RESUMEN
We describe the technique and results of medial submuscular plating of the femur in paediatric patients and discuss its indications and limitations. Specifically, the technique is used as part of a plate-after-lengthening strategy, where the period of external fixation is reduced and the plate introduced by avoiding direct contact with the lateral entry wounds of the external fixator pins. The technique emphasises that vastus medialis is interposed between the plate and the vascular structures. A total of 16 patients (11 male and five female, mean age 9.6 years (5 to 17)), had medial submuscular plating of the femur. All underwent distraction osteogenesis of the femur with a mean lengthening of 4.99 cm (3.2 to 12) prior to plating. All patients achieved consolidation of the regenerate without deformity. The mean follow-up was 10.5 months (7 to 15) after plating for those with plates still in situ, and 16.3 months (1 to 39) for those who subsequently had their plates removed. None developed a deep infection. In two patients a proximal screw fractured without loss of alignment; one patient sustained a traumatic fracture six months after removal of the plate. Placing the plate on the medial side is advantageous when the external fixator is present on the lateral side, and is biomechanically optimal in the presence of a femoral defect. We conclude that medial femoral submuscular plating is a useful technique for specific indications and can be performed safely with a prior understanding of the regional anatomy.
Asunto(s)
Placas Óseas , Fémur/cirugía , Diferencia de Longitud de las Piernas/cirugía , Osteogénesis por Distracción/métodos , Adolescente , Niño , Preescolar , Fijadores Externos , Femenino , Fémur/anomalías , Fémur/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Masculino , Osteogénesis por Distracción/instrumentación , Radiografía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The Achilles tendon (AT) is the most frequently ruptured tendon in the human body yet the aetiology remains poorly understood. Despite the extensively published literature, controversy still surrounds the optimum treatment of complete rupture. Both non-operative management and percutaneous repair are attractive alternatives to open surgery, which carries the highest complication and cost profile. However, the lack of a universally accepted scoring system has limited any evaluation of treatment options. A typical UK district general hospital treats approximately 3 cases of AT rupture a month. It is therefore important for orthopaedic surgeons to correctly diagnose and treat these injuries with respect to the best current evidence-based practice. In this review article, we discuss the relevant pathophysiology and diagnosis of the ruptured AT and summarize the current evidence for treatment.
Asunto(s)
Tendón Calcáneo/lesiones , Tendón Calcáneo/cirugía , Tendón Calcáneo/patología , Tendón Calcáneo/fisiopatología , Medicina Basada en la Evidencia , Humanos , Equipo Ortopédico , Procedimientos Ortopédicos , Factores de Riesgo , Rotura/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: Endourology is established in urology practice with routine use of fluoroscopic guidance. Medical personnel are rarely exposed to direct radiation exposure but secondary exposure occurs via radiation scatter. There are few reports on scatter radiation exposure and the subsequent risk to medical personnel involved in urological fluoroscopic procedures. We review the risks of scatter radiation exposure to medical personnel with reference to the routine use of fluoroscopic imaging in urological practice. MATERIALS AND METHODS: We measured staff radiation exposure during a series of ureteral endourological procedures using LiF:Mg,Ti thermoluminescent dosimeters placed at the extremities of the operating surgeon, the assistant and the scrub nurse. Doses for percutaneous nephrolithotomy (PCNL) procedures were calculated by extrapolating from the ureteral procedure thermoluminescent dosimeter data. Theoretical scattered radiation dose rates were also calculated. RESULTS: The average ureteral procedure fluoroscopy time was 78 seconds with an exposure rate of 71 kV, 2.4 mA. The surgeon received the highest radiation exposure with the lower leg (11.6 +/- 2.7 microGy) and foot (6.4 +/- 1.8 microGy) receiving more radiation than the eyes (1.9 +/- 0.5 microGy) and hands (2.7 +/- 0.7 microGy). For a predicted annual caseload of 50 ureteral cases, the dose received does not exceed 0.12% of the Ionising Radiations Regulations 1999 annual dose limit for adult workers. Radiation exposure during PCNLs is higher but does not exceed 2% of the annual dose limits even if 50 PCNLs are performed annually. CONCLUSIONS: Fluoroscopic screening results in radiation exposure of medical personnel. The estimate of maximum scatter radiation exposure to the surgeon for 50 PCNL procedures a year did not exceed 10 mGy. This amount is less than 2% of permissible annual limits of equivalent dose to the extremities. Medical personnel should be aware of scatter radiation risks and minimize radiation exposure when involved in fluoroscopic screening procedures.
Asunto(s)
Fluoroscopía/efectos adversos , Enfermedades Profesionales/etiología , Exposición Profesional/efectos adversos , Traumatismos por Radiación/etiología , Dispersión de Radiación , Dosimetría Termoluminiscente , Urología , Humanos , Nefrostomía Percutánea , Enfermedades Profesionales/prevención & control , Dosis de Radiación , Traumatismos por Radiación/prevención & control , Estudios Retrospectivos , Riesgo , Valores Limites del Umbral , Uréter/diagnóstico por imagen , Uréter/cirugía , Ureteroscopía , Pantallas Intensificadoras de Rayos X/efectos adversosRESUMEN
Stenosis and necrosis of the ureter are amongst the severe complications after renal transplantation. Several surgical techniques like simple nephrostomy or native pyeloureterostomy using the native ureter have been applied for repair. We report a case of modification to the conventional pyeloureterostomy where the native ureter was anastomosed to the transplant calyx to restore continuity of the urine collecting system. This technique is recommended as a feasible alternative when secondary reconstruction by native pyeloureterostomy is not possible.