RESUMEN
We report on four adult patients in whom intramedullary nailing of external rotation tibial shaft fractures resulted in significant intra-articular displacement of the posterior malleolus that required further operative fixation. An ankle injury was not recognized preoperatively in any case. Intramedullary nailing of certain tibial shaft fractures may be at risk for displacement of the posterior malleolus. The ankle joint should be examined very carefully not only preoperatively, but also intraoperatively in these cases.
Asunto(s)
Fijación Intramedular de Fracturas/efectos adversos , Fracturas Cerradas/cirugía , Fracturas de la Tibia/cirugía , Adulto , Femenino , Curación de Fractura , Fracturas Cerradas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Fracturas de la Tibia/diagnóstico por imagenRESUMEN
The thin-section computed tomographic (CT) scans of 11 patients with entrapped intra-articular fragments secondary to dislocation or fracture dislocation of the hip are studied. The effects of CT bone and soft-tissue contrast manipulation on the visibility of the intra-articular fragments are demonstrated in both patients and in vitro. When the mechanism of injury and clinical features raise the possibility of entrapped fragments, as in hip dislocation and fracture dislocation, special magnification and image-enhancement techniques are available for re-examining the acetabulum, especially when raw CT data are saved. Thus, index of suspicion and appropriate CT planning can ensure prompt diagnosis and treatment of entrapped intraarticular fragments in the hip joint.
Asunto(s)
Cartílago Articular/diagnóstico por imagen , Luxación de la Cadera/diagnóstico por imagen , Fracturas de Cadera/diagnóstico por imagen , Intensificación de Imagen Radiográfica/métodos , Tomografía Computarizada por Rayos X/métodos , Luxación de la Cadera/complicaciones , Fracturas de Cadera/complicaciones , HumanosAsunto(s)
Tornillos Óseos , Fijación Interna de Fracturas , Fracturas Cerradas/cirugía , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Articulación Sacroiliaca/diagnóstico por imagen , Articulación Sacroiliaca/cirugía , Adolescente , Femenino , Fracturas Cerradas/diagnóstico por imagen , Humanos , Huesos Pélvicos/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
We evaluated the anatomic structures at risk during posterior plating of the cervical spine and outlined a safe technique for screw insertion. Three cadaveric specimens were evaluated anatomically and radiographically. Screws and wires were inserted into the articular masses at different locations and angulations. The relationship of the neurovascular structures to the screws and wires was noted. To avoid injury to the nerve roots, vertebral artery, and spinal cord, the screw should be placed in the center of the articular masses perpendicular to the vertebral plane with 15 degrees lateral angulation.
Asunto(s)
Placas Óseas , Vértebras Cervicales/lesiones , Fijación de Fractura/métodos , Fracturas de la Columna Vertebral/cirugía , Tornillos Óseos , Hilos Ortopédicos , Vértebras Cervicales/cirugía , Fijación de Fractura/efectos adversos , HumanosRESUMEN
Sacral bar fixation is a well-recognized technique for the treatment of posteriorly unstable pelvic injuries, particularly sacral fractures. The sacral bars are placed in the iliac crest posterior to the sacrum. We reviewed 103 pelvic computed tomography (CT) scans and three cadaver pelves to measure the iliac crest prominence and its spatial relationship to the lamina of the sacrum. It was found that the best bony purchase for the bars is at the level of the L5-S1 junction. Lower placement of the bar increases the risk of violating the sacral canal and may also decrease the bony purchase of the bars. Some patients have an inadequate iliac crest posteriorly for proper placement; therefore, the pelvic CT scans should always be carefully evaluated preoperatively. The study also includes a description of a technique for percutaneous placement of sacral bars using fluoroscopic guidance.
Asunto(s)
Fracturas Óseas/cirugía , Dispositivos de Fijación Ortopédica , Huesos Pélvicos/lesiones , Tomografía Computarizada por Rayos X , Femenino , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/cirugía , Sacro/diagnóstico por imagen , Sacro/cirugíaRESUMEN
Screw penetration of the hip joint following acetabular fracture reconstruction is a relatively uncommon complication but, if not corrected, may have a catastrophic effect on the postoperative function of the hip joint. Intraoperative radiographs and postoperative standard anteroposterior (AP) radiographs frequently show super-imposition of the screws and acetabulum. Computed tomographic (CT) scanning has been the only diagnostic technique available allowing documentation of screw penetration into the hip joint. CT scan, however, can be performed only after termination of surgery. In search for a radiological view that will help in diagnosing screw penetration into the hip joint both intra- and postoperatively, we undertook a controlled study of 25 patients having either a posterior or extensile lateral surgical approach and six cadaveric specimens. A combination of a cross-table lateral view of the hip and a Judet iliac view proved more informative than AP or Judet obturator views in demonstrating absence or presence of the screw in the hip joint (if the screws were placed along the posterior wall or column). Intraoperative AP radiographs projected as a Judet obturator view were the least helpful in making this determination. When screw penetration is suspected, we recommend the use of intraoperative fluoroscopy in multiple projections or intraoperative arthrogram in the lateral projection of the pelvis. Also, Judet iliac and cross-table lateral radiographs in the operating room while the patient is still under anesthesia might exclude any screw penetration into the hip joint.