RESUMEN
BACKGROUND: Severely comminuted AO type-C3 intra-articular fractures of the distal end of the radius are difficult to treat. Failure to achieve and maintain nearly anatomic restoration can result in pain, instability, and poor function. We report the results of a retrospective study of the use of a standard protocol of open reduction and combined internal and external fixation of these fractures. METHODS: Seventeen of twenty-five patients treated with the protocol were available for follow-up evaluation. Six had an AO type-C3.1 fracture; eight, type-C3.2; and three, type-C3.3. Eleven fractures required a dorsal buttress plate and/or a volar buttress plate, and eleven required bone-grafting. The mean time until the external fixator was removed was seven weeks. RESULTS: At a mean of thirty months postoperatively, the mean arc of flexion-extension was 72% of that on the uninjured side and the mean grip strength was 73% of that on the uninjured side. The mean articular step-off was 1 mm, the total articular incongruity (the gap plus the step-off) averaged 2 mm, and the radial length was restored to a mean of 11 mm. Thirteen patients had less than 3 mm of total articular incongruity. Arthritis was graded as none in three patients, mild in ten, moderate in three, and severe in one. According to the Gartland and Werley demerit-point system, ten of the patients had a good or excellent result. According to the modified Green and O'Brien clinical rating system, five had a good or excellent result. One patient had a fracture collapse requiring wrist fusion, one had reflex sympathetic dystrophy, and three had minor Kirschner-wire-related problems. Total articular incongruity immediately postoperatively had a moderately strong correlation with the outcome as assessed with both clinical rating systems (r = 0.70 and 0.74 for the Gartland and Werley system and the Green and O'Brien system, respectively; p<0.05). CONCLUSIONS: Open reduction and combined internal and external fixation of AO type-C3 fractures can restore radiographic parameters to nearly normal values, maintain reduction throughout the period of fracture-healing, and provide satisfactory functional results.
Asunto(s)
Fijación Interna de Fracturas , Fijación de Fractura , Fracturas Conminutas/cirugía , Fracturas del Radio/cirugía , Traumatismos de la Muñeca/cirugía , Adulto , Fijadores Externos , Femenino , Estudios de Seguimiento , Fracturas Conminutas/diagnóstico por imagen , Humanos , Masculino , Satisfacción del Paciente , Radiografía , Fracturas del Radio/diagnóstico por imagen , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Traumatismos de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/cirugíaRESUMEN
Instability is the most common complication of shoulder arthroplasty. An understanding of the predisposing factors for developing instability is critical to the avoidance of this complication. Soft-tissue balance and proper component positioning must be attained during the index procedure to minimize the risk of developing postoperative instability. Once the shoulder does become unstable, the reason for the instability must be determined. Is the instability secondary to soft-tissue imbalance, component malposition, bony deformity, or a combination of these? Next, a decision must be made as to how to treat the instability. Nonsurgical treatment may be tried if no obvious cause is present. However, if the instability fails to resolve or recurs, surgical intervention should be undertaken early. If the instability is not treated, it may result in loosening of the prosthesis and early wear of the components. Once surgical intervention is undertaken, all elements of the instability must be recognized and treated.
Asunto(s)
Artroplastia de Reemplazo , Inestabilidad de la Articulación/etiología , Falla de Prótesis , Articulación del Hombro/cirugía , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/cirugía , Cuidados PosoperatoriosRESUMEN
The treatment of 81 consecutive patients with transluminal angioplasty on an outpatient basis did not result in increased morbidity or mortality or delayed complications. The patients were treated in the emergency department observation area for four hours after angioplasty and were then allowed to slowly resume normal activities over the next 48 hours. The authors conclude that outpatient angioplasty is safe in a controlled setting and is cost effective since hospitalization is not required.