Diafisis de femur
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Transcript of Diafisis de femur
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FRACTURAS DIAFISIS DE FEMUR
Dr. Andrei Lara Pg. Ortopedia y Traumatología
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• FRACTURAS POR ALTA ENERGIA
• IMPORTANTE MORBILIDAD Y MORTALIDAD
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ANATOMIA
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GRUPOS MUSCULAR ANTERIOR
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GRUPO MEDIO
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COMPARTIMENTO POSTERIOR
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FUERZAS DEFORMANTES • GLUTEOS
– ABDUCE FEMUR PROXIMAL
• PSOAS ILIACO – FLEXION Y ROTACION
EXTERNA
• ADUCTORES – VARO
• GASTROCNEMIO – FLEXION
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VASCULARIZACION
• ARCOS PRIMERO Y SEGUNDO DE LA ARTERIA FEMORAL
• VASOS PERIOSTICOS ATRAVIESAN EL PERIOSTIO – NUTREN 1/3 DEL HUESO
CORTICAL
• VASOS ENDOSTICOS– NUTREN 2/3
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BIOMECANICA DE FRACTURA
• FUERZAS DE TENSION – CURVATURA DEL HUESO – FUERZA 250 Nm
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DIAGNOSTICO
• DOLOR • DEFORMIDAD • TUMEFACCION • ACORTAMIENTO DEL MUSLO
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PERDIDA SANGUINEA SHOCKTRANSFUSIONES
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• LESION MENISCAL50% PACIENTES
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RADIOGRAFIA
• AP Y LATERAL • VALORAR– ESTRECHAMIENTO CANAL
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CLASIFICACION
• TERCIO PROXIMAL • TERCIO MEDIO • TERCIO DISTAL
INFRAITSMICAS
• TRANSVERSAS • OBLICUA • ESPIRALES • SEGMENTARIAS
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FRACTURAS CONMINUTA
• GRADO I Y II – NO TIENEN EFECTO SOBRE LA ESTABILIDAD
• GRADO III – FRAGMENOS EN MARIPOSA • CONTRAINDICADO EL ENCLAVADO
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CLASIFICACION AEFI
A SIMPLES B EN CUÑA C COMPLEJAS
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TIPO A
A1 ESPIRALES A2 OBLICUAS A3 TRANSVERSAS
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TIPO B
B1 CUÑA ESPIRAL B2 CUÑA CURVADA B3 CUÑA MULTIFRAGMENTARIA
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TIPO C
C1 ESPIRALES C2 SEGMENTARIAS C3 IRREGULARES
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TRATAMIENTO
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TRATAMIENTO • TRACCION– REDUCCION DE FRACTURA • RESTAURAR LA
LOGUITUD ANATOMICA • CARGA 18 A 24KG• FEMUR DISTAL: RIGIDEZ
DE RODILLA • FERULA DE THOMAS
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TRATAMIENTO
• FIJACION EXTERNA – LIMITADO USO– LESIONES AR FEMORAL– ESTABILIZACION
INADECUADA
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TRATAMIENTO
• PLACA – REDUCCION ANATOMICA – REHABILITACION PRECOZ – BIOMECANICA– COMPLICACIONES
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TRATAMIENTO • CLAVOS INTRAMEDULARES
– CARGAS POR COMPRESION• CURVA• TORSION
– NO ALTERAL EL HEMATOMA DE FRACTURA
– NO HAY DAÑO DE LOS VASOS PERIOSTICOS
– MOVILIDAD PRECOZ
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PLANIFICACION PREOPERATORIA
• RX INCLUYA CADERA Y RODILLA – Longitud del clavo– Diámetro del clavo– Ángulo de inserción de la hoja espiral– Posición de los agujeros de bloqueo
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• POSICION DEL PACIENTE–
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CLAVOS
• CFN• UFN
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INDICACIONES
LIMITACIIONES
TODAS LAS FRACTURAS DIAFISARIAS (32-A1-C3)
FRACTURAS METAFISARIAS QUE NO PERMITAN LA COLOCACIÓN ADECUADADE PERNOS DE BLOQUEO
SEUDOARTROSIS
FRACTURAS SUBTROCANTÉREAS
FRACTURAS SUBTROCANTÉREAS CON TROCÁNTER MENOR INTACTO
FRACTURAS CON AFECTACIÓN DEL TROCÁNTER MENOR
CAMBIO DE TRATAMIENTO TRAS FIJACIÓN EXTERNA
PACIENTES POLITRAUMATIZADOS*
FRACTURAS DIAFISARIAS CON FRACTURA HOMOLATERAL DEL CUELLOFEMORAL
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BLOQUEO
• PRIMERO DISTAL
• DINAMICO– INESTABILIDAD
ROTACIONAL
• ESTATICO – INESTABILIDAD
LONGUITUDINAL Y ROTACIONAL
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• ESTANDAR – ESTATICO– DINAMICO
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• HOJA ESPIRAL– FX SUBTROCANTERICAS – FIJAN EL
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LONGUITUD Y DIAMETRO
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INSICION
• CLAVO INTRAMEDULAR– ANTEROGRADO – RETORGADO
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ANTEROGRADO
Krettek C, Schulte-Eistrup S, Schandelmaier P, Rudolf J, Tscherne H (1994)Osteosynthese von Femurschaftfrakturen mit dem unaufgebohrtenAO-Femurnagel (UFN) – Operative Technik und erste klinische Ergebnissemit Standardverriegelung.Unfallchirurg 97: 549–567
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APERTURA CAVIDAD
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BLOQUEO PROXIMAL
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TECNICA MISS A NAIL
• FIJAR FX DE CUELLO FEMORAL
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RETROGRADO
• SOBRE LA FOSA INTERCONDILEA – ARTROTOMIA PARAROTULIANA MEDIAL– MEDIAL AL TENDON ROTULIANO
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DINAMIZACION SECUNDARIA
• RETIRO DE TORNILLO ESTATICO
• LUEGO DE 4 SEMANAS???
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• CARGA– DEPENDE FX– CONTACTO PLANTAR