RESUMEN

OBJECTIVES: The objective of this study is to describe the rehabilitation of individuals with Congenital Malformations (CMF) during the use of an External Fixator (EF) in Aquatic Therapy (AT) and to analyze the association between diagnosis, EF type and location with rehabilitation process outcomes, surgical intervention, and adverse effects. METHODS: This retrospective study included 29 medical records from which the personal and rehabilitation data of the patient were collected. The AT used was described and the outcome variables were associated. The medical records were selected by screening the database of the CMF clinic at the AACD. The inclusion criteria were participants with CMF who used EF treated between 2011 and 2019 of both genders and without age restriction. The exclusion criteria were incomplete medical record data or not undergoing AT while using EF. The extracted data included diagnosis, gender, age, EF type and location, objective of the surgery, adverse events, surgical interventions, time of rehabilitation in AT, physiotherapeutic objectives, and rehabilitation process outcomes in AT. RESULTS: The mean age of the participants was 12.1 ± 3.99 years, with male predominance (55 %) and hemimelia cases (37 %). The most used EF was circular (51 %), located in the femur (37 %), and the main objective of surgery was bone lengthening (52 %). The most recurrent adverse effect was infection (62 %) and 76 % completed AT. There was no association between the variables analyzed. CONCLUSIONS: It was possible to describe CMF rehabilitation with EF in AT. There was no association between the variables analyzed.

Asunto(s)

RESUMEN

Abstract Objectives: The objective of this study is to describe the rehabilitation of individuals with Congenital Malformations (CMF) during the use of an External Fixator (EF) in Aquatic Therapy (AT) and to analyze the association between diagnosis, EF type and location with rehabilitation process outcomes, surgical intervention, and adverse effects. Methods: This retrospective study included 29 medical records from which the personal and rehabilitation data of the patient were collected. The AT used was described and the outcome variables were associated. The medical records were selected by screening the database of the CMF clinic at the AACD. The inclusion criteria were participants with CMF who used EF treated between 2011 and 2019 of both genders and without age restriction. The exclusion criteria were incomplete medical record data or not undergoing AT while using EF. The extracted data included diagnosis, gender, age, EF type and location, objective of the surgery, adverse events, surgical interventions, time of rehabilitation in AT, physiotherapeutic objectives, and rehabilitation process outcomes in AT. Results: The mean age of the participants was 12.1 ± 3.99 years, with male predominance (55 %) and hemimelia cases (37 %). The most used EF was circular (51 %), located in the femur (37 %), and the main objective of surgery was bone lengthening (52 %). The most recurrent adverse effect was infection (62 %) and 76 % completed AT. There was no association between the variables analyzed. Conclusions: It was possible to describe CMF rehabilitation with EF in AT. There was no association between the variables analyzed.

RESUMEN

Objective To evaluate the quality of life of patients using an Ilizarov type external fixator for the treatment of complicated fractures and their sequelae. Method This is an observational and cross-sectional study, in which the 36-item short form survey (SF-36) questionnaire (translated into Portuguese) was applied during outpatient consultations in 2 periods, in the months of July 2018 and January 2019. The patients who participated in the study underwent their surgical procedures between January and June 2018. Results We evaluated 36 patients using an external Ilizarov fixator. We observed a predominance of male patients, with a mean age of 37.9 years. Fractures of leg bones and their complications represented half of the sample. Improvement in functional capacity and emotional aspects of the patients was observed throughout the treatment. Conclusion The use of the circular external fixator is an important and effective method for the surgical treatment of complex fractures and their sequelae. This study allowed us to conclude that, after treatment, patients achieved functional return to daily activities with adequate quality of life.

RESUMEN

Abstract Objective To evaluate the quality of life of patients using an Ilizarov type external fixator for the treatment of complicated fractures and their sequelae. Method This is an observational and cross-sectional study, in which the 36-item short form survey (SF-36) questionnaire (translated into Portuguese) was applied during outpatient consultations in 2 periods, in the months of July 2018 and January 2019. The patients who participated in the study underwent their surgical procedures between January and June 2018. Results We evaluated 36 patients using an external Ilizarov fixator. We observed a predominance of male patients, with a mean age of 37.9 years. Fractures of leg bones and their complications represented half of the sample. Improvement in functional capacity and emotional aspects of the patients was observed throughout the treatment. Conclusion The use of the circular external fixator is an important and effective method for the surgical treatment of complex fractures and their sequelae. This study allowed us to conclude that, after treatment, patients achieved functional return to daily activities with adequate quality of life.

Resumo Objetivo Avaliar a qualidade de vida dos pacientes em uso do fixador externo do tipo Ilizarov para tratamento de fraturas complexas e de suas sequelas Método Trata-se de um estudo observacional e transversal, em que foi aplicado o questionário 36-item short form survey (SF-36) (traduzido para a língua portuguesa) durante as consultas ambulatoriais em 2 períodos, nos meses de julho de 2018 e janeiro de 2019. Os pacientes que participaram do estudo realizaram seus procedimentos cirúrgicos no período de janeiro a junho de 2018. Resultados Foram avaliados 36 pacientes em uso de fixador externo do tipo Ilizarov. Foi observado predomínio do sexo masculino e idade média de 37,9 anos. As fraturas de ossos da perna e suas complicações representaram metade da amostra. Foi observada melhora na capacidade funcional e nos aspectos emocionais dos pacientes ao longo do tratamento. Conclusão O uso do fixador externo circular constitui um método importante e eficaz para o tratamento cirúrgico de fraturas complexas e de suas sequelas. Este trabalho permitiu concluir que, após o tratamento, os pacientes alcançaram retorno funcional às atividades diárias com adequada qualidade de vida.

Asunto(s)

RESUMEN

La corrección quirúrgica de grandes asimetrías faciales son un desafío para el equipo quirúrgico. En dichos casos, los resultados de la corrección utilizando técnicas quirúrgicas convencionales son limitados, lo que hace necesario la utilización de otras herramientas terapéuticas. La distracción ósea (DO) es una de ellas, pues permite el estiramiento controlado del callo óseo previamente creado mediante osteotomías. La DO permite realizar cambios en el posicionamiento óseo de gran envergadura, favoreciendo el crecimiento óseo como mecanismo de acción. El objetivo de este artículo es describir los resultados quirúrgicos de DO intraoral del tercio medio facial utilizado en dos pacientes con severas asimetrías faciales asociadas a malformaciones de origen genético. Se relata el diagnóstico, la planificación, las herramientas tecnológicas utilizadas, técnica quirúrgica y los resultados obtenidos.

Surgical correction of major facial asymmetries is a challenge for the surgical team. In such cases, treatment results from conventional surgical techniques are limited, which requires using other therapeutic tools. Bone distraction is one of them, as it allows controlled stretching of the bone callus previously developed through osteotomies. Distraction osteogenesis allows making changes in large bone positioning, favoring bone growth as an action mechanism. This article aims to describe the surgical results of intraoral distraction osteogenesis of the midface used in two patients with severe facial asymmetries related to congenital malformations. Diagnosis, planning, technological tools, surgical techniques, and results obtained are explained.

RESUMEN

The aim of this study is to evaluate the prevalence of the elongated styloid process in panoramic radiographic exams, in a subpopulation of northern Brazil in relation to age, sex and side. Panoramic radiographs were selected, and the apparent size of the styloid process was measured from the point where the styloid leaves the tympanic plate to the tip of the process. The data were analyzed using chi-square tests and variance analysis with a 5% significance level. Approximately 30% of the elongated styloid process was observed in patients between 18 to 35 years. Of the styloid processes that measured more than 30 mm (elongated), 764 styloid processes (81%) showed Type I elongation pattern, 97 styloid processes (10%) showed Type II calcification patterns, and 85 styloid processes (9%) showed Type III calcification patterns. The prevalence of the elongated styloid process was high, and no statistically significant correlation was found between the presence of the elongated styloid process and the variables studied. (AU)

O objetivo deste estudo é avaliar a prevalência do processo estilóide alongado em exames radiográficos panorâmicos, em uma subpopulação do norte do Brasil em relação à idade, sexo e lado. Radiografias panorâmicas foram selecionadas, e tamanho aparente do processo estilóide foi medido a partir do ponto em que o estilóide deixa a placa timpânica até a ponta do processo. Os dados foram analisados por meio de testes qui-quadrado e análise de variância com nível de significância de 5%. Aproximadamente 73% do processo estilóide alongado foi observado em pacientes entre 18 e 53 anos (p <0,05). Dos processos estilóides que mediram mais de 30 mm (alongados), 543 processos estiloide (82,9%) mostraram padrão de alongamento do Tipo I, 33 processos estiloide (5,03%) mostraram padrões de calcificação do Tipo II, e 79 processos estilóide (12,06%) mostraram padrões de calcificação do Tipo III. A prevalência do processo estilóide alongado foi alta e não foi encontrada correlação estatisticamente significante entre a presença do processo estilóide alongado e as variáveis estudadas. (AU)

RESUMEN

Congenital femoral deficiency (CFD) is a rare disorder with several limb anomalies including limb shortening and knee cruciate ligament dysplasia.Limb lengthening is usually performed to correct lower limb discrepancy. However, complications, such as knee subluxation/dislocation, can occur during this treatment.Here, we explore CFD knee abnormalities and knee dislocation during limb elongation, discussing when and whether knee ligament reconstruction prior to the lengthening would be necessary to reduce the risk of knee dislocation.There is not enough support in the literature for the routine reconstruction of cruciate ligaments in CFD patients.Of note, in cases of severe anteroposterior or posterolateral rotatory instability, cruciate ligament reconstruction might be considered to decrease the risk of knee subluxation/dislocation during the lengthening treatment. Cite this article: EFORT Open Rev 2021;6:565-571. DOI: 10.1302/2058-5241.6.200075.

RESUMEN

OBJETIVOS: Mostrar resultados, complicaciones y lecciones aprendidas utilizando el clavo intramedular magnético (IML, Intramedullary Magnetic Lengthener) en un grupo de pacientes sometidos a alargamiento óseo. PACIENTES Y MÉTODOS: Entre enero 2017 y diciembre 2019, 9 pacientes (15 segmentos), edad entre 15 y 39 años, fueron sometidos a alargamiento óseo con IML: 5 pacientes tuvieron alargamiento femoral bilateral por talla baja, 1 paciente se sometió a alargamiento de Piernas bilateral por Tibia vara y acortamiento mesomélico y 3 recibieron alargamientos femorales unilaterales por discrepancia de longitud de extremidades. Todos fueron operados por el mismo cirujano, con técnica standard. Se indicó kinesiterapia al menos 5 veces por semana durante la fase de distracción. RESULTADOS: En todos se logró el objetivo de alargamiento planteado. No hubo complicaciones intra ni postoperatorias graves (TVP, TEP, Embolia grasa), ni fallas del sistema distractor. Un paciente desarrolló contracturas articulares de ambas rodillas por no adhesión a Kinesiterapia. Ninguno requirió aporte de injerto óseo, sin embargo en 2 pacientes de alargamiento de Fémur bilateral, se presentó deformidad en varo, que hizo necesario recambio a clavo convencional y un paciente desarrolló una parálisis transitoria del Nervio Peroneo común. CONCLUSIONES: El advenimiento de los IML significó un gran avance en el campo de la osteogénesis por distracción, sin embargo, aún se trata de un procedimiento complejo, que debe ser planificado cuidadosamente para minimizar los riesgos y complicaciones. Una selección meticulosa del paciente y la evaluación física y psicológica previa, son fundamentales para el éxito del procedimiento. Los casos bilaterales requieren de un seguimiento cercano, por el riesgo de falla del implante.

objective: We show our results, complications and lessons learned using the Intramedullary Magnetic Lengthener (IML) in a group of patients who were subjected to bone lengthening. PATIENTS AND METHODS: Between January 2017 and December 2019, 9 patients (15 segments), aged between 15 and 39 years, underwent bone lengthening with IML: 5 patients had bilateral femoral lengthening due to short stature, 1 patient had bilateral leg lengthening due to Tibia vara and mesomelic shortening and 3 had unilateral femoral lengthening for limb length discrepancy. All were operated by the same surgeon, with standard technique. Physical therapy was indicated at least 5 times per week during the distraction phase. RESULTS: In every case, the proposed lengthening amount was achieved. There were no serious intraoperative or postoperative complications (DVT, Pulmonary Embolism, Fat Embolism), nor failures of the distractor system. One patient developed knee joint contracture due to non-adherence to Physical therapy. None required bone grafting, however, in 2 patients with bilateral Femur, a varus deformity appeared, which required nail exchange with a conventional trauma nail. One case developed a transit common Peroneal Nerve palsy. CONCLUSIONS: IMLs represent a great advance in the bone lengthening realm, however, it is still a complex procedure, which must be carefully planned to minimize risks and complications. Meticulous patient selection and prior physical and psychological evaluation are essential to the success of the procedure. Bilateral cases need a closer follow up, because implant failure is a potential risk.

Asunto(s)

RESUMEN

Objective: The objective of this study was to evaluate the biomechanical effect of mandibular corpus distraction osteogenesis with different orientations and rates. Materials and Methods: A three-dimensional model of the mandible was created. The vertical surgical cut was made, the force was applied horizontally in a bidirectional manner within two orientations: parallel to the occlusal plane and parallel to the inferior border of the mandible with three rates (0.5mm, 1mm and 1.5mm). Results: The maximum values for von Mises stress when the force was applied parallel to the inferior border of the mandible with all three rates were smaller than those with force direction parallel to the occlusal plane. The displacement in all three directions x, y, and z were not parallel and prominent in the anterior part of the mandible, while the movement at the posterior part is negligible, x and z displacement were bigger when force was applied parallel to the inferior border of the mandible, z displacement was more prominent than x and y displacement, both directions produced upward rotation of the mandible, this rotation was more noticeable when the force was applied parallel to the inferior border of the mandible. Conclusions: A vertical cut can be used in the patient with a long anterior face. This site of distraction achieves more lengthening of mandible than expansion.

Asunto(s)

RESUMEN

INTRODUCCIÓN: La braquimetatarsia es una enfermedad poco conocida e infrecuente, consiste en el acortamiento de uno o más metatarsianos, generalmente congénita. Existen diversos tipos de tratamiento. El objetivo de este estudio es describir los resultados en el tratamiento mediante elongación ósea progresiva utilizando mini fijador externo. MÉTODOS: Se trata de un estudio descriptivo observacional, incluyeron siete pacientes en el periodo, entre enero 2009 a diciembre 2015, edad comprendida entre 13 y 53 años. Se realizó elongación por callotaxis con minifijador externo y seguimiento a los pacientes con controles clínicos y radiológicos durante un año. RESULTADOS: Los pacientes fueron de sexo femenino, presentaron afección de cuarto metatarsiano. Tiempo de alargamiento promedio de seis semanas, longitud promedio de alargamiento de 17 mm (15 a 20 mm). El fijador externo fue retirado después de observar la consolidación ósea del segmento elongado con una radiografía del pie en tres proyecciones. Se observó que los pacientes consultaron por deformidad estética, dolor al utilizar calzado debido a la deformidad de dedos adyacentes que acompañaba a su braquimetatarsia con metatarsalgia debida hiperqueratosis plantar y alteración en la parábola metatarsal. CONCLUSIONES: El alargamiento óseo mediante distracción progresiva, es una buena opción para el tratamiento con resultados satisfactorios. Se recomienda realizar tratamiento quirúrgico para corregir la deformidad y debe ser realizado después que cierren los cartílagos de crecimiento en el pie.

BACKGROUND: The brachymetatarsia is a little known and infrequent disease. It consists of shortening of one or more metatarsals, usually of congenital origin. There are several types of treatments; The goal of this study is to describe the results in the treatment with progressive bone elongation using external mini-fixator. METHODS: This is an observational descriptive study, which includes seven patients during the period of January 2009 and December 2015, aged between 13 and 53 years. All of them underwent lengthening through callotaxis with external mini-fixator, after the treatment, followed up for one year with clinical and radiographic controls. RESULTS: The patients were female and presented shortening of the fourth metatarsal. Lengthning average time six weeks, length average of 17 mm (from 15 to 20 mm). The external fixator was retreated after observing the bone healed of the section lenghtening with a radiograph of foot in three projections. Patients consulted for aesthetic deformity, pain for using footwear due to the anormality of the adjacent toes and pain for the hyperqueratosis and alteration in the metatarsal parabole. CONCLUSIONS: The bone lengthening through the progressive distraction is a good option to treat with satisfactory results. It is advisable surgical treatment to correct the deformity and the operation is realized after the growth cartilages

Asunto(s)

RESUMEN

RESUMO O pé plano flexível é condição frequente na criança pequena e apresenta forte tendência para correção espontânea, ou tornar-se moderado ou leve no adulto, o que não causará problemas futuros. Entretanto, em uma pequena proporção de casos a deformidade é mais grave, não melhora, o que pode levar ao comprometimento do desempenho mecânico, deformidade e, eventualmente, dor. Nestes casos o tratamento cirúrgico deve ser considerado. O objetivo desta revisão sistemática foi avaliar os resultados da literatura no tratamento do pé plano flexível sintomático da criança ou adolescente por um procedimento bastante frequente que é a osteotomia de alongamento da coluna lateral do calcâneo. Foi realizada busca sistemática eletrônica nas bases de dados PubMed, Web of Science, Cochrane, CINAHL, SciELO, SCOPUS e LILACS por artigos publicados entre março de 1975 e setembro de 2016. Após aplicação dos critérios de elegibilidade, os artigos selecionados foram avaliados quanto aos resultados clínicos, radiográficos e complicações. Dos 341 artigos encontrados nas bases de dados, apenas oito estudos foram selecionados, segundo os critérios de inclusão e exclusão, com um total de 105 pacientes e 167 pés tratados. Somente três autores realizaram estudo prospectivo, mas sem caso controle ou aleatorização. A maioria das publicações no período avaliado é composta por estudos descritivos ou série de casos (nível de evidência III ou IV), com grandes variações metodológicas, mas com alto índice de satisfação dos pacientes e cirurgiões, em relação aos resultados. Entretanto, são necessárias pesquisas com desenho prospectivo, aleatorizado, grupo controle adequado e critérios de avaliação validados.

ABSTRACT Flexible flatfoot is a common condition in small children, which shows a strong tendency to spontaneously correct with their growth or to become moderate or mild in adults, which will not cause future problems. However, in a small number of cases, this condition is more severe, does not improve spontaneously, which may cause mechanical impairment, deformity, and, eventually, pain. In such cases, surgical treatment should be considered. The aim of this systematic review was to evaluate the literature results on the treatment of the symptomatic flexible flatfoot in children or adolescents through a very frequent procedure: calcaneal lateral column lengthening osteotomy, A systematic electronic search in PubMed, Web of Science, Cochrane, CINAHL, SciELO, SCOPUS and LILACS databases was performed. We searched articles published between March 1975 and September 2016. After applying the eligibility criteria, the selected publications were evaluated in relation to their clinical and radiographic results and complications. We found 341 articles in the mentioned databases, but selected only eight studies, according to the inclusion and exclusion criteria. These studies included a total of 105 patients and 167 treated feet. Only three authors performed prospective studies, but without case-control or randomization. The majority of publications were descriptive studies or case series (level of evidence III or IV), with great methodological variations, but with a high satisfaction rate on the part of both patients and surgeons in relation to the results. However, more prospective and randomized studies are required, with adequate control groups and validated evaluation criteria.

Asunto(s)

RESUMEN

OBJETIVO: Evaluar los resultados de alargamiento óseo sobre clavo endomedular (LON) en extremidades inferiores; comparar resultados locales con la literatura. MATERIAL Y MÉTODO: Estudio retrospectivo de pacientes operados con LON entre los años 2011 y 2015, con información de ficha clínica e imagenología. Descripción del paciente, procedimiento y evolución; con cálculo del Índice de Consolidación Radiológica (RCI) e Índice de Fijación Externa (EFI). Comparación con la literatura. RESULTADOS: Se reunieron 8 pacientes, con 12 procedimientos LON. 4 pacientes tuvieron alargamiento bilateral por talla baja constitucional y 4 pacientes tuvieron alargamiento unilateral por defectos de longitud, congénitos o adquiridos. En fémur (6) el alargamiento promedio fue 51 mm con 134 días de uso de tutor externo. El EFI promedio fue 0,87 meses/centímetro y RCI 1.83 meses/centímetro. En tibia (4) el alargamiento promedio fue 82 mm con 121 días de uso de tutor externo. El EFI promedio fue 0,49 meses/centímetro y RCI 1.64 meses/ centímetro. Todos los pacientes presentaron infección superficial de pines, requiriendo antibioterapia oral. 4 pacientes con LON de tibia presentaron contractura en equino y requirieron de alargamiento aquiliano percutáneo. 3 pacientes con LON de fémur presentaron retardo de consolidación, 2 requirieron aporte de injerto óseo. DISCUSIÓN: El LON es una excelente alternativa a los métodos tradicionales de alargamiento, con tiempos más cortos de uso de tutor externo. Se observan complicaciones relacionadas con la contractura músculo-tendinosa, manejadas al momento del retiro de tutor externo, con resultados satisfactorios para el paciente.

OBJECTIVE: To evaluate the results of bone lengthening over an intramedullay nail (LON) in lower limbs and compare our results with the literature. MATERIAL AND METHODS: retrospective study of patients who underwent LON between may 2011 and June 2015. The information was collected from clinical charts and Radiological studies. Description of the demographic data, procedures performed and follow up were registered. ; calculation of radiological consolidation index (RCI) and of external fixation index (EFI), previously defined in the literature, was performed. RESULTS: A total of 8 patients, with 12 LON procedures were included. 4 patients had bilateral lengthening for constitutional short stature and 4 patients had unilateral Lengthening for congenital or acquired defects. On femur (6), the average Lengthening was 51 mm. Mean time on external fixator was 134 days. The average EFI was 0.87 months/cm and RCI 1.83 months/cm. On tibia (4) the mean lengthening was 82 mm, and external fixator time was 121 days. The average EFI was 0.49 months/cm and RCI 1.64 months/cm. All patients had at least one superficial pin site infection, requiring oral antibiotic therapy. 4 patients whitin tibia group had an Equinus Contracture that required percutaneous Achilles lengthening. 3 patients whitin femoral group developed delayed bone healing and 2 of them required bone grafting on the distraction site. DISCUSSION: LON is an excellent alternative to traditional methods of lengthening, with shorter times under external fixator. There are complications related to tendon and muscle contracture, handled at the time of removal of external fixator, with satisfactory results for the patient.

Asunto(s)

RESUMEN

OBJECTIVE: This study aimed to demonstrate that the lengthening technique of an external fixator associated with locked intramedullary nail is an efficient method that decreases the duration of the external fixation and improves the rehabilitation period. METHODS: From January of 2005 to May of 2014, 31 patients with mean lower limb discrepancy of 5.31 cm were treated. The etiologies of the deformity were femur fracture sequelae, infection, hip development dysplasia, polio, and congenital short femur. RESULTS: The mean duration of external fixation was 2.47 months (external fixation index of 16.15 days per cm). The mean time for bone healing was 6.66 months (consolidation index 43 days per cm). Initial mean knee range of motion was -1° to 100°, progressing to 0°-115° at the end of treatment. The complications observed were incomplete osteotomies, hip subluxation, broken fixator, decreased knee range of motion, and need for locking screw removal. CONCLUSION: Femur lengthening with a monoplanar external fixator associated with locked intramedullary nail allowed for a shorter period of external fixation use, better protection for the regenerated bone tissue, and early rehabilitation with possible complications.

OBJETIVO: Demonstrar que a técnica de alongamento do fixador externo associado a haste intramedular bloqueada é eficaz e traz benefícios quanto ao tempo de uso do fixador e a melhoria na reabilitação. MÉTODO: Entre janeiro de 2005 e maio de 2014 foram tratados 31 pacientes com discrepância de membros inferiores com média de encurtamento de 5,31 cm. As etiologias da deformidade foram sequelas de fratura de fêmur, infecção, displasia de desenvolvimento do quadril, paralisia infantil e fêmur curto congênito. RESULTADOS: O tempo médio de fixação externa foi de 2,47 meses (índice de fixação externa de 16,15 dias por centímetro). O tempo médio necessário para consolidação óssea foi 6,66 meses (índice de consolidação 43 dias por centímetro). A amplitude de movimento do joelho média inicial era de -1 a 100 graus e no término do tratamento de 0 a 115 graus. As complicações observadas foram osteotomias incompletas, subluxação de quadril, quebra do fixador, limitação da amplitude do joelho e necessidade de retirada de material. CONCLUSÃO: A técnica de alongamento femoral com fixador externo monolateral sobre haste intramedular propicia um tempo menor de uso do fixador externo, melhor proteção do regenerado ósseo e reabilitação precoce, não isenta de complicações.

RESUMEN

ABSTRACT OBJECTIVE: This study aimed to demonstrate that the lengthening technique of an external fixator associated with locked intramedullary nail is an efficient method that decreases the duration of the external fixation and improves the rehabilitation period. METHODS: From January of 2005 to May of 2014, 31 patients with mean lower limb discrepancy of 5.31 cm were treated. The etiologies of the deformity were femur fracture sequelae, infection, hip development dysplasia, polio, and congenital short femur. RESULTS: The mean duration of external fixation was 2.47 months (external fixation index of 16.15 days per cm). The mean time for bone healing was 6.66 months (consolidation index 43 days per cm). Initial mean knee range of motion was -1° to 100°, progressing to 0°-115° at the end of treatment. The complications observed were incomplete osteotomies, hip subluxation, broken fixator, decreased knee range of motion, and need for locking screw removal. CONCLUSION: Femur lengthening with a monoplanar external fixator associated with locked intramedullary nail allowed for a shorter period of external fixation use, better protection for the regenerated bone tissue, and early rehabilitation with possible complications.

RESUMO OBJETIVO: Demonstrar que a técnica de alongamento do fixador externo associado a haste intramedular bloqueada é eficaz e traz benefícios quanto ao tempo de uso do fixador e a melhoria na reabilitação. MÉTODO: Entre janeiro de 2005 e maio de 2014 foram tratados 31 pacientes com discrepância de membros inferiores com média de encurtamento de 5,31 cm. As etiologias da deformidade foram sequelas de fratura de fêmur, infecção, displasia de desenvolvimento do quadril, paralisia infantil e fêmur curto congênito. RESULTADOS: O tempo médio de fixação externa foi de 2,47 meses (índice de fixação externa de 16,15 dias por centímetro). O tempo médio necessário para consolidação óssea foi 6,66 meses (índice de consolidação 43 dias por centímetro). A amplitude de movimento do joelho média inicial era de -1 a 100 graus e no término do tratamento de 0 a 115 graus. As complicações observadas foram osteotomias incompletas, subluxação de quadril, quebra do fixador, limitação da amplitude do joelho e necessidade de retirada de material. CONCLUSÃO: A técnica de alongamento femoral com fixador externo monolateral sobre haste intramedular propicia um tempo menor de uso do fixador externo, melhor proteção do regenerado ósseo e reabilitação precoce, não isenta de complicações.

Asunto(s)

RESUMEN

Objetivos: Describir y evaluar los resultados del tratamiento quirúrgico de defectos óseos postraumáticos (DOPT) segmentarios mediante técnica de inducción de membrana. Material y métodos: Estudio descriptivo longitudinal de 20 casos de DOPT segmentarios tratados en el Hospital Nacional Cayetano Heredia de Lima, desde enero de 2009 a junio de 2014, mediante reconstrucción en dos etapas con técnica de inducción de membrana. En la primera etapa se indujo la formación de membrana con un espaciador de cemento óseo impregnado con antibiótico. En la segunda etapa se reemplazó el espaciador por injerto óseo. Se evaluó el tiempo de consolidación, grado de acortamiento de la extremidad y resultado funcional. Se registraron las complicaciones. Resultados: Se incluyeron 20 pacientes (15 varones y 5 mujeres), con edad promedio de 29 años (rango: 13-54). Once casos fueron DOPT en tibia, 7 casos en fémur, uno en radio y uno en cúbito. El 90% de los DOPT fueron en longitud mayor o igual a 50 mm, con un promedio de 73 mm; 60% de los casos tenían cultivos positivos al inicio del tratamiento. Presentaron consolidación el 90% de los casos con un único aporte de injerto óseo, el tiempo promedio para la consolidación fue 8 meses. Uno requirió un segundo aporte de injerto y un caso presentó persistencia de infección sin consolidación. Conclusiones: La técnica de inducción de membrana es un método eficaz para el tratamiento de DOPT segmentarios. (AU)

Objectives: To describe the results of surgical treatment of post-traumatic segmental bone defects (PSBD) through the induction membrane technique. Material and Methods: Observational study in patients attended at Hospital Nacional Cayetano Heredia in Lima from January 2009 to June 2014, in whom a two-step reconstruction procedure for PSBD was performed using the induction membrane technique. In the first step, the formation of a membrane was induced with an antibiotic spacer block followed by replacement of the spacer with bone grafting. Time to bone consolidation, degree of shortening of the extremity, functional status and complications were recorded. Results: Twenty patients were included in the study (15 males and 5 females); mean age was 29 year (range: 13-54). Eleven cases had PSBD in the tibia, 7 in the femur, 1 in the radius and 1 in the ulna; in 90% of cases the PSBD had a length of at least 50mm (mean of 73 mm); 60% of cases had a positive culture at the beginning of treatment. Ninety percent consolidated the fracture with a single procedure in a meantime of 8 months. One patient required a second procedure and one presented a persistent infection without consolidation. Conclusions: The induction membrane technique is an efficacious procedure for managing PSBD. (AU)

Asunto(s)

RESUMEN

The Taylor Spatial Frame (TSF) is an external-fixator that corrects deformities in 6 axes, and can successfully manage disorders involving multiplanar deformities. In the developing-world, orthopaedic surgeons are often faced with deformities from neglected trauma and birth defects more severe than those typically seen in developed-countries. This article evaluates the applicability of TSF in the challenging medical environment of Haiti. At Haiti Adventist Hospital, the authors treated 80 cases using the TSF with a minimum follow-up of 1-year. Good results were observed in 99% of the cases (79 out of 80), approaching similar outcomes than those described in literature.

Asunto(s)

RESUMEN

Este artigo objetiva apresentar três casos de Síndrome de Eagle (SE) tratados por abordagem intraoral. Os pacientes chegaram ao serviço de emergência queixando-se de sintomas como dores cervicais, prejuízo nas funções estomatognáticas, zumbido e cefaléia. Uma detalhada avaliação clínica e radiográfica foi iniciada, na qual foi evidenciado o alongamento dos processos estilóides, que em conjunto com os sintomas clínicos determinou o diagnóstico de SE. Posteriormente, uma tomografia computadorizada com reconstrução 3D foi solicitada para a melhor orientação cirúrgica. A excisão dos alongamentos foi realizada por acesso intraoral, uma vez que a excisão cirúrgica dos processos estilóides é o padrão ouro no tratamento da SE, apresentando uma notável regressão dos sintomas. O acesso intraoral proporciona menor tempo cirúrgico, estética favorável sem cicatrizes visíveis e uma ótima recuperação do paciente... (AU)

This paper aims to present three Eagle's Syndrome (ES) cases treated surgically by an intraoral approach. The patients arrived at the emergency service complaining of symptoms such as neck pain, jeopardized stomatognathic functions, buzzing and headaches. A detailed clinical and radiographic evaluation was initialized, where styloid processes elongation was evidenced, which determined the diagnosis of ES when combined with the clinical symptoms. Furthermore, 3D computed tomography (CT) was performed to the best surgical guidance. Elongations excision was performed by intraoral approach, since the surgical excision of styloid process is the gold standard in the ES treatment, presenting a remarkable regression of symptoms. The intraoral approach provides shorter surgical period, favorable aesthetic without visible scaring and an optimal patient recovery... (AU)

Asunto(s)

RESUMEN

JUSTIFICATIVA E OBJETIVOS: A síndrome de Jó (SJ) é imunodeficiência rara, uma das formas de apresentação da Síndrome hiper IgE. O quadro clínico compreende abscessos cutâneos, pneumonias de repetição, pneumatoceles, eosinofilia, hiperimunoglobulinemia E (> 2.000 UI.mL-1), alterações craniofaciais e de crescimento ósseo. O relato descreve a doença e seu manuseio anestésico. RELATO DO CASO: Paciente masculino, negro, 13 anos, 40 kg, ASA II, com Síndrome de Jó diagnosticada aos 6 meses. Foi admitido para realização de alongamento de fêmur direito. Negava uso de medicamentos e não tinha antecedentes cirúrgicos, boa mobilidade cervical, distância interincisivos superior a 3 cm, Mallampati II e sem sinais de infecção. Os exames pré-operatórios eram normais. Foi monitorado com eletrocardioscópio, SpO2, PANI e P ET CO2. Após pré-oxigenação, realizou-se indução de anestesia geral venosa e manutenção com sevoflurano. Ao término do procedimento, o paciente foi extubado após reversão do bloqueio neuromuscular e encaminhado para a sala de RPA com Aldrete 9. Teve alta hospitalar após 72 horas, sem complicações. CONCLUSÕES: A opção da técnica anestésica é orientada pela observação criteriosa entre os riscos e benefícios específicos para cada paciente, de acordo com as sequelas respiratórias e o risco de infecção e sítio cirúrgico. No paciente em questão, havia a consideração de que a anestesia em neuroeixo poderia representar, pela predisposição de base imunológica, risco aumentado de infecções graves. O presente caso foi realizado de forma segura com anestesia geral.

BACKGROUND AND OBJECTIVES: Job's syndrome (JS), one of the presentations of the Hyper IgE Syndrome, is a rare immunodeficiency. It includes cutaneous abscesses, recurring pneumonias, pneumatoceles, eosinophilia, hyperimmunoglobulinemia E (> 2,000 IU.mL-1), and craniofacial and bone growth changes. This report describes the disease and its anesthetic management. CASE REPORT: The patient is a 13 year old black male, 40 kg, ASA II, with Job's Syndrome diagnosed 6 months prior to this admission. The patient was admitted for elongation of the right femur. He denied use of drugs and prior surgeries; he presented good cervical mobility, interincisive distance greater than 3 cm, Mallampati II, without signs of infection. Preoperative exams were within normal limits. He was monitored with electrocardioscope, SpO2, non-invasive blood pressure, and P ET CO2. After pre-oxygenation, general anesthesia was induced and he was maintained with sevoflurane. At the end of the procedure, the patient was extubated after reversal of the neuromuscular blockade, and the patient was transferred to the PACU with Aldrete 9, He was discharged from the hospital 72 hours later, without complications. CONCLUSIONS: The choice of anesthetic technique is guided by rigorous observation among risks and benefits for each patient, according to respiratory sequelae, risk of infection, and surgical site. In the patient described here, we considered that neuroaxis anesthesia could be associated with an increased risk of severe infections due to the patient immunologic background. The procedure was safely performed with general anesthesia.

JUSTIFICATIVA Y OBJETIVOS: El síndrome de Job (SJ) es una inmunodeficiencia rara, una de las formas de presentación del Síndrome hiper IgE. El cuadro clínico comprende abscesos cutáneos, neumonías de repetición, neumatoceles, eosinofilia, hiperinmunoglobulinemia E (> 2.000 UI.mL-1), alteraciones craneofaciales y de crecimiento óseo. El relato describe la enfermedad y su manejo anestésico. RELATO DEL CASO: Paciente masculino, negro, de 13 años, 40 kg, ASA II, con el Síndrome de Job diagnosticado a los 6 meses. Se le admitió para la realización de estiramiento del fémur derecho. Negaba el uso de medicamentos y no tenía antecedentes quirúrgicos, una buena movilidad cervical, una distancia interincisivos superior a los 3 cm, Mallampati II y tampoco tenía señales de infección. Los exámenes preoperatorios fueron normales. Fue monitorizado con electrocardioscopio, SpO2, PANI y PETCO2. Después de la preoxigenación se procedió a la inducción de anestesia general venosa y al mantenimiento con sevoflurano. Al finalizar el procedimiento, el paciente fue extubado después de la reversión del bloqueo neuromuscular y fue derivado a la sala de RPA con Aldrete 9. Tuvo su alta a las 72 horas, sin complicaciones. CONCLUSIONES: La opción de la técnica anestésica está orientada por la observación de un riguroso criterio entre los riesgos y beneficios específicos para cada paciente, de acuerdo con las secuelas respiratorias y con el riesgo de infección y el sitio quirúrgico. En el paciente en cuestión, se consideraba que la anestesia en el neuro eje podría representar, por la predisposición de base inmunológica, un riesgo aumentado de infecciones graves. El presente caso fue realizado de forma segura con anestesia general.

Asunto(s)

RESUMEN

Los defectos post traumáticos severos de miembros superiores en niños son infrecuentes y cuando ocurren involucran mecanismos de alta energía. Se realiza estudio descriptivo, sobre preescolar masculino, 7 años, indígena, quien presentó trauma severo en antebrazo derecho con fractura abierta III b y pérdida de 2/3 distales del cúbito y 2/3 proximales del radio con preservación de placa de crecimiento de éste último. Planteamos como objetivo preservar el miembro, mantener longitud axial y su máxima función realizando la reconstrucción de antebrazo por condrodiastasis del radio y transporte óseo del cúbito simultáneamente utilizando fijador externo llizarov. Logramos alargamiento de 2,5 cms. en radio y 3 cms. en cubito con la consolidación de ambos para la formación de un hueso único radio-cubito, conservando los movimientos intrínsecos de la mano, el crecimiento epifisiario, la flexo-extensión de codo y muñeca con abolición de pronosupinación. Concluimos que la cirugía reconstructiva con formación de hueso único mediante técnicas combinadas de alargamiento óseo es una opción terapéutica eficaz para el manejo del trauma complejo del antebrazo con pérdida de hueso en niños.

Severe post-traumatic defects in the upper limbs of children are rather rare and when they happen they involve mechanisms of high energy. Material and methods descriptive and prospective study about indigenous masculine, 7 years, who present severe trauma in right forearm with open fracture III b and loss of 2/3 distal of the ulna and 2/3 proximal of the radio with preservation of plate of growth. We outline as objective to preserve the limb, to maintain axial longitude and their maximun function carrying out the forearm reconstruction simultaneously for chondrodiatasis of the radio and bone transport of the ulna using external fixation llizarov. We achieved lengthening of 2,5 cm. in radio and 3 cm. in ulna with thinks about the consolidation of both for the formation of a one-bone radio-ulna, conserving the intrinsic movements of the hand, the epiphyseal growth, the elbow flexo-extension and wrist with pronosupination abolition. WE concluded that the reconstructive surgery with formation of one-bone mediating combined techniques of bone lengthening is a therapeutic effective option for the hadling of the complex trauma of the forearm with bone loss in children.

Asunto(s)

RESUMEN

Distraction osteogenesis has been extensively used to correct severe midface hypoplasia in syndromic craniosynostosis patients. However few studies have reported midface distraction outcomes through cephalometric evaluation. AIM: The purpose of the present study was to evaluate outcomes with midface distraction rigid external device (RED) in patients with syndromic craniosynostosis, in terms of quantity of bone lengthening, skeletal stability and facial growth. MATERIALS AND METHODS: Eleven patients were retrospectively evaluated in this study. Cephalometrics was carried out through three teleradiographies from each patient (T1 -before surgery; T2- immediate postop, rigth after distractor removal; T3 - late postop, obtained with a minimal interval of 12 months after surgery). RESULTS: Significant midface advancement was achieved with the procedure. The rate of horizontal relapse was minimal. We noticed a clear vertical facial growth, contrary to what was seen in the horizontal aspect, when there was a mild posterior relapse and no growth evidence. CONCLUSION: Cephalometric evaluation showed adequate results in midface bone lengthening with rigid external distractor.

A distração osteogênica tem sido extensamente empregada na correção da grave hipoplasia do terço médio da face de portadores de craniossinostose sindrômica. Poucos estudos têm apresentado os resultados da distração do terço médio da face através de avaliação cefalométrica. OBJETIVO: O objetivo do estudo foi o de avaliar os resultados obtidos com o avanço ósseo do terço médio da face seguida da utilização de dispositivo rígido externo de distração (RED), em portadores de craniossinostose sindrômica, através de análise cefalométrica. MATERIAL E MÉTODOS: O estudo teve desenho retrospectivo, onde onze pacientes foram avaliados retrospectivamente. A análise cefalométrica foi realizada a partir de três telerradiografias de cada paciente (T1- préoperatório; T2 - pós-operatório recente, logo após a remoção do distrator; T3 - pós-operatório tardio, obtida com um intervalo mínimo de 12 meses após cirurgia) RESULTADOS: Avanço significativo do terço médio da face foi obtido. A taxa de perda de resultado foi mínima. Foi observado evidente crescimento vertical da face, ao contrário do que corre na direção horizontal, onde existiu um pequeno reposicionamento posterior e nenhuma evidência de crescimento. CONCLUSÃO: Observou-se resultados adequados no alongamento do terço médio da face com o uso de distrator externo rígido, através da análise cefalométrica.

Asunto(s)