Interactive Journal of Medical Research

Traumatic dislocation of the hip is an extremely severe injury. Although previously considered an uncommon lesion, it now is seen more often as a result of motor vehicle accidents. In most cases, dislocation of the hip is associated with fractures of the acetabulum, which ultimately can result in a higher incidence of complications than the complications observed in pure simple dislocations. Early recognition and prompt closed reduction of the dislocated hip constitute the cornerstone of proper treatment of this injury. Once the dislocation is reduced, definitive treatment of the acetabular fracture can be delayed to obtain a precise diagnostic evaluation. If surgical reconstruction of the acetabular fracture is indicated, it is done best in the first 10 days after the injury. A few patients in whom nonconcentric reduction, failed closed reduction, or impaired neurologic status occurs after reduction will require early open reduction and internal fixation of the fracture. Complications can be caused by the initial injury or by the treatment. Avascular necrosis of the femoral head, degenerative osteoarthritis, and heterotopic ossification are the main complications encountered in patients with unsatisfactory final results. Despite a perfect reduction of the hip dislocation and anatomic reduction of the acetabular fracture, a significant degenerative process of the hip is expected when the patient is assessed at long-term followup.

OBJETIVOS: Revisar aspectos epidemiológicos das fraturas do planalto tibial em hospital de nível I. MÉTODOS: Analisamos, retrospectivamente, 239 fraturas do planalto tibial tratadas cirurgicamente. Levamos em consideração idade, sexo, mecanismo de trauma, classificações das lesões, lado acometido e lesões associadas. RESULTADOS: Dos pacientes estudados, 168 são do sexo masculino, a quinta década foi a mais acometida, quanto ao mecanismo de trauma o acidente de trânsito foi o principal fator causal, 128 casos foram do lado esquerdo e 22,6% tiveram lesões associadas. CONCLUSÕES: A maioria dos pacientes foi do sexo masculino, na quinta década de vida, e vítima de acidente de trânsito, sendo as fraturas por depressão e cisalhamento do planalto tibial as lesões mais comuns. Lesões associadas foram pouco frequentes em nossa casuística. Nível de Evidência II, Estudos Prognósticos. Investigação do Efeito de Característica de Um Paciente Sobre o Desfecho da Doença.

Complex fractures of the lateral tibial plateau may extend to the posterior rim of the knee and to the tibial spines. Displaced fractures of the posterolateral corner of the tibial plateau may result in joint incongruity and instability, especially with the knee in flexion. Anatomical reduction of the joint surface and containment of the tibial rim are the primary goals of the treatment in such cases. Dedicated surgical approaches including dissection of the peroneal nerve, sometimes in association with an osteotomy of the fibular head are typically used to address these injuries. Some techniques require special positioning of the patient on the operative table. Anatomical studies of the knee allowed us to conclude that an osteotomy of the lateral epicondyle of the femur may be a natural extension of the standard anterolateral approach to the tibial plateau. The main advantage of this approach is the broad exposure of the lateral joint surface, allowing its anatomical reduction. It does not violate the proximal tibiofibular joint or pose a risk to the peroneal nerve. The main limitation is the lack of visualization of the posterior metaphysis of the tibia, preventing the application of a buttress plate parallel to the plane of fracture split. To overcome this limitation, we describe a method to support the posterior tibial plateau rim, in cases of bicondylar tibial plateau fractures, combining the extended anterolateral with the posteromedial approach. For selected cases, with a significant compromise of the posterolateral and anterolateral quadrants of the tibial plateau, including the tibial spines, the extended anterolateral approach may be complemented by a planned detachment of the anterior horn of the lateral meniscus. In such variant, a complete exposure of the entire surface of the lateral tibial plateau and tibial spines is achievable, assuring optimal conditions for an anatomical reduction of the articular surface.

The biomechanical behavior of Pauwels type III fractures should be taken into consideration when performing internal fixation, since this repair should resist the shear force inherent in the vertical fracture line to the greatest extent possible. Recently, the use of a small fragment plate on the medial face of the femoral neck has been proposed by some authors, with satisfactory initial results. In the current study we analyze the mechanical role a medial plate used as a buttress plate for Pauwels type III femoral neck fractures, comparing the resistance of two fixation configurations using three cannulated screws. Pauwels type III fractures were simulated in synthetic bones models and two groups were created, one of those using two parallel screws at the bottom of the femoral neck and the third screw crossing the fracture horizontally (G1), and the other fixed in the same arrangement as G1, but with the addition of a medial side plate at the apex of the fracture (G2). The constructs were subjected to axial loading until catastrophic failure. The addition of a medial plate buttressing the femoral neck increased significantly the resistance to maximum loading (p = 0.003). Use of a medial buttress plate results in a mechanically superior construction for Pauwels type III fractures fixed with multiple cannulated screws. Level IV. Biomechanical comparative study.