Tratamiento de fracturas diafisarias inestables de fémur con clavo intramedular encerrojado tipo FMRP

Un grupo de 26 fracturas conminutas de fémur, rotacionalmente inestables, fueron tratadas con clavo intramedular encerrojado tipo FMRP. En 22 casos la conminución afectaba a más del 50% de la cortical. Del total de enclavados, 22 fueron estáticos y 4 dinámicos. La consolidación desde el punto de vista clínico y radiológico ocurrió en el 92% de los casos. En 2 casos se desarrolló un pseudoartrosis. Sólo un paciente mostró un acortamiento mayor de 1 cm. Una angulación mayor de 10° en cualquiera de los planos del espacio fue apreciada en 5 pacientes. No se produjo en ningún caso deformidad rotacional. El clavo intramedular encerrojado ha aumentado las indicaciones del enclavado intramedular en el tratamiento de las fracturas inestables de fémur. La incidencia de infección y pseudoartrosis es baja. La estabilidad del montaje permite una movilización inmediata del paciente, rehabilitación temprana y menor estancia intrahospitalaria. El clavo FMRP disminuye el tiempo de fluoroscopia, un fresado con instrumentos flexibles y es más barato que otros sistemas similares.Twenty six comminuted and rotationally unstable fractures of the femur were treated with the FMBP intramedullary locked nail. Twenty two of the fractures had comminution involving more than 50% of the cortex. Of the nailings, 22 were static and 4 dynamic. Clinical and radiographic union occurred in 92% of cases. There were 2 nonunions. There was one case of deep wound infection. Only one patient had a shortening greater than 1 cm. Angulation in any plane greater than 10° was noted in 5 patients. There were no instances of rotatory deformities. The interlocking nail has expanded the indications for the use of closed intramedullary nailing in the treatment of unstable femoral fractures. The incidence of infection and nonunion is low. Stability of the fractures allows immediate mobilization of the patients, early rehabilitation of the limb and shorter hospital stay. The FMRP nail eliminated fluoroscopy, flexible reamers and is cheaper as compared to other systems

Treatment of diaphyseal non-unions of the ulna and radius

Non-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation. We retrospectively reviewed a large cohort of forearm non-unions treated by using a uniform surgical approach during a period of 33 years (1975-2008) in a single trauma centre. All non-unions were managed following the AO-principles of compression plate fixation and autologous bone grafting if needed. The study cohort consisted of 47 patients with 51 non-unions of the radius and/or ulna. The initial injury was a fracture of the diaphyseal radius and ulna in 22 patients, an isolated fracture of the diaphyseal ulna in 13, an isolated fracture of the diaphyseal radius in 5, a Monteggia fracture in 5, and a Galeazzi fracture-dislocation of the forearm in 2 patients. Index surgery for non-union consisted of open reduction and plate fixation in combination with a graft in 30 cases (59%), open reduction and plate fixation alone in 14 cases (27%), and only a graft in 7 cases (14%). The functional result was assessed in accordance to the system used by Anderson and colleagues. Average follow-up time was 75 months (range 12-315 months). All non-unions healed within a median of 7 months. According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result. Complications were seen in six patients (13%). Our results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcom

Nonunion of fractures of the femoral neck in children

The authors present the prospective clinical outcome of nine pseudoarthroses resulting from surgical treatment carried out in nine children, whose ages varied from 6 years and 2 months to 14 years and 2 months (mean 10 years and 2 months), who had fractures of the femoral neck. Five were classified as type II, according to the Delbet classification modified by Colonna, and four were type III. The initial fractures were caused by high-energy traumas, such as trampling, bicycle falls, and car accidents. Treatment of choice was valgus osteotomy of the femoral neck associated or not with insertion of bony graft. The mean time of follow-up was 38 months, ranging from 23 to 71 months, and the mean time of pseudoarthrosis consolidation after osteotomy was 76.6 days, varying from 45 to 240 days. In this study, all the pseudoarthroses consolidated. For final analysis of clinical and radiographic results, the Ratliff’s classification was used. We obtained three cases as good results, five as fair and one as poor. The authors concluded that valgus osteotomy is a good option for treatment of pseudoarthrosis in the femoral neck fractures in children