Objective: To conduct a descriptive analysis on 31 cases of children with floating elbow who were attended at our clinic between 1994 and 2009, and to review the literature relating to this topic. Methods: Data were obtained through examining the medical records. The following variables were used: age, gender, side, mechanism, type of fracture, classification, treatment and complications. Results: Twenty-four patients (77.4%) were male and seven (22.6%) were female. The mean age was 8.5 (± 3.2) years, ranging from one to 14 years. The left side was predominantly affected (67.7%). The commonest injury mechanism was a fall from a height (74.2%). All the supracondylar fractures were Gartland type III. Distal radius fractures alone, of Salter-Harris type II, were diagnosed in 22 patients (71%). Open fractures occurred in 22 cases (71%). Closed reduction and application of a plaster cast for a closed fracture of the distal radius was performed in two patients (6.45%). Simultaneous conservative treatment for two fractures was not used. Sixteen supracondylar fractures (54.8%) were fixed using crossed wires, at 90° to each other, and in 14 cases (45.16%), an intramedullary wire was used together with another wire introduced through the lateral epicondyle at 45°. The following complications were observed: deformed consolidation (10%), nerve injuries (6%), compartment syndrome (3%) and pin path infection (16%). Conclusions: This is an uncommon injury that in most cases results from high-energy trauma. Surgical treatment for both fractures is recommended by most authors. Ulnar nerve injuries were correlated with the fixation method, but no neurological injuries were triggered by the initial trauma.
INTRODUÇÃOA presença inoportuna de um corpo estranho na cavidade peritoneal pode ocorrer durante operações com dificuldades técnicas e/ou intercorrências tais como: traumas com intensos sangramentos, traumas extensos multiviscerais, exéreses de volumosos tumores com grandes descolamentos, ressecções de volumosas visceromegalias, falta de controle e entrosamento por parte da equipe cirúr-gica e múltiplas re-operações com dificuldades técnicas e sangramentos 5,6 . A revisão criteriosa e sistemática de toda a cavidade peritoneal, seus espaços sub-frênicos e inter-viscerais antes da laparorrafia é condição técnica obrigatória e tática preventiva para evitar-se deixar corpos estranhos no paciente e consequentemente, suas implicações médico-legais 2,6 O período do diagnóstico destes corpos estranhos pode variar de semanas, meses e até anos 4 . Nesta paciente o que chamou a atenção foi a permanência deste CE assintomático por 40 anos e somente após é que apresentou manifestação clínica, objetivo deste relato. RELATO DO CASOMulher, 74 anos, leucodérmica, aposentada, casada, natural de Minas Gerais, foi internada apresentando dor abdominal tipo cólica no hipocôndrio direito e em todo andar supra-mesocólico, mal-estar e alteração do ritmo intestinal com predomínio de constipação. Refere ter sido submetida à colecistectomia há 40 anos, em outro serviço. No exame físico evidenciou-se massa palpável em flanco e hipocôndrio direito. Os exames laboratoriais pré-operatórios foram normais e a endoscopia digestiva alta mostrou pangastrite, úlcera duodenal em atividade, H.Pylori positivo e monilíase esofagiana. O clister opaco evidenciou massa volumosa, calcificada, com área de hipotransparência, arredondada, rechaçando o ângulo hepático do cólon. A tomografia computadorizada do abdome (Figura 1) confirmou esta massa sólida heterogênea de 8 cm de diâmetro, de contornos regulares e bem definidos, com calcificações parietais (Figura 2), no hipocôndrio direito e englobando o cólon e alças de delgado. Após preparo mecânico do cólon com manitol à 20%, antibioticoprofilaxia com 2 g de cefazolina na indução anestésiça, foi realizada laparotomia exploradora e exérese de uma massa sólido-cística localizada no hipocôndrio direito, de conteúdo esverdeado e friável, contendo fios de algodão . A paciente evoluiu bem tendo alta hospitalar no 4° dia. O resultado do exame histopatológico foi: macroscopia -massa capsulada endurecida, amarelo-esverdeada, consistência untuosa e firme-elástico com diâmetro 8X7,5X6,5 cm pesando 195 g; microscopia -parede conjuntiva, foco de (3):186-7 RESUMO -Racional -A presença de um corpo estranho dentro da cavidade peritoneal pode ocasionar dor, desconforto, mal-estar , febre, náuseas, obstrução intestinal, fistulização para o aparelho digestório e até a sua eliminação via retal. Objetivo -Relatar o caso de uma paciente com um textiloma no hipocôndrio direito, diagnosticado após 40 anos de submetida à colecistectomia e que agora apresentava massa palpável, quadro de sub-oclusão intestinal e diagnóstico inicial de ...
Objective: To conduct a descriptive analysis on 31 cases of children with floating elbow who were attended at our clinic between 1994 and 2009, and to review the literature relating to this topic. Methods: Data were obtained through examining the medical records. The following variables were used: age, gender, side, mechanism, type of fracture, classification, treatment and complications. Results: Twentyfour patients (77.4%) were male and seven (22.6%) were female. The mean age was 8.5 (± 3.2) years, ranging from one to 14 years. The left side was predominantly affected (67.7%). The commonest injury mechanism was a fall from a height (74.2%). All the supracondylar fractures were Gartland type III. Distal radius fractures alone, of SalterHarris type II, were diagnosed in 22 patients (71%). Open fractures occurred in 22 cases (71%). Closed reduction and application of a plaster cast for a closed fracture of the distal radius was performed in two patients (6.45%). Simultaneous conservative treatment for two fractures was not used. Sixteen supracondylar fractures (54.8%) were fixed using crossed wires, at 90° to each other, and in 14 cases (45.16%), an intramedullary wire was used together with another wire introduced through the lateral epicondyle at 45°. The following complications were observed: deformed consolidation (10%), nerve injuries (6%), compartment syndrome (3%) and pin path infection (16%). Conclusions: This is an uncommon injury that in most cases results from high-energy trauma. Surgical treatment for both fractures is recommended by most authors. Ulnar nerve injuries were correlated with the fixation method, but no neurological injuries were triggered by the initial trauma.
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