RESUMEN
Between 1990 to 1993, 21 patients with tibial plateau or proximal tibial fractures resulting from high-energy trauma were treated with the Monticelli-Spinelli external fixator. There were 13 men and 8 women (mean age, 45.2 years; range, 26 to 78). There were a total of 5 type A, 2 type B, and 14 type C fractures, using the Arbeitsgemeinschaft Fur Osteosynthesefragen (AO) classification system. Immediate postoperative reductions were good or excellent, according to strict radiographic criteria, in 16 of 21 patients. All patients obtained at least 90 degrees of knee flexion, and only one patient lost more than 5 degrees of full extension. Complications included seven superficial pin-tract infections and one deep vein thrombosis with resultant pulmonary embolism. Nineteen patients were available for follow-up (mean, 14 months). Clinically, 13 patients had satisfactory results where good or excellent radiographic reductions were maintained, knee extension was within 5 degrees of full, flexion was > or = 90 degrees, with < or = 5 degrees valgus/varus angulation. Six patients had unsatisfactory results, not meeting the above criteria. The Monticelli-Spinelli external fixator is a much-needed tool in the treatment of high-energy tibial plateau fractures that are not amenable to more extensive surgical procedures because of the associated soft-tissue injuries.
Asunto(s)
Fijación de Fractura/instrumentación , Fracturas de la Tibia/terapia , Adulto , Anciano , Femenino , Fijación de Fractura/métodos , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
From April 1990 to August 1994, the GSH supracondylar intramedullary nail (Smith & Nephew/Richards, Memphis, Tennessee) was used to treat 23 supracondylar femur fractures in 22 patients. Nineteen of the 23 fractures were highly comminuted and intra-articular. Fifteen patients with 16 fractures were followed up to healing or declaration of nonunion for an average of 10 months. All fractures were treated with direct reduction through a median parapatellar incision. Fixation of the intercondylar fractures was with 6.5-mm cannulated screws, and the GSH nail was then inserted between the screws to secure the articular segment to the shaft. Fifteen of the 16 fractures healed (94%) with excellent and good results at an average of 3.3 months. Initial postoperative fracture reduction was maintained in all patients until union, as shown by follow-up radiographs. Thirteen of the 16 patients were treated with immediate continuous passive motion of the knee. Average knee range-of-motion was 109 degrees. Complications included 1 nonunion, 1 delayed union, 1 hardware failure secondary to premature full weight-bearing, and 1 patient with impingement of the nail in the intercondylar notch. This impingement resolved with removal of the nail after fracture healing. The GSH supracondylar intramedullary nail is an excellent alternative for the treatment of supracondylar and intercondylar femur fractures.
Asunto(s)
Clavos Ortopédicos , Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/instrumentación , Traumatismos de la Rodilla/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Curación de Fractura , Humanos , Traumatismos de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
Injuries to the lower extremity are common in racquet sports. These can be either acute or chronic. Although acute injuries usually respond to treatment, chronic injuries are often less amenable to treatment. The occurrence of both kinds of injuries, however, can often be prevented by proper training techniques including stretching and strengthening exercises. These exercises are also important components of a proper rehabilitation program.