covid
Buscar en
Gaceta Médica de Bilbao
Toda la web
Inicio Gaceta Médica de Bilbao Malunión femoral en fracturas de diáfisis femoral tratadas con clavo intramedu...
Información de la revista
Vol. 106. Núm. 1.
Páginas 9-16 (enero 2009)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 106. Núm. 1.
Páginas 9-16 (enero 2009)
Acceso a texto completo
Malunión femoral en fracturas de diáfisis femoral tratadas con clavo intramedular
Malunion femoral after intramedullary nailing of femoral shaft fractures
Izter hezurraren lotura okerra muinbarneko iltzearekin tratatutako femur diafisi hausturetan
Visitas
4885
M.A. Cabrerizo*, M.J. Ere˜o, A. Diego, M. Otero, J.C. Rodríguez
Hospital Galdakao-Usánsolo. Galdakao. Bizkaia. Espa˜a UE.
Este artículo ha recibido
Información del artículo
Resumen

El objetivo del estudio era evaluar la incidencia y grado de deformidad del femur en fracturas de diáfisis femoral tratadas con clavo intramedular.

27 fracturas de diáfisis femoral fueron valoradas. Todos los pacientes fueron tratados con clavo de Grosse-Kempf. Se utilizó la clasificación de Winquist y Hansen. Había 4 fracturas sin conminución, 5 fracturas tipo I, 6 fracturas tipo II, 3 tipo III, 3 tipo IV y 6 tipo VI.

El estudio de la angulación se hizo con radiografías de todo el femur y la valoración de la dismetría y malrotación mediante TAC. Hubo dismetría > 10mm en 7 pacientes (25%), deformidad angular ≥ 10° en 2 pacientes y en 6 la deformidad rotacional era ≥ 15° (22%)

La incidencia de deformidades puede minimizarse con una técnica rigurosa.

Palabras clave:
fractura diáfisis femoral
clavo intramedular
malalineamiento óseo
Summary

Our aim was to appraise the incidence and grade of femur deformities in shaft femoral fractures treated by intramedullary nailing.

There were 27 fractures, all patient were treated with Grosse-Kempf nail. Winquist and Hansen classification was used: there were 4 fractures without comminution, 5 type I, 6 type II, 3 type III, 3 type IV y 6 type V. Angulation was evaluated by radiographs of the whole femur, dismetria and rotational alignment were determined by computed tomography. 7 patients had dismetria > 10mm (25%), angulation deformity ≥ 10° in 2 patients, and malrotation deformity was noted in 6 patients (22%).

The incidence of deformities could be minimised by a precise technique.

Key words:
femoral fractures
nail intramedullary
bone malalignment
rotational deformities
Laburpena

Azterlanaren helburua femurraren deformazioa aztertzea zen muinbarneko iltzearekin tratatutako femur diafisi hausturetan. 27 femur diafisi haustura aztertu ziren guztira, den-denak Grosse-Kempf iltzearekin tratatuak izan zirenak. Winquist eta Hansen sailkapena erabili zen: 4 hausturak ez zuten konminuziorik; 5 haustura I motakoak ziren; 6 haustura, II motakoak; 3, III motakoak; 3, IV motakoak; eta 6, VI motakoak. Angeluazioa aztertzeko, femur osoaren erradiografiak erabili ziren; dismetriaren eta errotazio okerraren azterketa TAC bitartez egin zen. Dismetria > 10 mm-koa zen 7 pazientetan (%25); deformazio angeluarra ≥ 10°-koa, 2 kasutan; eta errotazio deformazioa ≥ 15°-koa, 6 kasutan (%22). Deformazioak teknika zorrotz baten bidez minimiza daitezke.

Hitz gakoak:
femur diafisi haustura
muinbarneko iltze
hezur lerrokatze oker
El Texto completo está disponible en PDF
Bibliografía
[1.]
Kempf I., Grosse A., Beck G..
Closed locked intramedullary nailing. Its application to comminuted fractures of the femur.
J Bone Joint Surg., 67-A (1985), pp. 709-719
[2.]
Johnson K.D., Greenberg M..
Comminuted femoral shaft fractures.
Orthop Clinics of North America., 18 (1987), pp. 133-147
[3.]
Alho A., Stromsoe K., Ekeland A..
Locked intramedulary nailing of femoral shaft fractures.
J Trauma., 31 (1991), pp. 49-59
[4.]
Wiss D.A., Fleming C.H., Matta J.M., Clark D..
Comminuted and rotationally unstable fractures of the femur treated with an interlocking nail.
Clin Orthop., 212 (1986), pp. 35-47
[5.]
Braten M., Terjesen T., Rossvoll I..
Femoral shaft fractures treated by intramedullary nailing. A follow-up study focusing on problems related to the method.
Injury., 26 (1995), pp. 379-383
[6.]
Brumback R.J..
The Rationales of Interlocking Nailing of the Femur,Tibia and Humerus: An Overview.
Clin Orthop., 324 (1996), pp. 292-320
[7.]
Bonnevialle P., Andrieu S., Bellumore Y., Challe J.J., Rongieres M., Mansat M..
Troubles torsionnels et inégalités de longueurs aprés enclouage á foyer fermé pour fracture diaphysaire femorale et tibiale.
Rev Chir Orthop., 84 (1998), pp. 397-410
[8.]
Borel J.C., Dujardin F., Thomine J.M., Biga N..
Enclouage verrouillé des fractures complexes de la diaphyse fémoral de l'adulte. A propos de 68 cas.
Rev Chir Orthop., 79 (1993), pp. 553-564
[9.]
Braten M., Terjesen T., Rossvoll I..
Torsional deformity after intramedullary nailing of femoral shaft fractures. Measurement of anteversion angles in 110 patients.
J Bone and Joint Surg., 75 (1993), pp. 799-803
[10.]
Jaarsma R.L..
Rotational malalignment after fractures of the femur.
J Bone Joint Surg. 2004, 86-B,1100-1104./J Orhop Trauma, 18 (2004), pp. 403-409
[11.]
Deshmukh R.G., Lou K.K., Neo K., Yew K.S., Rozman J.G..
A technique to obtain correct rotational alignment during closed locked intramedullary nailing of the femur.
Injury., 29 (1998), pp. 207-210
[12.]
Krettek C., Miclau T., Grün O., Schandelmaier P., Tscherne H..
Intraoperative control of axes, rotation and length in femoral and tibial fractures.
Technical note. Injury, 29 (1998), pp. SC29-SC39
[13.]
Gustilo R.B., Anderson J.T..
Prevention of infection in the treatment of one thousand and twenty five open fractures of long bones: retrospective and prospective analyses.
J Bone and J Surg., 58-A (1976), pp. 453-458
[14.]
Winquist R.A., Hansen S.T..
Comminuted fractures of the femoral shaft treated by intramedullary nailing.
Orthopedic Clinics of North America., 11 (1980), pp. 633-647
[15.]
Murphy S.B., Simon S.R., Kijewski P.K., Wilkinson R.H., Griscom N.T..
Femoral anteversion.
J. Bone Joint Surg., 69-A (1987), pp. 1169-1176
[16.]
Ruwe P.A., Gage J.R., Ozonoff M.B., Deluca P.A..
Clinical determination of femoral anteversion.
J Bone and Joint Surg., 74-A (1992), pp. 820-830
[17.]
Kuo T.Y., Skedros J.G., Bloebaum R.D..
Measurement of femoral anteversion by biplane radiography and computed tomography imaging: comparison with an anatomic reference.
Investigative Radiology, 38 (2003), pp. 221-229
[18.]
Hooper G.J., Lyon D.W..
Closed unlocked nailing for comminuted femoral fractures.
J Bone and J Surg., 70-B (1988), pp. 619-621
[19.]
Howe T.S..
Double level fractures of the femur treated with closed intramedullary nailing.
Ann Acad Med Singapore, 27 (1988), pp. 188-191
[20.]
Browner B.d..
Pitfalls, Errors and Complications in the Use of Locking Küntscher Nails.
Clin Orthop., 212 (1986), pp. 192-208
[21.]
Krettek C., Rudolf J., Shandelmaier P., Guy P., Könemann B., Tscherne H..
Unreamed intramedullary nailing of femoral shaft fractures: operative techniques and early clinical experience with the standard locking option.
Injury, 4 (1996), pp. 233-254
[22.]
Krettek C.h., Miclau T., Grün O., Shandelmaier P., Tscherne H..
Intraoperative control of axes, rotation and length in femoral and tibial fractures.
Technical note. Injury, 29 (1998), pp. S-C29-S-C39
[23.]
Antonelli L..
Closed intramedullary nailing of diaphyseal fractures of the femur: problems related to anatomical variations of the greater trochanter.
Italian J.Orthop.& traumatology, 15 (1989), pp. 67-74
[24.]
Winquist R.A., Hansen S.T., Clawson D.K..
Closed intramedullary nailing of femoral fractures.
J Bone and J Surg., 66-A (1984), pp. 529-539
[25.]
Kempf I., Grosse A., Beck G..
Closed locked intramedullary nailing. Its application to comminuted fractures of the femur.
J Bone and J Surg., 67-A (1985), pp. 709-719
[26.]
Harper M.C., Carson W.L..
Curvature of the femur and the proximal entry point for an intramedullary rod.
Clin Orthop., 220 (1987), pp. 155-161
[27.]
Georgiadis G.M., Olexa T.M., Ebraheim N.A..
Entry sites for antegrade femoral nailing.
Clin Orthop., 330 (1996), pp. 281-287
[28.]
Johnson K.D., Tencer A.F., Sherman M.C..
Biomechanical factors affecting fractures stabiliy and femoral bursting in closed intramedullary nailing of femoral shaft fractures, with illustrative case presentations.
J Orthop trauma., 1 (1987), pp. 1-11
[29.]
Miller S.D., Burkart B., Damson E., Shrive N., Bray R.C..
The effect of the entry hole for an intramedullary nail on the strngth of the proximal femur.
J Bone and J Surg., 75-B (1993), pp. 202-206
[30.]
Dora C., Leunig M., Beck M., Rothenfluh D., Ganz R..
Entry Point Soft Tissue Damage in Antegrade Femoral Nailing: A Cadaver Study.
Journal of Trauma, 15 (2001), pp. 488-493
[31.]
Kyle R.F., Cabanela M.E., Russell T.A., Swiontkowski M.F., Winquist R.A., Zuckerman J.D., Schmidt A.H., Koval K.J..
Fractures of the proximal part of the femur.
J Bone and J Surg., 76-A (1994), pp. 924-947
[32.]
Christie J., Court-Brown C..
Femoral neck fracture during closed medullary nailing: brief report.
J. Bone and J Surg., 70-B (1988), pp. 670
[33.]
Kale S.P., Patil N., Pilankar S., Karkhanis A.R., Bagaria V..
Correct anatomical location of entry point for antegrade femoral nailing.
[34.]
Strecker W., Keppler P., Gebhard, Kinzl L..
Lenght and torsion of the lower limb.
J. Bone Joint Surg., 79 (1997), pp. 1019-1023
[35.]
Tornetta P., Tiburzi D..
Antegrade or retrograde reamed femoral nailing.
J Bone and J Surg., 82-A (2000), pp. 652-654
[36.]
David J.G., Stephen, Kreder H.J., Schemitsch E.H., Conlan L.B., Wild L., Mckee M.D..
Femoral intramedulary nailing: Comparison of fracturetable and manual traction.
J Bone and J Surg., 84-A (2002), pp. 1514-1521
[37.]
Jaarsma R.L., Ongkiehong B.F., Grüneberg C., Verdonschot N., Duysens J., Kampen A.V..
Compensation for rotational malalignment after intramedullary nailing for femoral shaft fractures. An analysis by plantar pressure measurements during gait.
Injury, 35 (2004), pp. 1270-1278
[38.]
Krettek C., Miclau T., Blauth M., Lindsey R.W., Donow C., Tscherne H..
Recurrent rotational deformity of the femur after static locking of intramedullary nails:case reports.
J Bone and J Surgery, 79-B (1997), pp. 4-8
[39.]
Braten M., Terjesen T., Rossvoll I..
Femoral anteversion in normal adults. Ultrasound measurements in 50 men and 50 women.
Acta orthop Scand, 63 (1992), pp. 29-32
[40.]
Reikeras O., Hoiseth A., Reigstad A., Fönstelien E., Femoral neck angles.
A specimen study with special regard to bilateral differences.
Acta Orthop Scand, 53 (1982), pp. 775-779
[41.]
Sojbjerg J., Eiskjaer S., Moller-Larsen F..
Locked nailing of comminuted and unstable fractures of the femur.
J Bone and J Surg., 72-B (1990), pp. 23-25
[42.]
Tornetta P. III, Ritz G., Kantor A..
Femoral torsion after interlocked nailing of unstable femoral fractures.
J Trauma, (1995), pp. 213-219
[43.]
Yang K.H., Han D.Y., Janhng J.S., Shin D.E., Park J.H..
Prevention of malrotation deformity in femoral shaft fracture.
J Trauma, 12 (1998), pp. 558-562
[44.]
Kim J.J., Kim E., Kim K.Y..
Predicting the rotationally neutral state of the femur by comparing the shape of the contralateral lesser trochanter.
Orthopedics, 24 (2001), pp. 1069-1070
[45.]
Jaarsma R.L., Verdonschot N., Van der Venne R..
Avoiding rotational malalignment after fractures of the femur by using the profile of the lesser trochanter: an in vitro study.
Arch Orthop Trauma Surg., 125 (2005), pp. 184-187
[46.]
Eckhoff DG, Montgomery WK, Kylcoyne RF, Stamm ER.: Femoral morphometry and anterior knee pain. Clin Orthop. 302:64-68.
[47.]
Tönnis D., Heinecke A..
Current concepts review. Acetabular andfemoral anteversion: Relationship with osteoarthritis of the hip.
J Boneand J Surg., 81-A (1999), pp. 1747-1770
Copyright © 2009. Academia de Ciencias Médicas de Bilbao
Descargar PDF
Opciones de artículo