Management of unicondylar femoral fractures is mainly done by open reduction and internal fixation. Anatomic reduction in the articular surface is paramount in this type of lesion. Medial condyle fractures lack specific osteosynthesis material for fixation.We report a case resolved with the sparsely documented technique using calcaneal plate fixation.
ResumoAs luxações anteriores representam cerca de 96% do total de luxações do ombro, sendo a recidiva/instabilidade mais comum em pacientes jovens. A lesão de outras estruturas do ombro é frequente, nomeadamente a lesão óssea de Bankart. Contudo, a associação com a fratura da apófise coracoide é muito rara.Este artigo descreve o caso clínico de um homem de 67 anos que recorreu ao serviço de urgência com queixas de omalgia persistente, com episódios de agudização, iniciados após queda da própria altura. O paciente apresentava ainda histórico de trauma do ombro 3 meses antes, avaliado em outro hospital. A luxação anterior do ombro foi constatada radiograficamente, e a tomografia computorizada (TC) do ombro confirmou erosão óssea da vertente anteroinferior da glenoide (perda óssea de cerca de 50% do diâmetro anteroposterior na região inferior da glenoide), com reabsorção quase completa de lesão óssea de Bankart (aparente em análise a posteriori da radiografia do episódio traumático inicial). Associadamente, foi diagnosticada uma fratura transversa da apófise coracoide (tipo II da classificação de Ogawa). O paciente foi submetido ao tratamento cirúrgico, com confecção do batente ósseo anterior utilizando remanescente do fragmento fraturado do coracoide suplementado por enxerto autólogo tricortical do ilíaco, fixados com parafusos canulados (de acordo com as técnicas de Bristow-Latarjet e Eden-Hybinett).No seguimento pós-operatório, foi observado um bom resultado funcional, sem novos episódios de luxação e sem queixas álgicas significativas.Descreve-se uma associação rara de lesões do ombro, e salienta-se o desafio do tratamento das mesmas dado o seu diagnóstico tardio, como no caso apresentado.
ResumoUma paciente de meia-idade com fratura do platô tibial e avulsão da eminência tibial foi tratada com uma combinação de fixação do platô com placa medial e sutura da eminência com fio não absorvível auxiliada por artroscopia.Nossa técnica para fraturas com avulsão da eminência tibial não interfere nos materiais de osteossíntese do platô tibial e, mais uma vez, teve bons resultados no tratamento de lesões combinadas e complexas do joelho.
Introduction: With the dramatic increase in the competitive sports of children and young people, overuse injuries have become more important in the pediatric population. Among these, the most frequent injuries in young athletes are stress fractures. The absence of evident traumatic history and the subtle radiographic changes can cause a diagnostic difficulty and delay the treatment. Fracture of the patella sleeve is a rare fracture only occurs in children. The diagnosis is difficult, both clinically and radiologically. High patella and hemarthrosis are important signs to diagnose this fracture. Presentation of 2 clinical cases of injuries in children and young people in sports: stress fractures and fracture of the patella sleeve. Methods: Retrospective descriptive method with reports of clinical cases based on patients’ electronic clinical processes. Results: We present a case of a child, a 13-year-old soccer practitioner who had mentioned well localized pain in the anterior aspect of the right leg with 5 days of evolution and analgesic gait and no history of trauma. The radiographs and CT showed a juxtaposed cortical lesion with apparent contact with the cortical bone without associated periosteal reaction. NMR confirmed stress fracture of the proximal tibial shaft. It was treated conservatively with immobilization with plaster and discharge. We present the case of an 11-year-old boy who suffered a fracture of the patella sleeve. In the imaging study, a fragment of bone with a displacement from the lower pole of the patella was visible. An open fracture reduction was performed. During the surgery confirmed avulsion fracture of a small osteochondral fragment, configuration of a sleeve-like fracture. The amount of cartilage was small, so it was decided to reinsert the 2 anchorages for patellar tendon. After fracture healing and rehabilitation, both returned to sports activity without sequelae or functional limitations. Discussion/Conclusion: A knowledge of the fracture of the patella sleeve, together with its clinical and radiological features, is important to avoid misdiagnosis and treatment delay. Care should be taken not to disturb the proximal tibial process. Although relatively uncommon in the pediatric age, the incidence of fractures described stress have been increasing in this age group. A high degree of suspicion is required to make the diagnosis and avoid too invasive treatment. REFERENCES Ray JM, Hendrix J. Incidence, mechanism of injury, and treatment of fractures of the patella in children. J Trauma 1992;32:464–7. Bates DG, Hresko MT, Jaramillo D. Patellar sleeve fracture: demonstration with MR imaging. Radiology 1994;193:825–7. Wu CD, Huang SC, Liu TK. Sleeve fracture of the patella in children. A report of five cases. Am J Sports Med 1991;19:525– 8. Houghton GR, Ackroyd CE. Sleeve fractures of the patella in children: a report of three cases. J Bone Joint Surg Br 1979;61:165–8. Shands PA, McQueen DA. Demonstration of avulsion fracture of the inferior pole of the patella by magnetic resonance imaging. A case report. J Bone Joint Surg Am 1995;77:1721–3. Dai LY, Zhang WM. Fractures of the patella in children. Knee Surg Sports Traumatol Arthrosc 1999;7:243–5. Fredericson M, Bergman G, Hoffman KL, et al. Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23: 472-81. Hunter-Griffin LY. Clinics in sports medicine: overuse injuries. Philadelphia (PA): W.B. Saunders, 1987. Jackson DW, Bailey D. Shin splints in the young athlete: a non-specific diagnosis. Phys Sports Med 1975; 3: 45-51.
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