RESUMEN
The authors report the results of a retrospective study conducted on 30 cases of fracture of the tibia and femur submitted to external fixation and subsequently to intramedullary osteosynthesis, treated between 1991 and 1999. Intramedullary osteosynthesis was used in 24 cases (5 in the femur and 19 in the tibia) as treatment subsequent to external fixation for nonunion or delays in consolidation. Sequential nailing was used as planned treatment in the remaining 6 cases. In 83.3% of cases the fracture was open (Gustilo Anderson type I (30%), type II (20%), type III (33.3%). The mean duration of external fixation was 13.24 weeks, and infection occurred in 4 cases (13.33%) during that time. Removal of the external fixator and intramedullary osteosynthesis were carried out during the same surgical session in 40% of the cases, while nailing was preceded by a period in plaster lasting an average of 4 weeks in the remaining 60% of cases. All of the cases achieved consolidation an average of 31 weeks after trauma, and 14.7 weeks after intramedullary synthesis. We observed the occurrence of infection in 3 cases (10%), but this did not keep consolidation from occurring.
Asunto(s)
Fijadores Externos , Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas , Fracturas Abiertas/cirugía , Fracturas no Consolidadas/cirugía , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Anciano , Antibacterianos/uso terapéutico , Niño , Fijadores Externos/efectos adversos , Femenino , Fracturas del Fémur/diagnóstico por imagen , Estudios de Seguimiento , Curación de Fractura , Humanos , Infecciones/tratamiento farmacológico , Infecciones/etiología , Masculino , Persona de Mediana Edad , Osteomielitis/tratamiento farmacológico , Osteomielitis/etiología , Complicaciones Posoperatorias/tratamiento farmacológico , Radiografía , Estudios Retrospectivos , Fracturas de la Tibia/diagnóstico por imagen , Factores de TiempoRESUMEN
The authors describe the surgical method used and present the preliminary results obtained in 29 patients affected with recurrent anterior dislocation of the shoulder treated by Neer capsuloplasty and Statak screws. The long-term results were evaluated based on the Rowe system: the score was excellent in 18 cases, good in 2, fair in 4, and poor in 5. All of the patients resumed work activity, with no restrictions, within 4 months of the onset of functional rehabilitation. The use of Statak screws allows us to simplify surgery, while guaranteeing repair of the Bankart lesion, when present. The method reported permits correction of instability, without excessive reduction of joint movement.
Asunto(s)
Luxaciones Articulares/cirugía , Articulación del Hombro/cirugía , Adolescente , Adulto , Tornillos Óseos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , RecurrenciaRESUMEN
The authors define the current role of femoral osteotomy in the treatment of the sequelae of congenital hip dysplasia (CHD) in the adult in light of the increasing orientation towards prosthetization. They report a personal philosophy on the subject after analyzing the criteria on which are based indications for osteotomy, the various types of osteotomy, the influence of osteotomy on other skeletal regions, the problems of prosthetization on osteotomy, and expectations concerning of the quality of the life of the patients submitted to osteotomy.
Asunto(s)
Luxación Congénita de la Cadera/cirugía , Osteotomía/métodos , Adulto , Factores de Edad , Anciano , Femenino , Cabeza Femoral/cirugía , Humanos , Masculino , Persona de Mediana Edad , Calidad de VidaRESUMEN
Gonococcal arthritis is a frequently occurring clinical entity that should be included routinely in a differential diagnosis of pedal joint pain. Unfortunately, the lack of specificity in the presentation makes gonococcal arthritis difficult to diagnose. Indices of suspicion should rise with any sexually active patient, particularly when septic arthritis is suspected without a detectable portal of entry. The authors emphasize again the importance of carefully choosing empiric antibiotic coverage for gonococcal arthritis. Three factors that should be considered are regional epidemiology, the anatomical site of the primary infection, and the possible coexistence of other infectious agents. Understanding the clinical staging of this condition will help to achieve a timely diagnosis and successful treatment.