RESUMO

SUMMARY: The objective of this study was to compare and analyze the clinical efficacy of different approaches of intramedullary nailing with blocking screws for proximal tibial fractures. One hundred cases of proximal tibial fractures treated in the orthopedic department from April 2021 to September 2023 were included in the study and divided into control and treatment groups using a random number table. A control group (n=50) treated with infrapatellar intramedullary nailing with blocking screws, and a treatment group (n=50) treated with suprapatellar intramedullary nailing with blocking screws. We observed the excellent and good rates in both groups, compared various perioperative indicators, changes in joint range of motion (ROM), Visual Analog Scale (VAS) pain scores, Lysholm knee joint function scores, changes in inflammatory factors, and various bone markers before and after treatment, and analyzed postoperative complications. There were no significant differences in baseline data such as age, sex, body mass index, fracture site, concomitant fibular fractures, time from fracture to surgery, injury mechanism, and AO/OTA fracture classification between the two groups (P>0.05). The excellent and good rate in the treatment group after treatment was 90.00 % (45/50), significantly higher than 72.00 % (36/50) in the control group (P0.05). However, the treatment group had shorter surgical times and fewer fluoroscopy times than the control group (P<0.05). After treatment, both groups showed increased ROM and Lysholm scores, as well as decreased VAS scores. Moreover, compared to the control group, the treatment group had higher ROM and Lysholm scores and lower VAS scores (P<0.05). Inflammatory factors including interleukin-1β (IL-1β), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), osteocalcin (BGP), and calcitonin (CT) increased in both groups after treatment, while total n- terminal propeptide of type I procollagen (Total-PINP) and b-C-terminal telopeptide of type I collagen (β-CTX) decreased. Compared to the control group, the treatment group exhibited greater increases in inflammatory factors and lower levels of Total-PINP and β-CTX, but higher BGP and CT levels (P<0.05). The incidence of postoperative complications was 8.00 % (4/50) in the treatment group and 24.00 % (12/50) in the control group, with statistically significant differences (P=4.762, X2=0.029). In the treatment of proximal tibial fractures, intramedullary nailing with blocking screws using the suprapatellar approach achieves significant clinical efficacy. It reduces surgical time, minimizes radiation exposure to healthcare workers and patients, improves knee joint range of motion and function, decreases postoperative pain and complication rates, suppresses inflammatory reactions, and promotes the improvement of bone markers related to fracture healing.

El objetivo de este estudio fue comparar y analizar la eficacia clínica de diferentes abordajes de clavo intramedular con tornillos de bloqueo para las fracturas de tibia proximal. Se incluyeron en el estudio 100 casos de fracturas de tibia proximal tratados en el departamento de ortopedia desde abril de 2021 hasta septiembre de 2023 y se dividieron en grupos de control y de tratamiento mediante una tabla de números aleatorios. Un grupo control (n=50) tratado con clavo intramedular infrapatelar con tornillos de bloqueo, y un grupo tratamiento (n=50) tratado con clavo intramedular suprapatelar con tornillos de bloqueo. Observamos excelentes y buenas tasas en ambos grupos, comparamos varios indicadores perioperatorios, cambios en el rango de movimiento articular (ROM), puntuaciones de dolor en la escala visual analógica (EVA), puntuaciones de función Lysholm de la articulación de la rodilla , cambios en factores inflamatorios y varios marcadores óseos, antes y después del tratamiento, y se analizaron las complicaciones postoperatorias. No hubo diferencias significativas en los datos iniciales como edad, sexo, índice de masa corporal, sitio de fractura, fracturas de fíbula concomitantes, tiempo desde la fractura hasta la cirugía, mecanismo de lesión y clasificación de fractura AO/OTA entre los dos grupos (P>0,05). La tasa de excelente y buena en el grupo con tratamiento después del tratamiento fue del 90,00 % (45/50), significativamente mayor que el 72,00 % (36/50) en el grupo control (P0,05). Sin embargo, el grupo con tratamiento tuvo tiempos quirúrgicos más cortos y menos tiempos de fluoroscopía que el grupo control (P <0,05). Después del tratamiento, ambos grupos mostraron un aumento de las puntuaciones de ROM y Lysholm, así como una disminución de las puntuaciones de VAS. Además, en comparación con el grupo control, el grupo con tratamiento tuvo puntuaciones ROM y Lysholm más altas y puntuaciones EVA más bajas (P <0,05). Los factores inflamatorios que incluyen interleucina-1β (IL-1β), proteína C reactiva (CRP), factor de necrosis tumoral-α (TNF-α), osteocalcina (BGP) y calcitonina (CT) aumentaron en ambos grupos después del tratamiento, mientras que el total disminuyó el propéptido n-terminal del procolágeno tipo I (Total-PINP) y el telopéptido β-C-terminal del colágeno tipo I (β-CTX). En comparación con el grupo control, el grupo con tratamiento mostró mayores aumentos en los factores inflamatorios y niveles más bajos de Total-PINP y β-CTX, pero niveles más altos de BGP y CT (P <0,05). La incidencia de complicaciones postoperatorias fue del 8 % (4/50) en el grupo de tratamiento y del 24 % (12/50) en el grupo control, con diferencias estadísticamente significativas (P=4,762, X2=0,029). En el tratamiento de las fracturas de tibia proximal, el clavo intramedular con tornillos de bloqueo mediante el abordaje suprapatelar logra una eficacia clínica significativa. Reduce el tiempo quirúrgico, minimiza la exposición a la radiación de los trabajadores de la salud y los pacientes, mejora el rango de movimiento y la función de la articulación de la rodilla, disminuye el dolor postoperatorio y las tasas de complicaciones, suprime las reacciones inflamatorias y promueve la mejora de los marcadores óseos relacionados con la curación de las fracturas.

Assuntos

RESUMO

Objective: Identify the predictors associated with delayed union at 6 months and non-union at 12 months in tibial shaft fractures treated with intramedullary nailing (IMN). Methods: This retrospective longitudinal study included a cohort of 218 patients who sustained tibial shaft fractures and received IMN between January 2015 and March 2022. We gathered data on a range of risk factors, including patient demographics, trauma intensity, associated injuries, fracture characteristics, soft tissue injuries, comorbidities, addictions, and treatment-specific factors. We employed logistic bivariate regression analysis to explore the factors predictive of delayed union and non-union. Results: At the 6-month follow-up, the incidence of delayed union was 28.9%. Predictors for delayed union included flap coverage, high-energy trauma, open fractures, the use of external fixation as a staged treatment, the percentage of cortical contact in simple type fractures, RUST score, and postoperative infection. After 12 months, the non-union rate was 15.6%. Conclusion: the main predictors for non-union after IMN of tibial shaft fractures are related to the trauma energy. Furthermore, the initial treatment involving external fixation and postoperative infection also correlated with non-union. Level of Evidence III; Retrospective Longitudinal Study.

Objetivo: identificar os fatores preditivos associados ao atraso de consolidação em 6 meses e à não união em 12 meses em fraturas da diáfise da tíbia tratadas com haste intramedular (HIM). Métodos: O estudo longitudinal retrospectivo de coorte incluiu 218 pacientes, que apresentaram fraturas da díafise da tíbia e receberam HIM entre janeiro de 2015 e março de 2022. Os desfechos principais pesquisados foram atraso de consolidação em 6 meses de acompanhamento, e não união em 12 meses. Coletou-se dados de uma variedade de fatores de risco. Utilizou-se análise de regressão logística bivariada para explorar os fatores preditivos de atraso de consolidação e não união. Resultados: Aos 6 meses, a incidência de atraso de consolidação foi de 28,9%. Os preditores de atraso de consolidação incluem cobertura de retalho, trauma de alta energia, fraturas expostas, uso de fixação externa como tratamento estagiado, porcentagem de contato cortical em fraturas simples, escore RUST e infecção pós-operatória. Após 12 meses, a taxa de não união foi de 15,6%, com fatores preditivos sendo necessidade de cobertura por retalho, lesão vascular, trauma de alta energia, fraturas expostas, uso de fixação externa como tratamento estagiado, porcentagem de contato cortical em fraturas simples e infecção pós-operatória. Nível de Evidência III; Estudo Longitudinal Retrospectivo.

RESUMO

ABSTRACT Objective: Identify the predictors associated with delayed union at 6 months and non-union at 12 months in tibial shaft fractures treated with intramedullary nailing (IMN). Methods: This retrospective longitudinal study included a cohort of 218 patients who sustained tibial shaft fractures and received IMN between January 2015 and March 2022. We gathered data on a range of risk factors, including patient demographics, trauma intensity, associated injuries, fracture characteristics, soft tissue injuries, comorbidities, addictions, and treatment-specific factors. We employed logistic bivariate regression analysis to explore the factors predictive of delayed union and non-union. Results: At the 6-month follow-up, the incidence of delayed union was 28.9%. Predictors for delayed union included flap coverage, high-energy trauma, open fractures, the use of external fixation as a staged treatment, the percentage of cortical contact in simple type fractures, RUST score, and postoperative infection. After 12 months, the non-union rate was 15.6%. Conclusion: the main predictors for non-union after IMN of tibial shaft fractures are related to the trauma energy. Furthermore, the initial treatment involving external fixation and postoperative infection also correlated with non-union. Level of Evidence III; Retrospective Longitudinal Study.

RESUMO Objetivo: identificar os fatores preditivos associados ao atraso de consolidação em 6 meses e à não união em 12 meses em fraturas da diáfise da tíbia tratadas com haste intramedular (HIM). Métodos: O estudo longitudinal retrospectivo de coorte incluiu 218 pacientes, que apresentaram fraturas da díafise da tíbia e receberam HIM entre janeiro de 2015 e março de 2022. Os desfechos principais pesquisados foram atraso de consolidação em 6 meses de acompanhamento, e não união em 12 meses. Coletou-se dados de uma variedade de fatores de risco. Utilizou-se análise de regressão logística bivariada para explorar os fatores preditivos de atraso de consolidação e não união. Resultados: Aos 6 meses, a incidência de atraso de consolidação foi de 28,9%. Os preditores de atraso de consolidação incluem cobertura de retalho, trauma de alta energia, fraturas expostas, uso de fixação externa como tratamento estagiado, porcentagem de contato cortical em fraturas simples, escore RUST e infecção pós-operatória. Após 12 meses, a taxa de não união foi de 15,6%, com fatores preditivos sendo necessidade de cobertura por retalho, lesão vascular, trauma de alta energia, fraturas expostas, uso de fixação externa como tratamento estagiado, porcentagem de contato cortical em fraturas simples e infecção pós-operatória. Nível de Evidência III; Estudo Longitudinal Retrospectivo.

RESUMO

INTRODUCTION AND IMPORTANCE: Fractures in the proximal tibial tuberosity are rare injuries. Even more uncommon are bilateral simultaneous fractures. Due to the few cases reported in the literature, we aimed to present a case which may contribute to the diagnosis and treatment of bilateral simultaneous tibial tubercle fractures. CASE PRESENTATION: A 13-year-old Hispanic male presented to the emergency department after experiencing sudden knee buckling while running after standing up from the catcher's position (squatted) during a baseball game, causing him to collapse to the ground. Plain radiographs revealed displaced tibial tubercle avulsion fractures in both knees. He underwent bilateral open reduction and internal fixation. Fracture healing was completed without complications. DISCUSSION: To the best of our knowledge, this is the first documented case of a Hispanic pediatric baseball player, adding to the small number of reported cases of bilateral tibial tubercle fractures. The presented case is rare in terms of the mechanism of injury, which has been scantly reported in the literature. CONCLUSION: Due to the rarity of atraumatic bilateral tibial tubercle fractures we believe this documentation may be of clinical relevance.

RESUMO

PURPOSE: This retrospective study aimed to assess the impact of distal nail placement on misalignment and healing rates in distal tibial fractures. METHODS: We reviewed all patients with distal tibial fracture treated with intramedullary nailing between 2015 and 2021, and a minimum follow-up of 12 months. Distal nail positioning was determined according to the Triantafillou zones. We related these positioning zones to misalignments (alignment ≥ 3°) and too bony union disorders (delayed union, non-union). RESULTS: Out of the 62 patients included, 56 (90.3%) show bone union without additional procedure, 3 (4.8%) with dynamization, and 3 (4.8%) showed non-union. Twenty-one (33.8%) presented misalignment, with valgus in the coronal plane being the most frequent (76.19%). In patients with and without misalignment, the most frequent distal nail position was 2-2 in 47.6% and 80.5%, respectively (p = 0.01). In multivariate analysis, distal nail positioning in the 2-2 zone showed a significant protective effect against misalignment (OR 0.18; p = 0.018), while nail positioning in the 3-2 zone generated a significant risk of misalignment (OR 18.55; p = 0.009). CONCLUSION: In intramedullary nailing of distal tibial fractures, distal positioning of the nail slightly lateral to the center of the talus in the coronal plane and slightly posterior in the sagittal plane (zone 2-2) allows high alignment percentages to be obtained. Positioning medial to this point in the coronal plane (zone 3) is associated with more significant misalignment and should be avoided.

Assuntos

RESUMO

Introdução: As fraturas de platô tibial são consideradas lesões intraarticulares comuns do joelho. Objetivo: Avaliar os fatores associados e a relação ao aumento do tempo de internação e custos nesses pacientes. Métodos: Estudo qualitativo descritivo de tabelas de frequência e cruzadas de 108 pacientes vítimas de trauma ortopédico. Foram avaliadas as médias de idade; gênero; trauma de alta energia; tempo de internação; e tempo médio da interferência. Resultados: O perfil epidemiológico foi idade média de 41,2 anos; homens (70,4%); vítimas de trauma de alta energia (53,70%); tempo de internação; e tempo mediano. Os fatores que interferiram para aumento dessas 2 últimas variáveis foram: mecanismos de lesão de alta energia (8 dias); tratamento provisório (10 dias); tratamento cirúrgico definitivo (8 dias); prolongamento justificado dos dias (8 dias), complicações na internação (11 dias); lesão de partes moles (10 dias); infecção da ferida (12 dias) e internamento na UTI (26 dias). Conclusão: Os fatores que apresentaram diferença significativa em relação ao aumento de dias de internamento hospitalar foram: mecanismo de lesão de alta energia, realização de tratamento provisório, fraturas complexas (tipo IV, V, VI), tipo de tratamento cirúrgico definitivo, complicações na internação - principalmente lesão de partes moles, infecção e internamento em UTI.

Introduction: Tibial plateau fractures are considered common intraarticular knee injuries. Objective: To evaluate the associated factors and their relationship to increased length of stay and costs in these patients. Methods: Descriptive qualitative study of frequency and cross tables of 108 patients who were victims of orthopedic trauma. Were evaluated mean age; gender; high-energy trauma; hospitalization time; and median time of the interference. Results: The epidemiological profile was a mean age of 41.2 years; men (70.4%); high-energy trauma victims (53.70%); hospitalization time; and median time. The factors that interfered with the increase in these last 2 variables were: high-energy injury mechanisms (8 days); interim treatment (10 days); definitive surgical treatment (8 days); justified extension of days (8 days), hospitalization complications (11 days); soft tissue injury (10 days); wound infection (12 days) and ICU stay (26 day\s). Conclusion: The factors that showed a significant difference in relation to the increase in hospitalization days were: mechanism of high-energy injury, provisional treatment, complex fractures (type IV, V, VI), type of definitive surgical treatment, complications in hospitalization - mainly soft tissue injury, infection and ICU admission.

RESUMO

OBJETIVOS Determinar la prevalencia de déficit de vitamina D, así como evaluar la seguridad y efectividad de un nuevo método de carga con colecalciferol en pacientes adultos con fractura de tibia. MATERIALES Y MÉTODOS Se reclutaron a 56 pacientes consecutivos con edades entre 18 y 65 años con fractura de tibia ingresados en nuestro hospital durante 1 año. Se determinó el nivel de 25-hidroxivitamina D ([25(OH)-D]) al ingreso y tras suplementación con 100.000 UI semanales de colecalciferol, durante 3 o 5 semanas, en casos de insuficiencia ([25(OH)-D] entre 20 ng/mL y 29,9 ng/mL) o deficiencia ([25(OH)-D] < 20 ng/mL), respectivamente. Se determinó la prevalencia de hipovitaminosis D, el porcentaje de normalización de [25(OH)-D], y los efectos adversos. RESULTADOS Se evaluaron 56 pacientes; 98,2% presentó hipovitaminosis D, y 28 (73,7%) y 10 (26,3%) presentaron déficit e insuficiencia, respectivamente. Tras la suplementación, 92,1% alcanzaron niveles [25(OH)-D] normales. Ningún paciente presentó efectos adversos. DISCUSIÓN La prevalencia de deficiencia de vitamina D en nuestra población fue mayor a la reportada en la literatura. Comprobamos que un esquema de suplementación en altas dosis de vitamina D es seguro, y más efectivo que los previamente recomendados. Este esquema de suplementación puede ser implementado en futuros estudios randomizados. CONCLUSIÓN La prevalencia de hipovitaminosis D en pacientes adultos chilenos con fractura de tibia fue alta (98,2%). El esquema de suplementación con vitamina D propuesto fue efectivo y seguro.

OBJETIVOS Determinar la prevalencia de déficit de vitamina D, así como evaluar la seguridad y efectividad de un nuevo método de carga con colecalciferol en pacientes adultos con fractura de tibia. MATERIALES Y MÉTODOS Se reclutaron a 56 pacientes consecutivos con edades entre 18 y 65 años con fractura de tibia ingresados en nuestro hospital durante 1 año. Se determinó el nivel de 25-hidroxivitamina D ([25(OH)-D]) al ingreso y tras suplementación con 100.000 UI semanales de colecalciferol, durante 3 o 5 semanas, en casos de insuficiencia ([25(OH)-D] entre 20 ng/mL y 29,9 ng/mL) o deficiencia ([25(OH)-D] < 20 ng/mL), respectivamente. Se determinó la prevalencia de hipovitaminosis D, el porcentaje de normalización de [25(OH)-D], y los efectos adversos. RESULTADOS Se evaluaron 56 pacientes; 98,2% presentó hipovitaminosis D, y 28 (73,7%) y 10 (26,3%) presentaron déficit e insuficiencia, respectivamente. Tras la suplementación, 92,1% alcanzaron niveles [25(OH)-D] normales. Ningún paciente presentó efectos adversos. DISCUSIÓN La prevalencia de deficiencia de vitamina D en nuestra población fue mayor a la reportada en la literatura. Comprobamos que un esquema de suplementación en altas dosis de vitamina D es seguro, y más efectivo que los previamente recomendados. Este esquema de suplementación puede ser implementado en futuros estudios randomizados. CONCLUSIÓN La prevalencia de hipovitaminosis D en pacientes adultos chilenos con fractura de tibia fue alta (98,2%). El esquema de suplementación con vitamina D propuesto fue efectivo y seguro.

Assuntos

RESUMO

Resumen: Introducción: el estándar de oro de tratamiento para la mayoría de las fracturas diafisarias de tibia está representado por el clavo endomedular (CEM). El objetivo de este estudio fue analizar la importancia del diámetro del CEM sobre la consolidación de fracturas diafisarias de tibia. Material y métodos: se realizó un estudio retrospectivo en pacientes con fracturas cerradas de tibia 42 OTA/AO, tratados con un CEM fresado y acerrojado, entre Enero de 2014 y Diciembre de 2020. Las variables analizadas fueron género, edad, comorbilidades, cantidad de cerrojos utilizados, relación clavo/canal (diferencia entre el diámetro del canal medular y clavo), el índice clavo/canal (razón entre diámetro del clavo y el canal medular), en relación con la tasa de consolidación y falla (retardo de consolidación y seudoartrosis). Resultados: la serie final se conformó por 96 pacientes y la tasa de consolidación fue de 91.7% (n = 88). Se observó un diámetro de clavo significativamente mayor en los pacientes que consolidaron respecto a los que fallaron (p = 0.0014), incrementando la posibilidad de consolidación 5.30 (p = 0.04) veces, por cada milímetro que el clavo aumentó su diámetro. Se observó un incremento de probabilidad de consolidación de 13.56 (p = 0.018) veces utilizando un clavo > 10 mm de diámetro. El índice clavo/canal ≥ 0.80 aumentó la posibilidad de consolidación 23.33 veces (p = 0.005). Conclusión: nuestros hallazgos sugieren que los CEM fresados y acerrojados en fracturas diafisarias de tibia deben colocarse del mayor diámetro posible (> 10 mm y con un índice clavo/canal ≥ 0.80) para favorecer la consolidación.

Abstract: Introduction: the gold standard for tibial diaphyseal fracture treatment is represented by the intramedullary nail (IMN). This study aimed to assess the relevance of nail diameter in bone healing of tibial diaphyseal fractures. Material and methods: a retrospective study was conducted analyzing patients with closed 42 OTA/AO tibial fractures, treated with a reamed and locked IMN between January 2014 and December 2020. The variables assessed were gender, age, comorbidities, number of bolts used, canal/nail index (difference between the diameter of the medullary canal and nail), nail/canal ratio (ratio between nail diameter and medullary canal), related to consolidation and failure rates (delay - and non-union). Results: 96 patients were included. The consolidation rate was 91.7% (n = 88). Patients with consolidation had a significantly larger nail diameter than those who failed (p = 0.0014), increasing the chance of consolidation 5.30 (p = 0.04) times for each millimeter that the nail increased its diameter. Using a nail > 10 mm increased the chance of consolidation 13.56 times (p = 0.018). A nail/canal ratio ≥ 0.80 increased the chance of consolidation 23.33 times (p = 0.005). Conclusion: our findings suggested that reamed and locked IMN in tibial diaphyseal fractures should be implanted with the largest possible diameter (> 10 mm and with a nail-to-canal ratio ≥ 0.80) to promote bone healing.

RESUMO

BACKGROUND: Postoperative cognitive dysfunction is widely recognized as severe postoperative central nervous dysfunction and has a significant impact on the 'patient's physical and mental health. METHODS: Postoperative models of tibial fracture in aged rats were established, including the control group, model group, CCL11 protein injection group, and saline injection group. Morris water maze test was used to detect the behavioral characteristics of rats. Enzyme-Linked Immunosorbent Assay was used or determine the content of CCL11 and CXCL10. Immunofluorescence staining was used to detect the distribution of CD14+CD163+macrophages in colon tissues and CD11b+CCR3+microglia cells in hippocampal tissues. Western blot analyzed NOX1 and STAT3 expression in hippocampus tissues. RESULTS: Water maze test results confirmed severe cognitive impairment in CCL11 rats. The content of CCL11 and CXCL10 in the CCL11 group was much higher than that of the model group. The distribution of macrophage and microglia cells in the CCL11 model group was greater than that in the model group and the saline group. The expression of NOX1 and STAT3 in the CCL11 group was higher compared with the model group. CONCLUSION: Abnormal macrophage function and excessive CCL11 secretion were observed in the rats with lower limb fractures after surgery. Postoperative central inflammation in rats with lower limb fracture induced postoperative cognitive dysfunction through the gut-brain axis molecular mechanism.

Assuntos

RESUMO

Abstract Objective To analyze the results of clinical, radiological, and functional outcomes of tibial plateau fracture (Schatzker Type V, VI) treated with Illizarov ring external fixator with or without minimum opening. Methods A total of 52 tibial plateau fractures of type V, VI were treated with Ilizarov ring external fixator with or without mininum internal fixation were studied. Functional outcome assessment was done using the American Knee Society (AKS) score with clinical, radiological union, and complications were analyzed. Results There were 37 (71.15%) male and 15 (28.84%) female patients, with a mean age of 39.07 ± 12.58 years old. Road traffic accidents (RTAs) were the major cause of fracture, accounting for 32 cases (61.53%) followed by fall injury, with 16 cases (30.76%), and direct impact, with 4 cases (7.69%). Twenty-one (40.38%) cases were type V and 31 (59.61%) cases were type VI fractures, and there were 24 (46.15%) cases of open fracture. The mean AKS score of Type V and Type VI fractures were 82.8 and 80.70, respectively, but this was statistically not significant at p<0.05. The mean AKS score of closed and open fractures were also statistically not significant at p<0.05. Conclusions For Schatzker Types V and VI complex tibial plateau fractures, Ilizarov external fixation is a safe, cost-effective and efficient treatment method that presents a satisfactory outcome.

Resumo Objetivo Analisar os resultados clínicos, radiológicos e funcionais da fratura do planalto tibial (Schatzker Tipo V, VI) tratada com fixador externo do anel Illizarov com ou sem abertura mínima. Métodos Um total de 52 fraturas do planalto tibial dos tipos V e VI foram tratadas com fixador externo do anel Ilizarov com ou sem fixação interna mínima. A avaliação do desfecho funcional foi feita utilizando-se o escore da American Knee Society (AKS, na sigla em inglês) com consolidação clínica, radiológica e complicações encontradas. Resultados Foram 37 (71,15%) pacientes do sexo masculino e 15 (28,84%) do sexo feminino, com idade média de 39,07 ± 12,58 anos. Acidentes de trânsito (ATs) foram a principal causa das fraturas, contabilizando 32 casos (61,53%), seguidos por lesão por queda, com 16 casos (30,76%), e impacto direto, com 4 casos (7,69%). Foram 21 (40,38%) casos de fraturas tipo V, 31 (59,61%) casos do tipo VI e 24 (46,15%) casos de fratura exposta. Os escores médios da AKS para as fraturas tipo V e VI foram de 82,8 e 80,70, respectivamente, mas não foi estatisticamente significativo em p <0,05. O escore médio da AKS para fraturas fechadas e abertas também não foi estatisticamente significativo em p <0,05. Conclusões Para a fratura do planalto tibial complexa dos tipos V e VI de Schatzker, a fixação externa de Ilizarov é um método de tratamento seguro, econômico e eficiente que resulta em resultados satisfatórios.

Assuntos

RESUMO

OBJECTIVE: Dynamization has already been described as a secondary intervention for delay unions of tibial shaft fractures treated with intramedullary nailing. Although it's a common procedure, it is not widely supported in the literature. The purpose of this study was to determine the union rate of nail dynamization in cases of delayed union of diaphyseal tibial fractures, and assess the effect of fracture morphology on union rates. MATERIALS AND METHODS: We retrospectively analyzed a series of 199 consecutive tibial shaft fractures. We recorded the dynamization rate, period from nailing to dynamization, nailing to the union, the fracture pattern (according to AO/ASIF and whether it was closed or open), the callus diameter before dynamization (fracture healing index; FHI) and union/failure rates. RESULTS: Out of a total of 199 fractures treated during the study period, 41 (20.6%) were dynamized. After applying inclusion and exclusion criteria, 39 patients with 39 fractures were included in the study. The mean time from nailing to dynamization was 18.4 ± 7.2 weeks. The union rate was 92.3% (n = 36) over a mean time of 14.1 ± 5.6 weeks as from dynamization. The overall failure rate was 6.7% (n = 3). There was no significant association between failure and AO/ASIF classification (p > 0.05) or fracture exposure (X 2 = 0.19; p = 0.66). The pre-dynamization FHI of ≥ 1.17 was significantly associated with consolidation (p < 0.05). CONCLUSION: In cases of delayed union of tibial fractures, dynamization offered a high union rate associated with pre-dynamization FHI, while fracture morphology did not affect the failure rate.

RESUMO

BACKGROUND: Tibial plateau fractures are traumatic injuries with severities ranging from nondisplaced to complicated fractures. This study describes the epidemiological characteristics of patients with tibial plateau fractures treated in five trauma clinics. METHODS: This retrospective, cross-sectional study included 1165 patients with tibial plateau fractures treated between December 2015 and May 2017. Subjects were selected from the medical records of five institutions based on the inclusion and exclusion criteria. Age, sex, laterality, fracture type, trauma mechanism, vehicle type, classification, and associated injuries were assessed via univariate and bivariate analyses. RESULTS: In total, 23.3% of patients with tibial fractures treated during the study period had tibial plateau fractures. Of those affected, 73% were men and 50% were younger than 40 years. Furthermore, 95.7% of fractures were caused by traffic accidents, 82.6% of which involved motorcycles. Fractures were closed in 93.1% of cases, and 78% of subjects had associated injuries. The most common fractures, according to Schatzker classification, were type VI (23%) and V (19.1%) fractures. CONCLUSIONS: Tibial plateau fractures are frequent injuries in our setting and mostly occur in men in their 30 s and 40 s. These fractures are typically caused by motorcycle traffic accidents. LEVEL OF EVIDENCE: IV.

Assuntos

RESUMO

INTRODUCTION: the gold standard for tibial diaphyseal fracture treatment is represented by the intramedullary nail (IMN). This study aimed to assess the relevance of nail diameter in bone healing of tibial diaphyseal fractures. MATERIAL AND METHODS: a retrospective study was conducted analyzing patients with closed 42 OTA/AO tibial fractures, treated with a reamed and locked IMN between January 2014 and December 2020. The variables assessed were gender, age, comorbidities, number of bolts used, canal/nail index (difference between the diameter of the medullary canal and nail), nail/canal ratio (ratio between nail diameter and medullary canal), related to consolidation and failure rates (delay and non-union). RESULTS: 96 patients were included. The consolidation rate was 91.7% (n = 88). Patients with consolidation had a significantly larger nail diameter than those who failed (p = 0.0014), increasing the chance of consolidation 5.30 (p = 0.04) times for each millimeter that the nail increased its diameter. Using a nail > 10 mm increased the chance of consolidation 13.56 times (p = 0.018). A nail/canal ratio 0.80 increased the chance of consolidation 23.33 times (p = 0.005). CONCLUSION: our findings suggested that reamed and locked IMN in tibial diaphyseal fractures should be implanted with the largest possible diameter (> 10 mm and with a nail-to-canal ratio 0.80) to promote bone healing.

INTRODUCCIÓN: el estándar de oro de tratamiento para la mayoría de las fracturas diafisarias de tibia está representado por el clavo endomedular (CEM). El objetivo de este estudio fue analizar la importancia del diámetro del CEM sobre la consolidación de fracturas diafisarias de tibia. MATERIAL Y MÉTODOS: se realizó un estudio retrospectivo en pacientes con fracturas cerradas de tibia 42 OTA/AO, tratados con un CEM fresado y acerrojado, entre Enero de 2014 y Diciembre de 2020. Las variables analizadas fueron género, edad, comorbilidades, cantidad de cerrojos utilizados, relación clavo/canal (diferencia entre el diámetro del canal medular y clavo), el índice clavo/canal (razón entre diámetro del clavo y el canal medular), en relación con la tasa de consolidación y falla (retardo de consolidación y seudoartrosis). RESULTADOS: la serie final se conformó por 96 pacientes y la tasa de consolidación fue de 91.7% (n = 88). Se observó un diámetro de clavo significativamente mayor en los pacientes que consolidaron respecto a los que fallaron (p = 0.0014), incrementando la posibilidad de consolidación 5.30 (p = 0.04) veces, por cada milímetro que el clavo aumentó su diámetro. Se observó un incremento de probabilidad de consolidación de 13.56 (p = 0.018) veces utilizando un clavo > 10 mm de diámetro. El índice clavo/canal 0.80 aumentó la posibilidad de consolidación 23.33 veces (p = 0.005). CONCLUSIÓN: nuestros hallazgos sugieren que los CEM fresados y acerrojados en fracturas diafisarias de tibia deben colocarse del mayor diámetro posible (> 10 mm y con un índice clavo/canal 0.80) para favorecer la consolidación.

Assuntos

RESUMO

Abstract Background: Postoperative cognitive dysfunction is widely recognized as severe postoperative central nervous dysfunction and has a significant impact on the 'patient's physical and mental health. Methods: Postoperative models of tibial fracture in aged rats were established, including the control group, model group, CCL11 protein injection group, and saline injection group. Morris water maze test was used to detect the behavioral characteristics of rats. Enzyme-Linked Immunosorbent Assay was used or determine the content of CCL11 and CXCL10. Immunofluorescence staining was used to detect the distribution of CD14+CD163+macro-phages in colon tissues and CD11b+CCR3+microglia cells in hippocampal tissues. Western blot analyzed NOX1 and STAT3 expression in hippocampus tissues. Results: Water maze test results confirmed severe cognitive impairment in CCL11 rats. The content of CCL11 and CXCL10 in the CCL11 group was much higher than that of the model group. The distribution of macrophage and microglia cells in the CCL11 model group was greater than that in the model group and the saline group. The expression of NOX1 and STAT3 in the CCL11 group was higher compared with the model group. Conclusion: Abnormal macrophage function and excessive CCL11 secretion were observed in the rats with lower limb fractures after surgery. Postoperative central inflammation in rats with lower limb fracture induced postoperative cognitive dysfunction through the gut-brain axis molecular mechanism.

RESUMO

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..

RESUMO

OBJECTIVE: The aim of this study is to purpose a novel approach to the concomitant triplanar and tibial shaft fracture. METHODS: Retrospective study between 2001 and 2019. We collected the patients' general information, clinical and radiographic data, and complications after the following three-step treatment: (1) fixation of the Salter-Harris II fracture of the triplane fracture, (2) fixation of the Salter-Harris II/IV fracture with cannulated screws, and (3) fixation of the tibial fracture with flexible titanium nails. RESULTS: The study included seven patients (six males) with a mean age of 14 years and a mean follow-up of 6.4 years (minimum two years). Five triplane fractures had two fragments and two had three fragments. Five fractures were classified as Salter-Harris II and two as Salter-Harris IV. Three tibial fractures were long oblique, three were spiral, and one had a third fragment. Six fractures affected the middle third and one affected the distal third of the tibia. All triplane and tibial fractures consolidated without significant displacement. No physeal damage was identified. CONCLUSIONS: This study described the association of tibial fractures with triplane ankle fractures managed by our proposed treatment, which proved to be effective for this fracture association. Level of Evidence IV, Case Series.

OBJETIVO: Propor uma nova abordagem para fraturas concomitantes da diáfise da tíbia e triplanares do tornozelo. MÉTODOS: Estudo retrospectivo entre 2001 e 2019. Foram coletadas informações gerais: dados clínicos, radiográficos e complicações. As fraturas seguiram três passos no tratamento: (1) fixação do fragmento Salter-Harris tipo III da fratura triplanar; (2) fixação do fragmento Salter-Harris II/IV com parafuso canulado; e (3) fixação da fratura diafisária da tíbia com hastes flexíveis. RESULTADOS: O estudo incluiu sete pacientes (seis homens) com idade média de 14 anos e seguimento médio de 6.4 anos (mínimo de dois anos). Cinco fraturas triplanares tinham dois fragmentos principais e duas tinham três fragmentos. Cinco fraturas na radiografia em perfil foram classificadas como Salter-Harris II e duas como Salter-Harris IV. Três fraturas diafisárias tibiais tinham traço obliquo longo, três traço espiral e uma fratura com terceiro fragmento. Seis fraturas eram do terço médio e uma fratura do terço distal da tíbia. Todas as fraturas triplanares e tibiais consolidaram sem desvio significativo e não tivemos nenhuma lesão fisária. CONCLUSÃO: O estudo descreveu a associação da fratura da tíbia com a fratura triplanar do tornozelo e nossa proposta de tratamento, que se mostrou uma boa opção no tratamento dessa fratura especial. Nível de Evidência IV, Série de casos.

RESUMO

ABSTRACT Objective: The aim of this study is to purpose a novel approach to the concomitant triplanar and tibial shaft fracture. Methods: Retrospective study between 2001 and 2019. We collected the patients' general information, clinical and radiographic data, and complications after the following three-step treatment: (1) fixation of the Salter-Harris II fracture of the triplane fracture, (2) fixation of the Salter-Harris II/IV fracture with cannulated screws, and (3) fixation of the tibial fracture with flexible titanium nails. Results: The study included seven patients (six males) with a mean age of 14 years and a mean follow-up of 6.4 years (minimum two years). Five triplane fractures had two fragments and two had three fragments. Five fractures were classified as Salter-Harris II and two as Salter-Harris IV. Three tibial fractures were long oblique, three were spiral, and one had a third fragment. Six fractures affected the middle third and one affected the distal third of the tibia. All triplane and tibial fractures consolidated without significant displacement. No physeal damage was identified. Conclusions: This study described the association of tibial fractures with triplane ankle fractures managed by our proposed treatment, which proved to be effective for this fracture association. Level of Evidence IV, Case Series.

RESUMO Objetivo: Propor uma nova abordagem para fraturas concomitantes da diáfise da tíbia e triplanares do tornozelo. Métodos: Estudo retrospectivo entre 2001 e 2019. Foram coletadas informações gerais: dados clínicos, radiográficos e complicações. As fraturas seguiram três passos no tratamento: (1) fixação do fragmento Salter-Harris tipo III da fratura triplanar; (2) fixação do fragmento Salter-Harris II/IV com parafuso canulado; e (3) fixação da fratura diafisária da tíbia com hastes flexíveis. Resultados: O estudo incluiu sete pacientes (seis homens) com idade média de 14 anos e seguimento médio de 6.4 anos (mínimo de dois anos). Cinco fraturas triplanares tinham dois fragmentos principais e duas tinham três fragmentos. Cinco fraturas na radiografia em perfil foram classificadas como Salter-Harris II e duas como Salter-Harris IV. Três fraturas diafisárias tibiais tinham traço obliquo longo, três traço espiral e uma fratura com terceiro fragmento. Seis fraturas eram do terço médio e uma fratura do terço distal da tíbia. Todas as fraturas triplanares e tibiais consolidaram sem desvio significativo e não tivemos nenhuma lesão fisária. Conclusão: O estudo descreveu a associação da fratura da tíbia com a fratura triplanar do tornozelo e nossa proposta de tratamento, que se mostrou uma boa opção no tratamento dessa fratura especial. Nível de Evidência IV, Série de casos.

RESUMO

RESUMEN Introducción: Las luxaciones de rodilla son poco frecuentes, lo que hace que su combinación abierta, con fracturas de rótula y del tercio superior de la tibia, sea rara y grave. Constituye una entidad causada por traumas de alta energía y se asocia a otras lesiones. Objetivo: Presentar un caso raro y complejo de luxación femorotibial posterior abierta con fractura del polo inferior de la rótula y tercio superior de la tibia. Caso clínico: Paciente masculino de 37 años de edad, que ingresó en el servicio de ortopedia y traumatología, quien como consecuencia de un accidente de tránsito, presentó luxación femorotibial posterior con fractura abierta del polo inferior de la rótula y tercio superior de la tibia, grados III-B, en el inferior derecho. Fue intervenido quirúrgicamente de urgencia; se realizó amplio desbridamiento quirúrgico, reducción de la luxación, reparación primaria de las lesiones ligamentosas, patelectomía parcial, reparación del tendón rotuliano y fijación externa para la fractura del tercio superior de la tibia. El paciente evolucionó bien, sin infección de la herida quirúrgica y recuperación total a los 4 meses. Conclusiones: La combinación de luxación femorotibial posterior abierta, con fractura del polo inferior de la rótula y tercio superior de la tibia es rara y obedece a altas energías traumáticas, como los accidentes automovilísticos. La cirugía de urgencia y la profilaxis antimicrobiana, es el método eficaz para el tratamiento definitivo de esta lesión.

ABSTRACT Introduction: Knee dislocations are infrequent, which makes the combination with open fractures of the patella and the upper third of the tibia, rare and serious. It is an entity caused by high-energy trauma and is associated with other injuries. Objective: To present a rare and complex case of open posterior femorotibial dislocation with fracture of the lower pole of the patella and the upper third of the tibia. Clinical case: A 37-year-old male patient, who was admitted to the orthopedic and trauma service, who, as a consequence of a traffic accident, presented posterior femorotibial dislocation with an open fracture of the lower pole of the patella and upper third of the tibia. grades III-B, in the lower right. He underwent emergency surgery; extensive surgical debridement, dislocation reduction, primary repair of ligamentous injuries, partial patellectomy, patellar tendon repair, and external fixation were performed for the fracture of the upper third of the tibia. The patient evolved well, without infection of the surgical wound and full recovery at 4 months. Conclusions: The combination of open posterior femorotibial dislocation, with fracture of the lower pole of the patella and upper third of the tibia is rare and is due to high traumatic energies, such as motor vehicle accidents. Emergency surgery and antimicrobial prophylaxis is the effective method for the definitive treatment of this lesion.

RESUMO

INTRODUCCIÓN: El concepto de "rodilla flotante" describe fracturas ipsilaterales del fémur y la tibia, donde la rodilla está desconectada del resto de la extremidad. El mecanismo suele ser un trauma de alta energía. Las tasas de infección, no unión, malunión y rigidez de la rodilla, pérdida excesiva de sangre, embolia grasa, son relativamente altas; lo que lleva a un deterioro funcional y con frecuencia resultados no satisfactorios. La reducción definitiva inmediata y fijación de las fracturas por clavo intramedular disminuye la incidencia de complicaciones. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo, serie de casos de 7 pacientes tratados con el Clavo Intramedular de SIGN (Surgical Implant Generation Network); para establecer resultados funcionales, lesiones concomitantes, complicaciones y ventajas del clavo en nuestra práctica. RESULTADOS: La mayoría de pacientes fueron del sexo masculino, con una media de 26 años de edad. Todas las lesiones fueron producidas en accidentes de tráfico, el 50% de las fracturas fueron expuestas. Según la clasificacion de Blake & McBryde, 6 fueron de Tipo I y un caso tipo IIa. Los resultados funcionales se evaluaron según los criterios de Karlström&Olerud; excelentes y buenos resultados se obtuvieron en el 85% de los casos. Todas las fracturas consolidaron; se describe un caso de infección superficial y un paciente presentó acortamiento de miembro <3cms y limitación menor del rango de movilidad de la rodilla. CONCLUSIÓN: El CIM de SIGN resultó eficiente y versátil en el tratamiento de rodilla flotante en adultos. Con buenos resultados funcionales (85%) y baja incidencia de complicaciones.

BACKGROUND: "Floating knee" describes ipsilateral fractures of the femur and tibia, where the knee is disconnected from the rest of the limb. The mechanism is usually a high-energy trauma. Rates of infection, lack of union, stiffness of the knee, excessive blood loss, fat embolism, are relatively high; leading to functional impairment and often unsatisfactory results. Immediate definitive reduction and fixation of fractures by intramedullary nail reduces the incidence of complications. METHODS: A descriptive study was carried out, a case series report of 7 patientes treated by the SIGN Intramedullary Nail (IMN); to establish the functional results, concomitant injuries, complications and advantages of this nail, in our practice. RESULTS: The majority of the patients were male, with a mean age of 26 years. All injuries were caused in traffic accidents, 50% of the fractures were exposed fractures. According to the Blake & McBryde classification, 6 were Type I and one case Type IIa. Functional results were evaluated according to the Karlström and Olerud criteria; excellent and good results were obtained in 85% of cases. All of the fractures healed; one case of superficial infection was described, one patient presented limb shortening <3 cm and minor limitation of the knee motion range. CONCLUSION: The SIGN intramedullary nail, was efficient and versatile for the treatment of floating knee in adults. It had good functional results (85%) and low incidence of complications.

Assuntos

RESUMO

OBJETIVOS: Estimar un modelo predictivo para la no-unión en pacientes que presentan fractura de tibia. MATERIALES Y MÉTODOS: Estudio de cohorte retrospectivo, en pacientes con fractura de tibia operadas entre 2012 y 2018, con un mínimo de 12 meses de seguimiento, excluyendo amputaciones traumáticas. Realizamos un modelo de regresión logística con 13 variables descritas en la literatura. Se descartaron las variables estadísticamente no significativas y las que no causaban efecto de confusión. Se evaluó la bondad de ajuste mediante el test de Hosmer-Lemeshow y la discriminación del modelo con la curva ROC. RESULTADOS: Se incluyeron 411 fracturas de tibia, las variables estadísticamente significativas fueron: exposición ósea OR » 2,57(IC:1,15­5,75, p » 0,022), diabetes OR » 3,29 (IC:1,37­7,91, p » 0,008) y uso de tutor externo OR » 1,77(IC:0,81­3,85), el que tuvo efecto de confusión. La bondad de ajuste demostró que los datos se ajustan adecuadamente al modelo (p » 0,35). La curva ROC demuestra un 70,91% de poder discriminatorio. Al evaluar aisladamente las fracturas expuestas, no hubo asociación estadísticamente significativa con ninguna variable. DISCUSIÓN: Al evaluar el modelo, obtuvimos una asociación estadísticamente significativa entre: no unión, exposición ósea, diabetes y uso de tutor externo, información concordante con la literatura. Al estudiar el subgrupo de fracturas expuestas, las demás variables son estadísticamente no significativas. Eso refleja que la exposición ósea es la variable que confiere mayor riesgo. El seguimiento adecuado de esos pacientes es fundamental dado este alto riesgo de evolucionar con no-unión. CONCLUSIÓN: En nuestra serie, la exposición ósea es el factor de riesgo más importante para presentar no unión de tibia.

OBJECTIVES: Estimate a predictive model for non-union in patients presenting with a tibial fracture. MATERIALS AND METHODS: Retrospective cohort study in patients with tibia fractures operated between 2012 and 2018, with a minimum follow-up of 12 months, excluding traumatic amputations. We performed a multivariate logistic regression model with 13 variables described in the literature. The variables that were statistically non-significant and those variables that do not cause confusion, were discarded. Goodness of fit was evaluated using the Hosmer-Lemeshow test and the discrimination of the model with the ROC curve. RESULTS: 411 tibial fractures were included, the statistically significant variables were: bone exposure OR » 2.57(CI:1.15­5.75, p » 0.022), diabetes OR » 3.29(CI:1.37­7.91, p » 0.008) and use of external fixation OR » 1.77(CI:0.81­3.85), being included in the model because of its confounding effect. Goodness of fit demonstrates that the data fit the model adequately(p » 0.35). The ROC curve demonstrates 70.91% discriminatory power. When evaluating the exposed fractures in isolation, there was no statistically significant association with any variable. DISCUSSION: When evaluating the model, we obtained a statistically significant association between non-union, bone exposure, diabetes and use of external fixation, being consistent with the literature. When studying the subset of exposed fractures, the other variables are statistically non-significant. This reflects that bone exposure is the variable that confers the greatest risk. Proper follow-up of these patients is essential given this high risk of evolving with non-union. CONCLUSION: In our series, bone exposure is the most important risk factor for presenting tibial non-union.

Assuntos