RESUMEN
Femoral neck fractures are progressively increasing, due to higher survival rates, particularly among the female population. The gamma nail was created to treat intertrochanteric fracture types 31-A1, 31-A2 and 31-A3 and in some cases basicervical fractures of type 31-B2-1. Complications can be classified as intraoperative and postoperative. The intraoperative might be related to the nail's introduction site, lag and distal locking screw positions. Postoperative complications depend mostly on an incorrect surgical technique, which can lead to an inaccurate nail position and consequent implant failure. We rarely observe failures caused by severe bone osteoporosis.
Asunto(s)
Clavos Ortopédicos/efectos adversos , Fracturas de Cadera/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & controlRESUMEN
This long-term retrospective study investigated the value of debridement versus debridement and Osteoset T antibiotic-loaded calcium sulphate pellets in the treatment of adult chronic osteomyelitis. Sixty-five patients were included in the study. The mean follow-up was 75 months (range: 36 to 334). Forty cases were treated by debridement, and 25 by debridement and Osteoset T. The healing rates were 60% and 80%, respectively; however, the difference was not significant. In a subgroup of 39 patients with medullary osteomyelitis and a normal immune system (IA according to the Cierny-Mader classification of adult osteomyelitis), 22 patients were treated with debridement, 17 with debridement and Osteoset T. The healing rates were 59% and 94%, respectively (p < 0.05). Twenty-eight patients with Staphylococcus aureus osteomyelitis were also studied apart; 13 were treated with debridement and 15 with debridement and Osteoset T. The healing rates were 46% and 80%, respectively. The difference was not significant. The results obtained with debridement were less good than with debridement plus Osteoset T, but the difference was not significant, except in a single subgroup. Osteoset T obviates the need for removal, which is the rule after implantation of gentamycin beads. Bony ingrowth is however limited.
Asunto(s)
Antibacterianos/administración & dosificación , Osteomielitis/cirugía , Tobramicina/administración & dosificación , Adolescente , Adulto , Anciano , Sulfato de Calcio/uso terapéutico , Desbridamiento , Sistemas de Liberación de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/diagnóstico por imagen , Osteomielitis/microbiología , Radiografía , Estudios Retrospectivos , Infecciones Estafilocócicas/cirugíaRESUMEN
In a proximal humerus resection for a bone tumor, the use of an osteoarticular allograft is considered the best restoration of shoulder function. We retrospectively reviewed the outcomes of 31 patients who had an intraarticular resection of the proximal humerus for a bone tumor. Twenty-three of the allografts were filled with cement. The average followup was 5.3 years. Of the 31 patients with more than 24 months followup, seven had revision surgery or removal of the allograft. Kaplan-Meier analysis showed that the probability of survival of the reconstruction was 78% at 5 years. Fracture was the main complication in 11 patients (37%) of whom seven were in the noncemented group. Four of these patients had successful surgery for conversion to an allograft-prosthetic composite, whereas one patient had a new allograft. Allografts that were filled with cement had four fractures (18%); three were subchondral fractures discovered by routine CT scans. None of these patients had pain or needed revision surgery. Osteochondral allograft in proximal humerus replacement is a reliable reconstructive technique if the allograft is augmented by filling the intramedullary space with cement. Moreover, cement augmented allografts are less expensive and technically easier than allograft-prosthetic composites.
Asunto(s)
Cementos para Huesos , Neoplasias Óseas/cirugía , Trasplante Óseo , Húmero/cirugía , Articulación del Hombro/cirugía , Adolescente , Adulto , Neoplasias Óseas/complicaciones , Femenino , Fracturas Espontáneas/etiología , Fracturas Espontáneas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios RetrospectivosRESUMEN
Twenty-seven patients who had resection of the proximal femur for bone tumors and reconstruction with an allograft prosthesis composite are reported. In most of the patients, the prosthesis was a long-stem revision type, cemented in the allograft and uncemented in the femoral shaft. The abductor muscles and iliopsoas were sutured to the corresponding tendons on the allograft. Implant-related complications and functional results were evaluated and are reported. Twenty-two patients achieved a minimum followup of 36 months (range, 36-126 months; average, 58 months). The implant was removed in two patients (one for infection, one for intraoperative fracture of the allograft). One patient experienced nonunion, whereas in the remaining 24 patients, the allograft eventually united to the host bone. A frequent late complication (17 patients) was fracture of the greater trochanter of the allograft. In the whole series, only four new operations were done for implant-related complications. In 22 patients who could be evaluated, the functional evaluation according to the Musculoskeletal Tumor Society System was excellent in 16 (73%) patients, good in four (18%), and fair in two (9%). These results compare favorably with those of megaprostheses for tumor resection of the proximal femur, where a Trendelenburg gait almost always is present.