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1.
Indian J Orthop ; 50(2): 206-12, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27053812

RESUMEN

BACKGROUND: Displaced fractures of the acetabulum are best treated with anatomical reduction and rigid internal fixation. Adequate visualization of some acetabular fracture types may necessitate extensile or combined anterior and posterior approaches. Simultaneous anterior iliofemoral and posterior Kocher-Langenbeck (K-L) exposures with two surgical teams have also been described. To assess whether modified Kocher-Langenbeck (K-L) approach can substitute standard K-L approach in the management of elementary acetabular fractures other than the anterior wall and anterior column fractures and complement anterior surgical approaches in the management of complex acetabular fractures. MATERIALS AND METHODS: 20 patients with transverse and associated acetabular fractures requiring posterior exposure were included in this prospective study. In 9 cases (7 transverse, 1 transverse with posterior wall, and 1 posterior column with posterior wall), stabilization was done through modified K-L approach. In 11 cases (3 transverse and 8 associated fractures), initial stabilization through iliofemoral approach was followed by modified K-L approach. RESULTS: The average operative time was 183 min for combined approach and 84 min for modified K-L approach. The postoperative reduction was anatomical in 17 patients and imperfect in 3 patients. The radiological outcome was excellent in 15, good in 4, and poor in one patient. The clinical outcome was excellent in 15, good in 3 and fair and poor in 1 each according to modified Merle d'Aubigne and Postel scoring system. CONCLUSION: We believe that modified K-L approach may be a good alternative for the standard K-L approach in the management of elementary fractures and associated fractures of the acetabulum when combined with an anterior surgical approach. It makes the procedure less invasive, shortens the operative time, minimizes blood loss and overcomes the exhaustion and fatigue of the surgical team.

2.
Bull Hosp Jt Dis (2013) ; 73(1): 57-60, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26517003

RESUMEN

With a well-established incidence of 15% to 20% following a spinal injury, the occurrence of neurogenic myositis ossificans of the hip is quite rare. The most widely accepted theory supporting its occurrence is the repeated microtrauma by forceful passive mobilization during rehabilitation. An extensive involvement around the hip is quite disabling to the patient. We present the case of a 41-year-old man with an extensive involvement of the right iliopsoas following an incident of head injury with no primary injury to the hip, with a disabling restriction of movement. Computed tomography images and its 3D reconstruction were used to define the exact extent of involvement. The mass was excised piece meal using the iliofemoral approach with an osteotomy of the anterior superior iliac spine, which allowed us to have a better visualization to the extensive mass. Postoperatively the patient regained a good range of motion. In addition to adding a rare case of atraumatic myositis ossificans of the iliopsoas to literature, this reports describes a novel approach for its excision.


Asunto(s)
Articulación de la Cadera/cirugía , Miositis Osificante/cirugía , Osteotomía/métodos , Músculos Psoas/cirugía , Columna Vertebral/cirugía , Adulto , Fenómenos Biomecánicos , Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/diagnóstico , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Humanos , Imagenología Tridimensional , Masculino , Miositis Osificante/diagnóstico , Miositis Osificante/etiología , Miositis Osificante/fisiopatología , Músculos Psoas/diagnóstico por imagen , Músculos Psoas/fisiopatología , Interpretación de Imagen Radiográfica Asistida por Computador , Rango del Movimiento Articular , Recuperación de la Función , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
3.
Asian Spine J ; 9(5): 741-7, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26435793

RESUMEN

STUDY DESIGN: A prospective clinical study. PURPOSE: The objective of the present study was to evaluate the behavior of spinal deformities in tuberculosis (TB) of the spine during the initial 2 years and to suggest remedial measures. OVERVIEW OF LITERATURE: Spinal TB is the most common cause of a kyphotic deformity in many parts of the world. Treatment of the established deformity is difficult, hazardous and has a high complication rate. METHODS: We followed 50 adult patients treated for spinal TB for a minimum of 2 years. Average values of vertebral body height loss (VBL), deformity angle, kyphosis angle, and lumbosacral joint angle at the final follow-up were compared with the values at initial presentation. The relationship between the amount of initial VBL and final kyphotic angle was analyzed. RESULTS: Average values of VBL, deformity angle, kyphosis angle, and lumbosacral joint angle at initial presentation were 0.26, 12.51°, 2.26°, and 12.3°, respectively; and the corresponding values at the final follow-up were 0.7, 17.8°, 5.64°, and 10.8°, respectively. The increase was extremely significant for the deformity angle (initial vs. 6th month, p=0.000; 6th month vs. 24th month, p=0.000) and kyphotic angle (initial vs. 6th month, p=0.003; 6th month vs. 24th month, p=0.000) in the thoracic and thoracolumbar regions during the first 2 years of the disease process. The increase in the deformity angle in the lumbar region was significant only in the initial 6 months (p=0.01). We could not find any correlation between the initial VBL and the final kyphotic angle (r=0.302, p>0.05). CONCLUSIONS: Different regions of the vertebral column respond differently to bony destruction caused by spinal TB. Deformity progression is more significant during the initial 6 months of the disease process, and this may be the best time to take remedial measures to prevent development/progression of the deformity. Kyphotic deformity keeps increasing even after 6 months of antituberculous treatment, and it does not correlate with the initial VBL in adults.

4.
Indian J Orthop ; 49(2): 136-42, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26015600

RESUMEN

BACKGROUND: Single bundle anterior cruciate ligament (ACL) reconstruction has been the current standard of treatment for ACL deficiency. However, a significant subset of patients continue to report residual symptoms of instability with a poor pivot control. Cadaveric biomechanical studies have shown double bundle (DB) ACL reconstructions to restore the knee kinematics better. This study evaluates the outcome of DB ACL reconstruction. MATERIALS AND METHODS: 30 consecutive patients who underwent anatomic DB ACL reconstruction were included in this prospective longitudinal study. There were all males with a mean age of 25 ± 7.45 years. All patients were prospectively evaluated using GeNouRoB (GNRB) arthrometer, functional knee scores (International Knee Documentation Committee [IKDC] and Lysholm) and postoperative magnetic resonance imaging (MRI) for comparing the graft orientation and footprint of the reconstructed ACL with that of the normal knee. RESULTS: The average followup was 36.2 months. At the time of final followup the mean Lysholm score was 93.13 ± 3.31. As per the objective IKDC score, 26 patients (86.6%) were in Group A while 4 patients (13.3%) were in Group B. The mean differential anterior tibial translation by GNRB, arthrometer was 1.07 ± 0.8 mm (range 0.1-2.3 mm). All cases had a negative pivot shift test. MRI scans of operated and the contralateral normal knee showed the mean sagittal ACL tibial angle coronal ACL tibial angle and tibial ACL footprint to be in accordance with the values of the contralateral, normal knee. CONCLUSION: The study demonstrates that DB ACL reconstruction restores the ACL anatomically in terms of size and angle of orientation. However, long term studies are needed to further substantiate its role in decreasing the incidence of early osteoarthritic changes compared to the conventional single bundle reconstructions.

5.
Indian J Orthop ; 49(1): 114-6, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25593363

RESUMEN

We report a case of ischemic neuropathy of the sciatic nerve in a patient with an anterior column fracture of the acetabulum operated by ilioinguinal approach. It resulted from occlusion of the blood supply to the sciatic nerve. There were no signs of a vascular insult until ischemic changes ensued on the 6(th) postoperative day on the lateral part of great toe. The patient underwent crossover femoro-femoral bypass grafting and there was a complete reversal of the ischemic changes at 6 months. The sciatic nerve palsy continued to recover until the end of 1 year; by which time the only deficit was a Grade 4 power in the extensor hallucis longus (EHL) and the extensor digitorum longus (EDL). There was no further recovery at 2 years followup.

6.
Musculoskelet Surg ; 99(1): 33-7, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25086576

RESUMEN

INTRODUCTION: Conservatively managed acromio-clavicular dislocations leave the patients with significant disability. Various techniques have been described to manage such injuries operatively. However, all such techniques involve exposure of the coracoid and use of metallic implants. We present a series of eight patients managed with small incision and minimal soft tissue dissection using palmaris longus tendon graft. We treated eight patients (all males), with acute acromio-clavicular dislocation with a palmaris Longus tendon graft. MATERIAL AND METHOD: The mean age of the patients at the time of final follow-up was 28.5 years (range 26-29 years), and the mean follow-up was 18 months (range 14-28 months). Functional assessment was done as per the DASH scores, along with a self-evaluation of the results. The vertical acromio-clavicular distance at final follow-up was compared to that at the time of presentation. RESULTS: The mean DASH score at final follow-up was 3.01; on self-evaluation, all patients rated their result as good. The patients had no or minimal pain at final follow-up. The mean vertical acromio-clavicular distance reduced from a mean pre-operative baseline values of 10.26 ± 2-1.40 ± 0.855 mm at latest follow-up. DISCUSSION: This is a mechanically sound technique, which required a small incision and minimal soft tissue dissection. It also does not require exposure of the coracoid, thus almost ruling out chances of significant neuro-vascular injury. The patients did not require any second surgery for implant removal. However, a longer follow-up with a larger number of patients is required to evaluate its long-term results and stability of the repair. CONCLUSION: Acromio-clavicular reconstruction using the palmaris Longus tendon graft is a simple surgery worth trying by a surgeon not proficient in arthroscopic techniques.


Asunto(s)
Articulación Acromioclavicular/lesiones , Luxaciones Articulares/cirugía , Tendones/trasplante , Adulto , Clavícula/cirugía , Estudios de Seguimiento , Humanos , Masculino , Procedimientos Ortopédicos/métodos , Rango del Movimiento Articular , Recuperación de la Función , Resultado del Tratamiento , Articulación de la Muñeca
8.
Indian J Orthop ; 48(5): 476-83, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25298554

RESUMEN

BACKGROUND: Femoral neck fracture is truly an enigma due to the high incidence of avascular necrosis and nonunion. Different methods have been described to determine the size of the femoral head fragment, as a small head has been said to be associated with poor outcome and nonunion due to inadequate implant purchase in the proximal fragment. These methods were two dimensional and were affected by radiography techniques, therefore did not determine true head size. Computed tomography (CT) is an important option to measure true head size as images can be obtained in three dimensions. Henceforth, we subjected patients to CT scan of hip in cases with displaced fracture neck of femur. The study aims to define the term small head or inadequate size femoral head" objectively for its prognostic significance. MATERIALS AND METHODS: 70 cases of displaced femoral neck fractures underwent CT scan preoperatively for proximal femoral geometric measurements of both hips. Dual energy X-ray absorptiometry scan was done in all cases. Patients were treated with either intertrochanteric osteotomy or lag screw osteosynthesis based on the size of the head fragment on plain radiographs. RESULTS: The average femoral head fragment volume was 57 cu cm (range 28.3-84.91 cu cm; standard deviation 14 cu cm). Proximal fragment volume of >43 cu cm was termed adequate size (type I) and of ≤43 cu cm as small femoral head (type II). Fractures which united (n = 54) had a relatively large average head size (59 cu cm) when compared to fractures that did not (n = 16), which had a small average head size (49 cu cm) and this difference was statistically significant. In type I fractures union rate was comparable in both osteotomy and lag screw groups (P > 0.05). Lag screw fixation failed invariably, while osteotomy showed good results in type II fractures (P < 0.05). CONCLUSION: Computed tomography scan of the proximal femur is advisable for measuring true size of head fragment. An objective classification based on the femoral head size (type I and type II) is proposed. Osteosynthesis should be the preferred method of treatment in type I and osteotomy or prosthetic replacement is the method of choice for type II femoral neck fractures.

9.
Indian J Orthop ; 48(4): 435-7, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25143653

RESUMEN

Congenital pseudoarthrosis of clavicle is a rare clinical entity. It usually presents as a swelling in the clavicular region at birth or soon after birth. Fitzwilliam's original description of 60 subtypes of congenital pseudoarthrosis of clavicle have addressed several anatomical variants, e.g. association with cervical rib and abnormally vertical and elevated upper ribs. However, congenital pseudoarthrosis of clavicle associated with bifurcation is an atypical anatomic variant. To the best of our knowledge, this variant has never been mentioned in the literature. In the present report, we have described this subtype of symptomatic congenital pseudoarthrosis of the clavicle with bifurcation and its possible management.

10.
J Orthop Traumatol ; 15(3): 173-9, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24879360

RESUMEN

BACKGROUND: Posterior wall fractures are the most common of all acetabular fractures, and there is universal consensus that displaced fractures are best treated with anatomical reduction and stable internal fixation. Though early and mid term results for such studies are available, few shed light on long term results. This study was performed to evaluate long term functional and radiological outcomes in patients with posterior wall acetabular fractures and to determine factors that may contribute adversely to a satisfactory final outcome. MATERIALS AND METHODS: We retrospectively analysed the hospital records for patients who underwent open reduction and internal fixation (ORIF) for posterior wall acetabular fractures. Twenty-five patients (20 men, five women), including one with bilateral posterior wall fracture, with a mean age of 41.28 ± 7.16 years (range 25-60 years) and a mean follow-up of 12.92 ± 6.36 years (range 5-22 years) who met the inclusion criteria formed the study cohort. Matta's criteria were used to grade postoperative reduction and final radiological outcome. Functional outcome at final follow-up was assessed according to d'Aubigné and Postel score. RESULTS: Anatomic reduction was achieved in 22 hips, imperfect in four and poor in none. Radiological outcome at final follow-up revealed excellent results in ten hips, good in eight, fair in five and poor in three. The final d'Aubigné and Postel scores were excellent in 14 hips, good in six and fair and poor in three each. Patients with anatomical reduction had a favourable functional and radiological long term outcome. However, the presence of associated injuries in lower limbs and a body mass index (BMI) >25 adversely affected the final functional outcome. Osteonecrosis was seen in three patients, heterotopic ossification in two and Morel Lavallee lesion in one. One patient had postoperative sciatic nerve palsy, which recovered 6 weeks after surgery. CONCLUSION: Anatomic postoperative reduction leads to optimal functional and radiological outcome on long term follow-up; however, the presence of associated lower-limb injuries and BMI >25 adversely affects a satisfactory final outcome in patients with posterior wall acetabular fractures. LEVEL OF EVIDENCE: (Level 4) Retrospective case series.


Asunto(s)
Acetábulo/lesiones , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Adulto , Femenino , Estudios de Seguimiento , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Recuperación de la Función , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
11.
Asian Spine J ; 8(3): 298-308, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24967043

RESUMEN

STUDY DESIGN: Prospective clinical study. PURPOSE: The present prospective study aims to evaluate the clinical, radiological, and functional and quality of life outcomes in patients with fresh thoracolumbar fractures managed by posterior instrumentation of the spine, using pedicle screw fixation and monosegmental fusion. OVERVIEW OF LITERATURE: The goals of treatment in thoracolumbar fractures are restoring vertebral column stability and obtaining spinal canal decompression, leading to early mobilization of the patient. METHODS: Sixty-six patients (46 males and 20 females) of thoracolumbar fractures with neurological deficit were stabilized with pedicle screw fixation and monosegmental fusion. Clinical, radiological and functional outcomes were evaluated. RESULTS: The mean preoperative values of Sagittal index, and compression percentage of the height of the fractured vertebra were 22.75° and 46.73, respectively, improved (statistically significant) to 12.39°, and 24.91, postoperatively. The loss of correction of these values at one year follow-up was not statistically significant. The mean preoperative canal compromise (%) improved from 65.22±17.61 to 10.06±5.31 at one year follow-up. There was a mean improvement in the grade of 1.03 in neurological status from the preoperative to final follow-up at one year. Average Denis work scale index was 4.1. Average Denis pain scale index was 2.5. Average WHOQOL-BREF showed reduced quality of life in these patients. Patients of early surgery group (operated within 7 days of injury) had a greater mean improvement of neurological grade, radiological and functional outcomes than those in the late surgery group, but it was not statistically significant. CONCLUSIONS: Posterior surgical instrumentation using pedicle screws with posterolateral fusion is safe, reliable and effective method in the management of fresh thoracolumbar fractures. Fusion helps to decrease the postoperative correction loss of radiological parameters. There is no correlation between radiographic corrections achieved for deformities and functional outcome and quality of life post spinal cord injury.

12.
Case Rep Orthop ; 2014: 616715, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24822144

RESUMEN

The occurrence of an intra-articular ossicle is not rare in the knee, with reports suggesting the existence of meniscal osscile. There are also reports describing the attachment of the posterolateral bundle of the anterior cruciate ligament (ACL) to an accessory ossicle. However, despite an extensive search of the English literature we did not find much written about an intrasubstance ossicle in the ACL. We present the case of a 13-year-old male with an intrasubstance ossicle in the anteromedial bundle of the ACL of his right knee.

13.
Foot Ankle Spec ; 7(1): 68-70, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24026085

RESUMEN

Longitudinal bracketed epiphysis (delta phalanx) is a rare congenital anomaly that affects phalanges in the hand more commonly than toes. We present a rare case of congenital hallux varus with longitudinal bracketed epiphysis of proximal phalanx with bifid distal phalanx of the great toe, which was managed with monorail type of external fixator. To the best of our knowledge, this is the first report of its successful implementation in simultaneous treatment of longitudinal bracketed epiphysis of the proximal phalanx of the great toe and hallux varus. Apart from adding to the literature a case of rare subtype of delta phalanx with hallux varus, the present study highlights the role of a reliable alternative in its management.


Asunto(s)
Fijadores Externos , Hallux Varus/cirugía , Hallux/anomalías , Hallux/cirugía , Falanges de los Dedos del Pie/anomalías , Falanges de los Dedos del Pie/cirugía , Niño , Epífisis/anomalías , Epífisis/diagnóstico por imagen , Epífisis/cirugía , Femenino , Hallux/diagnóstico por imagen , Hallux Varus/diagnóstico por imagen , Humanos , Osteotomía , Radiografía , Falanges de los Dedos del Pie/diagnóstico por imagen
14.
Chin J Traumatol ; 16(6): 365-7, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24295585

RESUMEN

Radial nerve palsy is the most common neurological involvement in humeral shaft fractures. But combined radial and median nerve injury in a closed diaphyseal fracture of the humerus is rare. Combined injury to both radial and median nerve can cause significant disability. A detailed clinical examination is therefore necessary following humeral shaft fractures. We report a patient with closed diaphyseal humeral fracture (AO 12A-2.3) together with radial and median nerve palsy, its management and review of the literature. As the patient had two nerves involved, surgical exploration was planned. Fracture was reduced and fixed with a 4.5 mm narrow dynamic compression plate. There was no external injury to both radial and median nerves on surgical exploration. Neurological recovery started at 3 weeks' follow-up. Complete recovery was seen at 12 weeks. Careful clinical examination is of the utmost importance in early diagnosis of combined nerve injuries, which allows better management and rehabilitation of the patient.


Asunto(s)
Nervio Mediano , Neuropatía Radial , Placas Óseas , Humanos , Fracturas del Húmero/cirugía , Húmero
15.
Chin J Traumatol ; 16(5): 295-7, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24103827

RESUMEN

The combination of ipsilateral humeral fractures at three different levels namely proximal, shaft and supracondyle has been rarely defined in the literature. We present a case report on such a complex injury in a 10-year-old child after falling down from the second floor of his house while playing. To the best of our knowledge, no such case report exists in the English literature. We define it as double floating arm injury. Firstly, shaft of humerus was open reduced and fixed with 4.5 mm narrow dynamic compression plate. Then closed reduction and pinning of the supracondylar humerus under an image intensifier was obtained. Open reduction using deltopectoral approach to the proximal humerus was done and the fracture was fixed with three K-wires. Ipsilateral multiple fractures in children often result from high energy trauma. Immediate reduction and fixation is required. Usually surgeons need to treat simple fractures firstly, which makes the subsequent treatment of complex fractures easier.


Asunto(s)
Fracturas del Húmero/complicaciones , Fracturas del Hombro/complicaciones , Niño , Humanos , Masculino
16.
Strategies Trauma Limb Reconstr ; 8(3): 181-5, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24043609

RESUMEN

Displaced unstable pelvic fractures are commonly associated with disruption of the osteoarticular junction of the sacroiliac joint. Posterior sacroiliac dislocation are commonly reported but there are only few reports the anterior type of sacroiliac dislocation where the iliac bone fractures and displaces anterior to sacrum, often in combination with fractures of pubic rami and symphyseal injuries. We present a case of an anterior type of sacroiliac fracture dislocation which was associated with a lumbar plexus injury involving both motor and sensory components. Preoperative neurological assessment was done by MRI scan. The tented nerve roots were explored and decompressed surgically, and sacroiliac fixation was done after reduction in the fracture and joint.

17.
Chin J Traumatol ; 16(2): 118-21, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23540903

RESUMEN

Nonunion in tibial plateau fractures is very rare. Limited literature is available on Pubmed search on intraarticular tibial nonunion. Most of the cases reported have been following failed surgical treatment and none was neglected fractures. Three patients of isolated and neglected medial tibial plateau nonunion with almost similar demographic profile are reported in this paper. All the three patients were managed by minimally invasive compression fixation using lag screws supplemented with limb realignment procedure of high tibial osteotomy. We discussed the injury mechanism, management and rehabilitation in such cases and reviewed the available literature regarding such a presentation.


Asunto(s)
Fijación Interna de Fracturas/métodos , Seudoartrosis/cirugía , Fracturas de la Tibia/cirugía , Adulto , Tornillos Óseos , Curación de Fractura , Humanos , Masculino , Osteotomía
18.
Int Wound J ; 10(4): 455-60, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22697785

RESUMEN

The recurrence of pressure ulcers (PrUs) and dehiscence of reconstructive flap have always been a problem. The present study aimed to evaluate the results of reconstructive flap surgeries in patients with spinal cord injury (SCI) having PrUs, using classic and modified flaps with improvisations to decrease wound dehiscence, flap necrosis and tension in flap. This is a prospective clinical study. The setting was a tertiary care centre in northern India. Thirty-five patients with SCI having 37 stage III and IV PrUs. PrUs were treated using classic and modified flaps with improvisations. The outcome was evaluated using criteria of wound dehiscence, flap necrosis and recurrence. The results of flap surgery were excellent in 32 (86·48%) patients, good in 4 (10·81%) patients and poor in 1 (2·7%) patient. Partial flap necrosis (2·7%), low incidence of PrU recurrence rate at flap site (5·4%) and overall PrU recurrence (11·4%) were the complications observed. Improvisation of classic and modified techniques of flap surgeries along with reinforcement of general care principles of paraplegia can be effective in minimising complications often associated with PrU reconstructive surgery thus improving the ultimate outcome.


Asunto(s)
Procedimientos de Cirugía Plástica/métodos , Úlcera por Presión/etiología , Úlcera por Presión/cirugía , Traumatismos de la Médula Espinal/complicaciones , Colgajos Quirúrgicos/irrigación sanguínea , Cicatrización de Heridas/fisiología , Adolescente , Adulto , Estudios de Cohortes , Desbridamiento/métodos , Femenino , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Humanos , India , Masculino , Persona de Mediana Edad , Paraplejía/complicaciones , Paraplejía/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/terapia , Úlcera por Presión/fisiopatología , Estudios Prospectivos , Procedimientos de Cirugía Plástica/efectos adversos , Recurrencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Traumatismos de la Médula Espinal/diagnóstico , Centros de Atención Terciaria , Resultado del Tratamiento , Adulto Joven
19.
ISRN Orthop ; 2013: 131757, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24959352

RESUMEN

Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm (n = 19)/3.5 mm (n = 14) volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18-61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7-12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (n = 26), good in 18% (n = 6), and fair in 3% (n = 1) patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse.

20.
Chinese Journal of Traumatology ; (6): 246-248, 2013.
Artículo en Inglés | WPRIM (Pacífico Occidental) | ID: wpr-325699

RESUMEN

Ulnar nerve injury in closed fracture of forearm in children is uncommon.Commonly, neurapraxia is the reason for this palsy but other severe injuries or nerve entrapment has been reported in some cases. The importance of diagnosis concerning the types of the nerve injury lies in the fact that they have totally different management.We present a case of ulnar nerve deficit in a child following a closed fracture of the forearm bones. It is imperative to diagnose exact cause of palsy as it forms the basis for treatment. MRI scan can help diagnosis and accordingly guide the management. Simple nerve contusion should be treated conservatively, and exploration with fixation of the fracture should be done in lacerations and entrapments of the nerve. Surgery is not the treatment of choice in cases that could be managed conservatively.


Asunto(s)
Niño , Humanos , Accidentes por Caídas , Errores Diagnósticos , Fracturas Cerradas , Diagnóstico , Terapéutica , Imagen por Resonancia Magnética , Fracturas del Radio , Diagnóstico , Terapéutica , Fracturas del Cúbito , Diagnóstico , Terapéutica , Nervio Cubital , Heridas y Lesiones , Neuropatías Cubitales , Diagnóstico
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