RESUMEN
BACKGROUND: Pulmonary infections are dreaded complications in acute spinal cord injuries. The prevention of pneumonia is essential for reducing mortality and the period of hospitalization. Swallowing disorders occur frequently in patients with cervical cord injuries and are accompanied by aspiration with a high risk of pneumonia. PATIENTS AND METHODS: In this study the identification and analysis of patients with newly acquired cervical cord injuries were carried out with respect to respiratory complications, treatment and prevention. RESULTS: A total of 27 patients with a cervical cord injury (tetraplegia) were identified. Of these 20 patients (74%) were identified with a swallowing disorder and a high risk of aspiration. Of these patients 11 (PEG group) received a percutaneous feeding tube (PEG tube), 9 patients (non-PEG group) with diagnosed dysphagia were treated without PEG tube. A total of 6 patients in the non-PEG group (67%) acquired pneumonia compared to 3 patients (27%) in the PEG group. CONCLUSION: A swallowing disorder is a major risk factor for a pulmonary infection after a cervical cord injury. An early placement of a PEG tube has a preventive effect with respect to aspiration pneumonia in patients with dysphagia.
Asunto(s)
Trastornos de Deglución/etiología , Trastornos de Deglución/rehabilitación , Nutrición Enteral/instrumentación , Neumonía por Aspiración/etiología , Neumonía por Aspiración/prevención & control , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/rehabilitación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: The ankylosing spondylitis (AS) is a systemic rheumatic disease, which affects the skeleton, joints and internal organs. Attributed to the augmented rigidity of the spine and the concomitant impairment of compensatory mechanism minor force might cause spine fractures. Multilevel stabilization and dorsoventral instrumentation is a well - established procedure. This study was to evaluate the surgical outcome of 119 patients with AS associated spine fractures. METHODS: From 07/96 to 01/10, 119 patients with 129 spine fractures due to AS were treated in our department. Data were collected retrospectively. In all patients the operative treatment of the fracture was either performed by ventral and/or dorsal spondylodesis. RESULTS: The median age was 67 years (37-95). There were 51 cervical, 55 thoracic and 23 lumbar spine fractures. On initial presentation no fractures in 18 patients (15%) and stable fractures in 15 patients (13%) were detected, which further secondarily dislocated. Thus, in 28% of the patients the injury was assessed falsely. 47% of the fractures were preceded by a trivial trauma in domestic surrounding. 61 patients (51%) developed either an incomplete or a complete paraplegia. In 32 patients ventral instrumentation, in 82 patients dorsal and in 15 patients dorsoventral instrumentation were performed. 14% developed postoperative wound infection an in 15% revision surgery due to implant loosening or insufficient stabilization was required. CONCLUSION: Early diagnostic of AS associated spine fractures using conventional radiographs and computed tomography scans is important for the detection and adequate treatment. A great amount of spine fractures are obviously either under diagnosed or underestimated, initially. A secondary dislocation of the fracture might result in severe neurological complications up to paraplegia.
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Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral , Espondilitis Anquilosante/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Errores Diagnósticos , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paraplejía/etiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Traumatismos de la Médula Espinal/etiología , Fracturas de la Columna Vertebral/diagnóstico , Espondilitis Anquilosante/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Allergies against bone cement or bone cement components have been well-described. We report on a 63-year-old patient who presented with progressive vitiligo all over the body after implantation of a cemented total knee replacement. A dermatological examination was performed and an allergy to benzoyl peroxide was found. A low-grade infection was diagnosed 5 months after implantation of the total knee replacement and the prosthesis was replaced with a cement spacer. After treating the infection of the knee replacement non-cemented arthrodesis of the knee was performed. In cases of new, unknown skin efflorescence, urticaria and periprosthetic loosening of cemented joint replacement, the differential diagnosis should include not only infections but also possible allergies against bone-cement and components such as benzoyl peroxide or metal components.
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Artroplastia de Reemplazo de Rodilla , Peróxido de Benzoílo/toxicidad , Cementos para Huesos/toxicidad , Fármacos Dermatológicos/toxicidad , Erupciones por Medicamentos/etiología , Osteoartritis de la Rodilla/cirugía , Vitíligo/inducido químicamente , Peróxido de Benzoílo/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Erupciones por Medicamentos/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Pruebas del Parche , Falla de Prótesis , Reoperación , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/cirugía , Staphylococcus epidermidis , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/cirugíaRESUMEN
INTRODUCTION: Heterotopic ossification (HO) is a common and serious complication after spinal cord injury, with an incidence of 5-50 %. Single-dose radiation therapy with 7 Gy is an established procedure for HO prophylaxis after total hip replacement. The aim of our study was to determine the clinical outcome after single-dose radiation therapy in the prophylaxis of HO in paraplegic patients. PATIENTS AND METHODS: Between January 2006 and July 2009, 75 paraplegic patients with heterotopic ossification were treated in our hospital. On the basis of the defined inclusion and exclusion criteria, 62 patients were included in our study, whereas 55 patients participated in our follow-up examination. All patients received a bi-weekly ultrasound of the hip for an attempt at early diagnosis of the condition. In case of an ultrasound suspicion of HO, a computed tomography (CT) or magnetic resonance imaging (MRI) of the hip was performed. After confirmation of HO, a single-dose radiation therapy with 7 Gy was performed. In group A, the patients were irradiated with an electrode voltage of 15 MeV (36 patients) and in group B with 6 MeV (26 patients). All patients were assessed with a standardised questionnaire with a mean follow-up of 30.6 months (range 6-78 months). RESULTS: The mean interval time between the initial spinal injury and HO development was 58,2 days (range 14-125). 69,4 % of all patients revealed a Brooker grade I, 27.4 % grade II and 3.2 % a grade III. No cases of Brooker grade IV (ankylosis) occurred. No patient showed side-effects after radiation therapy. However, in group A one patient (3,2 %) and in group B three patients (12.5 %) developed HO relapse. Those patients were treated again with a single-dose radiation therapy with 7 Gy and 15 MeV and, afterwards, they were free of complaints. Deep vein thrombosis was confirmed in 11 patients (32.3 %) in group A and in 8 patients (33.3 %) in group B. CONCLUSIONS: Single-dose radiation therapy with 7 Gy in the treatment of heterotopic ossification is an effective option. A higher electrode voltage improves the effectiveness of the irradiation and the clinical outcome. Essential for the outcome is the early detection and treatment of HO with single-dose radiation therapy. Randomised, prospective studies should be undertaken in order to confirm these findings.
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Osificación Heterotópica/etiología , Osificación Heterotópica/radioterapia , Radioterapia Conformacional , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/radioterapia , Enfermedades de la Columna Vertebral/etiología , Enfermedades de la Columna Vertebral/radioterapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osificación Heterotópica/diagnóstico , Dosificación Radioterapéutica , Traumatismos de la Médula Espinal/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico , Adulto JovenRESUMEN
BACKGROUND: The treatment of severe bacterial infections of the ankle joint is difficult and complex. In the case of a chronic infection with destruction of the ankle joint, a tibiotalar arthrodesis with external fixation is the treatment of choice. In this study the results of ankle arthrodesis due to bacterial infection using the Ilizarov external fixator are presented. PATIENTS AND METHODS: Between 2001 and 2004 37 patients (10 female, 27 male, mean age 58 years) were treated with a tibiotalar arthrodesis using the Ilizarov fixator. All patients had a confirmed infection in the course of their disease. Active infection was present in 20 patients at the time of the operation. Most secondary ankle arthritides (81 %) were caused post-traumatically after various internal fixation procedures. Previous ankle arthrodeses were tried in 14 cases (12 cases with internal fixation, two cases with external monolateral fixation). Patients were treated with a four-ring Ilizarov frame (in two cases with a five-ring frame) and stainless steel wires. All patients could be included at a mean follow-up of 46 (12-49) months. A modified AOFAS score was used for the functional outcome. RESULTS: The operation took 141 minutes at an average ranging from 90 to 252 minutes. The inpatient treatment lasted between 10 and 63 days (mean 26 days). The time spent in the fixator was 116.7 (69-245) days. All patients were mobilised under full weight bearing with the external fixator. Surgical revision was necessary in 13 patients: four patients needed wound revisions due to ongoing infection, six patients needed wire exchange due to deep infection in three cases and wire breakage in three cases, one patient needed additional wires because of an initially instable frame configuration and two patients needed secondary skin grafting. Bony consolidation was achieved in 32 patients (86.5 %). With a re-arthrodesis performed in four patients using the Ilizarov fixator, the overall fusion rate was 94.6 %. Infection was persistent in two cases with one solid ankle fusion and one ankle pseudarthrosis. At the time of follow-up 35 patients were able to walk under full weight loading with orthopaedic shoe modifications, four patients needed support of a cane and three patients wore an ankle-foot orthesis. The two patients with persistent pseudarthrosis were mobilised in a lower-leg orthesis after declining another surgical revision. The positioning of the hindfoot showed in seven cases an equinus of 10°, in one case a varus of 10° and in two cases a valgus positioning of 10°. A plantigrade foot positioning or with minimal degrees of deviation could be achieved in all other cases. The modified AOFAS score at the time of the follow-up examination ranged from 19 to 86 with an average score of 67.9 points. All patients except three were satisfied or rather satisfied with the treatment procedure and its results. CONCLUSION: The Ilizarov external fixator is a safe method for ankle fusion in cases of infection. The advances are a possible application at acute infection and immediate mobilisation at full weight bearing. However, it remains a time-consuming and stressful procedure for the patient.
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Articulación del Tobillo/cirugía , Artritis Infecciosa/cirugía , Artrodesis/instrumentación , Infecciones Bacterianas/cirugía , Fijadores Externos , Técnica de Ilizarov/instrumentación , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Resultado del TratamientoRESUMEN
Destructive changes of the elbow joint represent a challenge for both patient and surgeon. Resection arthroplasty is associated with postoperative instability and loss of power and is a rarely performed procedure. Interpositional arthroplasty remains a useful option for healthy active patients with severe post-traumatic elbow arthrosis and is one of the oldest methods used to reconstruct the elbow. The principle of interpositional arthroplasty is based on a sparing resection of the destroyed joint surface and on creating a congruent elbow joint with human tissue. Nowadays, autogenous dermis, fascia lata or Achilles allograft are used. A preoperatively stable elbow is required to prevent instability following interpositional arthroplasty. The use of total elbow arthroplasty is limited due to the contraindications and in such cases the only remaining options are salvage procedures of the elbow. In general, arthrodesis should be performed in patients with painful osteoarthritis of the elbow with high demands on the upper extremities. Historically, tuberculosis was the most common indication for elbow arthrodesis and various methods of elbow arthrodesis have been described. However, most attention has been given to the position in which the elbow joint should be fixed and should be decided depending on the individual characteristics of the patient. Sufficient bone stock is crucial for a successful elbow arthrodesis and in cases with massive bone loss reconstruction of the elbow using an allograft can be performed to restore bone quality. However, the high complication rate of this procedure limits the scope of its use. Nevertheless, allograft procedures can restore pain-free joint function for several years.
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Artrodesis/métodos , Artroplastia de Reemplazo de Codo/métodos , Artroplastia/métodos , Articulación del Codo/cirugía , Prótesis de Codo , Osteoartritis/cirugía , Terapia Recuperativa/métodos , Tendón Calcáneo/trasplante , Dermis/trasplante , Fascia Lata/trasplante , Humanos , Complicaciones Posoperatorias/etiología , Diseño de Prótesis , Reoperación , Factores de RiesgoRESUMEN
INTRODUCTION: Complex vertebral fractures can lead to injury of the spinal cord with resulting paraplegia. High-speed accidents are common causes, especially in younger patients. Malignant or inflammatory processes play an important role in the elderly. Less common reasons for a spinal cord injury are congenital malformations. We here report about a 17-year-old patient who suffered from paraplegia after an isolated rupture of the spinal cord without an injury of the vertebral bodies, intervertebral disc or ligamentous structures. This type of injury has not been reported in the literature before. PATIENT AND METHOD: We report about a 17-year-old patient, referred to our hospital, presenting with lumbal paraplegia after a high-speed accident 8 days prior to admission. After initial stabilisation of the polytraumatised patient, he was referred to our hospital for further treatment. RESULTS AND CONCLUSION: The radiological examination showed a bilateral acetabular fracture, a right anterior pelvic ring fracture and shaft fractures of the left humerus and right femur. Furthermore, the spinal cord at thoracic level 10/11 was ruptured. Interestingly, there was no injury of the vertebral bodies, intervertebral disc or ligamentous structures. A tethered cord as a possible anatomic variation could be excluded in this case by MRI. However, anatomic variations could be the reason for this injury and should be kept in mind.
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Paraplejía/complicaciones , Paraplejía/patología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/patología , Adolescente , Humanos , Masculino , Rotura/complicaciones , Rotura/patologíaRESUMEN
INTRODUCTION: Arm wrestling may cause severe injuries. Various injuries after arm wrestling have been reported in the literature, whereas the most common injury is the humeral shaft fracture. In this context we report on eleven cases with different injuries during arm wrestling. MATERIAL AND METHODS: All patients were analyzed using a standardized questionnaire. The effect of drugs, pre-existing conditions and injuries as well as sport activities were examined. Furthermore we report about a 24 year old patient who sustained a radial shaft fracture which has not been reported in the literature yet. RESULTS: 8 patients suffered from a fracture. The humerus was the most affected bone in 7 cases. 3 patients had a muscle strain, whereas in all 3 cases the patients were regularly sportive active and warmed-up be for the injury. Ten patients were reintegrated into the previous job after an average time period of 6 weeks. One patient was out of work. CONCLUSIONS: Regular sport activity and the muscle strength are important factors for the injury intensity. Further studies are necessary to confirm this theory.
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Traumatismos del Brazo/diagnóstico , Traumatismos del Brazo/terapia , Fracturas del Húmero/diagnóstico , Fracturas del Radio/diagnóstico , Lucha/lesiones , Adolescente , Adulto , Humanos , Masculino , Adulto JovenRESUMEN
INTRODUCTION: Blunt force injuries in martial arts occur frequently but isolated hematoma of muscles in the extremities is rare. Even minor trauma of the lower extremities due to throwing techniques in judo and other forms of Asian martial arts can lead to major pathologies. METHODS: A 9-year-old girl presented with an unclear swelling and soreness of the calf muscle. The patient could not remember an obvious traumatic event. She was admitted 4 days later because of increased swelling, pain and erythema. The parents reported a minor trauma at judo training 1 week ago. Further investigation was performed with MRI and confirmed a massive hematoma much greater than previously shown by sonography. RESULTS: Histologic and microbiologic evaluation demonstrated florid inflammation and proof of Staphylococcus aureus was found intra-operatively. DISCUSSION: The diagnosis of blunt force injuries due to martial arts is difficult in childhood because often children do not remember a traumatic event. Therefore, it is important to obtain a thorough history from caregivers. Because sonography depends highly on the experience of the investigator MRI is considered to be a better diagnostic modality to diagnose and guide treatment in this age group.
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Diagnóstico Tardío/prevención & control , Hematoma/diagnóstico , Traumatismos de la Pierna/diagnóstico , Imagen por Resonancia Magnética/métodos , Artes Marciales/lesiones , Enfermedades Musculares/diagnóstico , Heridas no Penetrantes/diagnóstico , Niño , Femenino , HumanosRESUMEN
AIM: Repeated luxations, periprosthetic fractures, infections, and nerve palsies are the most frequent complications of hip alloarthroplasty. Paresis acquired during elective implantation entails considerable restrictions in the quality of life. The risk of sustaining a nerve injury depends upon the initial clinical situation, cases of planned leg lengthening in patients with hip dysplasia and high luxations being particularly at risk. METHOD: A Medline search was conducted using the query "nerve palsies during hip prosthesis implantation", yielding 126 publications, of which 18 were used to predict the risk of nerve palsies in cases with simultaneous leg lengthening during total hip arthroplasties according to different preconditions. RESULTS: The risk for an acquired nerve lesion during hip alloarthroplasty in arthritis was 0.5 %. In cases of hip dysplasia (with no or moderate leg lengthening during the procedure), the risk was increased to 2.3 %. An even higher risk of 3.5 % was found in cases of revision surgery. According to the literature, the risk of nerve palsies in cases of continuous leg lengthening before THA is raised to 5.9 % with a linear correlation between the amount of leg lengthening and rate of nerve palsies. CONCLUSION: Neural lesions during single-stage leg lengthening of less than 3 cm in hip alloarthroplasty are uncommon. More extensive lengthening can be achieved with continuous procedures, which should be conducted under clinical monitoring of the peripheral nerves to avert possible nerve injury.
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Artroplastia de Reemplazo de Cadera/efectos adversos , Traumatismos de los Nervios Periféricos , Complicaciones Posoperatorias/cirugía , Luxación de la Cadera/cirugía , Humanos , Diferencia de Longitud de las Piernas/cirugía , Monitoreo Intraoperatorio , Osteoartritis de la Cadera/cirugía , Osteogénesis por Distracción/efectos adversos , Nervios Periféricos/fisiopatología , Complicaciones Posoperatorias/prevención & control , Falla de Prótesis , Factores de RiesgoRESUMEN
The operative management of open fractures of the lower limb requires a consistent treatment to avoid soft tissue complications. Acute angular shortening of the fracture enabling primary soft tissue closure is still an uncommon operative technique because of difficulties in correcting the secondary deformity. The case of a pediatric open fracture of the lower limb (Gustilo type IIIa) is described, which was treated with acute angular shortening followed by gradual correction using the Taylor spatial frame (TSF).
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Fijación Interna de Fracturas/instrumentación , Fracturas Abiertas/diagnóstico por imagen , Fracturas Abiertas/cirugía , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Adolescente , Fijación Interna de Fracturas/métodos , Humanos , Masculino , Radiografía , Resultado del TratamientoRESUMEN
AIM: Bipolar hemiarthroplasty is frequently used in femoral neck fractures. There is only little evidence regarding differences in complication rates if the procedure is performed by either a junior or senior surgeon. METHODS: 360 bipolar hemiarthroplasties were retrospectively investigated. Complication rates for junior and senior surgeons were evaluated as well as differences between daytime and nightshift surgery. We also assessed the duration of surgery for the two groups and its impact on the complication rate. RESULTS: The average duration of the procedure was 67 minutes (23-194) with statistically significant differences between junior and senior surgeons (77 vs. 61 minutes, p < 0.001). Complications occurred in 27 (7.5%) of all cases. Postoperative infections were most frequently found (3.1% of all complications), followed by haematomas and dislocations of the implant (1.7% and 1.1 %, respectively). 25 patients required revision operations. More complications were found in cases performed by junior surgeons (9.56% vs. 6.25%). This difference was not significant (p = 0.248). During on-call duty we also observed more complications compared to daytime surgery (11% vs. 7%). There was no coherence between the duration of surgery and the incidence of complications. CONCLUSIONS: Bipolar hemiarthroplasty is a reliable treatment option for femoral neck fractures even when performed by a junior surgeon. The higher incidence of complications during nighttime surgery should be a reason to perform those cases that are not urgent during the daytime shift.
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Fracturas del Cuello Femoral/cirugía , Prótesis de Cadera , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Diseño de Prótesis , Garantía de la Calidad de Atención de Salud/normas , Estudios de Tiempo y Movimiento , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/educación , Ritmo Circadiano , Competencia Clínica/normas , Estudios Transversales , Femenino , Fracturas del Cuello Femoral/epidemiología , Alemania , Humanos , Incidencia , Internado y Residencia , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Asistentes Médicos , Estudios Retrospectivos , Tolerancia al Trabajo ProgramadoRESUMEN
The clinical presentation of synovitis with rice bodies is found in a few systemic diseases as accompanying manifestations within joints or joint-associated bursa. A 79-year old patient was examined, who had complained of pain and swelling in the left shoulder for a long time. Sonography identified multiple spindle-shaped joint bodies within the joint effusion. MRI showed a large amount of so-called rice bodies with joint effusion in the shoulder and a massive destruction of the rotator cuff of the left shoulder. The histological examination showed a tuberculosis-specific inflammatory response with giant cells and epithelioid granulomas and molecular biological detection of Mycobacterium tuberculosis. Within a few months after surgical removal of the rice bodies from the joint space and the bursa a relapse occurred with repeated synovial effusion followed by a renewed surgical removal of the joint bodies. We describe the rare case of a patient with unilateral musculoskeletal manifestation of tuberculosis presented as synovitis of the left shoulder and the adjacent bursa with rice bodies and accelerated growth trend without coexisting active tuberculosis or tuberculosis in the previous history. Furthermore, a brief summary of the literature is given.
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Articulación del Hombro/patología , Sinovitis/patología , Tuberculosis/complicaciones , Tuberculosis/diagnóstico , Anciano , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
Factors such as instability and impingement lead to early cartilage damage and osteoarthritis of the hip joint. The surgical outcome of joint-preserving surgery about the hip joint depends on the preoperative quality of joint cartilage.For in vivo evaluation of cartilage quality, different biochemically sensitive magnetic resonance imaging (MRI) procedures have been tested, some of which have the potential of inducing a paradigm shift in the evaluation and treatment of cartilage damage and early osteoarthritis.Instead of reacting to late sequelae in a palliative way, physicians could assess cartilage damage early on, and the treatment intensity could be adequate and based on the disease stage. Furthermore, the efficiency of different therapeutic interventions could be evaluated and monitored.This article reviews the recent application of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and discusses its use for assessing cartilage quality in the hip joint. dGEMRIC is more sensitive to early cartilage changes in osteoarthritis than are radiographic measures and might be a helpful tool for assessing cartilage quality.
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Cartílago Articular/lesiones , Cartílago Articular/patología , Fracturas del Cartílago/diagnóstico , Gadolinio/administración & dosificación , Lesiones de la Cadera/diagnóstico , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Medios de Contraste/administración & dosificaciónRESUMEN
BACKGROUND: In a retrospective study, we compared the results of different surgical therapies in 30 patients who had an early-onset infection after implantation of a hip hemiarthroplasty. MATERIAL AND METHODS: Patients were divided into two groups: In group 1 (n=16, deep infection), we changed the polyethylene inlay as well as the femoral head. In group 2 (n=14, deep infection), an acetabular component was also implanted. RESULTS: In group 1, successful treatment was achieved in 37.5% of patients 6 months after the last operation, compared with 71.4% in group 2 (p=0.019). All patients were supported with antibiotics. In group 1, three patients died from septic multiorgan failure. Two patients in group 1 and one patient in group 2 received a Girdlestone operation. CONCLUSIONS: These results suggest that aggressive surgical treatment with soft tissue revision, lavage, and implantation of an acetabular component in combination with antibiotics is a useful technique for treating early-onset infection.
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Antibacterianos/administración & dosificación , Artroplastia de Reemplazo de Cadera/efectos adversos , Desbridamiento/métodos , Técnicas de Apoyo para la Decisión , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/terapia , Irrigación Terapéutica/métodos , Algoritmos , Femenino , Prótesis de Cadera/efectos adversos , Humanos , Masculino , Cuidados Posoperatorios/métodos , Reoperación/métodos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Immobilisation in external rotation has become a new option in the therapy of the traumatically dislocated shoulder. Brace comfort and patient's satisfaction with this kind of conservative treatment are evaluated in a retrospective survey. METHODS: 34 patients with a traumatic first-time anterior shoulder dislocation were immobilised in an external rotation brace for three weeks. Afterwards they were asked to complete a questionnaire regarding brace comfort and how they managed their daily life with one arm immobilised in external rotation. RESULTS: 29 questionnaires could be evaluated. 26 patients (90%) were satisfied with the new therapy. 24 patients (83%) would prefer the conservative treatment in an external rotation brace in case of another dislocation under similar circumstances. The impact of the brace therapy on daily live was reasonable. 79% of the patients (23) wore the brace more than 20 hours daily (average 22 hours, min.15, max. 24 hours). CONCLUSION: Despite the uncomfortable arm position during immobilisation the therapy in an external rotation brace showed a high acceptance. In addition to previous results regarding reposition of the labroligamentous complex it appears to be proven a suitable therapy for first-time traumatic anterior shoulder dislocation.
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Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Inmovilización/métodos , Satisfacción del Paciente , Rango del Movimiento Articular , Luxación del Hombro/diagnóstico , Luxación del Hombro/terapia , Adolescente , Adulto , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Post-traumatic supramalleolar deformities and malunions of ankle fusion require mostly a multiplanar correction. In cases of severe soft tissue damage, external fixation and gradual correction is a definite treatment alternative. METHOD: Between 2003 and 2007 a correction of supramalleolar deformities was performed in 9 patients with the Taylor spatial frame external fixator. The mean age was 30 years (min. 12, max. 68). There were 6 patients with deformities after malunion of supramalleolar fractures and 3 patients with malunion after ankle fusion. The mean angular deformity was 30 degrees and 5 patients had a rotational malposition of 13.6 degrees (min. 5 degrees, max. 25 degrees). 5 patients needed also lengthening (min. 10 mm, max. 40 mm) of the post-traumatic deformed tibia. The mean time of the follow-up examination was 23 months (min. 12, max. 41). RESULTS: Anatomic correction could be achieved in all patients. The average correction time was 36 days (min. 10, max. 82) with an average time period of 163 days (min. 130, max. 218) until the fixator was removed. The healing index of the leg lengthening cases was 77 d/cm. There were 2 pin-tract infections, 1 prolongated callus formation and 1 insufficient callus formation. CONCLUSION: In cases of post-traumatic supramalleolar deformities with poor soft tissue and bone quality the Taylor spatial frame is a useful tool. Angular, axial, translational and rotatory deformities are corrected simultaneously without complex and time-consuming fixator reconstructions.
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Traumatismos del Tobillo/cirugía , Fijadores Externos , Fracturas Mal Unidas/cirugía , Complicaciones Posoperatorias/cirugía , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Anciano , Traumatismos del Tobillo/diagnóstico por imagen , Artrodesis/métodos , Regeneración Ósea/fisiología , Niño , Diseño de Equipo , Femenino , Curación de Fractura/fisiología , Fracturas Mal Unidas/diagnóstico por imagen , Fracturas Abiertas/diagnóstico por imagen , Fracturas Abiertas/cirugía , Humanos , Técnica de Ilizarov , Diferencia de Longitud de las Piernas/diagnóstico por imagen , Diferencia de Longitud de las Piernas/cirugía , Masculino , Persona de Mediana Edad , Osteotomía/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía , Reoperación/instrumentación , Reoperación/métodos , Fracturas de Salter-Harris , Fracturas de la Tibia/diagnóstico por imagen , Adulto JovenRESUMEN
Solitary fibrous tumors (SFT) are rare spindle cell neoplasms. To date only very few cases of pelvic SFT have been reported in the literature. SFT are characterized by unique microscopic and immunohistochemical findings. Complete local resection is the treatment of choice. Recurrence and metastasis may be related to infrequent malignant histological features, but histology is not always a reliable predictor for prognosis. Therefore long-term follow-up is necessary.We report about a male patient with a malignant pelvic SFT. After complete resection the tumor recurred after a short period of 6 months posterior to the original location in the pelvis. The differential diagnoses and the therapy options are discussed with a review of the present literature.
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Neoplasias Pélvicas/diagnóstico , Neoplasias Pélvicas/cirugía , Tumores Fibrosos Solitarios/diagnóstico , Tumores Fibrosos Solitarios/cirugía , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Raras/diagnóstico , Enfermedades Raras/cirugía , Neoplasias Torácicas , Resultado del TratamientoRESUMEN
Combined injuries of the upper cervical spine are rare and can lead to life-threatening positional changes of the respiratory tract. Hence, it is very important to recognize tracheal and soft tissue injuries and to treat these adequately. We report on the clinical course and outcome of a case with a delayed high-grade tracheal stenosis after cervical spine injury, which could only be treated by emergency tracheotomy and partial transverse trachea resection.The 25-year-old female suffered a complex dislocated upper cervical spine fracture with a Jefferson fracture, an odontoid fracture and a dislocated C6/7 luxation fracture after a motor vehicle accident. Immediately after trauma inspiratory stridor was reported. Postoperatively, the tracheal stenosis increased and the histological examination of tissue collected during emergency bronchoscopy showed granulation tissue.Even if fractures of cervical spine injuries are treated successfully, soft tissue and tracheal injuries cannot be precluded. Therefore, it is most important that such patients are followed-up closely to classify the problem and to determine the ideal time for surgical treatment of tracheal injuries and stenoses.
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Vértebras Cervicales/cirugía , Traumatismos Vertebrales/complicaciones , Traumatismos Vertebrales/cirugía , Estenosis Traqueal/etiología , Adulto , Vértebras Cervicales/diagnóstico por imagen , Femenino , Humanos , Radiografía , Estenosis Traqueal/diagnóstico , Resultado del TratamientoRESUMEN
OBJECTIVES: The Complex Regional Pain Syndrome I (CRPS I) is a disease that might affect an extremity after trauma or operation. The pathogenesis remains yet unclear. It has clinical signs of severe local inflammation as a result of an exaggerated inflammatory response but neurogenic dysregulation also contributes to it. Some studies investigated the role inflammatory mediators and cytokines; however, few longitudinal studies exist and control groups except healthy controls were not investigated yet. METHODS: To get further insights into the role of systemic inflammatory mediators in CRPS I, we investigated a variety of pro-, anti-, or neuro-inflammatory mediators such as C-Reactive Protein (CRP), White Blood Cell Count (WBC), Interleukins 4, 6, 8, 10, 11, 12 (p70), Interferon gamma, Tumor-Necrosis-Factor alpha (TNF-a) and its soluble Receptors I/II, soluble Selectins (E,L,P), Substance-P (SP), and Calcitonin Gene-Related Peptide (CGRP) at different time points in venous blood from patients with acute (AC) and chronic (CC) CRPS I, patients with forearm fractures (FR), with neuralgia (NE), and from healthy volunteers (C). RESULTS: No significant changes for serum parameters investigated in CRPS compared to control groups were found except for CC/C (CGRP p = 0.007), FR/C (CGRP p = 0.048) and AC/CC (IL-12 p = 0.02; TNFRI/II p = 0.01; SP p = 0.049). High interindividual variations were observed. No intra- or interindividual correlation of parameters with clinical course (e.g. chronification) or outcome was detectable. CONCLUSION: Although clinically appearing as inflammation in acute stages, local rather than systemic inflammatory responses seem to be relevant in CRPS. Variable results from different studies might be explained by unpredictable intermittent release of mediators from local inflammatory processes into the blood combined with high interindividual variabilities. A clinically relevant difference to various control groups was not notable in this pilot study. Determination of systemic inflammatory parameters is not yet helpful in diagnostic and follow-up of CRPS I.