Correlación clínica - imagenológica de la injuria al manguito rotador posterior a enclavado intramedular anterógrado de húmero en el Hospital Teodoro Maldonado Carbo. 2017
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Las fracturas diafisarias de húmero se producen tanto por un traumatismo banal como una caída o por un traumatismo de alta energía como accidentes de tráfico o lesiones por arma de fuego, el tratamiento de elección es el enclavado intramedular ya que es una técnica mínimamente invasiva que cuando es realizada por cirujanos expertos presenta pocas complicaciones a pesar de que se pueden presentar lesiones al realizar el abordaje a través del manguito rotador y durante la reducción de la fractura, ya que el nervio radial discurre por la cara posterior del húmero. El objetivo de este trabajo consistió en identificar la correlación de las características ecográficas y clínicas de pacientes con fractura de húmero sometidos a enclavado intramedular anterógrado, la relación entre los hallazgos ecográficos sugestivos de lesión del manguito rotador con los signos y síntomas clínicos por medio del test de Constant-Murley. El universo fueron todos los pacientes sometidos a tratamiento quirúrgico (enclavado intramedular anterógrado del húmero) que no presentaron antecedentes de patologías de hombro. Fue un trabajo: retrospectivo, transversal, de corte cuantitativo, que se realizó durante el periodo 2015-2017. De los 50 pacientes sometidos a enclavado intramedular anterógrado de húmero, el sexo masculino, es el más afectado, entre la edad de 18 – 30 años constituyendo un 40% (20 pacientes). En este estudio solo se observaron 2 complicaciones, que fueron la neuropraxia del nervio radial en 4 pacientes (8%), mientras que en 3 pacientes existió protrusión del clavo hacia el espacio subacromial (6%). El 68% presentó un test de Constant-Murley excelente. El promedio del test de Constant-Murley fue de 81.9 puntos para toda la serie. 40 pacientes obtuvieron una puntuación 14 sobre 15 lo que indica que sufren de un dolor leve, en el 68% de los casos se presentaron ecografías normales. Se observó 12% de rupturas parciales del tendón del supraespinoso, se concluye que el uso del abordaje anterolateral para el enclavado humeral anterógrado asegura un buen resultado funcional y que los resultados clínicos no están relacionados por las lesiones ecográficas del manguito rotador.
Diaphyseal fractures of the humerus are caused either by a traumatism banal or a fall or by high-energy trauma such as traffic accidents or injuries by firearm, the treatment of choice is intramedullary nailing and is a minimally invasive technique that when it is performed by surgeons who are experts in the field it presents few complications, although injuries can occur when the rotator cuff is approached and the reduction of the fracture is made, since the radial nerve runs along the posterior face of the humerus. The aim of this work was to identify the correlation of the ultrasonographic and clinical characteristics of patients with fracture of humerus submitted to anterograde intramedullary nailing, the relationship between the echographic findings suggestive of rotator cuff injury with clinical signs and symptoms by means of the test Constant-Murley. The universe was all patients undergoing surgical treatment (intramedullary nailing of the humerus) who did not present a history of shoulder pathologies. It was a retrospective, cross-sectional, quantitative work that was carried out during the 2015-2017 period. Of the 50 patients subjected to anterograde intramedullary nailing of the humerus, the male sex is the most affected, between the age of 18 - 30 years constituting 40% (20 patients). In this study, only 2 complications were observed, which were radial nerve neuropraxia in 4 patients (8%), while in 3 patients there was protrusion of the nail into the subacromial space (6%). 68% presented an excellent Constant-Murley test. The average of the Constant-Murley test was 81.9 points for the entire series. 40 patients obtained a score of 14 out of 15, which indicates that they suffer from mild pain, 68% of the cases had normal ultrasound scans. 12% of partial ruptures of the supraspinatus tendon were observed, it is concluded that the use of the anterolateral approach the antegrade humeral nailing ensures a good functional result and that the clinical results are not related to the rotator cuff sonographic lesions.
Diaphyseal fractures of the humerus are caused either by a traumatism banal or a fall or by high-energy trauma such as traffic accidents or injuries by firearm, the treatment of choice is intramedullary nailing and is a minimally invasive technique that when it is performed by surgeons who are experts in the field it presents few complications, although injuries can occur when the rotator cuff is approached and the reduction of the fracture is made, since the radial nerve runs along the posterior face of the humerus. The aim of this work was to identify the correlation of the ultrasonographic and clinical characteristics of patients with fracture of humerus submitted to anterograde intramedullary nailing, the relationship between the echographic findings suggestive of rotator cuff injury with clinical signs and symptoms by means of the test Constant-Murley. The universe was all patients undergoing surgical treatment (intramedullary nailing of the humerus) who did not present a history of shoulder pathologies. It was a retrospective, cross-sectional, quantitative work that was carried out during the 2015-2017 period. Of the 50 patients subjected to anterograde intramedullary nailing of the humerus, the male sex is the most affected, between the age of 18 - 30 years constituting 40% (20 patients). In this study, only 2 complications were observed, which were radial nerve neuropraxia in 4 patients (8%), while in 3 patients there was protrusion of the nail into the subacromial space (6%). 68% presented an excellent Constant-Murley test. The average of the Constant-Murley test was 81.9 points for the entire series. 40 patients obtained a score of 14 out of 15, which indicates that they suffer from mild pain, 68% of the cases had normal ultrasound scans. 12% of partial ruptures of the supraspinatus tendon were observed, it is concluded that the use of the anterolateral approach the antegrade humeral nailing ensures a good functional result and that the clinical results are not related to the rotator cuff sonographic lesions.
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Ultrasonografía, Fracturas del húmero, Enclavado intramedular anterogrado, Manguito rotador, Test de Constant-Murley, Complicaciones, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador