RESUMO
INTRODUCTION: A traumatic event to the tibia with more than 14 cm of bone and soft tissue loss represents a challenge to most orthopedic surgeons and is considered a limb-threatening condition. Few solutions are available in such clinical situations and among them is the acute shortening and re-lengthening of bone and soft tissue. MATERIALS AND METHODS: Our study presents the management of 7 patients with grade III B open fractures (according to the Gustillo-Anderson classification) of the tibia who underwent resection of all the devitalized tissues, acute limb shortening to close the defect, application of an external fixator, and metaphyseal osteotomy for re-lengthening. The patient outcomes were based on different parameters using the evaluation system established by Paley et al. RESULTS: Results acquired during the study show an average bone loss of 19cm (with a minimum of 14 cm and a maximum of 31.50cm). The average time to full recovery of all patients was 19 months with a minimum of 14 months and a max of 34 months. Patient presented with excellent bony union and none existent or small refractory leg length discrepancy and did not require bone grafts or free flaps. Complications that the patients had were contractures, which required secondary procedures such as Achilles tendon re-lengthening and recurrent infections. DISCUSSION: Overall patients had excellent bone union and were able to perform activities of their daily living. The Ilizarov technique of compression-dis- traction osteogenesis is an elegant treatment option that should be considered in patients suffering such traumatic events providing excellent bony union and good functional outcomes for the patient.
Assuntos
Fraturas Expostas/cirurgia , Desigualdade de Membros Inferiores/cirurgia , Lesões dos Tecidos Moles/etiologia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Fixadores Externos , Fixação de Fratura/métodos , Consolidação da Fratura/fisiologia , Humanos , Técnica de Ilizarov , Desigualdade de Membros Inferiores/etiologia , Osteotomia/métodos , Recuperação de Função Fisiológica , Lesões dos Tecidos Moles/patologia , Fraturas da Tíbia/complicações , Fatores de Tempo , Adulto JovemRESUMO
Humeral shaft non-unions occur in 2-10% of all fracture cases. Increased incidence of these non-unions can be associated with ORIF, comminution, high impact injuries, bone loss or fracture gaping. Treatment guidelines for fracture non-union state that fractures with gaps greater than 4 cm should be treated with vascularized fibular autografts or transportation with an external fixator. Unfortunately these modalities carry considerable donor site morbidity and patient will experience considerable discomfort, especially when dealing with an external fixator. This report demonstrates how the use of a nonvascularized fibular strut can be effectively utilized as an alternate treatment modality for large humeral shaft non-union gaps. Further studies should be conducted to support this method as a viable treatment option for non-union gaps greater than 4 cm.
Assuntos
Matriz Óssea/transplante , Proteínas Morfogenéticas Ósseas/uso terapêutico , Fíbula/transplante , Fraturas não Consolidadas/cirurgia , Fraturas do Úmero/cirurgia , Feminino , Fixação Interna de Fraturas , Fraturas não Consolidadas/complicações , Humanos , Fraturas do Úmero/complicações , Infecções/complicações , Pessoa de Meia-IdadeRESUMO
La lepra es una enfermedad infecciosa crónica causada por el Mycobacterium leprae. Afecta la piel, mucosa de las vías respiratorias altas, ojos y nervios periféricos. El período de incubación de la enfermedad es, en promedio, de cinco años. Los síntomas pueden tardar hasta veinte años en aparecer. Es una enfermedad muy antigua; las antiguas civilizaciones de China, Egipto e India, muestran evidencia de casos de lepra, aproximadamente hacia el año 600 a. C. Actualmente existen zonas con alta incidencia en África, Asia y América Latina. En el presente artículo se describe un caso de Lepra lepromatosa, proveniente del suroriente de Venezuela y sus características inmunológicas, clínicas y diagnósticas con el fin de generar interés por la sospecha diagnóstica en pacientes con manifestaciones como las vistas en este paciente.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It affects the skin, upper respiratory mucosae, eyes and peripheral nerves. The incubation period of the disease is, on average, five years. Symptoms can take up to twenty years to appear. It is a very ancient disease, the eartly civilizations of China, Egypt and India, show evidence of leprosy cases, around the year 600 B. C. referido a nuestro hospital, donde se ingresa. Currently there are areas with high incidence in Africa, Asia and Latin America. In this article a case of lepromatous leprosy, from the southeastern Venezuela and its immunological characteristics are described in order to generate interest and social conscience in this epidemiological problem.