r e v b r a s o r t o p . 2 0 1 5;5 0(1):22-29 w w w . r b o . o r g . b r Artigo Original Tratamento das fraturas em duas partes do colo cirúrgico do úmero com o uso de haste intramedular metafisária bloqueada proximalmente com estabilidade angular ଝ informações sobre o artigo Histórico do artigo: Recebido em 30 de novembro de 2013 Aceito em 13 de fevereiro de 2014 On-line em 1 de agosto de 2014 Palavras-chave: Fratura do úmero Fixação intramedular de fraturas Procedimentos cirúrgicos r e s u m o Objetivos: Avaliar os resultados funcionais de pacientes com fraturas do colo cirúrgico tratados com haste intramedular metafisária bloqueada (HIMB) e estabilidade angular. Métodos: Foram analisados 22 pacientes prospectivos entre 21 e 69 anos, avaliados entre janeiro de 2010 e janeiro de 2011, e correlacionados tempo de consolidação, idade, sexo, complicaç ões e resultado funcional com o protocolo da University of California at Los Angeles (UCLA) modificado.Resultados: O tempo de consolidação médio foi de 9,26 ± intervalo de confiança (IC) de 0,40 semana. Um caso (4,5%) não se consolidou. Não houve infecção. Houve um caso (4,5%) de capsulite adesiva com boa evolução ao tratamento clínico. Cinco pacientes (22,7%) apresentaram leve dor eventual e um caso (4,5%) referiu dor de média intensidade associada a impacto subacromial do implante. O escore médio UCLA modificado foi 30,4 ± IC 1,6 ponto obtidos no fim de 12 meses de avaliação, 18 casos (81,8%) com escore «excelente» e «bom», três casos (13,6%) com escore «razoável» e um caso (4,5%) com escore «ruim».Conclusão: No grupo de pacientes avaliados, o tratamento das fraturas em duas partes do colo cirúrgico com HIMB e a estabilidade angular demonstraram resultados funcionais satisfatórios e baixo índice de complicaç ões, semelhantes aos encontrados na literatura.
ObjectivesTo evaluate the functional results from patients with surgical neck fractures treated with a locked metaphyseal intramedullary nail and angular stability.MethodsTwenty-two patients between the ages of 21 and 69 years were evaluated prospectively between January 2010 and January 2011. Their time taken for consolidation, age, sex, complications and functional results were correlated using the modified protocol of the University of California at Los Angeles (UCLA).ResultsThe mean time taken for consolidation was 9.26 weeks ± confidence interval (CI) of 0.40 weeks. One case (4.5%) did not become consolidated. There were no cases of infection. There was one case (4.5%) of adhesive capsulitis with good evolution through clinical treatment. Five patients (22.7%) presented occasional mild pain and one case (4.5%) reported medium-intensity pain associated with the subacromial impact of the implant. The mean score on the modified UCLA scale was 30.4 ± CI 1.6 points, obtained at the end of 12 weeks of evaluation: 18 cases (81.8%) with “excellent” and “good” scores, three cases (13.6%) with “fair” scores and one case (4.5%) with a “poor” score.ConclusionIn the group of patients evaluated, treatment of two-part surgical neck fractures by means of a locked metaphyseal intramedullary nail and angular stability demonstrated satisfactory functional results and a low complication rate, similar to what is seen in the literature.
Introduction: Cockett syndrome (CS) is characterized by compression of the left common iliac vein by the right common iliac artery against the spinal wall, causing obstruction of left lower limb (LLL) blood flow. The clinical condition is mainly manifested by pain and edema of the LLL and, in more severe cases, even by left iliofemoral venous thrombosis. It is already well established in the literature that in cases such as Cockett syndrome, orthopedic surgeries also corroborate the occurrence of deep vein thrombosis (DVT), mainly by the positioning and manipulation of the limb during the intervention; by the continuous reaction secondary to the use of cement; by significant blood loss; by postoperative (PO) edema; and by the mobility limitations PO. Case report: A 42-year-old patient complained of left foot pain and repetitive sprains for 2 years. After a complete physical examination indicating a cavovarus foot and a pointed hindfoot, an AP and profile radiograph of the limb was requested, which revealed data compatible with a foot cavity. The nuclear magnetic resonance demonstrated the necessity for cavo foot correction surgery and reconstruction of the structure of the ankle. The patient was classified as ASA 1 and had no indication for prophylaxis for DVT according to the Hospital Protocol. The surgical procedure occurred without intercurrences, and the patient was discharged in good general condition in the 2nd PO with guidelines and prescriptions. The patient returned to the foot clinic on the 7th PO complaining of abrupt pain in the LLL, accompanied by edema, hyperemia and cyanosis of the limb. A Doppler ultrasonography was performed, which detected extensive thrombosis of the iliac vein and compression of the same by the contralateral iliac artery, raising the hypothesis of CS. In the present paper, the exam images, surgery, PO and evolution for the DVT will be presented and discussed, as well as the resolution of this condition through endovascular surgery with angioplasty and stent implantation. Conclusion: CS and orthopedic surgeries are, in isolation, important risk factors for the development of DVT and, above all, when overlapped, they increase this risk exponentially. Endovascular surgery with angioplasty and stent implantation is the main form of treatment, presenting excellent clinical results.
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