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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(05): 579-587
DOI: 10.1055/s-0041-1732332
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Função do fixador externo circular de Ilizarov no tratamento de fraturas tibiais com síndrome compartimental iminente/incompleta[*]

Article in several languages: português | English
Kaushik Bhowmick 
1   Departmento de Ortopedia, Christian Medical College and Hospital, Vellore, Tamilnadu, Índia
,
Chandrasekaran Gunasekaran 
1   Departmento de Ortopedia, Christian Medical College and Hospital, Vellore, Tamilnadu, Índia
,
Jacob J. Kandoth 
1   Departmento de Ortopedia, Christian Medical College and Hospital, Vellore, Tamilnadu, Índia
,
Boopalan Ramasamy 
1   Departmento de Ortopedia, Christian Medical College and Hospital, Vellore, Tamilnadu, Índia
,
Thilak S. Jepegnanam 
1   Departmento de Ortopedia, Christian Medical College and Hospital, Vellore, Tamilnadu, Índia
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Resumo

Objetivo O tratamento das fraturas da tíbia complicadas por síndrome compartimental afeta o tratamento e o resultado funcional dos pacientes devido às complicações associadas à fasciotomia. O objetivo deste estudo é diferenciar a síndrome compartimental iminente/incompleta (SCI) da síndrome compartimental aguda (SCA) estabelecida nas fraturas tibiais, para avaliar o resultado da fixação do aparelho de Ilizarov nos pacientes fraturados e com SCI, que não foram submetidos à fasciotomia.

Métodos Após o estabelecimento dos critérios de inclusão e exclusão, 19 pacientes foram incluídos no estudo de janeiro de 2007 a dezembro de 2017. Todos eram do sexo masculino, com média de idade de 42,3 ± 11,38 anos. Todos esses pacientes foram tratados com a fixação do aparelho de Ilizarov, de acordo com o protocolo médico e cirúrgico estabelecido neste estudo.

Resultados O acompanhamento médio dos nossos 19 pacientes foi de 47 ± 41,5 meses. O tempo médio de aplicação do fixador circular foi de 3,7 ± 1,7 dias. No total, 3 (16,7%) desses pacientes não apresentaram consolidação. Não houve complicações nas partes moles ou neurovasculares no pós-operatório imediato. A consolidação ocorreu finalmente em todos os pacientes, sem prejuízo da mobilidade e sem sequela de síndrome compartimental.

Conclusão O fixador circular de Ilizarov pode ser utilizado no tratamento dos pacientes com fraturas tibiais com SCI, e evita a fasciotomia, com suas várias complicações de infecção e não consolidação. O resultado é um número menor de procedimentos cirúrgicos e uma reabilitação mais rápida. Os cirurgiões devem diferenciar cuidadosamente a SCA e a SCI, pois, nesses pacientes, os resultados clínicos e funcionais variam significativamente. Fasciotomias desnecessárias devem ser evitadas.

Palavras-chave

técnica de Ilizarov - fraturas da tíbia - síndromes compartimentais

* Trabalho desenvolvido no Departamento de Ortopedia, Christian Medical College and Hospital, Vellore, Índia




Publication History

Received: 02 December 2020

Accepted: 19 February 2021

Article published online:
28 October 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg Br 1996; 78 (01) 95-98
    CrossrefPubMedGoogle Scholar
  • 2 Blair JA, Stoops TK, Doarn MC. et al. Infection and nonunion after fasciotomy for compartment syndrome associated with tibia fractures: a matched cohort comparison. J Orthop Trauma 2016; 30 (07) 392-396
    CrossrefPubMedGoogle Scholar
  • 3 Azar FM. Traumatic disorders. In: Canale ST, Beaty JH. editors, Campbell's Operative Orthopaedics. 12th ed.. Philadelphia, PA, USA: Elsevier; 2013
    Google Scholar
  • 4 Sood LK, Kanojia R, Vijay K, Mehra A, Sud A, Guglani A. Compartment syndrome - Early diagnosis and treatment. Indian J Orthop 2001; 35 (03) 177-179
    Google Scholar
  • 5 Sharma N, Singh V, Agrawal A, Bhargava R. Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation: A retrospective analysis of 15 cases. Indian J Orthop 2015; 49 (05) 502-509
    CrossrefPubMedGoogle Scholar
  • 6 Ruedi T, Buckley R, Moran C. Editors, AO principles of fracture management. New York: Thieme; 2007
    Google Scholar
  • 7 Tiwari A, Haq AI, Myint F, Hamilton G. Acute compartment syndromes. Br J Surg 2002; 89 (04) 397-412
    CrossrefPubMedGoogle Scholar
  • 8 Daniels M, Reichman J, Brezis M. Mannitol treatment for acute compartment syndrome. Nephron 1998; 79 (04) 492-493
    CrossrefPubMedGoogle Scholar
  • 9 Lachiewicz PF, Funcik T. Factors influencing the results of open reduction and internal fixation of tibial plateau fractures. Clin Orthop Relat Res 1990; (259) 210-215
    PubMedGoogle Scholar
  • 10 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
    PubMedGoogle Scholar
  • 11 Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998; 28 (02) 88-96
    CrossrefPubMedGoogle Scholar
  • 12 Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am 1973; 55 (07) 1331-1350
    CrossrefPubMedGoogle Scholar
  • 13 Checketts RG, MacEachem AG, Otterbum M. Pin track infection and the principles of pin site care. In: De Bastiani G. Apley AG, Goldberg AA. editors, Orthofix external fixation in trauma and orthopaedics. London: Springer; 2000: 97-103
    CrossrefGoogle Scholar
  • 14 Canadian Orthopaedic Trauma Society. Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg Am 2006; 88 (12) 2613-2623
    CrossrefPubMedGoogle Scholar
  • 15 Metcalfe D, Hickson CJ, McKee L, Griffin XL. External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis. J Orthop Traumatol 2015; 16 (04) 275-285
    CrossrefPubMedGoogle Scholar
  • 16 McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk?. J Bone Joint Surg Br 2000; 82 (02) 200-203
    CrossrefPubMedGoogle Scholar
  • 17 Shadgan B, Pereira G, Menon M, Jafari S, Darlene Reid W, O'Brien PJ. Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults. J Orthop Traumatol 2015; 16 (03) 185-192
    CrossrefPubMedGoogle Scholar
  • 18 Dubina AG, Paryavi E, Manson TT, Allmon C, O'Toole RV. Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome. Injury 2017; 48 (02) 495-500
    CrossrefPubMedGoogle Scholar
  • 19 Ertürk C, Altay MA, Altay N. et al. The effect of 2 different surgical methods on intracompartmental pressure value in tibial shaft fracture: An experimental study in a rabbit model. Ulus Travma Acil Cerrahi Derg 2017; 23 (02) 85-90
    PubMedGoogle Scholar
  • 20 Rudloff MI. Fractures of the Lower Extremity. In: Canale ST, Beaty JH. editors. Campbell's operative orthopaedics. Philadelphia: Elsevier Mosby; 2013: 2617-2724
    CrossrefGoogle Scholar
  • 21 Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder?. J Orthop Trauma 2002; 16 (08) 572-577
    CrossrefPubMedGoogle Scholar
  • 22 McQueen MM, Duckworth AD, Aitken SA, Court-Brown CM. The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome. J Bone Joint Surg Am 2013; 95 (08) 673-677
    CrossrefPubMedGoogle Scholar
  • 23 Whitney A, O'Toole RV, Hui E. et al. Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome?. J Trauma Acute Care Surg 2014; 76 (02) 479-483
    CrossrefPubMedGoogle Scholar
  • 24 Collinge C, Kuper M. Comparison of three methods for measuring intracompartmental pressure in injured limbs of trauma patients. J Orthop Trauma 2010; 24 (06) 364-368
    CrossrefPubMedGoogle Scholar
  • 25 Lollo L, Grabinsky A. Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital. Int J Crit Illn Inj Sci 2016; 6 (03) 133-142
    CrossrefPubMedGoogle Scholar
  • 26 Sellei RM, Hingmann SJ, Kobbe P. et al. Compartment elasticity measured by pressure-related ultrasound to determine patients “at risk” for compartment syndrome: an experimental in vitro study. Patient Saf Surg 2015; 09 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 27 Schmidt AH. Continuous compartment pressure monitoring-better than clinical assessment?. J Bone Joint Surg Am 2013; 95 (08) e52(1–2)
    CrossrefPubMedGoogle Scholar
  • 28 Bussell HR, Aufdenblatten CA, Subotic U. et al. Compartment pressures in children with normal and fractured lower extremities. Eur J Trauma Emerg Surg 2019; 45 (03) 493-497
    CrossrefPubMedGoogle Scholar
  • 29 Parkkinen M, Madanat R, Lindahl J, Mäkinen TJ. Risk Factors for Deep Infection Following Plate Fixation of Proximal Tibial Fractures. J Bone Joint Surg Am 2016; 98 (15) 1292-1297
    CrossrefPubMedGoogle Scholar