment of supracondylar and intercondylar femur fractures.
Asunto(s)
Clavos Ortopédicos , Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/instrumentación , Traumatismos de la Rodilla/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Curación de Fractura , Humanos , Traumatismos de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
The case presented is a 22-year-old man with previously treated synovial chondromatosis of the shoulder. He subsequently presented with pain and tenderness above the biceps tendon. Magnetic resonance imaging and radiographs revealed recurrent synovial chondromatosis in the biceps tendon sheath. The patient underwent an open procedure to remove the loose bodies and partial tenosynovectomy. The patient has subsequently done well and resumed normal activities. To our knowledge there are no reported cases of synovial chondromatosis involving the biceps tendon sheath in the literature.
Asunto(s)
Condromatosis Sinovial/cirugía , Articulación del Hombro/cirugía , Tendones , Adulto , Condromatosis Sinovial/fisiopatología , Humanos , Cuerpos Libres Articulares/diagnóstico , Cuerpos Libres Articulares/cirugía , Imagen por Resonancia Magnética , Masculino , Radiografía , Recurrencia , Tendones/diagnóstico por imagenRESUMEN
The management of intraarticular fractures such as tibial plateau fractures in weightbearing joints is inherently complex. Bicondylar tibial plateau fractures resulting from high energy trauma are particularly difficult to treat successfully. The objectives in managing these fractures are to obtain adequate reduction and appropriate stabilization while allowing early range of motion and limiting potential morbidity. The incidence of complications and long-term sequelae is relatively high in cases treated with traditional open reduction and internal fixation. From 1986 through 1993, 32 bicondylar tibial plateau fractures were treated at our institution. Of these, 26 were treated operatively using various methods of open reduction and internal fixation, and, more recently, indirect reduction techniques with percutaneous screw and/or external fixation. These newer techniques include arthroscopically-assisted reduction with percutaneous screw fixation or applications of a hybrid circular external fixator with or without limited internal fixation. These techniques provide adequate reduction and fixation while limiting the complications associated with traditional open methods. This retrospective study was conducted to compare these newer techniques with more traditional methods of open reduction and internal fixation (ORIF).
Asunto(s)
Fijación de Fractura/métodos , Fracturas de la Tibia/cirugía , Adulto , Anciano , Protocolos Clínicos , Femenino , Estudios de Seguimiento , Fijación de Fractura/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Equipo Ortopédico/efectos adversos , Complicaciones Posoperatorias , Radiografía , Estudios Retrospectivos , Fracturas de la Tibia/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Reamed intramedullary nailing was used within 36 hours of patient admission to treat 32 consecutive femoral shaft fractures caused by low-velocity gunshot wounds. The femoral shaft fracture was classified according to the AO system, and comminution was graded according to the classification of Winquest and Hansen. Patients were followed for an average of 14.7 months (range, 6 to 36 months), and the average time to union was 18.6 weeks. The average hospital stay was 7 days, which is approximately one half the average stay reported in the literature for treating this kind of injury with delayed nailing. The shorter hospital stay represents potential savings of up to $9,000 per patient. Immediate intramedullary rodding is a safe, effective, and economic option for the treatment of a femoral shaft fracture caused by a low-velocity gunshot wound. However, a lack of compliance with instructions concerning weight-bearing in this patient population needs to be taken into account when planning postoperative care.
Asunto(s)
Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas , Heridas por Arma de Fuego/cirugía , Adolescente , Adulto , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/etiología , Fémur/irrigación sanguínea , Fémur/diagnóstico por imagen , Fémur/lesiones , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/diagnóstico por imagen , Radiografía , Estudios Retrospectivos , Factores de Tiempo , Heridas por Arma de Fuego/complicacionesRESUMEN
This study was undertaken to determine the optimal time after injury for arthroscopically assisted anterior cruciate ligament reconstruction using a double semitendinosus graft. We analyzed 87 patients. Time from injury to surgery was established as acute, subacute, or chronic; the three groups were matched. Meniscal damage and treatment were categorized. Chondral lesions were graded, postoperative parameters of motion, strength recovery, and stability were tabulated at 3, 6, 12, and 18 months. Complications were compared. Six percent of the patients with chronic knee injuries had two normal menisci at surgery, compared with 29% of the acute and subacute groups. Reparable tears were found in 37.8% of the knees. Chondral lesions were found in the tibiofemoral joint in 17% of acute, 7% of subacute, and 44% of the chronic knees. Postoperative motion recovery was significantly less at all time intervals for the acute group. Quadriceps strength recovery was slower in the acute knees. Stability was similar in all groups. Arthrofibrosis was found in 22% of acute, 0 subacute, and 12.5% of the chronic knees. Patellofemoral pain was noted in 17% of the acute, 0 of the subacute, and 9.3% of the chronic knees. This study showed that surgery done within 6 months of injury does not jeopardize the knee. Recovery after acute anterior cruciate ligament reconstruction is significantly slower than after subacute or chronic reconstruction.
Asunto(s)
Ligamento Cruzado Anterior/cirugía , Traumatismos en Atletas/cirugía , Traumatismos de la Rodilla/cirugía , Trasplante de Tejidos/métodos , Artroscopía , Traumatismos en Atletas/rehabilitación , Humanos , Traumatismos de la Rodilla/rehabilitación , Meniscos Tibiales/cirugía , Factores de TiempoRESUMEN
We present a case of synovial chondromatosis of the shoulder in a 22-year-old man. The patient was initially treated with arthroscopic debridement and partial synovectomy of the shoulder joint. Eighteen months later, the patient returned with similar symptoms. However, repeat radiographic studies showed involvement of both the shoulder and biceps tendon sheath. The patient was taken back to the operating room for an arthroscopic debridement of the shoulder joint and debridement of the biceps tendon sheath through an open approach. Use of the arthroscope to evaluate and treat this patient allowed him to return to normal activities much sooner than a formal open synovectomy would have allowed. Additionally, the morbidity associated with arthroscopic techniques is much lower than that of open procedures. In cases of synovial chondromatosis, the results in terms of efficacy and recurrence rates of each method appear comparable.
Asunto(s)
Artroscopía , Condromatosis Sinovial/cirugía , Articulación del Hombro/cirugía , Tendones/cirugía , Adulto , Condromatosis Sinovial/diagnóstico , Humanos , Cuerpos Libres Articulares/diagnóstico , Cuerpos Libres Articulares/cirugía , Imagen por Resonancia Magnética , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Recurrencia , Articulación del Hombro/patología , Tendones/patologíaRESUMEN
Comminuted bicondylar tibial plateau fractures remain a difficult problem for the orthopaedic surgeon. Treatment has ranged from traction to cast immobilization to open reduction and internal fixation; none of these has emerged as ideal. Recently, one of the senior authors (DJC) used a technique of indirect reduction followed by application of a hybrid circular external fixator, noting a stability similar to that of an open reduction and internal fixation but with fewer complications. This paper reviews both the authors' experience and citations from the literature with regard to this problematic fracture.
Asunto(s)
Fijadores Externos , Fijación Interna de Fracturas/métodos , Fracturas de la Tibia/terapia , Femenino , Humanos , Masculino , Osteomielitis/etiología , Complicaciones Posoperatorias/etiología , Radiografía , Estudios Retrospectivos , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugíaRESUMEN
Fifty knees with a mean follow-up time of greater than 5 years after arthroscopic meniscectomy were evaluated clinically and roentgenographically. Clinically, patients did well, with 98% patient satisfaction and 90% good or excellent results based on a modified Lysholm score. Although postoperative roentgenography showed some progression of Fairbank's changes in 61% with significant progression in 15% of knees, when changes in the nonoperative knee were considered, only 40% of operative knees showed progression, with only 4% of these knees showing significant progression. Normal results on preoperative anteroposterior roentgenography with the patient weight bearing and an anatomic tibiofemoral axis of greater than or equal to 4 degrees of valgus correlated with better long-term roentgenographic results.
Asunto(s)
Artroscopía/métodos , Meniscos Tibiales/diagnóstico por imagen , Osteoartritis/diagnóstico por imagen , Factores de Edad , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Meniscos Tibiales/cirugía , Persona de Mediana Edad , Osteoartritis/cirugía , Satisfacción del Paciente , RadiografíaRESUMEN
Single-dose radiation therapy was prospectively evaluated for its efficacy in prevention of heterotopic ossification in patients at high risk after total hip arthroplasty. Thirty-one patients (34 hips) were treated between 1981 and 1988. Risk factors for inclusion in the protocol included prior evidence of heterotopic ossification, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Patients with hypertrophic osteoarthritis or traumatic arthritis with osteophytes were not included. Operations on 34 hips included 19 primary total and 11 revision total hip arthroplasties and 4 excisions of heterotopic ossification. All patients received radiotherapy to the hip after operation with a single dose of 700 centigray. Radiotherapy is recommended on the first postoperative day. After this single-dose radiation treatment, no patient had clinically significant heterotopic ossification. Recurrent disease developed in two hips (6%), as seen on radiography (grades 2 and 3). This series documents a 100% clinical success rate and a 94% radiographic success rate in preventing heterotopic ossification in patients at high risk after total hip arthroplasty. Single-dose radiotherapy is as effective as other radiation protocols in preventing heterotopic ossification after total hip arthroplasty. It is less expensive and easier to administer than multidose radiotherapy.
Asunto(s)
Articulación de la Cadera/patología , Prótesis de Cadera/efectos adversos , Osificación Heterotópica/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Articulación de la Cadera/efectos de la radiación , Humanos , Masculino , Persona de Mediana Edad , Osificación Heterotópica/prevención & control , Estudios Prospectivos , Dosis de Radiación , Reoperación , Factores de RiesgoRESUMEN
From 1981 to 1986, 23 patients (24 hips) were treated with single-dose irradiation after hip surgery in an attempt to prevent heterotopic bone formation. All patients were at high risk for the development of heterotopic ossification because of the presence of heterotopic bone in either hip secondary to trauma or previous surgery, ankylosing spondylitis, or hypertrophic osteoarthritis. Thirteen patients (14 hips) underwent primary total-hip arthroplasty, and ten patients underwent revision total-hip arthroplasty or excision of heterotopic bone. The minimum follow-up period was 6 months. All patients were treated by means of a linear accelerator with a single dose of 700 cGy, calculated at midplane. Almost all treatments were given within 72 hours after surgery. Recurrent disease of Brooker grade II type developed in only one (4%) patient. This result is comparable with outcomes reported after fractionated courses of postoperative radiation therapy delivered over a period of 1 or 2 weeks. Postoperative hip irradiation with a single 700-cGy dose appears to be as effective as fractionated courses of radiation in the prevention of heterotopic bone formation in patients at high risk for the development of this complication.