Complex Fractures of the Limbs: Diagnosis and Management

172 Pages·2014·8.176 MB·English

by  E. Carlos Rodríguez-Merchán, Juan Carlos Rubio-Suárez (eds.)

E. Carlos Rodríguez-Merchán
Juan Carlos Rubio-Suárez
Editors
Complex Fractures
of the Limbs
Diagnosis and Management
123
Complex Fractures of the Limbs

E. Carlos Rodríguez-Merchán
Juan Carlos R ubio-Suárez
Editors
Complex Fractures
of the Limbs
Diagnosis and Management
Editors
E. Carlos Rodríguez-Merchán Juan Carlos Rubio-Suárez
Department of Orthopaedic Surgery Department of Orthopaedic Surgery
La Paz University Hospital-IdiPaz La Paz University Hospital-IdiPaz
Madrid Madrid
Spain Spain
ISBN 978-3-319-04440-8 ISBN 978-3-319-04441-5 (eBook)
DOI 10.1007/978-3-319-04441-5
Springer Cham Heidelberg Dordrecht London New York
Library of Congress Control Number: 2014935870
© Springer International Publishing Switzerland 2014
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Pref ace
Bone fractures are becoming more and more common and complex, and
therefore their management is becoming more and more diffi cult. Generally
speaking, bone fractures are produced in high-energy traumatisms, mainly in
traffi c accidents, so that many of them take place in the setting of a poly-
trauma patient. We consider that a bone fracture is complex when there is
marked comminution, there are severe soft tissue injuries associated with it,
it takes place in an osteoporotic bone, or it is associated with a previous
implant (for bone fi xation or total joint replacement). If a complex fracture is
not treated in the appropriate way, it may cause severe complications and
sequelae (nonunion, malunion, infection). In this book we have analyzed the
current management of complex fractures of the limbs based on the experi-
ence of the contributing authors and on an in-depth review of the literature.
Madrid, Spain E. Carlos Rodríguez-Merchán
Madrid, Spain Juan Carlos Rubio-Suárez
v

Contents
1 Complex Fractures of the Proximal Humerus . . . . . . . . . . . . . 1
Elena Casado-Sanz, Raúl Barco, and Samuel A. Antuña
2 Complex Distal Humerus Fractures. . . . . . . . . . . . . . . . . . . . . . 9
Raúl Barco and Samuel A. Antuña
3 Fracture-Dislocations of the Elbow . . . . . . . . . . . . . . . . . . . . . . 17
Eduard Alentorn-Geli, Xavier Espiga, Raúl Barco,
and Samuel A. Antuña
4 Complex Fractures of the Distal Radius . . . . . . . . . . . . . . . . . . 29
José Manuel Martínez-Díez
5 Complex Fractures of the Pelvic Ring . . . . . . . . . . . . . . . . . . . . 37
Juan Carlos Rubio-Suárez
6 Complex Fractures of the Acetabulum . . . . . . . . . . . . . . . . . . . 51
Eduardo Zamora-Carrera and Juan Carlos Rubio-Suárez
7 Complex Fractures of the Distal Femur. . . . . . . . . . . . . . . . . . . 61
E. Carlos Rodríguez-Merchán, Primitivo Gómez- Cardero,
and Ángel Martínez-Lloreda
8 Complex Fractures of the Proximal Tibia. . . . . . . . . . . . . . . . . 77
Carlos Alberto Encinas-Ullán, Primitivo Gómez- Cardero,
and E. Carlos Rodríguez-Merchán
9 Complex Fractures of Tibial Pilon. . . . . . . . . . . . . . . . . . . . . . . 87
José Manuel Martínez-Díez
10 Complex Fractures of the Calcaneus. . . . . . . . . . . . . . . . . . . . . 95
Eduardo García-Rey
11 Complex Open Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Aitor Ibarzábal-Gil
12 Soft Tissue Coverage in Complex Fractures of the Limbs. . . . 107
Carmen Iglesias-Urraca
13 Nonunion of Complex Fractures of the Limb. . . . . . . . . . . . . . 119
Aitor Ibarzábal-Gil and Elena Gálvez-Sirvent
vii
viii Contents
14 Skeletal Reconstruction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Carmen Iglesias-Urraca
15 Management of the Polytrauma Patient . . . . . . . . . . . . . . . . . . 137
Juan Carlos Rubio-Suárez
16 Surgical Treatment of Osteoporotic Knee Fractures . . . . . . . . 147
E. Carlos Rodríguez-Merchán
17 Rehabilitation in Complex Fractures of the Limbs . . . . . . . . . 155
Hortensia de la Corte-Rodríguez,
Juan Manuel Román-Belmonte, E. Carlos Rodríguez-Merchán,
and Hortensia de la Corte-García
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
1
Complex Fractures
of the Proximal Humerus
Elena Casado-Sanz , Raúl Barco ,
and Samuel A. Antuña
1.1 Introduction Although there are many classifi cations for
cataloging these fractures, none of them is com-
Proximal humerus fractures are very common. In plete and useful enough to frame all fracture pat-
patients over 65, they are second only to distal terns and their possible variations. We will use
radius fractures as the most common fractures of the Neer Classifi cation in this chapter, as it is one
the upper limb. If we analyze their overall fre- of the most widespread. It is based on the four-
quency , proximal humerus fractures are the third part anatomy of the proximal humerus and
most common fractures behind proximal femur defi nes the displacement as an angulation greater
and distal radius. than 45° or a separation between fragments of
Seventy-fi ve percent of the cases occur in greater than 1 cm. This leaves us with 1-part
patients above age 60 that have suffered direct (non-displaced), 2-part, 3-part, and 4-part frac-
trauma after an accidental fall from their own tures. The Neer Classifi cation also assesses the
height. In younger patients, however, high-energy viability of the humeral head according to the
trauma to the shoulder is the usual mechanism of fracture pattern and the soft tissue attachments
injury [1 ]. and the humeral head’s relationship to the gle-
R adiographic diagnosis of these fractures noid to classify fractures associated with disloca-
should always be performed with appropriate tion [2 ].
projections. The fracture usually can be framed Approximately 80 % of the cases are consid-
within a classifi cation with the help of an antero- ered non-displaced fractures and treated conser-
posterior and lateral shoulder view in the plane vatively. Among the remaining 20 % of cases,
of the scapula. With a CT scan , it would be easier there is a small percentage of fractures that can
to evaluate complex fractures such as fracture be solved with a simple osteosynthesis [2 , 3 ].
dislocations, fractures associated with the glenoid Since this chapter aims to review complex frac-
and articular humeral head, posterior displace- tures of the proximal humerus and their potential
ment of the greater tuberosity, and the presence treatments, we will exclusively cover these types
of an associated fracture of the lesser tuberosity. of fractures.
1.2 Three- and Four-Part
E. Casado-Sanz (cid:129) R. Barco (cid:129) S. A. Antuña (*)
Department of Orthopaedic Surgery, Fractures in Young Patients
Shoulder and Elbow Unit ,
La Paz University Hospital-IdiPaz ,
T reatment of 3- and 4-part fractures in young
Paseo de la Castellana 261 , Madrid 28046 , Spain
people is challenging. The fi rst thing to consider
e-mail: [email protected];
[email protected]; [email protected] in all cases is the risk to the potential disruption
E.C. Rodríguez-Merchán, J.C. Rubio-Suárez (eds.), Complex Fractures of the Limbs, 1
DOI 10.1007/978-3-319-04441-5_1, © Springer International Publishing Switzerland 2014