Our purpose was to evaluate the use of indirect and closed reduction with Ilizarov external fixator in intraarticular calcaneal fractures. In a period of 3 years, 16 patients with 18 intraarticular fractures of calcaneus (eleven type III and seven type IV according to Sanders classification) were treated with the Ilizarov fixator. Twelve patients were male and four female. The average age was 42 years (range 25 – 63 years). Three fractures were open. Fractures were evaluated by preoperative radiographs and CT scans. Restoration of the calcaneal bone anatomy was obtained by closed means using minimally invasive reduction technique by Ilizarov fixator. Arthrodiatasis and ligamento-taxis, and closed reduction of the subtalar joint were performed in 14 cases. In 4 cases the depressed posterior calcaneal facet was elevated by small lateral incision and stabilized in frame by wires. Postoperatively, partial, early weight bearing was encouraged in all patients. The mean follow-up period was 1,5 years (range 1 – 3 years). The AOFAS Ankle – Hindfoot Score, and physical examination were used in functional evaluation. The average score was 79,8 (range 72 – 90). Six patients had limited degenerative radiological findings of osteoarthrosis about the subtalar joint and three of them had painful subtalar movement. One of the patients complained of heel pad pain. Nine (6.25%) grade II pin tract infections were detected from a total of 144 wires. No secondary reconstructive procedures, including osteotomies, subtalar fusions, or amputations, have been done. Indirect closed reduction of calcaneal bone anatomy and arthrodiatasis of subtalar joint with Ilizarov external fixator is a viable surgical alternative for intraarticular calcaneal fractures
Whiplash vertigo syndrome is often seen in victims of rear-end vehicle collisions. These patients commonly complain of headache, vertigo, tinnitus, poor concentration, irritability, and sensitivity to noise and light. Sixteen patients (medium age, 39,5 years) that they refered in orthopaedic examination because of long-lasting subjective complaints after cervical spine injury underwent clinical, laboratorial and psychometric examinations. The mean posttraumatic interval was 43 months. Ten patients were injured in road accidents, 5 during sports and one at work, all with mechanism trial of whip. Each patient was evaluated with otorhinolaryngologic examination, audiometry tests, CT: petrus – internal auditory meatus and cerebellopontine corner. Also each patient was evaluated with neurologic examination, psychological well-being scale (sf-36), and personality profile scale. None of the patients had neurologic symptoms, and no lesions of the cervical spine were identified. All the patients had negative clinical, radiological and standard laboratorial control, but may be is a critical point that the eleven of these patients had pathologic OGTT (Oral Glucose Tolerance Test). Also did not exist differentiations from the mean values in psychological well-being scale (SF-36), and personality profile scale of healthy population. Test results were unrelated to the length of the post-traumatic interval. However, 2 distinct syndromes were identified. Ten patients had cervicoencephalic whiplash type syndrome (CES), characterized by headache, vertigo, tinnitus poor concentration, and disturbed adaptation to light intensity. Six patients had the lower cervical spine whiplash type syndrome (LCSS), characterized by vertigo, tinnitus cervical and cervicobrachial pain. The verification of Whiplash Vertigo syndrome require more objective clinical means. This article proposes that exists an organic base for the syndrome, but does not promote that whiplash injury certainly cause it
Aim of our study was the investigation and the cross-correlation of various neurologic scales to estimate, comparatively with the functional results of patients after damage of spinal cord injuries. Between 1989 – 2005, 115 patients were submitted in stabilization of Lower Cervical Spine that was judged unstable. The neurologic situation was certified with the scales: Frankel, ASIA motor score, NASCIS motor score, FIM scale, and MBI scale. In the protocol took part the 94 patients for that existed in neurologic details and long follow-up for at least two years. From the study of course of scores of all scales was not found statistically important difference between ASIA, NASCIS and other motor scales. However 12 patients with important improvement of mobility at ASIA motor score and NASCIS motor score they have not difference in Frankel scale, despite the make that the MRP (Motor Percentage Recovery) was improved: 21.5% Also 8 patients with relatively big improvement in their total scores did not have corresponding functional improvement (FIM scale, and [MBI] scale) A lot of neurologic methods – scales were used and are used today. However for the essential and modern follow-up of patients with spinal cord injuries, it needs certification with a scale of classic team of (measurement of mobility) and a scale of functional faculties of the patient
According to AO classification there were 3 non-unions with quiescent infection and no drainage, 4 with active infection and no drainage, and 16 with infection and drainage. The ankle joint was ankylosed in 6 patients preoperatively and it was painful in all patients. Thirteen patients had an angular deformity of more than 7 degrees (range 7–30 degrees, mean 16 degrees). Sixteen patients had a mean bone defect of 2.5 cm (range 1 to 6 cm). Monofocal or bifocal compression-distraction osteogenesis technique with or without bridging the ankle joint was performed in all cases. Ankle arthrodesis was necessary in 4 cases. Mean external fixation time was 139.6 days and mean follow-up period was 4 years.
The purpose of this study is to determine the indications and effectiveness of hybrid external fixation in the treatment of tibial plateau fractures and to evaluate the patient’s functional recovery. Twenty-seven patients with 28 intra-articular fractures of the proximal tibia were surgically treated with hybrid external fixation in a two years period (1999–2001). There were 25 patients (19 men and 6 women) available for the last follow up evaluation. The mean age was 35 years (17–76). According to Schatzker classification, there were 6 fractures type V and 22 type VI. Three of them were open fractures. The method included, indirect reduction based on ligamentotaxis and compression of the fractured segments with olive pins, in most patients. Additional limited internal fixation with free screws was also performed in 5 cases. Open reduction was necessary in 6 patients. Mobilization of the injured articulation was started at the third postoperative day, while full weight bearing was allowed after three months. The fixator was removed in average 12th week. Final evaluation was done according subjective, functional, clinical and radiological criteria. Mean follow up period was 14 months. All fractures except one united at an average time of 13, 5 weeks. Twenty-two patients (77.6%) graded as excellent and good, hi detail, subjective results were acceptable in 72%, functional in 84%, clinical in 70% and radiological in 80%. Complications included one axial deformity, one septic pseudarthrosis, one peronial palsy and superficial pin path infections. The use of hybrid external fixation in the comminuted tibial plateau fractures (Schatzker V, VI), insure good restraining and early union, avoid major soft tissue complications and allow quick mobilization and functional recovery of the knee joint. Moreover it is an application rather atraumatic because, only occasionally requires open reduction.