Use of blocked intramedullary shaft for the treatment of humeral diaphyseal fractures

Clinical and radiographic outcomes of 31 patients with humeral diaphyseal fractures submitted to surgery with intramedullary shafts were studied. From these, four patients presented fractures at the shaft insertion site and were treated using a different method. From the 27 patients left, the healing rate was 96.1%, with an average duration of 63.4 days. Five of them complained of pain in the shoulder and only one presented abduction limitation. Temporary palsy of the radial nerve was found in two patients and pseudoarthrosis in one of them, who was submitted to a new surgical intervention with plate and autologous bone graft, after 5 months. It was concluded that, although blocked intramedullary shafts presents a high incidence of the retrograde access port leading to fractures in its insertion site and the anterograde port causing pain in the shoulder.Estudamos os resultados clínicos e radiográficos de 31 pacientes portadores de fraturas diafisárias do úmero que foram operados com hastes intramedulares. Destes quatro apresentaram fraturas no local da inserção da haste e foram tratados com outro método. Dos 27 pacientes restantes o índice de consolidação foi de 96,1 % e que durou em média de 63,4 dias. Cinco queixaram-se de dor no ombro e em apenas um apresentou limitação da abdução. Paralisia temporária do nervo radial foi constatada em dois pacientes e pseudartrose em um que após 5 meses da cirurgia foi submetido a nova intervenção cirúrgica com o emprego de placa e enxerto ósseo autólogo. Concluímos que embora o emprego de hastes intramedulares bloqueadas apresentou alto índice de a via de acesso retrógrada pode levar a fraturas no seu ponto de entrada e via anterógrada com violação do manguito rotador pode gerar dores no ombro.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e TraumatologiaUniversidade de São Paulo Faculdade de MedicinaUNIFESP, Depto. de Ortopedia e TraumatologiaSciEL

Estudo multicêntrico comparativo do tratamento de fraturas diafisárias multifragmentárias de tíbia com hastes bloqueadas não-fresadas e placas em ponte

OBJECTIVE: A prospective, randomized study to compare patients with closed, multi-fragmented tibial diaphyseal fractures treated using one of two fixation methods undertaken during minimally invasive surgery: nonreamed interlocking intramedullary nails or bridging plates. MATERIALS AND METHODS: Forty-five patients were studied; 22 patients were treated with bridging plates, 23 with interlocking nails without reaming. All fractures were Type B and C (according to the AO classification). RESULTS: Clinical and radiographic healing occurred in all cases. No cases of infection occurred. The healing time for patients who received nails was longer (4.32 weeks on average) than the healing time for those who received plates (P = 0.026). No significant differences were observed between the two methods regarding ankle mobility for patients in the two groups. CONCLUSIONS: The healing time was shorter with the bridging plate technique, although no significant functional differences were found.OBJETIVOS: Estudo prospectivo e randomizado comparou pacientes com fraturas diafisárias multifragmentárias fechadas de tíbia, tratados com dois métodos de fixação: hastes intramedulares bloqueadas não-fresadas e placas em ponte. MATERIAL E MÉTODOS: Foram estudados 45 pacientes sendo utilizadas 22 placas em ponte e 23 hastes bloqueadas. Todas as fraturas foram tipos B e C (Classificação AO). RESULTADOS: A consolidação clínica e radiográfica ocorreu em todos os casos. Não houve caso de infecção. Verificou-se que o tempo de consolidação dos pacientes que receberam haste foi maior (em média 4,32 semanas) do que o tempo de consolidação daqueles que receberam placa (p = 0,026). Não foram observadas diferenças estatisticamente significantes entre os dois métodos no tocante à mobilidade do tornozelo nos pacientes dos dois grupos. CONCLUSÕES: O tempo de consolidação foi menor com uso de placas em ponte, porém sem diferenças funcionais significantes

Cross-sectional study on different entry points for anterograde femoral intramedullary osteosynthesis

OBJECTIVE: To analyze the degree of knowledge among professionals who treat fractures using the recommended technique, with regard to correlating the nail with the entry point that is considered appropriate. METHODS: A questionnaire that presented five types of nail and simulated a transverse diaphyseal fracture of the femur was developed. RESULTS: Responses regarding the entry points corresponding to choosing the type of nail were obtained from 370 orthopedists who were participating in the 41st Brazilian Congress of Orthopedics and Traumatology. It was observed that only 20% correctly identified the entry point and that there was no difference between the professionals within the specialty of Traumatology and the others. CONCLUSION: It was concluded that the majority of the physicians attending the congress were unaware of the entry points.OBJETIVO: Analisar o grau de conhecimento dos profissionais que tratam essas fraturas com a técnica preconizada relacionando a haste ao ponto de entrada considerado apropriado. MÉTODOS: Foi desenvolvido um questionário no qual constavam cinco tipos de hastes e simulada uma fratura diafisária do fêmur transversa. RESULTADOS: Os pontos de entrada correspondentes à escolha do tipo de haste foram respondidos por 370 médicos ortopedistas que participaram do 41º Congresso Brasileiro de Ortopedia e Traumatologia. Constatou-se que somente 20% acertaram o ponto de entrada e que não houve diferença entre os profissionais que faziam a especialidade Traumatologia e os demais. CONCLUSÃO: Concluiu-se que a maioria dos médicos que frequentaram o congresso desconhece tal fato.UNIFESP-EPM Departamento de OrtopediaUNIFESP-EPM Departamento de Ortopedia e TraumatologiaUNIFESP, EPM, Depto. de OrtopediaUNIFESP, EPM Depto. de Ortopedia e TraumatologiaSciEL

Minimal invasive ostheosintesis for treatment of diaphiseal transverse humeral shaft fractures

OBJECTIVE:To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique.METHODS:Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures.RESULTS:In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury.CONCLUSION:It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft.Level of Evidence III, Therapeutic Study.Universidade de Campinas Hospital das Clinicas Department of Orthopedics and TraumatologySwedish Medical CenterUniversidade Federal de São Paulo (UNIFESP) Departament of Orthopedics and TraumatologyUNIFESP, Departament of Orthopedics and TraumatologySciEL

Recommendations for avoiding knee pain after intramedullary nailing of tibial shaft fractures

<p>Abstract</p> <p>Background</p> <p>The objective of this study is to analyze the proximal tibiofibular joint in patients with knee pain after treatment of tibial shaft fractures with locked intramedullary nail.</p> <p>Findings</p> <p>The proximal tibiofibular joint was analyzed in 30 patients, who reported knee pain after tibial nailing, and standard radiograph and computed tomography were performed to examine the proximal third of the tibia. Twenty patients (68.9%) presented the proximal screw crossing the proximal tibiofibular joint and 13 (44.8%) had already removed the nail and/or screw. Four patients (13.7%) reported complaint of knee pain. However, the screw did not reach the proximal tibiofibular joint. Five patients (17.2%) complained of knee pain although the screw toward the joint did not affect the proximal tibiofibular joint.</p> <p>Conclusion</p> <p>When using nails with oblique proximal lock, surgeons should be careful not to cause injury in the proximal tibiofibular joint, what may be one of the causes of knee pain. Thus, the authors suggest postoperative evaluation performing computed tomography when there is complaint of pain.</p

Profile of trauma victims of motorcycle accidents treated at hospital São Paulo

OBJECTIVE:To evaluate retrospectively, through analysis of medical records, the epidemiological aspects of patients traumatized by motorcycle accidents treated at the orthopedics ward, Hospital São Paulo, Brazil.METHODS:It is a retrospective observational study. The analysis of patients' medical records comprised the period from January 2008 to December 2009. The data checked were: age, gender, type of collision, type and location of fracture, treatment performed (conservative or surgical), type of surgery, cost of synthesis material and hospitalization, period of hospitalization and postoperative complications. After data collection, statistical analysis was performed.RESULTS:We analyzed 381 victims involved in motorcycle accidents. Patients were predominantly male (85%), with a mean age of 30.7 years old. Referring to distribution and site of lesions, 75.5% of individuals had lower limb fractures and in 95.4% of the cases, the treatment of choice was surgery. Twenty-nine patients were rehospitalized due to postoperative complications, such as exposure and failure of synthesis material, wound infection, necrosis, osteomyelitis, and pseudoarthrosis.CONCLUSION:It was possible to identify useful characteristics for planning preventative strategies to reduce the rate of motorcycle accidents and redirect public investment in health. Level of Evidence III, Retrospective Study.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Orthopedics and TraumatologyUNIFESP, EPM, Department of Orthopedics and TraumatologySciEL

The view of Brazilian orthopedists on partial weight bearing in open fractures of the tibial shaft following osteosynthesis

BACKGROUND: Tibial shaft fractures are the most frequent among long bone fractures. They are described in the literature according to the device and method of treatment, with recommendations that range from full weight bearing to non-weight bearing restrictions. There are studies comparing osteosynthesis devices and surgical aspects, but no references were found on how or when to allow weight bearing on the affected limb in the standing position. OBJECTIVES: The present study learned from Brazilian orthopedists which methods of osteosynthesis they use to treat open tibial fractures, whether they refer patients to physical therapy, when and why they allow partial weight bearing for both physical activity and therapy. METHODS: Two hundred and thirty-five orthopedists answered a questionnaire during the 14th Brazilian Conference of Orthopedic Trauma. Results: The results showed that, in Brazil, the most widely used osteosynthesis device is the external fixator, but earlier weight bearing while standing occurs when intramedullary nails are used. Most orthopedists refer patients to physical therapy and allow partial weight bearing in the standing position according to the material used for synthesis. CONCLUSIONS: It was concluded that there is a preference for external fixation, that most orthopedists refer patients to physical therapy and that the synthesis material influences restrictions on partial weight bearing.CONTEXTUALIZAÇÃO: As fraturas da diáfise da tíbia são as mais frequentes dentre as dos ossos longos. Há descrições na literatura, de acordo com o método e dispositivo de tratamento, com recomendações que vão desde a descarga total até a proibição do suporte de peso corporal em ortostase. Existem estudos comparando os dispositivos de osteossíntese e os diversos aspectos cirúrgicos, porém não são encontradas referências que descrevam como e quando se deve liberar a descarga sobre o membro acometido na posição ortostática. OBJETIVOS: Verificar, entre os ortopedistas brasileiros, qual ou quais são os métodos de osteossíntese adotados para o tratamento de fraturas expostas de tíbia, se indicam o tratamento fisioterápico, quando e quais fatores influem para liberar a descarga parcial em ortostase, tanto para a função quanto para a fisioterapia. MÉTODOS: 235 ortopedistas responderam a um questionário durante o XIV Congresso Brasileiro de Trauma Ortopédico. RESULTADOS: Os resultados mostraram que, no Brasil, o dispositivo de osteossíntese mais utilizado é o fixador externo (FE), porém a descarga de peso em pé ocorre mais precocemente quando são utilizadas as hastes intramedulares. A grande maioria dos ortopedistas indica fisioterapia, e o período para liberação de descarga de peso parcial em ortostatismo varia de acordo com o material de síntese utilizado. Conclusões: Concluiu-se que há preferência pelos FEs, a grande maioria indica tratamento fisioterápico e o material de síntese influencia o tempo de liberação de descarga parcial de peso em ortostatismo.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Ortopedia e TraumatologiaUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaSciEL

Tibial plateau fractures fixation using posterior approaches - preliminary results of 12 cases

OBJECTIVE: To describe our preliminary results of posterior shearing tibia plateau fractures treated by a direct dorsal approach and plate fixation. METHODS: A consecutive series of twelve patients with tibia plateau fractures treated by direct posterior approach was selected from our database. Conventional radiographies, computed tomography scans and medical records were reviewed. All cases were followed to union, as defined by painless weight bearing and radiographic healing. RESULTS: Between July 2009 and April 2010, our trauma service received 89 tibia plateau fractures and treated 80 (89,9%) operatively. Twelve patients (13,5%) sustained posterior shearing tibia plateau fractures. All fractures were treated through the posterior approach, although 3 required association with an anterolateral approach as well. The mean age of patients was 35 years and mean follow-up was 12 (range 8-23) months. The fractures were classified according to AO/OTA: five 41 B1, four 41 B3, two 41 C1 and one 41 C3. There was one wound dehiscence, managed with local wound care, and one loss of reduction treated by reoperation. No patient sustained neurovascular injury, nonunion, malunions or knee instability. In four cases the reduction was rated as poor (> 2 mm step off), in five cases reduction was rated as imperfect ( 2mm de degrau articular), em 5 casos foi considerada imperfeita (< 2 mm de degrau articular) e em 3 casos obtivemos uma redução anatômica. CONCLUSÃO: Os autores concluem que o uso da abordagem posterior deve ser considerada em casos de fraturas com onde haja componente de cisalhamento posterior do planalto da tíbia. Uma casuística ampliada é necessária para avaliar o real benefício desta abordagem.UNIFESP Departamento de Ortopedia e TraumatologiaUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de OrtopediaUNIFESP, Depto. de Ortopedia e TraumatologiaUNIFESP, EPM, Depto. de OrtopediaSciEL