RESUMEN
PURPOSE: The primary aim was to analyse the lateral malleolus morphology with a focus on the shape of the distal fibula for IM fixation of the fibula in infra- and transsyndesmotic fracture patterns. The secondary aim was to propose a treatment algorithm according to the lateral malleolar anatomy. METHODS: 77 healthy, skeletally mature volunteers underwent CT scanning of the ankle. The fibula medullary canal and its cortical thickness were quantitatively analysed at 4 different levels measured from the fibular tip (1.5 cm, 3.0 cm, 4.5 cm, and 6.0 cm). A geometric classification was proposed, and a decision algorithm was developed. Statistical significance was set at a p-value < 0.05. RESULTS: The smallest diameter of the medullary canal of the fibula was at 6.0 cm from the tip of the fibula, in 98.2% of the ankles. The distal fibula can be classified into triangular and rectangular type, according to the cortical thickness index (p < 0.0001). In 16.7% ankles, the internal diameter of the fibula at 6.0 cm was equal or narrower than 3.5 mm (p < 0.05). CONCLUSION: The shape of the distal fibula as evaluated by CT-guided analysis allows for IM osteosynthesis of the lateral malleolus in 83% of individuals. In our study, the smallest diameter of the medullary canal of the fibula was located 6.0 cm from the tip of the lateral malleolus. Coronal CT evaluation is advantageous in indicating which type of IM implant should be used safely for infra- and transsyndesmotic fracture patterns, potentially reducing intraoperative risks.
Asunto(s)
Fracturas de Tobillo , Fracturas de Peroné , Humanos , Tobillo , Peroné/diagnóstico por imagen , Peroné/cirugía , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Fijación Interna de Fracturas , Tomografía Computarizada por Rayos XRESUMEN
Introdução: A displasia fibrosa (DF) do osso é uma desordem congênita, rara, que corresponde de 5 a 10% dos tumores ósseos benignos, não hereditária, que cursa com amplo espectro de apresentação, variando do assintomático à dor óssea, fraturas de repetição, deformidades ósseas (fêmur em cajado de pastor e fácies leonina) e compressão de nervos cranianos. Histologicamente é composta de estroma fibroso celular de baixo a moderado grau circundando trabéculas ósseas de formato irregular sem borda osteoblástica. Todos os casos contêm a mutação GNAS1. A DF apresenta duas formas: a monostótica, mais comum (70-80%), e a poliostótica, mais rara (20-30%), que quando acompanhada de manchas café-com-leite e puberdade precoce constitui a síndrome de McCune-Albright ou Síndrome de Mazabraud em casos mais raros. O tratamento pode ser feito com medicamentos como bifosfonato ou de forma cirúrgica, objetivando-se a correção das lesões com curetagem e enxertia óssea ou como iremos mostrar a seguir, pela Técnica de Masquelet. Este trabalho relata o caso de um menino de 20 anos de idade cujos sinais e sintomas conduziam ao diagnóstico de DF sendo realizado tratamento com Técnica de Masquelet e follow up de 18 meses. Além disso, faz revisão de literatura sobre uma doença pouco comum, com variada gama de diagnósticos diferenciais. Objetivo: relatar um caso de displasia fibrosa com tratamento cirúrgico de enxerto autólogo de fíbula pela Técnica de Masquelet. Método: relato de caso de paciente do Ambulatório de Especialidade do Hospital do Servidor Público Municipal, de 20 anos de idade, que foi acompanhado por 1 ano e meio apresentando um tumor ósseo na tíbia compatível com diagnóstico de displasia fibrosa, que ao longo desse período foi submetido à Técnica de Masquelet. Conclusão: É pouco descrito na literatura o tratamento de displasia fibrosa pela Técnica de Masquelet, que mostrou ter ótimo resultado funcional para o paciente estudado. Palavras-chave: Displasia Fibrosa Óssea. Displasia Fibrosa. Técnica de Masquelet. Técnica de Membrana Induzida.
Asunto(s)
Humanos , Masculino , Adulto , Osteomielitis/terapia , Seudoartrosis/terapia , Tibia/cirugía , Trasplante Autólogo/métodos , Huesos/fisiopatología , Fracturas Óseas/congénito , Fémur/cirugía , Displasia Fibrosa Poliostótica , Peroné/cirugía , Mutación/fisiología , Neoplasias/cirugíaRESUMEN
ABSTRACT: Mandibular reconstruction is a challenging procedure, especially in cancer patients with defects that are greater than 6 cm. Free vascularized fibular flap is the gold standard treatment in these cases since it allows three-dimensional restoration of the lost segments after ablative surgery in addition to providing the possibility of a subsequent implant-supported rehabilitation improving the functional and aesthetic outcomes of the surgery.To obtain accurate results, preoperative planning must be done with detail. Approaches for the preoperative planning include both the conventional analog planning and the virtual planning that are valid alternatives in meeting the trans-surgical requirements.This study makes a comparative analysis of 2 clinical cases with a diagnosis of squamous cell carcinoma that were reconstructed using a vascularized fibular free flap. The first case was planned using the conventional analog method whereas the second case was planned using the virtual planning approach.The impact of virtual planning and conventional analog planning on preoperative planning time, ischemia period, and total surgical time is analyzed according to the experience obtained in the cases presented. In addition, the authors described the technique used for each planning method along with a literature review in which the results are contrasted and discussed.
Asunto(s)
Colgajos Tisulares Libres , Reconstrucción Mandibular , Trasplante Óseo , Estética Dental , Peroné/cirugía , Humanos , Mandíbula/cirugía , Reconstrucción Mandibular/métodos , Tempo OperativoRESUMEN
BACKGROUND: The mandible is responsible for vital functions of the stomatognathic system, and its loss results in functional and aesthetic impairment. Mandibular reconstruction with free fibula flap is considered the gold standard for mandibular reconstruction. CASE PRESENTATION: We describe here the 38-year follow-up of the patient who was the first case of mandibular reconstruction with free fibula flap reported in the literature. The original report describes a 27-year-old woman who had undergone extensive mandibulectomy due to an osteosarcoma. A microvascularized fibula flap was used for mandibular reconstruction in 1983. Two years later, a vestibulo-lingual sulcoplasty with skin graft was performed to allow the construction of a total dental prosthesis. Fifteen years after the initial treatment, an autologous iliac crest graft was placed in the fibula flap, aimed at increasing bone thickness and height for rehabilitation with implant supported prosthesis. In 2015, a rib graft was positioned in the mental region, enhancing the support to the soft tissues of the face and improving the oral function. A recent review of the patient shows well-balanced facial morphology and optimal functional results of the procedure. CONCLUSIONS: The fibula flap method, described in 1975 and first reported for mandibular reconstruction in 1985, continues to be applied as originally described, especially where soft tissue damage is not extensive. Its use in reconstructive surgery was expanded by advancements in surgery and techniques such as virtual surgical planning. However, there is still a lack of evidence related to the long-term evaluation of outcomes. The present work represents the longest-term follow-up of a patient undergoing mandibular reconstruction with free vascularized fibula flap, presenting results showing that, even after 38 years, the procedure continues to provide excellent results.
Asunto(s)
Implantes Dentales , Colgajos Tisulares Libres , Neoplasias Mandibulares , Reconstrucción Mandibular , Procedimientos de Cirugía Plástica , Adulto , Trasplante Óseo , Femenino , Peroné/cirugía , Estudios de Seguimiento , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Neoplasias Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/cirugíaRESUMEN
El acortamiento y la rotación del peroné son las deformidades más frecuentemente encontradas cuando se presentan maluniones postraumáticas del tobillo resultando en ensanchamiento de la mortaja e inestabilidad astragalina, con consecuentes cambios artrósicos. Los pacientes acuden por presentar dolor y limitación en sus actividades diarias y deportivas. En el presente estudio retrospectivo se hace una evaluación de los resultados clínicos y radiológicos de 9 pacientes que se sometieron a tratamiento quirúrgico posterior a maluniones de fracturas de peroné, en los cuales se realizaron osteotomías de alargamiento y desrotación para reconstrucción del tobillo, en la Unidad de Cirugía de Pie y Tobillo del Hospital Universitario de Caracas, entre junio de 2014 y agosto del 2019. Se realizaron mediciones radiológicas pre y postoperatorias de los ángulos de inclinación astragalina, talocrural y bimaleolar, y se reportaron los cambios degenerativos articulares. Para la evaluación clínica y funcional se aplicó la Escala Análoga Visual (VAS) para el dolor, y la Escala AOFAS de retropié, evidenciándose mejoría en cuanto a dolor, función y alineación. El objetivo del tratamiento fue restituir la longitud inicial del peroné, mediante osteototomías oblicuas en el sitio de la fractura anterior, o transversas suprasindesmales, con lo cual también se corrige la alineación del astrágalo, y de esta manera prevenir o disminuir los síntomas y signos inherentes a degeneración articular progresiva(AU)
The shortening and rotation of the fibula are the most frequent deformities found when post-traumatic ankle malunions occur, resulting in widening of the mortise and talus instability, with consequent arthritic changes. Patients have pain and limitation in their daily activities and sports. In the present retrospective study, an evaluation of the clinical and radiological results of 9 patients who underwent surgical treatment after fibular fracture malunions was performed, in which osteotomies of lengthening and de-rotation were performed for reconstruction of the ankle, in the Unit of Foot and Ankle Surgery at the University Hospital of Caracas, between June 2014 and August 2019. Pre and postoperative radiological measurements of the astragaline, talocrural and bimaleolar inclination angles were performed, and degenerative joint changes were reported. For the clinical and functional evaluation, the Visual Analog Scale (VAS) was applied for pain, and the AOFAS Hindfoot Scale, evidencing improvement in pain, function, and alignment. The objective of the treatment was to restore the initial length of the fibula by means of oblique osteotomies at the site of the previous fracture or suprasindesmal transverse osteotomy, which also corrects the alignment of the talus and thus prevents or decreases the symptoms and signs inherent to joint progressive degeneration(AU)
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Anciano , Osteotomía , Alargamiento Óseo , Fracturas Mal Unidas , Traumatología , Fracturas Óseas , Peroné/cirugíaRESUMEN
CASE: A total knee arthroplasty (TKA) was performed on a 35-year-old man with congenital fibular deficiency and a 20° varus and 28° antecurvatum tibial deformity of the left lower limb. CONCLUSION: One-stage TKA and correction of the extraarticular deformity by means of intraarticular bone resections and a standard soft tissue release were performed to restore the limb's mechanical axis. Patients with congenital fibular deficiency present a wide range of limb deformities because of bone deficiencies or treatment sequels, which might require a specific surgical technique and small-sized implants to obtain good results during a TKA.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Adulto , Artroplastia de Reemplazo de Rodilla/métodos , Peroné/cirugía , Humanos , Extremidad Inferior , MasculinoRESUMEN
INTRODUCTION: Proximal tibiofibular joint dislocations (PTFJD) are uncommon and underdiagnosed injuries. Urgent reduction is mandatory to avoid chronic disfunction. The scarcely available literature does not present a unified management guideline. An acute PTFJD case report with spontaneous reduction and a review of the literature is presented, aiming to assist the diagnosis and management of this pathology. CASE REPORT: A 22-years old male presented to the emergency department with high intensity right knee pain after falling in a four-wheel motorcycle. The physical exam revealed a prominent painful mass on the lateral aspect of his knee and proximal leg. His range of motion and knee stability were unremarkable. X-rays were informed negative for musculoskeletal injuries. According to a sustained suspicion of PTFJD, the study was continued with a magnetic resonance imaging (MRI), which suggested PTFJD. During the following 24 hours, the patient referred he was entirely asymptomatic after feeling a loud "clank". He has been followed for three months with MRI, and remains asymptomatic with full functions. CONCLUSION: PTFJD diagnosis requires appropriate images. Urgent close reduction is mandatory; if unsuccessful, open reduction, primary repair and internal fixation are indicated. The prognosis of spontaneous reduction remains uncertain and requires a serial clinical evaluation. In the case of recurrence, the appropriate surgical management is indicated according to the elapsed time from the injury.
INTRODUCCIÓN: La luxación tibiofibular proximal (LTFP) es una lesión poco frecuente y no diagnosticada. De no ser tratada a tiempo, puede generar una sintomatología crónica de dolor e inestabilidad. La escasa evidencia disponible no entrega un protocolo de enfrentamiento ni consenso respecto a su manejo. Con el objetivo de asistir al enfrentamiento de esta lesión, se presenta una revisión de la literatura de una LTFP con reducción espontánea. CASO CLÍNICO: Hombre de 22 años consulta por dolor intenso en su rodilla derecha, posterior a caída en cuatrimoto. Al examen físico con aumento de volumen doloroso en cara lateral de la rodilla y pierna proximal, con movilidad completa y estable. Radiografías son informadas sin alteraciones. Se mantiene la sospecha clínica de LTFP, se continúa estudio con resonancia magnética (RM), la que es sugerente de LTFP. Dentro de las 24 horas de evolución, el paciente indica haber sentido un clank espontáneo en su rodilla afectada con cese completo de sintomatología. Se sigue al paciente por tres meses con RM de control, manteniendo una rodilla asintomática; examen físico y funcionalidad normal. CONCLUSIÓN: El diagnóstico de las LTFP requiere un adecuado uso de imágenes. Su manejo consiste en una reducción cerrada de urgencia y de no lograrse, una reducción abierta, reparación y fijación interna. El pronóstico de las reducciones espontáneas es incierto, por lo que deben ser seguidas de forma seriada y en caso de recidiva, manejadas quirúrgicamente según el tiempo de evolución.
Asunto(s)
Peroné , Luxación de la Rodilla , Adulto , Peroné/cirugía , Fijación Interna de Fracturas/métodos , Humanos , Luxación de la Rodilla/diagnóstico por imagen , Luxación de la Rodilla/cirugía , Articulación de la Rodilla/cirugía , Masculino , Tibia/cirugía , Adulto JovenRESUMEN
PURPOSE: Despite the fact that open reduction and internal fixation with a plate, either non-locked or locked, is the standard of care for managing lateral malleolus fractures, intramedullary (IM) fixation of the fibula has been recently introduced as an alternative, mainly for some potential complicated situations. We hypothesized that almost all patterns of distal fibula fracture can be safely fixed with an IM device, with the potential benefit of providing biomechanical efficiency, but using a soft-tissue friendly implant. Here, we present a multicenter case series based on a proposed algorithm. PATIENTS AND METHODS: Sixty-nine consecutive patients were managed with fibular IM fixation for closed malleolar fractures. Twenty patients were managed by IM screw fixation and 49 by fibular nailing. Outcome was measured both according to the American Orthopaedic Foot and Ankle Society (AOFAS) score for ankle and hindfoot, and the time to bone union. RESULTS: The mean AOFAS for Group I was 99.35 ± 1.95 points and that for Group II was 89.30 ± 16.98 points. There were no significant differences between the fracture pattern, according to the Lauge-Hansen classification, and post-operative levels of pain and functional activity among patients in both groups (p > 0.05). All fractures healed uneventfully in both groups. The mean time to union for Group I was 8.15 weeks and for Group II was 8.25 weeks (p > 0.05). CONCLUSION: In this multicenter case series, intramedullary fixation for the lateral malleolus fracture presented itself as a viable and safe option for the treatment of almost all patterns of fibula fracture in adults. Overall, we were able to demonstrate the potential indications of the proposed algorithm for the choice of IM implant for the lateral malleolus fracture in terms of the Lauge-Hansen staged classification.
Asunto(s)
Fracturas de Tobillo , Fijación Intramedular de Fracturas , Adulto , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Placas Óseas , Peroné/diagnóstico por imagen , Peroné/cirugía , Fijación Interna de Fracturas , Humanos , Resultado del TratamientoRESUMEN
Here we describe a successful surgical management of a distal fibular fracture combined with a tarsocrural luxation and multiple metatarsal fractures in the left foot of a southern brown howler monkey (Alouatta guariba clamitans). We achieved satisfactory outcome by applying intramedullary pinning for each of the bone fractures and closed reduction of joint luxation-kept in place only by bone alignment, without further ligament reconstruction. Bone healing occurred uneventfully within eight weeks and the monkey's foot regained its normal function. Therefore, we could properly release the patient back into the wild.
Asunto(s)
Alouatta/lesiones , Peroné/lesiones , Curación de Fractura , Fracturas Óseas/veterinaria , Metatarso/lesiones , Alouatta/fisiología , Animales , Peroné/fisiología , Peroné/cirugía , Fracturas Óseas/cirugía , Masculino , Metatarso/fisiología , Metatarso/cirugíaRESUMEN
OBJECTIVE: The common fibular nerve (CFN) is the most frequently injured nerve in the lower limbs. Surgical management is necessary in approximately two thirds of patients and includes neurolysis, suture, graft repair, or nerve transfer. The distal sural nerve is the preferred donor for grafting, but it is not without complications and requires a second incision. We sought to study the surgical anatomy of the lateral sural cutaneous nerve (LSCN) with the aim of repairing CFN injuries through the same incision and as a potential source for grafting in other nerve injuries. METHODS: The popliteal fossa was dissected in 11 lower limbs of embalmed cadavers to study LSCN variations. Four patients with CFN injuries then underwent surgical repair by LSCN grafting using the same surgical approach. RESULTS: At the medial margin of the biceps femoris, the LSCN emerged from the CFN approximately 8.15 cm above the fibular head. The LSCN ran longitudinally to the long axis of the popliteal fossa, with an average of 3.2 cm medial to the fibular head. The mean LSCN length and diameter were 9.61 cm and 3.6 mm, respectively. The LSCN could be harvested in all patients for grafting. The mean graft length was 4.4 cm. Motor function was consistently recovered for foot eversion but was recovered to a lesser extent for dorsiflexion and toe extension. All patients recovered sensitive function (75% of S3). Hypoesthesia was recognized at the calf. CONCLUSIONS: LSCN harvest is a viable alternative for nerve grafting, especially for repairing short CFN injuries, thereby avoiding the need for a second incision.
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Peroné/cirugía , Pierna/cirugía , Transferencia de Nervios , Nervio Peroneo/cirugía , Nervio Sural/cirugía , Adolescente , Adulto , Estudios de Factibilidad , Peroné/inervación , Humanos , Pierna/fisiopatología , Extremidad Inferior/cirugía , Masculino , Procedimientos Neuroquirúrgicos , Neuropatías Peroneas/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto JovenRESUMEN
La inestabilidad de la articulación tibioperonea proximal puede presentarse con una luxación, con escasos síntomas laterales de la rodilla, dolor, malestar e incomodidad durante distintas actividades o síntomas relacionados con la irritación del nervio peroneo común. Un preciso diagnóstico prequirúrgico es imperativo, así como el tratamiento conservador con inmovilización y kinesiología por cuatro a seis semanas. En la población adolescente, el planeamiento prequirúrgico puede ser dificultoso por la presencia de los cartílagos abiertos, por lo tanto, se debe tomar precaución en la realización de los túneles y en la colocación de implantes en relación con la fisis abierta. El objetivo del siguiente trabajo es presentar el caso de un niño de once años con inestabilidad tibioperonea proximal recurrente, además mostrar detalles de la técnica quirúrgica, protocolo postoperatorio y sus excelentes resultados
Instability of the proximal tibiofibular joint (PTFJ) can present as dislocations, vague symptoms of lateral knee pain, discomfort during activity, or symptoms related to irritation of the common peroneal nerve. An accurate preoperative diagnosis is imperative and should include a trial of taping of the PTFJ for a 4- to 6-week time frame before surgical reconstruction is indicated. In the adolescent population, surgical planning can be complicated by the presence of open physes; therefore, caution must be taken to avoid drilling through or placing screw fixation across the physes. Potential complications include growth arrest and limb length discrepancy. Therefore, the purpose of this case report is to describe the surgical technique for addressing PTFJ instability in adolescent patients. The aim of this case report is to present a case of instability of the proximal tibiofibular joint (PTFJ) treated surgically in an eleven-year-old male soccer player, focused on technical tips, strict rehab protocol with excellent results
Asunto(s)
Niño , Tibia/cirugía , Peroné/cirugía , Placa de Crecimiento/cirugía , Inestabilidad de la Articulación , Articulación de la Rodilla/cirugíaRESUMEN
El tumor pardo, también conocido como osteoclastoma ó como osteítis fibrosa quística, es un tumor lítico, que se presenta en hiperparatiroidismo (primario, secundario y terciario), aunque su presentación habitual es altamente invasiva, no tiene potencial de malignidad. Los tumores pardos en la mano son muy poco frecuentes y existen solo algunos reportes de casos. Presentamos un paciente masculino de 18 años con una tumoración dura, no móvil, adherida a planos profundos en región dorsal de la mano derecha sobre el cuarto metacarpiano, que además limita la flexión y extensión del cuarto dedo sin alterar su función neurovascular. El paciente fue sometido a resección de la tumoración que involucraba por completo al cuarto metacarpiano derecho, además se realizó un abordaje lateral directo en miembro pelvico izquierdo para tomar un injerto autólogo de peroné no vascularizado. Es importante la detección temprana de este tipo de tumores y se debe dar un adecuado seguimiento, ya que, al progresar, generan una destrucción ósea importante y el tratamiento se vuelve de mayor complejidad. En etapas tempranas, el manejo agresivo con resección y aporte óseo puede evitar secuelas funcionales. El uso de injerto no vascularizado de peroné de seis centímetros para la sustitución del cuarto metacarpiano por osteolísis secundaria a un tumor pardo es una alternativa adecuada de tratamiento que permite la preservación estético funcional de la mano.
The brown tumour, also known as osteoclastoma, or as osteitis fibrosa cystica, is a lytic tumour, which occurs in hyperparathyroidism (primary, secondary, and tertiary), although its usual presentation is highly invasive, has no potential for malignancy. Brown tumours of the hand are sporadic, and there are only few case reports. The case is presented of an 18-year-old male patient with a solid, non-mobile tumour, adhered to deep planes, in the dorsal region of the right hand over the fourth metacarpal. This also limited the flexion and extension of the fourth finger, but did not show alterations in the neurovascular function of the finger. The patient underwent a tumour resection that completely involved the right fourth metacarpal. A direct lateral approach was made in the left pelvic limb to perform a non-vascularised autologous fibular graft. Early detection of this type of tumour is important, and an adequate follow-up must be carried out, since when they progress, they generate significant bone destruction and the treatment becomes more complex. In early stages, aggressive management of resection and bone support can prevent functional sequelae.
Asunto(s)
Humanos , Masculino , Adolescente , Osteítis Fibrosa Quística/cirugía , Huesos del Metacarpo/cirugía , Osteítis Fibrosa Quística/etiología , Osteítis Fibrosa Quística/diagnóstico por imagen , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/complicaciones , Trasplante Óseo , Huesos del Metacarpo/diagnóstico por imagen , Peroné/cirugía , Hiperparatiroidismo Secundario/complicacionesRESUMEN
INTRODUCTION: Composite and large head and neck defects requiring extensive skin-mucosa coverage are often reconstructed by combining flaps. Herein, we present a simple and reliable two-stage fibula osteocutaneous (FOC) flap technique to improve the survival of a large skin paddle for oromandibular reconstructions. METHODS: From October 2011 to September 2016, 47 patients with through-and-through oromandibular defects were reconstructed using FOC flaps with large skin paddles. To ensure optimum survival of skin paddles, temporary orocutaneous fistula were left in place and closed during the second stage operation via de-epithelialization of the skin paddle and suturing of mucosa. Demographic data, operative details, and postoperative complications were recorded. RESULTS: The skin paddle dimensions ranged from 20 to 31.5 cm in length and 12 to 17 cm in width with an average area of 430.4 cm2 (range 300-504). The average time between the two stages and hospital stay were 10 days and 14 days, respectively. Complications at the donor site included wound dehiscence (n = 3, 6.4%), partial skin graft loss (n = 3, 6.4%) and hematoma (n = 2, 4.3%). Recipient site complications included two (4.3%) early postoperative venous congestions that resolved after elevation and three (6.4%) partial skin flap necrosis (less than 5% surface area). All complications resolved with bedside conservative management. There was only one take-back for evacuation of recipient site hematoma (2.1%) but no flap loss. CONCLUSION: Two-staged large skin paddle FOC flaps can simplify reconstruction of extensive oromandibular defects by improving the reliability of the sizable skin paddle and negating the need for a second flap.
Asunto(s)
Carcinoma de Células Escamosas/rehabilitación , Fístula Cutánea/cirugía , Peroné/cirugía , Supervivencia de Injerto/fisiología , Hospitales Universitarios , Mandíbula/cirugía , Neoplasias de la Boca/rehabilitación , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/patología , Colgajos Quirúrgicos/trasplante , Adulto , Carcinoma de Células Escamosas/cirugía , Femenino , Estudios de Seguimiento , Humanos , Hiperemia/etiología , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/cirugía , Necrosis , Complicaciones Posoperatorias , Estudios Retrospectivos , Trasplante de Piel , Colgajos Quirúrgicos/efectos adversos , Taiwán , Sitio Donante de Trasplante , Resultado del TratamientoRESUMEN
Fundamento:la rodilla es una de las articulaciones más afectadas por el proceso degenerativo articular, se asocia a deformidades angulares en especial el varo, lo que hace más difícil su tratamiento.Objetivo:presentar el caso clínico de una paciente con artrosis de la rodilla y deformidad en varo tratada mediante artroscopia y ostectomía proximal del peroné de forma combinada y simultánea.Caso clínico:paciente de 64 años de edad, blanca, femenina sin antecedentes mórbidos de salud, la cual sufre de dolor de tipo mecánico a nivel de la rodilla izquierda alrededor de un año de evolución, que aumenta con la actividad física, se alivia con el reposo y la administración de analgésicos y antiinflamatorios no esteroideos. El examen radiográfico simple de ambas rodillas mostró la desviación en varo evidenciado en la medición de los ángulos tibial y femorotibial, esta deformidad fue más acentuada en la rodilla izquierda. Para dar respuesta a esta situación, la paciente fue intervenida quirúrgicamente donde se le realizó artroscopia y ostectomía proximal del peroné de forma combinada y simultánea.Conclusiones:la técnica propuesta es ventajosa al combinar dos procedimientos en uno, es factible y reproducible en instituciones que cuenten con servicio de artroscopia(AU)
Background: knee is one of the joints most affected by osteoarthritis, associated to angular deformities especially the varus, which makes treatment even more difficult. Objective: to show a case report of a patient with knee osteoarthritis and varus deformity treated by simultaneous arthroscopy and proximal fibular ostectomy. Clinical case: a 64 year-old, white woman, without health morbid antecedents, was taken to the outpatient department complaining of left knee pain for a year, the pain gets worse with physical activities and reliefs with rest, pain killers and non steroidal anti-inflammatory drugs. Simple X Rays showed varus deformity of both knees more accentuated in the left one. Because of patient condition, she underwent surgery where it was performed a combined and simultaneous arthroscopy and proximal fibular ostectomy. Conclusions: the technique is a useful, while combining two procedures in one, and it is feasible and reproducible in institutions with arthroscopic service training(AU)
Asunto(s)
Anciano , Artroscopía , Osteoartritis de la Rodilla/rehabilitación , Osteoartritis de la Rodilla/cirugía , Osteoartritis de la Rodilla/terapia , Rodilla , Articulación de la Rodilla , Osteotomía , Peroné/cirugíaRESUMEN
Resumen: Objetivo: Demostrar los resultados en la neoformación ósea de tibia utilizando la técnica de inducción de membrana más la transposición de peroné ipsolateral no vascularizado. Caso clínico: Masculino de 25 años, antecedente de sufrir impacto por arma de fuego en pierna izquierda dos años antes, presentó un diagnóstico inicial de fractura expuesta Gustilo IIIB AO 42C3 IO4NV1MT2 con pérdida ósea de 7 cm de diáfisis tibial. Durante su evolución se realizaron múltiples aseos quirúrgicos y colocación de injertos cutáneos con resultados no favorables, por lo que se emplea la técnica de membrana inducida más colocación de peroné ipsolateral no vascularizado, teniendo una evolución a los cuatro meses posterior a su última intervención con deambulación dependiente de bastón. Conclusión: La técnica de inducción de membrana con transposición de peroné ipsolateral no vascularizado podría ser una alternativa adecuada para el manejo de pérdidas óseas en los pacientes.
Abstract: Objective: To demonstrate the outcome of tibial bone neo formation, using induced-membrane technique and non-vascularized ipsolateral fibular graft transposition. Case report: A 25 years old male with a 2 years ago firearm injury in left leg, presenting an initial diagnosis of open fracture Gustilo IIIB AO 42C3 IO4NV1MT2 with a 7cm tibial diaphyseal bone defect. During his hospital evolution multiple interventions were made including surgical debridement and skin grafts placement, with unfavorable results. Therefore, we decided to use the induced-membrane technique and non-vascularized ipsolateral fibular graft transposition, resulting in a cane dependent ambulation, in 4 months evolution after last intervention. Conclusion: Induced-membrane technique and non-vascularized ipsolateral fibular graft transposition could be a successful alternative for the management of patients with severe bone loss.
Asunto(s)
Humanos , Masculino , Adulto , Tibia/cirugía , Trasplante Óseo , Procedimientos de Cirugía Plástica , Peroné , Peroné/cirugía , Trasplante de Piel , Resultado del Tratamiento , Fracturas Abiertas/cirugíaRESUMEN
Introducción: En el proceder quirúrgico del tratamiento del genu varo doloroso, la osteotomía del peroné es un paso común que acompaña a la osteotomía valguizante de la tibia, con un porcentaje de complicaciones conocidas. Los autores del presente trabajo comenzaron a aplicar un nuevo enfoque en el tratamiento de esta afección, con la ostectomía del peroné, donde también se presentan complicaciones. Objetivo: Identificar las complicaciones en pacientes operados mediante ostectomía del peroné. Métodos: Fueron evaluados 116 pacientes portadores de cambios degenerativos del compartimento interno de la rodilla; operados mediante ostectomía del peroné, durante el período de abril del 2016 a abril del 2018. Las complicaciones fueron recogidas desde el momento de la intervención quirúrgica, su evolución y tratamiento, a través del seguimiento por consulta externa. Resultados: En los pacientes obesos se observó el mayor número de complicaciones (9), de ellas 4 referentes a neuropraxia de la rama profunda del nervio peroneo o fibular, 2 con hematomas de la herida y una con infección. Hubo 2 pacientes con linfangitis. Hubo 11 pacientes con 14 complicaciones (9,4 por ciento de los intervenidos). Conclusiones: Las complicaciones más importantes fueron neuropraxia de las ramas superficial y profunda del nervio peroneo, el hematoma e infección de la herida(AU)
Introduction: In the surgical procedure of genu varum pain treatment, the osteotomy of the fibula is a common step that accompanies the valgus tibial osteotomy, with a percentage of known complications. The authors of this work began to apply a new approach in the treatment of this condition, with fibular ostectomy, where complications also occur. Objective: To identify the complications that may appear in the ostectomy of the fibula. Methods: 116 patients with degenerative changes of the internal compartment of the knee were evaluated; operated by fibular ostectomy, during the period from April 2016 to April 2018. Complications were collected from the moment of surgery, its evolution and treatment, through follow-up by external consultation. Result: In the obese patients, the greatest number of complications was observed (9), of which 4 related to neuropraxia of the deep branch of the peroneal or fibular nerve, 2 with wound hematomas and one with infection. There were 2 patients with lymphangitis. There were 11 patients with 14 complications (9.4 percent of those who underwent surgery). Conclusions: The most important complications were neuropraxia of the superficial and deep branches of the peroneal nerve, the hematoma of the wound and infection(AU)
Asunto(s)
Humanos , Persona de Mediana Edad , Anciano de 80 o más Años , Osteotomía , Genu Varum/complicaciones , Peroné/cirugía , Epidemiología DescriptivaRESUMEN
RESUMEN Introducción: en el diagnóstico y tratamiento del genu varo doloroso es importante el estudio radiográfico de la rodilla, se pueden visualizar los cambios estructurales que aparecen en las superficies articulares de la rodilla. Objetivo: demostrar desde el punto de vista radiológico la variación que ocurre posterior a la ostectomía del peroné en los pacientes operados de genus varos. Materiales y métodos: se realiza un estudio descriptivo, prospectivo y lineal en el Hospital Militar Dr. Mario Muñoz Monroy de Matanzas desde abril del 2016 -2017 donde se aplica la técnica de ostectomía del peroné, del Dr. Zhang Ying-Ze, se presentan los primeros 51 pacientes operados, un total de 57 rodillas, a los cuales se les realizó radiografía previa a la operación y posterior a ella al cabo de los 6 meses, donde se midió la altura del espacio articular externo. Resultados: el promedio de edad es de 67,2 años (50 años el menor y 84 años el mayor), de los cuales 23 eran hombres y 28 mujeres, previo al tratamiento quirúrgico el promedio de este espacio fue de 8,84 mm±1,01 mm (18 mm el mayor y el menor 2 mm) y al cabo de los 6 meses fue de 6,08 mm±0,9 mm(el mayor 10 mm y el menor 2 mm), en 6 pacientes no hubo variación de esta medida. Conclusiones: con la ostectomía proximal del peroné se logra disminuir el espacio articular externo modificando el eje mecánico y anatómico del miembro inferior, lo que se traduce por una disminución de la compresión interna articular (AU).
ABSTRACT Background: the radiographic study of the knee is very important in the painful genu varum diagnosis and treatment: structural changes appearing in the knee joint surfaces may be observed. Objective: to show the changes taking place after fibular ostectomy in the patients surgically treated of genu varum from the radiological point of view. Material and methods: a lineal, prospective, descriptive study was carried out in the Military Hospital "Dr. Mario Muñoz Monroy" of Matanzas from April 2016 to April 2017, in 51 patients operated on applying Dr Zhang Ying-Ze's fibular ostectomy technique: a total of 57 knees. X-rays were taken before the surgery and six months after it, measuring the height of the external intra joint space. Results: the average age was 67.2 years (50 years the youngest and 84 the eldest patients); 23 were men and 28 women. Before the surgical treatment the average space was 8.84 mm±1.01 mm (18 mm the biggest and 2 mm the smallest); six months after surgery, it was 6.08 mm±0.9 mm (10 mm the biggest and 2 mm the smallest); six patients did not showed changes of the space. Conclusions: with the proximal fibular ostectomy we achieved the reduction of the external fibular space, modifying the anatomical and mechanical axis of the lower limb, what leads to a reduction of the internal joint compression (AU).
Asunto(s)
Humanos , Masculino , Femenino , Genu Varum/cirugía , Peroné/cirugía , Osteotomía/rehabilitación , Radiografía/métodos , Rodilla/anomalías , Rodilla/cirugíaRESUMEN
RESUMEN Introducción: en el diagnóstico y tratamiento del genu varo doloroso es importante el estudio radiográfico de la rodilla, se pueden visualizar los cambios estructurales que aparecen en las superficies articulares de la rodilla. Objetivo: demostrar desde el punto de vista radiológico la variación que ocurre posterior a la ostectomía del peroné en los pacientes operados de genus varos. Materiales y métodos: se realiza un estudio descriptivo, prospectivo y lineal en el Hospital Militar Dr. Mario Muñoz Monroy de Matanzas desde abril del 2016 -2017 donde se aplica la técnica de ostectomía del peroné, del Dr. Zhang Ying-Ze, se presentan los primeros 51 pacientes operados, un total de 57 rodillas, a los cuales se les realizó radiografía previa a la operación y posterior a ella al cabo de los 6 meses, donde se midió la altura del espacio articular externo. Resultados: el promedio de edad es de 67,2 años (50 años el menor y 84 años el mayor), de los cuales 23 eran hombres y 28 mujeres, previo al tratamiento quirúrgico el promedio de este espacio fue de 8,84 mm±1,01 mm (18 mm el mayor y el menor 2 mm) y al cabo de los 6 meses fue de 6,08 mm±0,9 mm(el mayor 10 mm y el menor 2 mm), en 6 pacientes no hubo variación de esta medida. Conclusiones: con la ostectomía proximal del peroné se logra disminuir el espacio articular externo modificando el eje mecánico y anatómico del miembro inferior, lo que se traduce por una disminución de la compresión interna articular (AU).
ABSTRACT Background: the radiographic study of the knee is very important in the painful genu varum diagnosis and treatment: structural changes appearing in the knee joint surfaces may be observed. Objective: to show the changes taking place after fibular ostectomy in the patients surgically treated of genu varum from the radiological point of view. Material and methods: a lineal, prospective, descriptive study was carried out in the Military Hospital "Dr. Mario Muñoz Monroy" of Matanzas from April 2016 to April 2017, in 51 patients operated on applying Dr Zhang Ying-Ze's fibular ostectomy technique: a total of 57 knees. X-rays were taken before the surgery and six months after it, measuring the height of the external intra joint space. Results: the average age was 67.2 years (50 years the youngest and 84 the eldest patients); 23 were men and 28 women. Before the surgical treatment the average space was 8.84 mm±1.01 mm (18 mm the biggest and 2 mm the smallest); six months after surgery, it was 6.08 mm±0.9 mm (10 mm the biggest and 2 mm the smallest); six patients did not showed changes of the space. Conclusions: with the proximal fibular ostectomy we achieved the reduction of the external fibular space, modifying the anatomical and mechanical axis of the lower limb, what leads to a reduction of the internal joint compression (AU).
Asunto(s)
Humanos , Masculino , Femenino , Genu Varum/cirugía , Peroné/cirugía , Osteotomía/rehabilitación , Radiografía/métodos , Rodilla/anomalías , Rodilla/cirugíaRESUMEN
A common technique for fixation of rotational fibular fractures is to use an interfragmentary compression screw with a laterally positioned neutralization plate. The objective of the present investigation was to examine the anatomic feasibility of distal fibula bicortical fixation within this plating technique. A specific screw insertion technique was performed through a laterally positioned one-third tubular plate on a consecutive series of 81 intact cadaveric ankle mortises. The most distal plate hole was drilled, aimed 10° posterior to the midline of the fibula. The second-most distal plate hole was drilled, aimed 25° superiorly. The specimens were then dissected, and the screw termini were physically examined for whether they had penetrated the articular cartilage of the ankle mortise. The length of the most distal bicortical screw measured a mean ± standard deviation of 20.44 ± 2.49 (range 14 to 26) mm, with an extra-articular terminus in 95.06% of specimens. The length of the second-most distal bicortical screw measured a mean ± standard deviation of 19.68 ± 3.02 (range 12 to 28) mm, with an extra-articular terminus in 100% of the specimens. The results of the present study provide evidence that bicortical distal fibular fixation in accordance with basic fixation principles is anatomically possible and feasible with a one-third tubular plate. This could potentially obviate the need for more expensive fixation options (i.e., locked plates or anatomically contoured plates) and fixation options that are biomechanically stable but potentially anatomically impeding (i.e., posterior antiglide plating).