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Intracapsular proximal femoral fracture is a frequent injury in elderly patients, often associated with low-energy trauma and reduced bone mass. In young patient, it is uncommon, usually caused by high-energy trauma and accompanied by damage to the adjacent soft tissues. However, reports of open intracapsular proximal femoral fracture due to indirect trauma are rare in the orthopedic literature. In the present article, we describe a case of this injury in a 35-year-old man involved in a car accident. The proximal femur was exposed at the gluteal region due to a mechanism similar to dislocation of the posterior hip. We describe the initial treatment and subsequent management until achieving a definitive solution using total hip arthroplasty and muscle transfer to reconstruct the abductor mechanism of the hip. At 10 months of follow-up, the patient presented good functional outcome, with gradual recovery of the abductive strength and a Harris Hip Score of 91 points. In addition, a radiographic study showed that the cemented total prosthesis was well-positioned. This therapeutic strategy (total hip arthroplasty with muscle transfer to reconstruct the abductor musculature) was successful to treat an intracapsular proximal femoral fracture with bone exposure.

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Abstract Intracapsular proximal femoral fracture is a frequent injury in elderly patients, often associated with low-energy trauma and reduced bone mass. In young patient, it is uncommon, usually caused by high-energy trauma and accompanied by damage to the adjacent soft tissues. However, reports of open intracapsular proximal femoral fracture due to indirect trauma are rare in the orthopedic literature. In the present article, we describe a case of this injury in a 35-year-old man involved in a car accident. The proximal femur was exposed at the gluteal region due to a mechanism similar to dislocation of the posterior hip. We describe the initial treatment and subsequent management until achieving a definitive solution using total hip arthroplasty and muscle transfer to reconstruct the abductor mechanism of the hip. At 10 months of follow-up, the patient presented good functional outcome, with gradual recovery of the abductive strength and a Harris Hip Score of 91 points. In addition, a radiographic study showed that the cemented total prosthesis was well-positioned. This therapeutic strategy (total hip arthroplasty with muscle transfer to reconstruct the abductor musculature) was successful to treat an intracapsular proximal femoral fracture with bone exposure.

Resumo A fratura intracapsular do fêmur proximal é uma lesão frequente no paciente idoso, e em geral está associada a trauma de baixa energia e redução da massa óssea. No jovem, esta lesão é pouco frequente, decorre de trauma de alta energia, e resulta em dano das partes moles adjacentes. Contudo, o relato de fratura intracapsular do fêmur proximal com exposição óssea por trauma indireto é raro na literatura ortopédica. Neste relato, esta lesão foi diagnosticada em um homem de 35 anos, vítima de acidente automobilístico. Mediante um mecanismo semelhante ao da luxação posterior do quadril, o segmento proximal do fêmur determinou exposição óssea através da região glútea. Foram descritos o tratamento inicial e os tratamentos subsequentes até a solução definitiva por artroplastia total do quadril associada a transposição muscular para reconstrução do mecanismo abdutor do quadril. Após 10 meses de seguimento, o paciente apresentava boa recuperação funcional, com retorno gradual da força abdutora, Harris Hip Score de 91 pontos, com estudo radiográfico revelando prótese total cimentada bem posicionada. A estratégia terapêutica utilizada neste paciente (artroplastia total do quadril com transferência muscular para a reconstrução da musculatura abdutora) foi uma solução eficiente para tratar a fratura intracapsular do fêmur proximal com exposição óssea.

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Introduction: Open fractures, although uncommon, with trauma have costs that exceed all other reasons for hospitalizations. Its epidemiology has fundamental importance to plan treatment and define priorities. Objective: To assess prospectively the epidemiological profile of open fractures and the degree of satisfaction with initial care. Methods: Epidemiological, prospective, descriptive, observational study was carried out in a convenience sample of open fractures. Quantitative, qualitative, and epidemiological aspects regarding open fractures were evaluated, as well as the degree of satisfaction with the initial care. Results: 124 patients treated with 155 open fractures. 88% were male; mean age 43 years (± 42.99); non-white (56.72%); married (52.41%); low level of education (51.60%); farmer, self-employed, bricklayer, industrialist (51.60%); with monthly earnings of up to 2 minimum wages (87%); healthy (76.13%); victims of labor accidents (39.51%) in bones of the hands (58.02%); 55% on the left side; attended between Thursday to Saturday (50%); work shift 6 a.m.-6 p.m. (77%). There was high level of satisfaction with the initial care provided (98%). Conclusion: Open fractures were related to healthy men, 43 years old, low education and low income, predominant in upper limbs, at 6 a.m. to 6 p.m., from Thursday to Saturday. Most were satisfied with the service provided. Level of Evidence II, Epidemiological, prospective, descriptive, observational study.

Introdução: As fraturas expostas, apesar de pouco comuns, têm custos que superam todos os outros motivos das internações. Sua epidemiologia é de fundamental importância para planejar o tratamento e definir prioridades. Objetivos: Avaliar prospectivamente o perfil epidemiológico das fraturas expostas e o grau de satisfação do atendimento inicial. Métodos: Estudo epidemiológico, prospectivo, descritivo, observacional, em amostra de conveniência das fraturas expostas. Avaliaram-se aspectos epidemiológicos quantitativos e qualitativos das fraturas expostas e o grau de satisfação com o atendimento inicial. Resultados: Foram atendidos 124 pacientes com 155 fraturas expostas. Desses, 88% eram do sexo masculino com média de idade 43 anos (± 42,99); não branco (56,72%); casado (52,41%); com baixo nível de instrução (51,60%); agricultor, autônomo, pedreiro ou industriário (51,60%); com ganho mensal de até dois salários-mínimos (87%); hígidos (76,13%); vítimas de acidentes trabalhistas (39,51%) nos ossos das mãos (58,02%); especialmente do lado esquerdo (55%); atendidos entre quinta-feira e sábado (50%); no período diurno (77%). Esses pacientes mostraram elevado nível de satisfação com o atendimento inicial realizado (98%). Conclusões: As fraturas expostas se relacionaram com homens hígidos, em torno de 43 anos, baixo grau de instrução e baixa renda, nos membros superiores, no período diurno de quinta a sábado. A maioria ficou satisfeita com o atendimento prestado. Nível de Evidência II, Estudo Epidemiológico, Prospectivo, Descritivo e Observacional.

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ABSTRACT Introduction: Open fractures, although uncommon, with trauma have costs that exceed all other reasons for hospitalizations. Its epidemiology has fundamental importance to plan treatment and define priorities. Objective: To assess prospectively the epidemiological profile of open fractures and the degree of satisfaction with initial care. Methods: Epidemiological, prospective, descriptive, observational study was carried out in a convenience sample of open fractures. Quantitative, qualitative, and epidemiological aspects regarding open fractures were evaluated, as well as the degree of satisfaction with the initial care. Results: 124 patients treated with 155 open fractures. 88% were male; mean age 43 years (± 42.99); non-white (56.72%); married (52.41%); low level of education (51.60%); farmer, self-employed, bricklayer, industrialist (51.60%); with monthly earnings of up to 2 minimum wages (87%); healthy (76.13%); victims of labor accidents (39.51%) in bones of the hands (58.02%); 55% on the left side; attended between Thursday to Saturday (50%); work shift 6 a.m.-6 p.m. (77%). There was high level of satisfaction with the initial care provided (98%). Conclusion: Open fractures were related to healthy men, 43 years old, low education and low income, predominant in upper limbs, at 6 a.m. to 6 p.m., from Thursday to Saturday. Most were satisfied with the service provided. Level of Evidence II, Epidemiological, prospective, descriptive, observational study.

RESUMO Introdução: As fraturas expostas, apesar de pouco comuns, têm custos que superam todos os outros motivos das internações. Sua epidemiologia é de fundamental importância para planejar o tratamento e definir prioridades. Objetivos: Avaliar prospectivamente o perfil epidemiológico das fraturas expostas e o grau de satisfação do atendimento inicial. Métodos: Estudo epidemiológico, prospectivo, descritivo, observacional, em amostra de conveniência das fraturas expostas. Avaliaram-se aspectos epidemiológicos quantitativos e qualitativos das fraturas expostas e o grau de satisfação com o atendimento inicial. Resultados: Foram atendidos 124 pacientes com 155 fraturas expostas. Desses, 88% eram do sexo masculino com média de idade 43 anos (± 42,99); não branco (56,72%); casado (52,41%); com baixo nível de instrução (51,60%); agricultor, autônomo, pedreiro ou industriário (51,60%); com ganho mensal de até dois salários-mínimos (87%); hígidos (76,13%); vítimas de acidentes trabalhistas (39,51%) nos ossos das mãos (58,02%); especialmente do lado esquerdo (55%); atendidos entre quinta-feira e sábado (50%); no período diurno (77%). Esses pacientes mostraram elevado nível de satisfação com o atendimento inicial realizado (98%). Conclusões: As fraturas expostas se relacionaram com homens hígidos, em torno de 43 anos, baixo grau de instrução e baixa renda, nos membros superiores, no período diurno de quinta a sábado. A maioria ficou satisfeita com o atendimento prestado. Nível de Evidência II, Estudo Epidemiológico, Prospectivo, Descritivo e Observacional.

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ABSTRACT Introduction: open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR). Methods: patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status. Results: Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score. Conclusions: Isolated open tibial shaft fractures are potentially harmful to the patient's quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.

RESUMO Introdução: o tratamento de fraturas expostas isoladas da diáfise da tíbia (FEIDT) apresenta desafios por frequentemente associar severa lesão óssea com condições ruins de tecido mole, fatores relevantes em países de média e baixa renda, especialmente devido a atrasos na implementação da fixação definitiva e falta de treinamento adequado no manejo de tecidos moles. Consequentemente, FEIDTs representam importante fonte de incapacitação na América Latina. Este estudo objetivou apresentar uma visão geral das FEIDTs em sete hospitais do cone sul da América Latina. O objetivo secundário foi avaliar o seu impacto na qualidade de vida baseado na taxa de retorno ao trabalho (TRT). Métodos: foram incluídos no estudo pacientes com FEIDT tratados em sete hospitais de Brasil e Argentina entre novembro de 2017 e março de 2020. Resultados clínicos e radiográficos foram analisados num período de 120 dias. Avaliação final comparou TRT com o questionário SF-12, consolidação óssea e condições de marcha. Resultados: setenta e dois pacientes foram tratados, 57 seguidos por 120 dias e 48 completaram o questionário SF-12. Após 120 dias, 70,6% havia retornado ao trabalho, 61,4% tinha fratura consolidada. Idade, antibioticoterapia, tipo de tratamento definitivo e infecção influenciaram significativamente na TRT. A condição de marcha apresentou forte correlação com TRT e o componente físico do SF-12. Conclusão: FEIDTs são potencialmente deletérias à qualidade de vida dos pacientes 120 dias após o tratamento inicial. TRT é significativamente maior para pacientes mais jovens, sem história de infecção e que conseguem correr na avaliação da condição de marcha..

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RESUMEN Fundamento: las fracturas de la meseta tibial son lesiones traumáticas frecuentes por lo general son provocadas por mecanismos de compresión vertical en varo o valgo, de allí la incidencia de fracturas abiertas con pérdida de piel no son frecuentes, ya que estas responden por lo general a mecanismos directos. Objetivo: presentar el caso de una paciente con fractura abierta de la meseta tibial tipo VI de Schatzker J. Presentación del caso: paciente de 61 años de edad, mestiza, femenina sin antecedentes mórbidos de salud, la cual sufre accidente del tránsito al proyectarse contra un camión y es traída al servicio de urgencias de Ortopedia y Traumatología por presentar dolor e inflamación a nivel de la rodilla y pierna izquierda, que le impide la marcha y los movimientos, además de presentar herida avulsiva de base distal que se comunicaba con el foco de fractura. El examen radiográfico simple de la rodilla izquierda en proyecciones anteroposterior y lateral mostró solución de continuidad del tejido óseo a nivel de la zona metafiso-epifisaria de la tibia proximal izquierda. El tratamiento definitivo de la paciente consistió en la colocación de tornillo canulado y fijación externa tipo Hoffman 1® mediante dos anclajes en el fémur y tibia. Conclusiones: las fracturas de la meseta tibial tipo VI de Schatzker J, son lesiones traumáticas de difícil tratamiento debido a su asociación a complicaciones como: comunicación con el exterior y pérdida de piel. La fijación externa es un método de osteosíntesis útil y de fácil aplicación, que permite el tratamiento de estas lesiones complicadas.

ABSTRACT Background: tibial plateau fractures are common traumatic lesions due to vertical compression in varus and valgus. That is why open fractures associated to skin loss are not so frequent, because they are caused by direct mechanisms. Objetive: to present the case of a patient with an open fracture of the tibial plateau type VI by Schatzker J. Case report: a 61 year old mixed race, woman without health morbid antecedents, who after having a traffic accident was taken to emergency room of Orthopedics and Traumatology complaining of pain, swelling and limitation of movement of the left knee and leg. Simple imaging examination in antero-posterior and lateral views showed a structural break in the continuity of bone at epiphysis and metaphysis in the left proximal tibia. Definite treatment consisted of an osteosynthesis with cannulated screw and fixation by an external device type Hoffmann 1 with two pins in femur and tibia respectively. Conclusions: tibial plateau fractures type VI according to Schatzker J classification system are difficult to treat because of associated lesions and complications as open fractures and skin loss. External fixation is a useful and easy method to fix complex fractures as tibial plateau fractures.

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Abstract Purpose To evaluate different concentrations of ciprofloxacin to prevent infection after open fracture contaminated with S. aureus in rats using absorbable local delivery system. Methods Fifty-two Wistar rats were assigned to six groups. After 4 weeks, all animals underwent 99mTc-ceftizoxima scintigraphy evaluation, callus formation measurement and histological analysis. ANOVA, t-Student and Kruskal Wallis were used for quantitative variables statistical analysis, whereas qui square and exact Fisher were used for qualitative variables. Results Treatment using 25% and 50% of ciprofloxacin incorporated at the fracture fixation device were effective in preventing bone infection compared to control group (p<0.05). Chitosan were not effective in preventing bone infection when used alone compared to control group (p>0.05). Histological findings demonstrated bone-healing delay with 50% of ciprofloxacin. No difference in callus formation were observed (p>0.05). Conclusion Local delivery treatment for contaminated open fracture using chitosan with ciprofloxacin is effective above 25%.

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SUMMARY OBJECTIVE To investigate the clinical efficacy of cefazolin sodium pentahydrate combined with vacuum sealing drainage (VSD) in the treatment of open fracture complicated with soft tissue injury. METHODS Sixty-three patients with open fracture complicated with soft tissue injury were divided into observation (n = 33) and control (n = 30) groups. After surgical reduction, fixation, and repair of the fractures, the control group was treated with VSD for 10 days, and the observation group was treated with cefazolin sodium pentahydrate based on VSD for 10 days. The infection control time was recorded. After treatment, the pain of patients was evaluated. Before and after treatment, the serum levels of C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumor necrosis factor α (TNF-α), cortisol, epinephrine, norepinephrine, and glucose were detected. After 6 months of treatment, the total effective rate of the treatment was evaluated. RESULTS The infection control time and Visual Analogue Scale score after treatment in the observation group were significantly lower than in the control group, respectively (P < 0.05). After the treatment, the serum levels of CRP, IL-6, IL-8, TNF-α, cortisol, epinephrine, norepinephrine, and glucose in each group were significantly lower than before the treatment (P < 0.05), and each index in observation was significantly lower than in the control group (P < 0.05). CONCLUSIONS In the treatment of open fractures complicated with soft tissue injury, cefazolin sodium pentahydrate combined with VSD can effectively reduce inflammation and stress, thus improving the treatment efficacy.

RESUMO OBJETIVO Investigar a eficácia clínica do cefazolin penta-hidrato de sódio combinado com drenagem por vedação a vácuo (VSD) no tratamento da fratura exposta complicada com lesão nos tecidos moles. MÉTODOS Sessenta e três doentes com fratura exposta complicada com lesões nos tecidos moles foram divididos em grupos de observação (n=33) e controle (n=30). Após redução cirúrgica, fixação e reparação da fratura, o grupo de controle foi tratado com VSD durante dez dias e o grupo de observação foi tratado com cefazolina penta-hidrato de sódio com base no VSD durante dez dias. O tempo de controle de infecção foi gravado. Após o tratamento, a dor dos doentes foi avaliada. Antes e após o tratamento, foram detectados os níveis séricos de proteína C-reativa (CRP), interleucina (IL)-6, IL -8, fator de necrose tumoral alfa (TNF-α), cortisol, epinefrina, norepinefrina e glicose. Após seis meses de tratamento, a taxa efetiva total de tratamento foi avaliada. RESULTADOS O tempo de controle da infecção e a pontuação da Escala Visual Analógica após o tratamento no grupo de observação foram significativamente inferiores ao do grupo de controle, respectivamente (P<0,05). Após o tratamento, os níveis séricos de CRP, IL-6, IL-8, TNF-α, cortisol, epinefrina, norepinefrina e glicose em cada grupo foram significativamente menores do que antes do tratamento, respectivamente (P<0,05), e cada índice de observação foi significativamente inferior ao do grupo de controle (P<0,05). CONCLUSÃO No tratamento da fratura exposta complicada com lesões nos tecidos moles, o cefazolin penta-hidrato de sódio combinado com VSD pode efetivamente reduzir a inflamação e o estresse, melhorando assim a eficácia do tratamento.

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Purpose To evaluate different concentrations of ciprofloxacin to prevent infection after open fracture contaminated with S. aureus in rats using absorbable local delivery system. Methods Fifty-two Wistar rats were assigned to six groups. After 4 weeks, all animals underwent 99mTc-ceftizoxima scintigraphy evaluation, callus formation measurement and histological analysis. ANOVA, t-Student and Kruskal Wallis were used for quantitative variables statistical analysis, whereas qui square and exact Fisher were used for qualitative variables. Results Treatment using 25% and 50% of ciprofloxacin incorporated at the fracture fixation device were effective in preventing bone infection compared to control group (p<0.05). Chitosan were not effective in preventing bone infection when used alone compared to control group (p>0.05). Histological findings demonstrated bone-healing delay with 50% of ciprofloxacin. No difference in callus formation were observed (p>0.05). Conclusion Local delivery treatment for contaminated open fracture using chitosan with ciprofloxacin is effective above 25%.(AU)

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INTRODUCTION: Tibia shaft fractures are among the most common in orthopedic practice, but Brazilian literature remains limited on the subject. OBJECTIVE: To evaluate the characteristics of tibia shaft fractures and conduct a comparison between exposed and closed fractures of the tibia. METHODS: This comparative prospective study examined all tibia shaft fractures admitted to our services over a twelve-month period. The cases were evaluated according to age, trauma mechanism, sex, associated fractures, treatment, hospital stay, and readmission rate during the six months after discharge. RESULTS: Fifty-three cases met the inclusion criteria. The average age was 36 years (SD 14.3) and 83% were males (p<0.001). Traffic accidents were responsible for 73.6% of fractures (p<0.001). Exposed fractures were found in 52.8% of the cases (p=0.56). When initial treatment consisted of stabilization with external fixation, these cases were more likely to be rehospitalized (p=0.009). Cases of open fracture also had longer hospital stays (p<0.001) and a higher readmission rate (p=0.028). CONCLUSION: Open fractures are associated with more severe trauma, expressed in longer hospital stays and high rates of readmission. Cases of fracture which were initially treated with external fixation had a higher readmission rate. Level of Evidence II; Prospective comparative study.

INTRODUÇÃO: Fratura diafisária de tíbia é uma das fraturas mais comuns na prática ortopédica, porém a literatura brasileira ainda é limitada na sua avaliação. OBJETIVO: Avaliar as características das fraturas diafisárias de tíbia e realizar uma comparação entre as expostas e fechadas. MATERIAL E MÉTODOS: Foi realizado um estudo, prospectivo comparativo por 12 meses, com todas as fraturas diafisárias de tíbia admitidas. Os pacientes foram avaliados nos seguintes critérios: idade, mecanismo de trauma, sexo, fraturas associadas, tratamento, tempo de internação e índice de reinternação nos seis meses subsequentes à alta. RESULTADOS: Foram avaliados 53 casos que se encaixavam nos critérios de inclusão. A idade média dos pacientes avaliados no nosso estudo era de 36 anos (DP14,3), 83% eram homens (p<0,001). Acidente de tráfego foi responsável por 73,6% (p<0,001). Lesões expostas foram encontradas em 52,8% (p=0,56). O fixador externo, quando utilizado como método de estabilização inicial, apresentou maior índice de reinternação (p=0,009). As lesões expostas apresentaram tempo de internação (p<0,001) e índice de reinternação superior as fechadas (p=0,028). CONCLUSÕES: As fraturas expostas estão envolvidas com traumas de maior gravidade, tanto pelo tempo aumentado de internação hospitalar quanto pelo alto índice de reinternação. Fraturas tratadas inicialmente com fixador externo apresentam maior taxa de reinternação. Nível de Evidência II; Estudo prospectivo comparativo.

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ABSTRACT Introduction Tibia shaft fractures are among the most common in orthopedic practice, but Brazilian literature remains limited on the subject. Objective To evaluate the characteristics of tibia shaft fractures and conduct a comparison between exposed and closed fractures of the tibia. Methods This comparative prospective study examined all tibia shaft fractures admitted to our services over a twelve-month period. The cases were evaluated according to age, trauma mechanism, sex, associated fractures, treatment, hospital stay, and readmission rate during the six months after discharge. Results Fifty-three cases met the inclusion criteria. The average age was 36 years (SD 14.3) and 83% were males (p<0.001). Traffic accidents were responsible for 73.6% of fractures (p<0.001). Exposed fractures were found in 52.8% of the cases (p=0.56). When initial treatment consisted of stabilization with external fixation, these cases were more likely to be rehospitalized (p=0.009). Cases of open fracture also had longer hospital stays (p<0.001) and a higher readmission rate (p=0.028). Conclusion Open fractures are associated with more severe trauma, expressed in longer hospital stays and high rates of readmission. Cases of fracture which were initially treated with external fixation had a higher readmission rate. Level of Evidence II; Prospective comparative study.

RESUMO Introdução Fratura diafisária de tíbia é uma das fraturas mais comuns na prática ortopédica, porém a literatura brasileira ainda é limitada na sua avaliação. Objetivo Avaliar as características das fraturas diafisárias de tíbia e realizar uma comparação entre as expostas e fechadas. Material e Métodos Foi realizado um estudo, prospectivo comparativo por 12 meses, com todas as fraturas diafisárias de tíbia admitidas. Os pacientes foram avaliados nos seguintes critérios: idade, mecanismo de trauma, sexo, fraturas associadas, tratamento, tempo de internação e índice de reinternação nos seis meses subsequentes à alta. Resultados Foram avaliados 53 casos que se encaixavam nos critérios de inclusão. A idade média dos pacientes avaliados no nosso estudo era de 36 anos (DP14,3), 83% eram homens (p<0,001). Acidente de tráfego foi responsável por 73,6% (p<0,001). Lesões expostas foram encontradas em 52,8% (p=0,56). O fixador externo, quando utilizado como método de estabilização inicial, apresentou maior índice de reinternação (p=0,009). As lesões expostas apresentaram tempo de internação (p<0,001) e índice de reinternação superior as fechadas (p=0,028). Conclusões As fraturas expostas estão envolvidas com traumas de maior gravidade, tanto pelo tempo aumentado de internação hospitalar quanto pelo alto índice de reinternação. Fraturas tratadas inicialmente com fixador externo apresentam maior taxa de reinternação. Nível de Evidência II; Estudo prospectivo comparativo.

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Fundamento: en una fractura abierta existe penetración del hueso a través de la piel con una lesión acompañante, de gravedad variable, en el tejido blando subyacente. Los fijadores externos son un sistema idóneo para su tratamiento.Objetivo: evaluar la evolución de pacientes con fracturas abiertas en los que se utilizó el fijador externo RALCA ® como parte del tratamiento.Métodos: estudio prospectivo, longitudinal, sobre 253 pacientes atendidos entre enero del 2000 y diciembre del 2014, en el Hospital Julio Aristegui Villamil con el diagnóstico de fractura abierta, a los que se les colocó un fijador externo RALCA®. Se analizó: etiología del trauma, localización y tipo de fractura, presencia de infección, no unión, necesidad de otras intervenciones quirúrgicas, tiempo de seguimiento, tiempo de la consolidación e incorporación a la vida social activa. Resultados: predominaron los pacientes del sexo masculino (62,4 %),entre 30 y 50 años (49,7 %), con fracturas abiertas, tipo I (33,5 %) y II (25,2 %) de Gustilo, ocasionadas por accidentes del tránsito (44,6 %), más frecuentes en la tibia (41,8 %). El uso del fijador externo RALCA® posibilitó la aplicación de montajes multiplano (58,1 %) y compresión del foco fracturario (85,3 %) para estimular la consolidación. En el 4,7 % de los pacientes hubo necesidad de otra intervención quirúrgica. El tiempo de consolidación varió en dependencia de la magnitud del daño de las partes blandas. El retardo de la consolidación (7,1 %) y la osteítis del alambre (5,5 %) fueron las complicaciones más frecuentes. El 79,4 % de los pacientes se reincorporó a su vida social activa antes del primer año de evolución. Conclusiones: la versatilidad de montajes del fijador externo RALCA® permite utilizarlo como método de osteosíntesis en fracturas abiertas de disímil localización, logra estabilizar la lesión y proteger el aporte vascular que ofrecen las partes blandas al tejido óseo.

Foundation: In an open fracture there is penetration of bone through the skin with an accompanying lesion, of varying severity, in the underlying soft tissue. External fixators are ideal systems for their treatment. Objective: to evaluate the evolution of patients with open fractures in whom the RALCA ® external fixator was used as part of the treatment.Methods: A prospective, longitudinal study of 253 patients attended between January 2000 and December 2014 at the Julio Aristegui Villamil Hospital with the diagnosis of open fracture, who were placed an external RALCA® fixator. It was analyzed: trauma etiology, location and type of fracture, presence of infection, non-union, need for other surgical interventions, follow-up time, consolidation time and incorporation into active social life. Results: Male patients (62.4%), between 30 and 50 years (49.7%), with open fractures, type I (33.5%) and II (25.2%) Gustilo, caused by traffic accidents (44.6%), more frequent in the tibia (41.8%) were the most frequent. The use of the RALCA® external fixator made it possible to apply multiplane (58.1%) and compression of the fracture focus (85.3%) to stimulate consolidation. In 4.7% of the patients there was a need for another surgical intervention. The time of consolidation varied depending on the magnitude of soft tissue damage. Conclusions: the versatility of RALCA® external fixator assemblies allows it to be used as a method of osteosynthesis in open fractures of different locations; it stabilizes the lesion and protects the vascular supply of the soft tissue to the bone tissue.

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An open fracture of the calcaneus with loss of substance is a challenging injury and requires specialized care, involves high costs, and demands attention despite its lower incidence. The main complications are osteomyelitis, pressure ulcers, and fistulas, as well as pain conditions in the lateral, medial, and plantar regions. This is due to the wide loss of tissue and the change in anatomical conformation of the calcaneus in some cases. However, in cases of flattening of the calcaneus bone, these complications may be prevented or treated successfully. This technical note describes the resection osteotomy technique for calcaneus flattening to prevent and treat complications after micro-surgical flap in cases of open fracture or loss of substance.

A fratura exposta do calcâneo com perda de substância é uma lesão desafiadora, demanda cuidados especializados, envolve elevados custos e exige atenção, apesar de sua menor incidência. As principais complicações são osteomielite, úlceras de pressão, fistulas, além de quadros álgicos nas regiões lateral, medial e plantar. Essa relação se deve à grande perda de tecido e à mudança da conformação anatômica do calcâneo em alguns casos. Porém, quando ocorre uma modelação do formato ósseo do calcâneo com seu aplainamento, essas complicações podem ser prevenidas ou tratadas com sucesso. O objetivo desta nota técnica é descrever a técnica de osteotomia de ressecção para aplainamento do calcâneo na prevenção e no tratamento de complicações após retalho microcirúrgico em casos de fratura exposta ou perda de substância.

RESUMEN

ABSTRACT An open fracture of the calcaneus with loss of substance is a challenging injury and requires specialized care, involves high costs, and demands attention despite its lower incidence. The main complications are osteomyelitis, pressure ulcers, and fistulas, as well as pain conditions in the lateral, medial, and plantar regions. This is due to the wide loss of tissue and the change in anatomical conformation of the calcaneus in some cases. However, in cases of flattening of the calcaneus bone, these complications may be prevented or treated successfully. This technical note describes the resection osteotomy technique for calcaneus flattening to prevent and treat complications after micro-surgical flap in cases of open fracture or loss of substance.

RESUMO A fratura exposta do calcâneo com perda de substância é uma lesão desafiadora, demanda cuidados especializados, envolve elevados custos e exige atenção, apesar de sua menor incidência. As principais complicações são osteomielite, úlceras de pressão, fistulas, além de quadros álgicos nas regiões lateral, medial e plantar. Essa relação se deve à grande perda de tecido e à mudança da conformação anatômica do calcâneo em alguns casos. Porém, quando ocorre uma modelação do formato ósseo do calcâneo com seu aplainamento, essas complicações podem ser prevenidas ou tratadas com sucesso. O objetivo desta nota técnica é descrever a técnica de osteotomia de ressecção para aplainamento do calcâneo na prevenção e no tratamento de complicações após retalho microcirúrgico em casos de fratura exposta ou perda de substância.

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RESUMEN

La úlcera de Marjolin es un tumor maligno cutáneo, raro y agresivo, que se desarrolla en la piel previamente traumatizada o con inflamación crónica. Se presenta un paciente masculino, blanco, de 43 años de edad, aquejado por una lesión ulcerada, sangrante y exofítica, en el tercio distal de la pierna izquierda, donde ya tenía una gran cicatriz a causa de una fractura abierta de tibia y peroné, que además presentó osteomielitis crónica como complicación. Se realizó exéresis y biopsia de la lesión, y se obtuvo como resultado un carcinoma epidermoide de tipo espino celular, compatible con una úlcera de Marjolin. Se decide presentar este caso por la baja frecuencia de presentación de la enfermedad. Se concluye que los pacientes con este tipo de lesión deberán ser sometidos a exámenes periódicos para evitar o solucionar posibles recidivas.

Marjolin’s ulcer is rare and aggressive cutaneous malignancy that develops in previously traumatized or chronically inflamed skin. We present the case of a 43-year-old white man suffering from an exophytic bleeding ulcerated lesion on the distal third of the left leg where he already had a large scar from a compound fracture of the tibia and fibula complicated with chronic osteomyelitis. Surgical excision and biopsy were performed, showing a squamous cell carcinoma consistent with Marjolin’s ulcer. We decided to present this case given the rare occurrence of the disease. We concluded that patients with this type of lesion should be subject to periodic examinations to prevent or treat potential recurrences.

RESUMEN

OBJECTIVES: To determine whether a time delay greater than 6h from injury to surgical debridement influences the infection rate in open fractures. METHODS: During a period of 18 months, from October 2010 to March 2012, 151 open fractures were available for study in 142 patients in our hospital. The data were collected prospectively and the patients were followed up for 6 weeks. The patients were divided into two groups regarding the time delay from injury to surgical debridement (more or less than 6 hours). RESULTS: Surgical debridement was carried out in less than 6h from injury in 90 (59.6%) fractures and after 6 hours from injury in 61 (40.4%) fractures. Infection rates were 12.22% and 13.24%, respectively. The global infection rate was 13.24%. CONCLUSION: A significantly increased infection rate was not observed in patients whose surgical debridement occurred more than 6h after injury. However, in the fractures of high-energy trauma, a statistically significant increase of the rate of infection was observed in those operated 6 hours after trauma. Level of Evidence II, Study Type Comparative and Prospective.

RESUMEN

Objectives: To determine whether a time delay greater than 6h from injury to surgical debridement influences the infection rate in open fractures. Methods: During a period of 18 months, from October 2010 to March 2012, 151 open fractures were available for study in 142 patients in our hospital. The data were collected prospectively and the patients were followed up for 6 weeks. The patients were divided into two groups regarding the time delay from injury to surgical debridement (more or less than 6 hours). Results: Surgical debridement was carried out in less than 6h from injury in 90 (59.6%) fractures and after 6 hours from injury in 61 (40.4%) fractures. Infection rates were 12.22% and 13.24%, respectively. The global infection rate was 13.24%. Conclusion: A significantly increased infection rate was not observed in patients whose surgical debridement occurred more than 6h after injury. However, in the fractures of high-energy trauma, a statistically significant increase of the rate of infection was observed in those operated 6 hours after trauma. Level of Evidence II, Study Type Comparative and Prospective.

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La fractura expuesta de tobillo se presenta de forma esporádica en la práctica de la traumatología. Su evolución clínica está sujeta a múltiples factores, con una propensión hacia la osteoartritis del tobillo con el transcurso de los años. Se presentan dos casos atendidos en el Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos, a los que se les realizó el tratamiento quirúrgico de urgencia consistente en la limpieza quirúrgica de la lesión expuesta, reducción de la luxación y la fijación interna de la fractura. Por la poca frecuencia en la presentación de este tipo de lesión del tobillo y por el interés que puede presentar para el personal médico, en especial para los médicos traumatólogos, se decidió la presentación de estos casos.

Open ankle fracture is sporadically seen in the orthopedic practice. Its clinical course is subject to multiple factors, showing a propensity to cause ankle osteoarthritis over the years. Two cases treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos are presented. The patients underwent emergency surgical treatment consisting of surgical cleaning of the open wound, reduction of the dislocation and internal fixation of the fracture. These cases are presented due to the infrequency of this type of ankle injury and its importance for the medical staff, especially orthopedic doctors.

RESUMEN

OBJECTIVE: To assess socio-demographic characteristics of individuals that suffered open fractures caused by motorcycle traffic accident and evaluate infection rate in search of associated risk factors. METHODS: A retrospective study comprising 81 patients with open fractures caused by motorcycle accidents was carried out. Clinic and socio-demographic features were collected from patients' records. Comparison between infected and non-infected patients was performed to find out which variables were possibly associated to this complication. RESULTS: Patients were mostly young adults (mean 32.9 years old), of the masculine gender (83.9%), single (60.5%), from the country side (40.7%), mostly presenting tibial open fractures (48.2%). Fractures type IIIA and type IIIB were the most prevalent lesions (68,8%), and soft tissue damage graded as I and II were the most frequent (64.62%). Infection was present in 23.7% of the patients and it was associated to age higher than 40 years old (p=0.011), to time delay from trauma to first surgical procedure longer than 24 hours (p=0,012), and also to soft tissue damage extent (p=0.001). CONCLUSIONS: Patients with open fractures caused by motorcycle traffic accident were mostly young single men, coming from the state capital and presented severe tibial open fractures, which 23.7% of the cases progressed to infection. Level of Evidence III, Retrospective Comparative Study.