RESUMEN
24 acetabular fractures, displaced in the dome, were operated on through the triradiate incision, and 23 were followed for at least 2 years. All but one fracture were anatomically reduced in the dome. At follow-up, 7 hips had developed arthrosis, all with comminuted fractures with separate osteochondral dome fragments. Heterotopic bone formation occurred in 13 hips: 10/14 with indomethacin prophylaxis had no heterotopic bone, whereas all 9 without indomethacin prophylaxis had. We conclude that the triradiate incision is suitable for surgical treatment of complex acetabular fractures, and that the heterotopic bone formation can be reduced by indomethacin prophylaxis.
Asunto(s)
Acetábulo/lesiones , Fracturas Óseas/cirugía , Ortopedia/normas , Adolescente , Adulto , Anciano , Terapia Combinada , Femenino , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/tratamiento farmacológico , Marcha , Hospitales Universitarios , Humanos , Indometacina/administración & dosificación , Indometacina/uso terapéutico , Masculino , Persona de Mediana Edad , Ortopedia/métodos , Osificación Heterotópica/epidemiología , Osificación Heterotópica/etiología , Osteoartritis de la Cadera/epidemiología , Osteoartritis de la Cadera/etiología , Dolor/epidemiología , Dolor/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Radiografía , Rango del Movimiento Articular , Suecia/epidemiología , Resultado del TratamientoRESUMEN
Two cases of genu recurvatum deformity and leg length discrepancy after partial growth arrest of the proximal tibial physis are described. The patients are both boys thirteen and fifteen years old respectively. The etiology of the deformity is considered to be local pressure on the tibial tuberosity, in the first case after treatment with plaster cast after correction of an angular deformity in a tibial fracture and in the second case after prolonged treatment with patellar tendon bearing brace. The boys were treated with physeal distraction which corrected both the leg length discrepancy and the angular deformity. The technique is recommended because the correction is done at the site of the deformity and knee motion is possible during the entire treatment period.
Asunto(s)
Alargamiento Óseo/métodos , Placa de Crecimiento/fisiopatología , Diferencia de Longitud de las Piernas/cirugía , Adolescente , Humanos , Masculino , Aparatos Ortopédicos/efectos adversos , Tibia/crecimiento & desarrollo , Tibia/patología , Tibia/cirugía , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/terapiaRESUMEN
In an easily practicable method of measuring the motion range in the ankle under load, the patient is asked to put his foot on a 30-cm-high stool and then lean forward as much as possible without lifting his heel from the supporting stool. In this position the knee is flexed and the greater part of the body weight is on the examined foot. Dorsal extension is then measured with a protractor as the angle between the support line of the foot and the long axis of the leg. The loaded plantar flexion is measured in the same position but with the heel raised as much as possible. In a study of 317 healthy ankles, this method was found to give greater and more reproducible values than measuring on unloaded ankles in sitting or supine positions. Measurements of the loaded dorsal extension were also made on radiographs of 66 healthy ankles. The mean value was 32.5 degrees; the mean talar forward tilt was 5.0 degrees. In normal daily life, at least 10 degrees are required; for performing athletics and sports activities, a loaded dorsal extension range of 20 degrees-30 degrees is necessary.
Asunto(s)
Tobillo/fisiología , Movimiento , Fenómenos Biomecánicos , Femenino , Humanos , MasculinoRESUMEN
Transverse computed tomography of injured ankles gives additional information compared with conventional roentgen diagnostic techniques. In transverse sections the distal tibio-fibular joint and the suprasyndesmotic region can be examined with regard to incongruence and synostoses. It is also possible to examine the relations between the talus and the malleolar facets in different ankle positions. The technical problems and advantages are discussed.
Asunto(s)
Articulación del Tobillo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Traumatismos del Tobillo , Articulación del Tobillo/fisiopatología , Humanos , MovimientoAsunto(s)
Traumatismos del Tobillo , Fracturas Óseas/terapia , Fracturas Abiertas/terapia , Fracturas de la Tibia/terapia , Adolescente , Adulto , Tobillo/cirugía , Moldes Quirúrgicos , Fijación de Fractura , Fijación Interna de Fracturas , Fijación Intramedular de Fracturas , Fracturas Óseas/cirugía , Fracturas Abiertas/cirugía , Humanos , Inmovilización , Masculino , Fracturas de la Tibia/cirugía , Tracción , Cicatrización de HeridasRESUMEN
The maximal isometric muscle strength of hip abduction, knee extension and knee flexion was measured in 23 patients operated on for femur diaphyseal fractures and fitted with a stable intramedullary Küntscher nail after reaming of the medullary cavity. The trauma, the immobilization and the surgery influenced the musculature of the operated as well as the intact leg. The muscle power recovered in a couple of years, but even after 2-6 years a significantly reduced power was found in the knee extensors, and a probably significant reduction in the power of the knee flexors in the operated leg when the two legs were compared. Malrotation of the fracture seemed to adversely affect the recovery of muscle power.