RESUMEN
PURPOSE: To compare the outcomes of intramedullary Kirschner wire versus screw and plate fixation for unstable forearm fractures in children aged older than 10 years. METHODS: Records of 32 children aged 10 to 15 (mean, 12) years with displaced fractures of the radius and ulna were retrospectively reviewed. 17 boys and 4 girls underwent intramedullary Kirschner wiring, whereas 10 boys and one girl underwent plating. All patients had been initially treated with closed reduction and casting. Indications for surgical intervention were fractures with angulation of >10 degrees and total displacement. Patients were followed up for a mean of 24 (range, 13-40) months. Angulation and range of movements of the elbow, wrist, and forearm, as well as clinical and cosmetic results were compared. RESULTS: Both treatments achieved excellent clinical outcomes, but intramedullary Kirschner wiring resulted in better cosmesis, shorter operating times, easier hardware removal, and lower implant costs. CONCLUSION: Intramedullary Kirschner wiring is a better option than plating for the treatment of unstable forearm fractures in older children.
Asunto(s)
Hilos Ortopédicos , Fijación Intramedular de Fracturas/instrumentación , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugía , Adolescente , Placas Óseas , Tornillos Óseos , Distribución de Chi-Cuadrado , Niño , Femenino , Humanos , Masculino , Radiografía , Fracturas del Radio/diagnóstico por imagen , Estadísticas no Paramétricas , Resultado del Tratamiento , Fracturas del Cúbito/diagnóstico por imagenRESUMEN
Elbow dislocation associated with both ipsilateral radial and ulnar shaft fractures is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a case of an 80-year-old woman who had a posterolateral elbow dislocation and ipsilateral radial and ulnar shaft fractures and underwent closed reduction and plate fixation. She had an excellent outcome after 22 months of follow-up.
Asunto(s)
Lesiones de Codo , Luxaciones Articulares/complicaciones , Fracturas del Radio/complicaciones , Fracturas del Cúbito/complicaciones , Anciano de 80 o más Años , Articulación del Codo/cirugía , Femenino , Fijación Interna de Fracturas , Humanos , Luxaciones Articulares/cirugía , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugíaRESUMEN
Primary hydatid disease of the skeletal muscle without systemic involvement is rare. A 40-year-old woman presented with a painful mass in her medial left upper thigh. She was misdiagnosed as having a deep intramuscular abscess and a fine needle aspiration was performed, but the fluid came out crystal clear. Further inquiry revealed that her 16-year-old daughter had been operated on twice for liver and lung hydatid disease. Thus, a provisional diagnosis of hydatid disease was made. An echinococcal haemagglutination test was positive. Ultrasonography and magnetic resonance imaging findings were consistent with a type-2 hydatid cyst showing a 'water-lily' sign. The cystic mass within the left gracilis was resected en bloc. Adjunctive albendazole chemotherapy (400 mg/day) was prescribed for 3 months. At the 22-month follow-up, the patient remained free of symptoms.
Asunto(s)
Equinococosis/diagnóstico , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/parasitología , Adulto , Albendazol/uso terapéutico , Equinococosis/tratamiento farmacológico , Femenino , Humanos , Imagen por Resonancia Magnética , Enfermedades Musculoesqueléticas/tratamiento farmacológicoRESUMEN
The os trigonum is an inconsistently present accessory bone of the foot situated at the posterolateral aspect of the talus. It may be radiographically confused with fractures of the posterior process of the talus. Fracture of the os trigonum per se is extremely rare. Hyperplantarflexion of the ankle is the mechanism of injury in which the os trigonum is compressed between the posterior malleolus of the tibia and the tuber calcaneus. Computed tomography is the choice of imaging modality in cases where fractures of posterior talus structures, including the os trigonum, are suspected. A high index of suspicion is necessary to diagnose a fracture of the os trigonum after a severe plantarflexion injury to the ankle. Conservative treatment is usually successful. We report a case of a fracture of the os trigonum, its clinical features, treatment and significance.
Asunto(s)
Fracturas Óseas , Astrágalo/lesiones , Adulto , Femenino , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/terapia , Humanos , Radiografía , Astrágalo/diagnóstico por imagenRESUMEN
STUDY DESIGN: Retrospective study of patients after extension of previous scoliosis fusions to the pelvis. OBJECTIVE: To determine whether modern instrumentation and surgical techniques provide for increased fusion rates with fewer complications. SUMMARY OF BACKGROUND DATA: Traditionally, long fusions to the pelvis in adults with idiopathic scoliosis have resulted in high complication rates, including pseudarthrosis. METHODS: The hospital and clinic charts of 41 patients (40 female, 1 male) were reviewed 41 months (range: 24-116) after surgery for extension to the pelvis of previous scoliosis fusions. Thirty-nine of 41 had a combined anteroposterior fusion extension; two had posterior extension only. In 37 of 41 patients, Cotrel-Dubousset (CD) instrumentation was used; in two, Isola (Acromed Corp., Cleveland, OH), in one, TSRH; (Sofamor-Danek, Memphis, TN), and in one, Synergy (Cross Medical Products, Columbus, OH). Parameters analyzed were fusion rate, sagittal and coronal balance, lumbar lordosis, length of fusion extension, and distal fixation method. RESULTS: Complications were seen in 30 of 41 patients. The pseudarthrosis rate was 37% (15/41) and was significantly related to the method of distal posterior fixation. With sacral fixation only, the rate was 53% (8/15), with iliac fixation only 42% (3/7), and with both iliac and sacral fixation 21% (4/19; P < 0.05). This was not correlated with fusion rate, and the length of fusion extension did not affect the pseudarthrosis rate or sagittal balance. CONCLUSION: When fixed to the ilium and sacrum, modern instrumentation appears capable of maintaining sagittal balance with lower rates of pseudarthrosis when previous scoliosis fusions are extended to the pelvis. The complication rate remains significant.