This paper presents a review of the literature on pseudarthrosis of the scaphoid in skeletally immature individuals, taking into consideration its epidemiology, diagnosis and treatment, as well as its controversies. Knowledge of this subject makes it possible for patients to be given appropriate treatment immediately. Pseudarthrosis of the scaphoid in skeletally immature patients is a rare condition that results from error or lack of diagnosis of a fracture. Thus, careful clinical and radiographic examination should be performed in order to confirm or rule out this diagnosis. Several treatment methods have been reported and have shown good results. These include conservative plaster cast treatment, bone graft without osteosynthesis, bone graft with Kirschner wires, percutaneous screws and bone graft with compression screws. The treatment performed depends on the characteristics of the pseudarthrosis and the surgeon's experience.
Resumo Objetivo Avaliar o uso do retalho fasciocutâneo sural de fluxo reverso na cobertura de lesões no terço distal dos membros inferiores. Métodos Foram analisados 24 casos, 20 de origem traumática, três por lesões esportivas e um por ressecção de lesão tumoral. Resultados Dos 24 prontuários avaliados, 16 eram homens e oito mulheres. A idade variou de seis a 75 anos. A maioria dos pacientes evoluiu com cicatrização total do retalho (21). Houve apenas um caso de necrose total do retalho em paciente diabético insulinodependente e hipertenso, evoluiu para posterior amputação do membro. Em dois casos, houve necrose parcial com posterior cicatrização por segunda intenção, um desses pacientes era tabagista pesado. As complicações foram associadas às comorbidades e, ao contrário do evidenciado por outros estudos, não houve correlação com a curva de aprendizado. Também não houve correlação com o local ou o tamanho da lesão a ser coberta. Conclusão Tem-se como relevância clinica que a técnica de retalho fasciocutâneo sural de fluxo reverso usada obteve 87,5% de sucesso, é uma opção viável e eficaz no arsenal terapêutico das lesões complexas dos membros inferiores.
Scaphoid fractures are the most common fractures of the carpal bones, corresponding to 60%. Of these, 10% progress to nonunion; moreover, 3% can present necrosis of the proximal pole. There are various methods of treatment using vascularized and non-vascularized bone grafts.To evaluate and compare the rate of scaphoid consolidation with necrosis of the proximal pole using different surgical techniques.The authors conducted a review of the literature using the following databases: PubMed and BIREME/LILACS, where 13 case series were selected (ten with use of vascularized bone grafts and three of non-vascularized bone grafts), according to inclusion and exclusion criteria.In most cases VBGs were used, especially those based on the 1,2 intercompartmental supraretinacular artery, due to greater reproducibility in performing the surgical technique.
Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients with multidirectional instability in the shoulder. Method: In 17 patients (mean age, 23 years) operated at São Vicente de Paulo Hospital and the Institute of Orthopedics and Traumatology of Passo Fundo, Brazil from 1999 to 2009, we performed trapezius transfer to the proximal humerus. In these patients, the mean interval between trauma and surgery was 8 months. Results: Functional improvement and resolution of multidirectional instability of the shoulder were observed in all the patients. No patient showed immediate postoperative complications. The mean active mobility was as follows: 95˚ flexion, 50˚ abduction, 45˚ external rotation, and internal rotation at the level of the first lumbar vertebra (L1). The trapezius muscle strength was classified as grade III, and the UCLA functional outcome was 22 points. The postoperative satisfaction was excellent, and occasional pain and weakness was reported by all the patients. Conclusions: Transfer of the trapezius muscle to the proximal humerus provides better results in patients with a more than 6-monthold lesion. This procedure also preserves passive mobility of the limb, confers shoulder stability, provides active mobility, and prevents osteoarthrosis.
ObjectiveAnalyze the percutaneous fixation technique for scaphoid fractures in the waist of the scaphoid and the proximal pole, and demonstrate its result.MethodsA retrospective cross-cohort study conducted from January 2005 to April 2015, aiming at the consolidation time, epidemiological profile, level of function, return to work, and complications.ResultsTwenty-eight patients were selected, with a mean of eight weeks of follow-up. They presented a mean age of 30.5 years, male prevalence (25 patients; 89.2%), and no differences between dominant and non-dominant sides. The mean time from diagnosis was 4.16 weeks, but in three cases of fibrous union, the pre-operative period was over one year. The most frequent mechanism of injury was a fall on the outstretched hand, in 22 cases (78.5%). Of all fractures, 24 cases were in the waist (85.8%) and four were of the proximal pole (14.2%); seven patients had displacement (25%). There was consolidation in 26 cases (92.8%) with a mean of 7.5 weeks after surgery. In cases of non-union, radiological follow-up was up to 24 weeks, requiring a new surgical intervention.ConclusionsPercutaneous fixation is an excellent, reproducible technique that allows early active mobility of the wrist with a low complication rate, although it requires a learning curve.
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