RESUMEN
Bilateral asymmetric hip fracture dislocation is an extremely rare entity. The injury is caused by a high velocity mechanism. We reported a case of bilateral hip fracture dislocation and its management. A 30-year-old man with no previous medical or surgical history was involved in a road accident involving a high-speed collision between two trucks. X-rays of the pelvis revealed asymmetrical bilateral fracture-luxation of the hips. The reduction of the hips was done under general anesthesia. Asymmetrical bilateral traumatic dislocation fracture of the hip is a rare serious injury. Reduction must be performed within 6 hours. Short- and long-term monitoring of the patient is essential.
Asunto(s)
Accidentes de Tránsito , Luxación de la Cadera , Fracturas de Cadera , Humanos , Masculino , Adulto , Fracturas de Cadera/cirugía , Fracturas de Cadera/etiología , Luxación de la Cadera/etiología , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/cirugía , Fractura-Luxación/diagnóstico por imagen , Anestesia General/métodosRESUMEN
INTRODUCTION: Continuous spinal anesthesia for surgical repair of hip fracture in elderly patients has been shown to preserve hemodynamics better than general and single shoot spinal anesthesia. However, hypotension still occurs, even with continuous spinal anesthesia. AIM: This study aimed to demonstrate that hypobaric bupivacaine is more effective in preserving hemodynamics than isobaric bupivacaine when patients are operated in lateral position. METHODS: It was a prospective randomized controlled single-blind study conducted in an orthopaedic institute during two years (2017-2018). One hundred and ten patients aged more than 65 years, scheduled for hip fracture repair, were randomized to receive either hypobaric or isobaric bupivacaine. Repeated doses of 2.5 mg bupivacaine were injected until sensory blockade reached T12. Hypotension and severe hypotension were defined as a decrease of more than 20% and 30% from the baseline systolic arterial blood pressure and were treated with ephedrine. Statistical analysis used Chi2 and Student tests to compare either number and percentage or mean and median. P<0.05 was significant. RESULTS: Less patients experienced hypotension and severe hypotension in hypobaric group than in isobaric group (respectively 53% vs. 73%; p<0.05 and 22% vs. 53%; p< 0.01). Ephedrine consumption was significantly lower in hypobaric group (1.9 mg vs. 5.6 mg; p<0.01). CONCLUSION: Hypobaric bupivacaine may be used rather than isobaric bupivacaine for further preserving hemodynamics in continuous spinal anesthesia for hip fracture surgery in elderly.
Asunto(s)
Anestesia Raquidea , Fracturas de Cadera , Hipotensión , Anciano , Humanos , Efedrina , Estudios Prospectivos , Método Simple Ciego , Hemodinámica , BupivacaínaRESUMEN
INTRODUCTION: Aseptic loosening is the main long-term complication and indicates total hip replacement failure. There are many and often intricate causes for aseptic loosening. Incorrect placement of the implants is the most incriminated factor. Other patient and implant related factors may also predispose to loosening but to various degrees. METHODS: We conducted a retrospective study of 64 cases with aseptic loosening of total hip prosthesis to individuate patient, implant type and surgical technique related factors leading to aseptic loosening and to provide recommendations to minimize this risk. RESULTS: This was an analytic retrospective study of 64 cases with aseptic loosening. The classification is that used by the French Society of Orthopedic Surgery and Traumatology. The average age of the patients at the time of the first arthroplasty was 40 years, 62 years at the time of loosening. Charnley stem was implanted in 55 cases, Muller stem in 9 cases. Acetabular component was well positioned in 69% of cases with an average inclination of 47.8 °. The stems were canal-filling in 86% of cases with Grade A cementation in 60% of cases. The mean time for loosening onset was 12 years. 72% of the prostheses had a survival longer than 10 years. Statistical analysis of the results identified risk factors leading to loosening, such as: age, body mass index, level of activity, cup inclination, femoral offset and cementation quality. CONCLUSION: A significant reduction in aseptic loosening of total hip prostheses may only be achieved by a more rigorous selection of patients, a greater security in the technical act and a better choice of the implant to be placed.