RESUMEN
Cases of posttraumatic pes equinovarus after compartment syndrome have become more frequent in the last 3 decades because limb-saving procedures like compartment splitting, vascular repair, and microvascular free flaps have become well established in trauma surgery, thus reducing early below knee amputations. But if the deep flexor compartment is not split completely or if the muscles are crushed by direct trauma severe necrosis and subsequent muscle contractures result in a very severe clubfoot deformity. Metatarsalgia of fifth, fourth, and third metatarsal head even in well-fitted orthopaedic shoes occurs as well as painful bunions and fatigue fractures of the fifth metatarsal. Infected ulcers below the fifth/fourth metatarsal bone in a numb plantar sole often require head resection because of osteomyelitis.From 1994 to 2007 a total of 24 patients with severe pes equinovarus after compartment and/or postischemic syndrome were treated operatively. Only in 5 cases was a triple, Chopart, or Lisfranc arthrodesis necessary; 19 cases however could be treated only by soft tissue procedures like tenolysis, tendon lengthening, medial release of the scarred flexor retinacula and contracted capsules of the posterior ankle, subtalar and talonavicular joint to reorientate all axes of the foot. By temporary K-wire transfixation (6 weeks), initial external tibiotarsal transfixation of the foot (10 days), and additional tendon transfer for active foot elevation excellent and good long-term (5 years) results are achievable.The results according to the McKay Score are not significantly different regarding the triple arthrodesis group versus the pure soft tissue release group. Nevertheless, saving joints in the latter group seems to be very important.
Asunto(s)
Síndromes Compartimentales/cirugía , Deformidades Adquiridas del Pie/cirugía , Enfermedades del Pie/cirugía , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Adolescente , Humanos , Masculino , Resultado del Tratamiento , Adulto JovenRESUMEN
Thirty-five displaced fractures of the distal radius, classified by standard radiographs as extra-articular type A2 and A3 fractures according to the AO classification, were investigated before operative treatment by computed tomography. The comparative analysis surprisingly revealed an involvement of the articular surface of the distal radius in 57%. The intra-articular fractures were classified after CT as C1 in 15%, C2 in 65%, and C3 in 20%. The distal radioulnar joint was involved in 80% of the type C injuries and showed a dorsal subluxation in 17% of all cases. Similar to the results of type A2 and A3 fractures, type B and C fractures of the distal radius also may be underestimated in standard radiographs. This concerns important components such as the involvement of the radiocarpal joint surface and concomitant injuries of the distal radioulnar joint. Since joint congruency is an important predictor of outcome, CT scanning should be used more generously for planning and controlling surgical therapy.
Asunto(s)
Radiografía , Fracturas del Radio/diagnóstico por imagen , Tomografía Computarizada Espiral , Traumatismos de la Muñeca/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Hilos Ortopédicos , Errores Diagnósticos , Fijadores Externos , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Fracturas del Radio/clasificación , Fracturas del Radio/cirugía , Sensibilidad y Especificidad , Traumatismos de la Muñeca/clasificación , Traumatismos de la Muñeca/cirugíaRESUMEN
Complete cardiac bypass has been performed in the experiments on 21 random-bred dogs under thiopental-ketamine anesthesia using artificial heart ventricles (AHV), "Kedr" type. In 9 dogs 15 hours after AHV insertion their output was increased by half, as compared to baseline cardiac output values; in the rest of animals AHV worked in the regimen of normal perfusion. The study of acid-base balance parameters has revealed that AHV functioning in the regimen of normal perfusion for 2.5 hours leads to the development of moderate decompensated metabolic acidosis, the degree of which depends on the duration of AHV functioning. Changes in arterial and venous blood pO2 in long-term AHV functioning is indicative of blood flow activation in arteriovenous shunts. Blood flow increase during the first 15-20 min is accompanied by the improvement of blood oxygenation and stabilization of the acid-base balance parameters. AHV functioning in hyperperfusion regimen for 1 hour leads to deterioration of ventilation-perfusion pulmonary ratio and the onset of hypoxemia.