The aim of this abstract is to show that acute osteomyelitis is one of the most feared complication of orthopedic surgery. A rapid and aggressive treatment is mandatory in order to avoid significant bone loss, joint destruction and, in most cases, salvage of the limb. After apparent cure of the infection, sequelae must be addressed. In this case, the joint destruction was important, so reconstruction procedures where impossible. In a superficial and relatively small joint such as the elbow, it is preferred to do an arthrodesis than an arthroplasty because the risk of reactivation of the infection with implant involvement is very important. We present a case report of a 69 years old woman, who had a supra-intra-condylar fracture (AO 13-C1) of the right humerus. She was treated with open reduction and internal fixation with 2 internal lag screws and 2 external lag screws. After 6 weeks, she was admitted with a dislocated elbow associated with pain, loss of limb function, cubita nerve palsy and a purulent discharge from the surgical wound. She started vancomycin and was submitted to surgery with debriment, hardware removal and fixation with an external fixator was used. The local signs of infection disappeared progressively. After normalization of the laboratory parameters of infection, the patient was submitted to an elbow arthrodesis using a posterior contour plate. The elbow achieved solid fixation and infection was eradicated, at least for the time being, allowing the patient to use the upper limb in her daily live activities. The treatment of post operative acute osteomyilits is challenging, In this case, after apparent solution of the infection, a solid fixation of the elbow was achieved, allowing the use of the upper limb in the patient daily activities.
The aim of this abstract is to show that when dealing with an infected non-union, all possibilities of treatment must be considered in order to choose the best treatment plan for each patient. This case shows the evolution of an infected non-union following type III open fractures which, after the used of several methods that failed, had to be solved with amputation. We present a case report of a 41 years old man, with a type IIIA open fracture of the right tibia and fibula. Initially, he was treated with an external fixator, which was removed and plate implanted. After this, he who presented to us with an infected non-union. He was submitted to surgery, the plate was removed and a circular external fixator was used. Six months later, the external fixator was removed and a reamed intramedullary nail was implanted with bone graft from iliac crest. One year later, the facture site was still mobile, so he was submitted to fixation with internal plate. As this last method also failed, a bellow knee amputation was performed, 4 years after the initial event. After several attempts with several distinctive methods, the infected non-union had to be solved with the sacrifice of the limb. The treatment of infected non-union is one of the most difficult in Orthopedic Surgery. There are several procedure that can be used. When all these fail, amputation and consequent limb prosthetic substitution, might allow the patient to return to the society.
The purpose of this study was to evaluate the results of subcutaneous ulnar nerve transposition in the treatment of Cubital Tunnel Syndrome (CTS) and the influence of prognostic factores such as preoperative McGowan stage, age and duration of symptoms. 36 patients (17 men and 19 women) with CTS who underwent subcutaneous ulnar nerve transposition between 2006 and 2009 were evaluated postoperatively, an average follow-up of 28 months. Sensory and motor recovery was evaluated clinically. The postoperative outcome was based on modified Bishop score, subjective assessment of function and on the degree of patient satisfaction. The dominant side was involved in 61% cases and the mean age was 51.2 years. There were 9 (25%) McGowan stage I, 18 (50%) stage II and 9 stage III patients. We used the Mann-Whitney and Kruskal-Wallis test to compare continuous variables and chi-square and Fisher Exact Test for categorical variables. There was a statistically significant improvement of sensory (p=0.02) and motor (p=0.02) deficits. We obtained 21 (58.3%) excellent results, seven (19.4%) fair, six (16.7%) satisfactory, and two bad ones (5.55%). There was a statistically significant improvement of function (p<0.001). There is controversy in the literature regarding the best surgical treatment for CTS. The duration and severity of symptoms and advanced age, more than the surgical technique, seem to influence prognosis. With the technique used, the satisfaction rate was 86% and 72% recovered their daily activities without limitations. 78% of patients with severe neuropathy improved after surgery. The rates of postoperative complications were comparable with those of other studies. The severity of neuropathy and duration of symptoms (>12months) pre-operatively, but not age, had a negative influence on the outcome. The results showed that the subcutaneous ulnar nerve transposition is safe and effective for postoperative clinical sensory and motor recovery for several degrees of severity in CTS. Given the major prognostic factors, surgical treatment should be advocated as soon as axonal loss has become clinically evident.
The Achilles tendon is formed by the fusion of gastrocnemius and soleus muscle, and is one of the strongest of the human body. Acute ruptures occur mostly in men between 30 and 50 years of age, with irregular sports activity. Rupture generally occurs in a low perfusion area, between 2 and 6 cm above the calcaneal tuberosity. We reviewed and examined 45 patients with Achilles tendon rupture submitted to surgical correction, between January 2004 and December 2008 (5 years), in our Hospital. For each patient was determined the injury type, time until diagnosis, time between diagnosis and surgery, surgical technique employed, immobilization period, rehabilitation program, occurrence of complications and rerupture, follow-up period and clinical outcome (AOFAS score). The most frequent cause of rupture was professional activity (46%), followed by soccer practice (38%). The diagnosis was made in the first medical observation in 71% of patients. The mean surgical period until surgery was of 0.7 days, and the mean time of admission was of 3.56 days. The used surgical techniques were open surgery (25 cases), open surgery augmented with gastrocnemius fascia (5 cases), and percutaneous surgery with the Achillon system (15 cases). The mean AOFAS score was of 92.42 (84–100), was of 100 in the Achillon group, 92 in the open surgery group and 91 in the augmented surgery group. The complications all occurred in the open surgery group, with one infection, one surgical incision healing delay and one case of sural nerve injury. The mean follow-up was of 4.4 months and the main complain was of local tenderness in the surgical wound, with all patients having returned to their normal level of activity. This series complications rate is low, and the AOFAS score and satisfaction rate is higher in the percutaneous group, following the tendency expressed in the international literature. Reflecting the growing tendency for information in our patients, one important cause of dissatisfaction in the open surgery group is not to have had the opportunity of a percutaneous surgery. The results of percutaneous surgery are excellent, with a lower rate of complications, less surgical wound complaints. The possibility raised by other studies of a higher rerupture rate in the percutaneous group was not confirmed in this group. Currently all Achilles ruptures are treated percutaneously in our Hospital, if the rupture meets the indications criteria for this type of surgery.
