RESUMEN
The aim of the study was to analyse the survivorship of 60 total hip arthroplasties using the cementless Lord prosthesis in 51 patients with inflammatory joint disease. Patients were operated on between the years 1985 and 1988. The mean follow-up time was 13.8 (4.0-18.6) years. During the follow-up, one deep infection was encountered, and seven patients died of causes unrelated to the hip replacement. Revision surgery or death of the patient was used as an end point. The overall survival was 88.1% [95% confidence interval (CI) 76.6-94.1] for the stem, and 64.3% (95% CI 50.6-75.1) for the cup at 15 years. Causes for revision surgery were loosening of the cup in 17 hips, loosening of both components in five hips, and one deep infection.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Osteoartritis de la Cadera/cirugía , Falla de Prótesis , Enfermedades Reumáticas/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico , Resultado del TratamientoRESUMEN
We have analysed the results of 28 total elbow replacements in 27 patients. The replacements were made using the Kudo unconstrained, unlinked, total elbow prosthesis. The elbows were all affected by rheumatoid arthritis. The follow-up time was from 3 to 7 years, with a mean follow-up of 58 months. Our results with this prosthesis in rheumatoid arthritis appear promising and only few complications were noticed. In one case, a radiological loosening of the ulnar component was observed at the 5-year visit but without any clinical symptoms and no operations were needed. In two other cases, an open reduction was performed within the first 3 months to correct a subluxation. A triceps tendon was re-inserted for a fourth patient 55 months postoperatively. In general, the range of motion became statistically significantly better with the prosthesis and there was also a high rate of relief of pain in patients in whom the elbow was severely affected by rheumatoid arthritis.
Asunto(s)
Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Prótesis Articulares , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Diseño de Prótesis , Radiografía , Factores de Tiempo , Resultado del TratamientoRESUMEN
The survival of 77 cementless total hip arthroplasties using a Bi-Metric femoral stem and two types of acetabular components was analysed in 55 patients with juvenile chronic arthritis. The patients were treated between 1986 and 1996. Their mean age was 8.0 years at the onset of the disease and 28.1 years at the time of surgery. The mean follow-up period was 9.6 years. Follow-up evaluations were conducted 3 months and 1, 4, 8, 12 and 16 years post-operatively. The endpoints of survival analysis were revision surgery, death of the patient or the end of the year 2002. The 10-year survival was 77.6% for the Romanus cup and 49.1% for the TTAP-ST cup. In contrast to these inadequate outcomes, the cementless Bi-Metric stem yielded excellent results with a survival rate of 100% for aseptic loosening during a mean follow-up period of 10 years.
Asunto(s)
Artritis Juvenil/cirugía , Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Factores de TiempoRESUMEN
The aim of the present study was to establish a threshold for the initial displacement of a spiral tibial shaft fracture beyond which its retention in an acceptable position cannot be guaranteed by plaster immobilization. We reviewed the records and radiographs of 131 plaster cast-treated patients with spiral tibial shaft fracture, initially displaced 50% or less, for patients whose fracture had either lost its acceptable retention or consolidated in an unacceptable position. The fractures were classified, according to the true initial displacement as measured on the first radiographs, into four pairs of categories using cut-off points of 10, 20, 30 and 40% of the diameter of the tibial diaphysis. Comparison was then made of the proportions of failed treatments between each of these pairs. Plaster cast treatments failed in 28% when the true initial displacement was 30% or less, and in 46% when the true initial displacement was more than 30%. The risk of failed plaster cast treatment increased when true initial displacement exceeded 30%. In all patients whose plaster cast treatment was interrupted the true initial displacement was more than 30%. We therefore conclude that diaphyseal fractures of the tibia for which the initial displacement exceeds 30% are not suitable for plaster cast treatment.
Asunto(s)
Fracturas de la Tibia/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Moldes Quirúrgicos , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Fracturas de la Tibia/clasificación , Fracturas de la Tibia/patología , Insuficiencia del TratamientoRESUMEN
OBJECTIVE: To scrutinize the fracture patterns of femoral shaft fractures caused by low-energy injury mechanism and to delineate the problems associated with the treatment of these fractures. MATERIALS AND METHODS: Of a total of 192 consecutive skeletally mature patients with 201 acute fresh femoral shaft fractures admitted during a 10-year period (1985-1994), 50 patients had a fracture caused by low-energy trauma. The fractures were classified in terms of their configuration, site, degree of comminution, and soft-tissue injury. The previous fractures, chronic illnesses, and continuous medications of the patients as well as the injury mechanisms and concomitant injuries were registered. All general and local complications and their consequences were recorded. Forty patients could be followed until the bony union of the fracture was achieved, the mean follow-up time being 14 months. RESULTS: The incidence of these injuries was 2.5 per 100,000 person-years. There were 32 women and 18 men. The mean age of the patients was 65 years (range, 17-92 years). Thirteen patients were younger than 60 years of age. Thirty-two (64%) had at least one local or general factor weakening the mechanical strength of the bone that predisposed them to a fracture. Thirty-two patients sustained a fracture of the left femur (p < 0.05). All fractures were closed. None of the patients had significant concomitant injuries. In 33 cases, the site of the fracture was in the middle third of the femur. The fracture configuration was spiral in 29, transverse in 10, oblique-transverse in 7, and oblique in 4 cases. Postoperative complications, including delayed union, nonunion, and malunion, occurred with 29 patients. Eighteen reoperations among 12 patients were performed because of these complications. CONCLUSIONS: Femoral shaft fractures caused by low-energy violence occur mainly in patients suffering from a chronic disease or a condition causing osteopenia of the femur. The most common fracture pattern was a spiral one in the middle third of the femoral shaft. Despite the low-energy violence, the treatment of these fractures is not devoid of complications. The treatment of these seemingly simple fractures requires careful planning and meticulous operative technique.
Asunto(s)
Fracturas del Fémur/patología , Fracturas Cerradas/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/etiología , Fracturas del Fémur/cirugía , Curación de Fractura , Fracturas Cerradas/etiología , Fracturas Cerradas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
BACKGROUND AND AIMS: The purpose of the study was to find out the consequences of malunion of tibial shaft fracture. PATIENTS AND METHODS: Sixty-four fractures were treated using an intramedullary nail or an intramedullary compression nail. Malunion was defined as an angular or rotational deformity exceeding five degrees or a shortening exceeding 10 mm. RESULTS: The number of malunited fractures was 17. The main reason for malunion was a technical failure occurring in 11 fractures. Patients with malunion had on average twice as many pathological functional findings as patients with sound union (P < 0.05). The mean number of subjective complaints was 5.3 in the malunion group and 3.3 in the sound union group. Among patients less than 45 years of age, those with malunited fractures had to reduce or give up physical exercise more often than those with fractures with sound union (P < 0.05). CONCLUSION: Malunion of tibial shaft fracture seems to be especially harmful in distal fractures, in fractures with marked primary displacement, in fractures caused by high energy injury, and among patients less than 45 years of age.
Asunto(s)
Fijación Intramedular de Fracturas , Fracturas Mal Unidas/cirugía , Complicaciones Posoperatorias/cirugía , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Anciano , Clavos Ortopédicos , Evaluación de la Discapacidad , Análisis de Falla de Equipo , Ejercicio Físico/fisiología , Femenino , Fijación Intramedular de Fracturas/instrumentación , Fracturas Cerradas/diagnóstico por imagen , Fracturas Cerradas/cirugía , Fracturas Mal Unidas/diagnóstico por imagen , Fracturas Abiertas/diagnóstico por imagen , Fracturas Abiertas/cirugía , Humanos , Diferencia de Longitud de las Piernas/diagnóstico por imagen , Diferencia de Longitud de las Piernas/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía , Reoperación , Fracturas de la Tibia/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Sixty-four displaced tibial shaft fractures were treated using intramedullary nailing, either primarily or after an attempt at conservative treatment, which consisted of closed reduction under anaesthesia and immobilisation in a long-leg plaster cast. There were 37 closed and 27 open fractures. Three patients had a fracture of both tibiae. The median time period from the intramedullary nailing of the closed solitary fractures to union was about the same after primary nailing as after delayed nailing. Although the fractures were different in these groups, it is possible that the time spent in conservative treatment before intramedullary nailing brings no additional benefits. The incidence of deep infection in open fractures after primary nailing was 1/16. The fractures, in which an acceptable position could not be maintained using conservative methods, were mainly spiral in configuration and located in the distal third or at the junction of the middle and distal thirds of the tibia.
Asunto(s)
Clavos Ortopédicos , Fijación Intramedular de Fracturas , Fracturas Cerradas/cirugía , Fracturas Abiertas/cirugía , Fracturas de la Tibia/cirugía , Adulto , Moldes Quirúrgicos , Femenino , Estudios de Seguimiento , Fijación de Fractura , Curación de Fractura , Fracturas Cerradas/diagnóstico por imagen , Fracturas Cerradas/epidemiología , Fracturas Abiertas/diagnóstico por imagen , Fracturas Abiertas/epidemiología , Humanos , Modelos Logísticos , Masculino , Complicaciones Posoperatorias/epidemiología , Radiografía , Estudios Retrospectivos , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/epidemiología , Factores de Tiempo , Insuficiencia del TratamientoRESUMEN
A total of 135 patients with a fresh tibial shaft fracture and with no other significant injuries underwent primary conservative treatment. Data on their smoking habits were obtained from hospital records and by questionnaire. Although the smokers had better prospects for healing of the fracture at the outset than non-smokers (lower mean age and less fractures caused by high-energy injuries), the smokers were found to have a significantly longer mean time to clinical union and a higher incidence of delayed union. According to a crude calculation, smokers had a 4.1-fold risk of tibial shaft fracture caused by low-energy injury, compared with non-smokers. An accelerated failure time model showed that the more comminuted or open the fracture, the higher the number of cigarettes smoked and the older the patient, the longer was the time to clinical union of the tibial shaft fracture. Female sex appeared to be a further risk factor for delayed healing. A logit model indicated that comminution of the fracture, smoking and female sex were associated with delayed union and non-union. If a patient has a markedly raised probability of delayed union of tibial shaft fracture because of many risk factors as reported in the previous literature or in this study, operative treatment should be considered as the primary alternative instead of conservative treatment. Stopping smoking during healing of tibial shaft fracture could also promote the union of the fracture.
Asunto(s)
Curación de Fractura , Fumar/efectos adversos , Fracturas de la Tibia/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas no Consolidadas/etiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Fracturas de la Tibia/cirugíaRESUMEN
The purpose of this study was to assess the results of conservative treatment of tibial fractures. The series consisted of 165 tibial fractures in 163 consecutive patients. Over one-fifth (35) were open fractures. The treatment was in the main conservative, the primary treatment of only three fractures was operative. Full weight-bearing was started after 124 days on average. The average duration of primary treatment by plaster immobilization was 99 days. A questionnaire was completed and returned by 84% of the patients. Symptomatic, clinically and radiologically evident deep venous thrombosis was observed in 0.6%, pulmonary embolism in 1.9%, signs of fat embolism in 1.9%, superficial infection in 3.1%, osteitis in 0.6% and refracture in 2.5% of fractures. The average time to union was about 14 weeks. The incidence of radiological malpositions developing during the time of treatment was high. The risk of shortening was associated with oblique and severely comminuted fractures and possibly also with severely displaced fractures. Subjective sequelae were reported by a large number of patients. An optimal result is not guaranteed in all tibial fractures by conservative treatment.
Asunto(s)
Fracturas de la Tibia/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Moldes Quirúrgicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/diagnóstico por imagenRESUMEN
Among 440 adult patients with tibial shaft fracture and accompanying fibular fracture there were eight cases with radiographically ununited fibulae 4 months after the injury, each with uneventful tibial union. Fractures with severe soft-tissue injuries were excluded from this study. In 293 patients the treatment method of the tibial fracture was conservative, comprising closed reduction and immobilization by long plaster cast. In 147 patients it was intramedullary Küntscher nailing, and all the eight cases with delayed fibular union occurred among these, the frequency being 5.4%. The typical accompanying fibular fracture to develop delayed union was a comminuted one in the middle or distal third of the bone. At a followup examination 5 to 8 years after the original injury four of the eight fractures were found to have ultimately spontaneously united, while three showed a radiographically indisputable nonunion. One patient had undergone segmental fibular ostectomy because of persistent local pain but in the remaining patients the subjective symptoms were negligible. The occurrence of delayed fibular union in association with rigid intramedullary nailing of concomitant tibial shaft fracture is a phenomenon of which trauma surgeons should be aware even if the natural course of the condition often seems to be benign.
Asunto(s)
Peroné/lesiones , Fracturas no Consolidadas , Fracturas de la Tibia/complicaciones , Adolescente , Adulto , Anciano , Femenino , Peroné/diagnóstico por imagen , Peroné/patología , Fracturas no Consolidadas/diagnóstico por imagen , Fracturas no Consolidadas/patología , Fracturas no Consolidadas/terapia , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/terapia , Factores de TiempoRESUMEN
Magnetic resonance imaging (MRI) of normal fracture repair was evaluated in six randomly chosen adult patients with solitary, closed fractures of the tibial shaft by obtaining serial MRI scans until union of the fracture. The mean time to union was 14.3 weeks. Ultralow-field 0.02-Tesla magnet equipment was used. The MRI scans showed a characteristic pattern of events common for all the patients studied and compatible with the recognized histomorphology of fracture repair. The intramedullary cavity demonstrated a marked decrease in the signal intensity. In the soft tissues surrounding the fracture the initially evenly high signal intensity gradually developed a granular appearance with embedded low-intensity nodules. These nodules corresponded to the first areas to become mineralized, as could be seen on plain radiographs several weeks later. The question of whether MRI renders it possible to predict delayed union calls for continued investigations.