{"id":284,"date":"2013-12-16T21:02:25","date_gmt":"2013-12-16T21:02:25","guid":{"rendered":"http:\/\/ortopediahspe.com.br\/site\/?p=284"},"modified":"2017-02-14T17:47:10","modified_gmt":"2017-02-14T17:47:10","slug":"tratamento-cirurgico-de-fratura-do-planalto-tibial-com-fixador-externo-hibrido","status":"publish","type":"post","link":"https:\/\/ortopediahspe.com.br\/site\/tratamento-cirurgico-de-fratura-do-planalto-tibial-com-fixador-externo-hibrido\/","title":{"rendered":"Tratamento Cir\u00fargico de Fratura do Planalto Tibial com Fixador Externo H\u00edbrido"},"content":{"rendered":"

Ayres Fernando Rodrigues1, Eduardo Angoti Magri2, Charlles de Oliveira\u00a0Luz3, Danilo Canesin Dal Molin4, Juliano Valente Lestingi5<\/p>\n

1. Assistente do Grupo de Trauma do IAMSPE<\/p>\n

2. Assistente do Grupo de Trauma do IAMSPE<\/p>\n

3. Residente do IAMSPE<\/p>\n

4. Residente do IAMSPE<\/p>\n

5. Chefe do Grupo de Trauma do IAMSPE<\/p>\n

RESUMO<\/strong><\/p>\n

Os autores apresentam a t\u00e9cnica para tratamento de fratura de planalto tibial com
\nextensa les\u00e3o de partes moles com fixador externo h\u00edbrido e sua evolu\u00e7\u00e3o.
\nDescritores: Planalto tibial, fixador externo h\u00edbrido.<\/p>\n

SUMMARY<\/strong><\/p>\n

The authors report an alternative technique for treatment of tibial plateau fracture
\nwith huge lesiono f soft tissue with hibrid extern fixation and your evolution
\nKeywords: Hibrid extern fixation, tibial plateau fracture.
\n<\/strong><\/p>\n

INTRODU\u00c7\u00c3O<\/strong><\/p>\n

<\/strong>As fraturas da extremidade proximal da t\u00edbia s\u00e3o de dif\u00edcil tratamento, sobretudo
\nas com cominui\u00e7\u00e3o metafis\u00e1ria. Resultam de for\u00e7as compressivas axiais combinadas, ou
\nn\u00e3o, com estresse em varo ou valgo. Os princ\u00edpios de tratamento envolvem a redu\u00e7\u00e3o
\nanat\u00f4mica da superf\u00edcie articular e a restaura\u00e7\u00e3o funcional do eixo mec\u00e2nico do membro
\ninferior.\u00a0A op\u00e7\u00e3o cir\u00fargica a ser escolhida envolve fatores como: perfil do paciente, condi-
\n\u00e7\u00e3o do envelope de partes moles, tipo da fratura e outros traumatismos associados.<\/p>\n

Em traumas de baixa energia, desde que os tecidos moles n\u00e3o sejam um fator adverso,
\na cirurgia deve ser realizada em um \u00fanico tempo com osteoss\u00edntese definitiva.
\nEm traumas de alta energia deve-se pensar no principio de controle de danos, com
\nmanuten\u00e7\u00e3o do alinhamento do membro enquanto se aguarda a resolu\u00e7\u00e3o das m\u00e1s condi\u00e7\u00f5es
\nde partes moles.<\/p>\n

INDICA\u00c7\u00c3O CIR\u00daRGICA<\/strong><\/p>\n

\u2022 A varia\u00e7\u00e3o relatada de depress\u00e3o articular que pode ser aceita vai de menos de\u00a02 mm a 1 cm<\/p>\n

\u2022 Instabilidade maior que 10 graus com o joelho completamente estendido, em\u00a0compara\u00e7\u00e3o com o lado contralateral<\/p>\n

\u2022 Fraturas expostas<\/p>\n

\u2022 S\u00edndrome compartimental<\/p>\n

\u2022 Les\u00e3o vascular associada<\/p>\n

Vantagens do uso de fixador externo: m\u00ednima desvitaliza\u00e7\u00e3o de partes moles, mant\u00e9m<\/p>\n

o comprimento e o alinhamento, possibilitando apoio parcial da carga e inicio de<\/p>\n

exerc\u00edcios de amplitude de movimento.<\/p>\n

PLANEJAMENTO PR\u00c9-OPERAT\u00d3RIO<\/strong><\/p>\n

\u2022 Avalia\u00e7\u00e3o clinica do paciente<\/p>\n

\u2022 Avalia\u00e7\u00e3o neurovascular do membro<\/p>\n

\u2022 Radiografias do membro<\/p>\n

\"fixador-externo-hibrido1\"<\/a><\/p>\n

T\u00c9CNICA CIR\u00daRGICA<\/strong><\/p>\n

O paciente \u00e9 posicionado em dec\u00fabito dorsal horizontal em mesa radiotrasparente,<\/p>\n

com o membro acometido sendo visualizado em toda sua extens\u00e3o nas incid\u00eancias anteroposterior<\/p>\n

e perfil atrav\u00e9s de fluoroscopia.<\/p>\n

Posicione dois fios paralelos \u00e0 articula\u00e7\u00e3o, com o maior \u00e2ngulo poss\u00edvel entre eles.<\/p>\n

Estes fios devem respeitar a zona de seguran\u00e7a (observe a localiza\u00e7\u00e3o do nervo peroneal)<\/p>\n

da t\u00edbia proximal.<\/p>\n

\"fixador-externo-hibrido3\"<\/a><\/p>\n

Conecte um anel que permita a flex\u00e3o do joelho aos dois fios.<\/p>\n

\"fixador-externo-hibrido5\"<\/a><\/p>\n

Tencione os fios at\u00e9 a redu\u00e7\u00e3o adequada. Corte e dobre as extremidades e posicione\u00a0as\u00a0tampas de prote\u00e7\u00e3o.<\/p>\n

Insira os parafusos de Schanz na superf\u00edcie antero-medial da t\u00edbia, conforme determinado\u00a0durante planejamento pr\u00e9-operat\u00f3rio. A haste de fibra de carbono deve se\u00a0estender proximalmente para conectar os pinos de Schanz ao anel fixador hibrido.<\/p>\n

\"fixador-externo-hibrido7\"<\/a><\/p>\n

\"fixador-externo-hibrido8\"<\/a><\/p>\n

P\u00d3S-OPERAT\u00d3RIO<\/strong><\/p>\n

\u2022 Imediato: carga parcial, mobiliza\u00e7\u00e3o ativa e passiva com amplitude total de\u00a0joelho e tornozelo<\/p>\n

\u2022 Liberado carga total com 6 semanas de p\u00f3s -operat\u00f3rio<\/p>\n

\u2022 Retirado o fixador com sinais radiol\u00f3gicos de consolida\u00e7\u00e3o \u00f3ssea.<\/p>\n

\"fixador-externo-hibrido9\"<\/a><\/p>\n

\"fixador-externo-hibrido13\"<\/a><\/p>\n

REFER\u00caNCIAS BIBLIOGR\u00c1FICAS<\/strong><\/p>\n

1. Watson JT, Schatzker J. Tibial plateau fractures. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal\u00a0trauma. Basic science, management, and reconstruction. Philadelphia: Saunders; 2003. p.2074-130.<\/p>\n

2. R\u00fcedi TP, Sommer C, Leutenegger A. New techniques in indirect reduction of long bone fractures. Clin Orthop Relat\u00a0Res. 1998;(347):27-34.<\/p>\n

3. Yacoubian SV, Nevins RT, Sallis JG, Potter HG, Lorich DG. Impact of MRI on treatment plan and fracture classification\u00a0of tibial plateau fractures. J Orthop Trauma. 2002;16(9):632-7.<\/p>\n

4. Bennett WF, Browner B. Tibial plateau fractures: a study of associated soft tissue injuries. J Orthop Trauma. 1994;8(3):183-8.<\/p>\n

5. Tscherne H, Lobenhoffer P. Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res.\u00a01993;(292):87-100.<\/p>\n

6. Gardner MJ, Yacoubian S, Geller D, Pode M, Mintz D, Helfet DL, et al. Prediction of soft-tissue injuries in Schatzker II<\/p>\n

tibial plateau fractures based on measurements of plain radiographs. J Trauma. 2006;60(2):319-23.<\/p>\n

7. Lachiewicz PF, Funcik T. Factors influencing the results of open reduction and internal fixation of tibial plateau fractures.\u00a0Clin Orthop Relat Res. 1990;(259):210-5.<\/p>\n

8. Moore TM, Patzakis MG, Harvey JB. Tibial plateau fractures: definition, demographics, treatment rationale, and long\u00a0term results of closed traction management or operative reduction. J Orthop Trauma. 1987;1(2):97-119.<\/p>\n

9. Schatzker J. Fractures of the tibial plateau. In: Schatzker J, Tile M, editors. The rationale of operative fracture care.\u00a0Berlin: Springer-Velag; 1996. p.419-38.<\/p>\n

10. Muller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Berlin:\u00a0Springer-Verlag; 1990. p.148-57.<\/p>\n

11. DeCoster TA, Nepola JV. Cast brace treatment of proximal tibial plateau fractures: ten year follow-up study. Clin\u00a0Orthop Relat Res. 1988;(231):196-204.<\/p>\n

12. Watson JT, Schatzker J. Tibial plateau fractures. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal\u00a0trauma. Basic science, management, and -reconstruction. Philadelphia: Saunders; 2003, p.2074-130.<\/p>\n

13. Gossling HR, Peterson CA. A new surgical approach in the treatment of depressed lateral condylar fractures of the tibia.\u00a0Clin Orthop Relat Res. 1979;(140):96-102.<\/p>\n

14. Perry CR, Evans LG, Rice S, Fogarty J, Burdge RE. A new surgical approach to fractures of the lateral tibial plateau.\u00a0J Bone Joint Surg Am. 1984;66:1236-40.<\/p>\n

15. Koval KJ, Polatsch D, Kummer FJ, Cheng D, Zuckerman JD. Split fractures of the lateral tibial plateau: evaluation of\u00a0three fixation methods. J Orthop Trauma. 1996;10(5): 304-8.<\/p>\n

16. Caspari RB, Hutton PM, Whipple TL, Meyers JF. The role of arthroscopy in the management of tibial plateau fractures.\u00a0Arthroscopy. 1985;1(2):76-82.<\/p>\n

17. Paccola CAJ. Fraturas articulares complexas: uma t\u00e1tica operat\u00f3ria para restabelecer a superf\u00edcie articular. Rev Bras\u00a0Ortop. 1998;33(7):557-60.<\/p>\n

18. Mazoue CG, Guanche CA Vrahas MS. Arthroscopic management of tibial plateau fractures: an unselected series. Am\u00a0J Orthop. 1999; 28(9):508-15.<\/p>\n

19. Galla M, Lobenhoffer P. The direct, dorsal approach to the treatment of unstable tibialposteromedial fracture-dislocations.\u00a0Unfallchirurg. 2003;106(3):241-7.<\/p>\n

20. Georgiadis GM. Combined anterior and posterior approaches for complex tibial plateau fractures. J Bone Joint Surg\u00a0Br. 1994;76(2):285-9.<\/p>\n

21. Mueller KL, Karunakar MA, Frankenburg EP, Scott DS. Bicondylartibial plateau fractures: a biomechanical study. Clin\u00a0Orthop Relat Res. 2003;(412):189-95.<\/p>\n

22. Tscherne H, Lobenhoffer P. Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res.\u00a01993;(292):87-100.<\/p>\n

23. Stevens DG, Beharry R, McKee MD, Wadell JP, Schemitsch EH. The long-term functional outcome of operatively\u00a0treated tibial plateau fractures. J Orthop Trauma. 2001;15(5):312-20.<\/p>\n

24. H\u00fcfner T, St\u00fcbig T, Citak M, G\u00f6sling T, Krettek C, Kendoff D. Utility of intraoperative three-dimensional imaging at\u00a0the hip and knee joints with and without navigation. J Bone Joint Surg Am. 2009;91(Suppl 1):<\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Ayres Fernando Rodrigues1, Eduardo Angoti Magri2, Charlles de Oliveira\u00a0Luz3, Danilo Canesin Dal Molin4, Juliano Valente Lestingi5 1. Assistente do Grupo de Trauma do IAMSPE 2. Assistente do Grupo de Trauma do IAMSPE 3. Residente do IAMSPE 4. Residente do IAMSPE 5. Chefe do Grupo de Trauma do IAMSPE RESUMO Os autores apresentam a t\u00e9cnica para […]<\/p>\n","protected":false},"author":1,"featured_media":1278,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,20],"tags":[],"class_list":["post-284","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-joelho","category-trauma","cat-3-id","cat-20-id","has_thumb"],"yoast_head":"\nTratamento Cir\u00fargico de Fratura do Planalto Tibial com Fixador Externo H\u00edbrido - Centro de Estudos de Ortopedia HSPE<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ortopediahspe.com.br\/site\/tratamento-cirurgico-de-fratura-do-planalto-tibial-com-fixador-externo-hibrido\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tratamento Cir\u00fargico de Fratura do Planalto Tibial com Fixador Externo H\u00edbrido - Centro de Estudos de Ortopedia HSPE\" \/>\n<meta property=\"og:description\" content=\"Ayres Fernando Rodrigues1, Eduardo Angoti Magri2, Charlles de Oliveira\u00a0Luz3, Danilo Canesin Dal Molin4, Juliano Valente Lestingi5 1. Assistente do Grupo de Trauma do IAMSPE 2. Assistente do Grupo de Trauma do IAMSPE 3. Residente do IAMSPE 4. Residente do IAMSPE 5. 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