Fractures of the horizontal surface of the distal tibia are known commonly as pylon or plafond fractures, and represent 1-5% of lower extremity fractures, 7-10% of all tibial fractures. The protocol consisted of immediate (within eight to 24 hours) open reduction and internal fixation of the fibula, using a fibular plate or one third tubular plate and application of an external fixator spanning the ankle joint. In the second stage, the treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can preserve soft tissue, simplify operative procedure and decrease wound, obtain rigid internal fixation and guarantee early function exercises of ankle joint. In this study we evaluated 22 patients treated in Clinical Emergency Hospital Constanta between April 2012 -July 2013 diagnosed with multifragmentary fractures of the distal tibia. This study evaluates the treatment of complex fractures of distal tibia with locked plate after external fixation. There were 17 males and 5 females of mean age 51,7 years (31-68). The mean follow-up period was 14 weeks. (Ranging from 9-16 weeks). All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks) showing radiological union. There were no cases
The ankle stability and its biomechanics can be compromised after ligamentous and malleolus lesions. The complete early diagnosis, and also the early and late postsurgery results, must be formulated and explained using the tibio-astragalus radiologic indices. The paper evaluates the importance of these presurgery and postsurgery indices, analyzing also the late results under causal report. Our subordinating to the exigency of radiologic indices to obtain a reparation as anatomic as possible, shows that the surgical treatment must be applied to osteo-ligamentous lesions properly, so that to get the remake of tibio-astragalus biomechanics.
Bone changes occurring in people with rheumatoid arthritis increase the incidence of fractures in these patients. In the complex fractures of the 3-part proximal humerus, the treatment of choice is represented by open reduction and osteosynthesis. Because of the important role of the distal portion of the humerus in the elbow joint, fi rm osteosynthesis with angularly blocked implants provides a superior biomechanics and stability in the treatment of complex fractures even in the elderly with a diminished bone stock due to osteoporosis. The preliminary diagnosis was established following simple radiographs. Establishing the diagnosis required computerized tomography and three-dimensional elbow reconstruction. Surgery was performed following the analysis of the imaging data, practicing the fi rst step of reduction and osteosynthesis by the MIPO technique of the proximal humerus fracture, subsequent reduction and osteosynthesis of the distal humerus fracture, the defective bone was fi lled with artifi cial bone graft, and the osteosynthesis of the osteotomized olecan. Reduced soft tissue damage, reduced postoperative pain, reduced functional impairment, and axillary nerve protection confer superiority to osteosynthesis through the mini-invasive approach (MIPO) versus the transdeltoid approach. RezumatModifi cările ososase ce apar la persoanele cu poliartrită reumatoidă cresc incidenţa fracturilor la acești pacienţi. În fracturile complexe ale humerusului proximal cu 3 fragmente, tratamentul de elecţie este reprezentat de reducerea deschisă și osteosinteză. Datorită rolului important al porţiunii distale a humerusului, în cadrul articulaţiei cotului, osteosinteza fermă prin plăci blocate premulate, angular stabile, oferă o biomecanică și o stabilitate superioară în tratamentul fracturilor complexe chiar și la persoanele în vârstă, cu un stoc osos diminuat din cauza osteoporozei. Diagnosticul preliminar a fost stabilit în urma efectuării radiografi ilor simple. Stabilirea diagnosticului a impus efectuarea unei tomografi i computerizate și o reconstrucţie tridimensională a cotului. Intervenţia chirurgicală a fost efectuată în urma analizei datelor imagistice, practicându-se în primă etapă reducere și osteosinteză prin tehnica MIPO a fracturii de humerus proximal, ulterior reducerea și osteosinteza fracturii de humerus distal, plombajul defectului osos cu substituent și hobanajul olecranului osteotomizat. Lezarea redusă a ţesuturilor moi, reducerea durerii postoperator, diminuarea gradului de insufi cienţă funcţională și protejarea nervului axilar conferă superioritate osteosintezei prin abordul miniminvaziv (MIPO) faţă de abordul transdeltoidian. Cuvinte cheie: MIPO, reconstrucţie 3D tomografi e computerizată, poliartrită reumatoidă, fractura humerus proximal, fractură humerus distal CASE REPORT
Background: The gold standard treatment for complex fractures of tibial shaft is the reamed interlocking intramedullary nail. There has been some controversies about dynamization of statically locked nail, and some authors recommend routine dynamization for promotion of healing. This study evaluates the treatment of complex fractures of tibia shaft with static and dynamic interlocking intramedullary nail method. Methods: In this retrospective study, we studied 100 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with tibia and fibula shaft fractures. They were treated by external fixation, and intramedullary nail. The intramedullary nail was blocked distally static or dynamic. Results: All patients achieved union during 12-18 weeks. The need of dynamization was required at 23 patients after 10 weeks from osteosynthesis. No significant complication was observed in our patients. Alignment of tibial fracture was perfect in all patients without any shortening and rotation. Conclusion: Locked intramedullary nailing is the treatment of choice for fractures of the tibial shaft.
The first uses of the polymers at the articular level were: joint components, cement fixation of prosthetic components at the bone, and sutures of tendons and ligaments. Since 1970, when polymethyl methacrylate (PMMA) was introduced, bone cement is the choice of choice to fix the prosthetic implant to bone. The cementation of the implant components is a commonly used procedure for hip, knee and shoulder arthroplasty: the femoral stem and the acetabular cup (in the case of total hip arthroplasty), the femoral and tibial components (in the case of total knee arthroplasty), the humeral stem (in hemiarthroplasty, total arthroplasty: anatomical or arthroplasty with inverse shoulder prosthesis) The objectives of this study are to establish the optimal indication of the cementing process, to evaluate and compare the results of cemented hemiarthroplasty, the real benefit from the immediate postoperative functional recovery program, for elderly patients with a diminished bone stock with complex fractures of proximal humerus. The success of the surgical treatment for complex fractures of proximal humerus depends to a large extent on establishing a correct diagnosis, an optimal surgical indication, a thorough preoperative planning, an optimal implant, a periarticular soft tissue reconstruction, and an effective postoperative recovery program.
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