Fracturas de Fémur Proximal de Alta Energía Tratadas con Reducción a Través de Mini-open y Clavo Cefalo-medular

Resumen

Objetivo Evaluar los resultados radiológicos de pacientes con fractura de fémur proximal tratados con clavo cefalo-medular y reducción abierta a través de abordaje mini-open.

Material y Métodos Estudio retrospectivo-descriptivo de una serie consecutiva de 45 pacientes (38 hombres, 7 mujeres, edad promedio 52 años) con fractura de cadera de alta energía tratados con clavo cefalo-medular y reducción a través de abordaje mini-open. Se registró el mecanismo del accidente y presencia de lesiones asociadas. En todos los casos se contó con radiografías preoperatorias y tomografía axial computada (TAC). Se clasificaron de acuerdo a la AO. Se registró en número de fragmentos que presentaba la fractura. Se tomaron radiografías de control en forma mensual hasta la consolidación. Se midió el ángulo cervico-diafisiario operado y contralateral.

Resultados Todos los casos fueron secundarios a un accidente de alta energía. Veintidós pacientes presentaron lesiones asociadas. El número de fragmentos promedio fue de 3. La diferencia entre el ángulo cervico-diafisiario post operatorio de la cadera fracturada versus la cadera contralateral fue de 4,9 grados. Un paciente presentó no-unión. El tiempo promedio hasta la consolidación radiográfica fue de 3,7 meses.

Conclusión El uso de clavos cefalo-medulares asociado a reducción a través de mini-open en pacientes jóvenes con fractura de fémur proximal de alta energía, presenta buenos resultados radiológicos con bajo número de complicaciones.

Abstract

Objective To evaluate radiologic results of patients with proximal femur fracture treated with cephalo-medullary nails and open reduction through mini-open approach.

Materials and Methods A retrospective-descriptive study of 45 patient consecutive series (38 male, 7 female. Mean age 52 years old) with high energy hip fracture treated with cephalo-medullary nails and open reduction through mini-open approach. Accident mechanism and associated lesions were documented. Every case was evaluated with pre-operative radiography and CT-scan. Fractures were classified according to AO classification. Patients were radiographically controlled monthly until bone healing. Cervical-diaphysial angle was measured and compared bilaterally.

Results Every case was secondary to high energy trauma. 22 patients presented associated lesions. The mean number of bone fragments was 3. The difference between postoperative cervical-diaphysial angle versus contralateral hip was 4.9°. Only 1 patient presented non-union. The mean time until consolidation confirmed with radiography was 3.7 months.

Conclusion The use of cephalo-medullary nails associated to open reduction through a mini-open approach in young patients with high energy associated proximal femur fractures, presents satisfactory radiologic results with a low amount of complications.

Palabras clave

fractura cadera - alta energía - joven - clavo cefalo-medular

Keywords

hip fracture - high energy - young - cephalo-medullary nails

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