RESUMEN

Congenital pseudarthrosis of the forearm poses a considerable challenge because of its rarity. The objective of this report is to introduce a novel surgical technique for its treatment. Here, we document a case of congenital pseudarthrosis of the radius in a 3-year-old boy diagnosed with type-1 neurofibromatosis. The surgical treatment involved the excision of approximately 9 cm of native radial periosteum and a bifocal radius osteotomy, which was supplemented with a vascularized tibial periosteal transplant to facilitate bone healing. Anastomosis between the anterior tibial vessels and radial vessels was performed. No immediate or late postoperative complications were observed. After 3 weeks, a robust callus formation was observed, and during a follow-up examination 3 years and 4 months later, a wide range of active forearm rotation was noted. This report suggests that vascularized periosteal flaps show promise as a viable treatment option for congenital pseudarthrosis of the forearm. They offer an alternative to vascularized fibular grafts or single-bone forearm constructs.

Asunto(s)

Periostio , Seudoartrosis , Tibia , Humanos , Seudoartrosis/congénito , Seudoartrosis/cirugía , Masculino , Preescolar , Periostio/trasplante , Tibia/cirugía , Neurofibromatosis 1/complicaciones , Neurofibromatosis 1/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/trasplante , Osteotomía/métodos , Radio (Anatomía)/trasplante , Radio (Anatomía)/cirugía , Radio (Anatomía)/anomalías , Trasplante Óseo/métodos

RESUMEN

Nonunion remains one of the main complications of scaphoid fractures, with no consensus being reached as to the best surgical technique for scaphoid pseudoarthrosis. Thus, different types of procedures for bone stability and biological stimulus for consolidation have been described. The use of arthroscopy for scaphoid pseudoarthrosis has advantages as it allows for treating associated injuries, preserving wrist proprioception by minimizing damage to the joint capsule and ligaments and not deteriorating the already fragile scaphoid vasculature, leading to a quick recovery. Arthroscopy was initially indicated for stable scaphoid pseudoarthroses, being used in all patterns of this condition, including unstable ones and those with flexion collapse. However, most scientific articles describe the use of arthroscopy only through the dorsal portals, creating technical difficulty in complete debridement of the site of pseudarthrosis and in placing bone graft. This study describes the 360-degree technique, which standardizes arthroscopy in scaphoid pseudoarthrosis treatment, allowing, with the use of dorsal, volar, and radial portals, direct approach to the entire circumference of the nonunion site, facilitating the debridement of the injury site, the correction of the scaphoid deformity, and the placement of a graft directly on the site of the defect, mainly in its volar region after correction of the flexion deformity. The 360-degree technique aims to help and standardize the arthroscopic procedure for scaphoid pseudarthrosis, creating a routine with defined surgery stages. Additional portals allow complete access to the entire nonunion site and better positioning of the bone graft under direct view.

Asunto(s)

Fracturas Óseas , Fracturas no Consolidadas , Seudoartrosis , Hueso Escafoides , Humanos , Seudoartrosis/cirugía , Seudoartrosis/complicaciones , Hueso Escafoides/cirugía , Hueso Escafoides/lesiones , Radio (Anatomía)/trasplante , Articulación de la Muñeca , Fracturas no Consolidadas/cirugía , Trasplante Óseo/métodos , Fijación Interna de Fracturas/métodos

RESUMEN

OBJECTIVES: To analyze the clinical and radiological outcomes of a series of patients treated with a pedicled vascularized bone graft (VBG) of the distal radius for the treatment of recalcitrant atrophic nonunions of the distal humerus. DESIGN: Retrospective clinical study. SETTING: University-affiliated teaching hospital. PATIENTS: Fifteen patients with supracondylar humeral atrophic nonunions with at least 3 previous failed surgical interventions were included. INTERVENTION: Debridement of the distal humerus nonunion through a posterior elbow approach with provisional fixation was performed. Then, a pedicled VBG was harvested from the distal radius and tunneled back into the humeral bone defect. Iliac crest was used as needed, both for the nonunion and to stabilize the radius. Finally, definitive fixation with 2 locked plates was performed. MAIN OUTCOME MEASUREMENTS: Radiological results, complications, elbow range of motion, Mayo elbow performance score, and subjective pain were evaluated. RESULTS: There were 4 male and 11 female patients, with a mean age of 51 (range, 28-73) years. The mean follow-up period was 46 (range, 37-72) months with a minimum of 3 years. Radiological consolidation was achieved in all patients. Elbow range of motion was >100 degrees in 11 patients and between 50 and 100 degrees in 4 patients. Preoperative Mayo scores were poor in all patients. At final follow-up, Mayo scores were excellent in 3, good in 9, and fair in 3 patients. The mean postoperative visual analog scale score was 1.2 (range 0-3). CONCLUSIONS: Pedicled VBG of the distal radius was shown to be a reliable and effective alternative for the treatment of recalcitrant atrophic nonunions of the distal humerus, when other methods have failed. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Asunto(s)

Trasplante Óseo/métodos , Fijación Interna de Fracturas/efectos adversos , Fracturas no Consolidadas/cirugía , Fracturas del Húmero/cirugía , Radio (Anatomía)/trasplante , Adulto , Anciano , Placas Óseas , Estudios de Cohortes , Femenino , Fijación Interna de Fracturas/métodos , Curación de Fractura/fisiología , Fracturas no Consolidadas/diagnóstico por imagen , Fracturas no Consolidadas/etiología , Hospitales de Enseñanza , Humanos , Fracturas del Húmero/diagnóstico por imagen , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Pronóstico , Radio (Anatomía)/irrigación sanguínea , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Resultado del Tratamiento , Lesiones de Codo

RESUMEN

BACKGROUND: Carpometacarpal joints can be affected by traumatic or degenerative pathology. Although different techniques have been described to treat these conditions, most authors agree that arthrodesis is an effective treatment modality. Vascularized bone grafts of the distal radius have been used to treat carpal conditions, such as scaphoid nonunion or Kiënbock disease, and they have been shown to have several advantages over nonvascularized bone grafts. METHODS: We report a case of a carpal boss in a female patient treated with an arthrodesis of the second and third carpometacarpal joints by using the fourth extensor compartment artery vascularized bone graft. RESULTS: At 6 weeks postoperative bone union was achieved. At 2 years follow-up the patient was able to perform daily life activities without pain. CONCLUSIONS: The fourth ECA VBG with reverse blood flow from the dorsal intercarpal arch allowed the graft to reach the CMC. A solid fusion was obtained at 6 weeks due to the biological advantage of the VBG.

Asunto(s)

Artrodesis/métodos , Articulaciones Carpometacarpianas/cirugía , Radio (Anatomía)/irrigación sanguínea , Radio (Anatomía)/trasplante , Esclerosis/cirugía , Artralgia/fisiopatología , Artralgia/cirugía , Articulaciones Carpometacarpianas/patología , Articulaciones Carpometacarpianas/fisiopatología , Femenino , Humanos , Persona de Mediana Edad , Osteoartritis/fisiopatología , Osteoartritis/cirugía , Esclerosis/fisiopatología , Articulación de la Muñeca/fisiopatología , Articulación de la Muñeca/cirugía

RESUMEN

Cortical bone grafting is commonly required in the finger, hand, and carpus when managing bony trauma. A donor site that can provide a small or large amount of cortical bone graft that is easily accessible and within the same surgical field would be the ideal donor site. In high-energy injuries, a long cortical graft may be needed to reconstruct massive bony defects. In low-energy injuries such as scaphoid nonunions in which a wedge graft is needed, a reliable and easily accessible source of bone grafting would be beneficial. Although the traditional iliac bone grafting can be used, this option requires a separate sterile field to be prepared and may lead to donor site pain and morbidity. We propose an option that places the donor source close to the hand and wrist. The radial aspect of the distal radius metaphysis/diaphysis is superficial, which makes access and closure simpler than other alternatives. Furthermore, the technique only partly violates 1 of the 3 surfaces of the radius so that there is minimal weakening of the integrity of the bone and the likelihood of fracture is low. In this article, we describe the indications, contraindications, surgical technique, and postoperative management of the radial aspect of the distal radius metaphysis/diaphysis as a source of bone grafting.

Asunto(s)

Trasplante Óseo , Hueso Cortical/trasplante , Diáfisis/trasplante , Radio (Anatomía)/anatomía & histología , Radio (Anatomía)/trasplante , Sitio Donante de Trasplante , Humanos

RESUMEN

OBJECTIVES: To compare the radiographic and functional outcomes of 2 surgical techniques for treating scaphoid nonunion. DESIGN: Randomized prospective study. PATIENTS/PARTICIPANTS: Researchers assessed the outcomes every 2 weeks until bone healing and at discharge. INTERVENTIONS: (1) Vascularized bone grafting (VBG) using the 1, 2 intercompartmental suprareticular artery and (2) a distal radius nonvascularized bone graft. MAIN OUTCOMES/INTERVENTIONS: Time to union (primary), union rate, and functional outcomes. RESULTS: Seventy-five patients were followed for 29 months; 2 were lost to final follow-up. Both groups had similar baseline characteristics. The VBG group reached bone union earlier by 12 days (P = 0.002), but union rates were similar (P = 0.312). There was also less ulnar deviation in the VBG group (P = 0.03). There were no other differences between either intervention groups. CONCLUSIONS: Although the VBG group attained earlier union, this may not be clinically meaningful, nor justify the greater technical difficulty and use of resources associated with this intervention. LEVEL OF EVIDENCE: Therapeutic Level II. See instructions for authors for a complete description of levels of evidence.

Asunto(s)

Fracturas no Consolidadas/cirugía , Hueso Escafoides/cirugía , Trasplante Óseo , Fracturas no Consolidadas/diagnóstico por imagen , Humanos , Radiografía , Radio (Anatomía)/irrigación sanguínea , Radio (Anatomía)/trasplante , Recuperación de la Función , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/lesiones , Resultado del Tratamiento

RESUMEN

INTRODUCTION: The giant cell tumor represents 5% of all the primary bone tumors and 20% of the benign bone neoplasias. The most common locations are the distal femur and the proximal tibia (50%) as well as the distal radius (10%). Treatment methods include the intralesional resection of the latent and active tumors, and broad resection for the aggressive lesions. The wrist reconstruction after broad resection of the distal radius represents a challenge for the orthopedic surgeon. OBJECTIVE: To present 2 clinical cases of patients diagnosed with giant cell tumor of the distal radius who were treated with broad resection and placement of a massive allograft with wrist arthrodesis. To perform a bibliographic review and the analysis of the different treatment methods described. MATERIAL AND METHODS: Description of the treatment and course of each case, as well as a bibliographic review and the analysis of the treatments found. RESULTS: Radiologic data of the allograft integration at 11 months and a functionality which was compatible with all the activities of daily living. DISCUSSION: The massive allograft of the distal radius with wrist arthrodesis represents a very safe and appropriate option for the reconstruction of this anatomic segment after broad resection.

Asunto(s)

Artrodesis , Neoplasias Óseas/cirugía , Tumor Óseo de Células Gigantes/cirugía , Radio (Anatomía)/trasplante , Adulto , Femenino , Humanos , Persona de Mediana Edad

RESUMEN

We conducted a prospective randomised study comparing the clinical, functional and radiographic results of 46 patients treated for scaphoid nonunion using a vascularised bone graft from the dorsal and distal aspect of the radius (group I), relative to 40 patients treated by means of a conventional non-vascularised bone graft from the distal radius (group II). Surgical findings included 30 sclerotic, poorly-vascularised scaphoids in group I versus 20 in group II. Bone fusion was achieved in 89.1% of group I and 72.5% of group II patients (p=0.024). Functional results were good to excellent in 72.0% of the patients in group I and 57.5% in group II. Considering only patients with sclerotic, poorly-vascularised scaphoids, the mean final outcome scores obtained were 7.5 and 6.0 for groups I and group II, respectively. We conclude that vascularised bone grafting yields superior results and is more efficient when there is a sclerotic, poorly-vascularised proximal pole in patients in scaphoid nonunion.

Asunto(s)

Trasplante Óseo/métodos , Fracturas no Consolidadas/cirugía , Hueso Escafoides/cirugía , Traumatismos de la Muñeca/cirugía , Actividades Cotidianas , Curación de Fractura , Fracturas no Consolidadas/fisiopatología , Fuerza de la Mano/fisiología , Humanos , Satisfacción del Paciente , Prótesis e Implantes , Radio (Anatomía)/irrigación sanguínea , Radio (Anatomía)/cirugía , Radio (Anatomía)/trasplante , Rango del Movimiento Articular , Recuperación de la Función , Hueso Escafoides/lesiones , Hueso Escafoides/patología , Resultado del Tratamiento , Traumatismos de la Muñeca/patología , Traumatismos de la Muñeca/fisiopatología

RESUMEN

We compared two surgical techniques for the treatment of scaphoid non-union, namely, using distal radius vascularised bone graft and iliac crest non-vascularised bone graft. Eighty patients with symptomatic scaphoid non-union underwent surgical treatment, including 35 patients treated with distal radius vascularised bone graft and 45 treated by iliac crest non-vascularised bone graft. Patients were assessed objectively by examination of wrist range of motion, grip strength and radiographic findings in the postoperative period after a mean time of 2.8 (1.4) (range 1-5.2) years. Similar functional results were obtained with the two techniques. All cases of non-union in the non-vascularised group obtained consolidation in a mean time of 8.89 (2.26) months and in the vascularised group in a mean time of 7.97 (3.06) months. Three cases of consolidation failure occurred in the vascularised group and were related to technical difficulties.

Asunto(s)

Trasplante Óseo/métodos , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Fracturas no Consolidadas/cirugía , Hueso Escafoides/irrigación sanguínea , Hueso Escafoides/lesiones , Adolescente , Adulto , Estudios de Cohortes , Curación de Fractura , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/fisiopatología , Fracturas no Consolidadas/diagnóstico por imagen , Fracturas no Consolidadas/fisiopatología , Humanos , Ilion/trasplante , Masculino , Persona de Mediana Edad , Radiografía , Radio (Anatomía)/trasplante , Recuperación de la Función , Resultado del Tratamiento , Adulto Joven

RESUMEN

The use of pedicled vascularised bone grafts from the distal radius makes it possible to transfer bone with a preserved circulation and viable osteoclasts and osteoblasts. Experiments performed at the basic science level has provided substantial evidence that low-intensity ultrasound can accelerate and augment the fracture healing process. Only an adequate double-blind trial comparing treatment by ultrasound stimulation in patients treated by similar surgical techniques can provide evidence of the true effect of ultrasound. This paper describes the results of such a trial. From 1999 to 2004, 21 fractures of the scaphoid with established non-union treated with vascularised pedicle bone graft were selected for inclusion in a double-blind trial. All patients were males, with an average age of 26.7 years (range 17-42 years) and an average interval between injury and surgery of 38.4 months (range 3 months-10 years). Low-intensity ultrasound was delivered using a TheraMed 101-B bone-growth stimulator (30 mW/cm2, 20 min/day), which was modified to accomplish double-blinding. These modifications did not affect the designated active units. The placebo units were adjusted to give no ultrasound signal output across the transducer. Externally, all units appeared identical but were marked with individual code numbers. Patients were randomly allocated to either an active or placebo stimulation. Follow-up averaged 2.3 years (range 1-4 years). All patients achieved fracture union (active and placebo groups), but compared with the placebo device (11 patients), the active device (ten patients) accelerated healing by 38 days (56+/-3.2 days compared with 94+/-4.8 days, p<0.0001, analysis of variance).

Asunto(s)

Curación de Fractura/fisiología , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/terapia , Radio (Anatomía)/trasplante , Hueso Escafoides/lesiones , Hueso Escafoides/cirugía , Terapia por Ultrasonido , Adolescente , Adulto , Análisis de Varianza , Método Doble Ciego , Fracturas no Consolidadas/diagnóstico por imagen , Humanos , Masculino , Radiografía , Radio (Anatomía)/irrigación sanguínea , Hueso Escafoides/diagnóstico por imagen

RESUMEN

O autor realizou estudo prospectivo em 34 pacientes portadores de pseudartrose de escafóide, tratados cirurgicamente pela técnica descrita por MATHOULIN & HAERLE (1998), com um tempo médio de seguimento de oito meses. A amostra foi composta por seis pseudartroses do terço proximal, 24 do terço médio e quatro do terço distal. As cirurgias foram realizadas por via de acesso ventral e o enxerto ósseo vascularizado obtido da epífise ventral do rádio distal, com pedículo baseado no ramo radial do arco palmar do carpo. A estabilizaçao do escafóide foi realizada por fio de Kirschner ou parafuso de 2,0 mm de diâmetro ou pela associaçao de ambos. No pós-operatório, todos os pacientes foram submetidos à imobilizaçao com tala gessada axilo-palmar, até que se constatasse a consolidaçao, obtida em 88 por cento dos casos, em um tempo médio de 45 dias. A melhora da dor foi alcançada em 30 pacientes, nao tendo sido observada melhora significante na força de preensao palmar e amplitude de movimento articular. Do total, 85 por cento dos pacientes puderam retornar ao trabalho prévio, em um tempo médio de 17 semanas. Analisados os dados, houve 71 por cento de resultados satisfatórios

Asunto(s)

Arterias , Trasplante Óseo , Seudoartrosis , Radio (Anatomía)/trasplante , Hueso Escafoides

RESUMEN

Os autores apresentam técnica inédita de obtençao de enxerto ósseo esponjoso, retirado do terço distal do rádio, a partir do tubérculo de Lister, e de grande utilidade nas cirurgias de mao e punho, devido à proximidade da área em que se está atuando. Foram realizados inicialmente estudos experimentais em seis punhos de seis cadáveres frescos para demonstraçao da técnica e mensuraçao da quantidade de enxerto obtida. Posteriormente, foi feita sua aplicaçao clínica em 20 pacientes com indicaçoes cirúrgicas variadas. Demonstram a facilidade da técnica, a boa quantidade de enxerto obtida e a baixa morbidade do local doador, com ausência de complicaçoes em sua casuística.

Asunto(s)

Humanos , Radio (Anatomía)/trasplante , Trasplante Óseo/métodos , Cadáver , Monoaminooxidasa/cirugía , Radio (Anatomía)/anatomía & histología , Muñeca/cirugía

RESUMEN

Este trabalho teve por objetivo comparar o desempenho do enxerto homólogo descalcificado simples (DS) e o enxerto homólogo descalcificado retardado (DR). Coelhos doadores foram sacrificados e deles obtidos segmentos diafisários do rádio de 2,5 cm de comprimento, que foram descalcificados. Em seguida, foram implantados no interior do músculo reto abdominal direito de coelhos receptores. Após quatro semanas, estes mesmos animais foram reoperados e produzida uma falha óssea de 2,0 cm de comprimento nas diáfises dos dois rádios. A falha do lado direito foi preenchida com o enxerto retirado do músculo abdominal do próprio animal (DR) e, do lado esquerdo, foi implantado o enxerto descalcificado simples (DS). O outro implante colhido do músculo foi destinado à histologia. Foram feitas radiografias dos antebraços nos tempos subsequüentes. Os animais foram injetados com tetraciclina após a primeira cirurgia e com alaranjado de xilenol e tetraciclina após a segunda cirurgia, com o objetivo de marcar o osso neoformado. Em um grupo controle foi criada a falha óssea que foi deixada sem preenchimento e, em outro grupo, a falha foi preenchida por esponja de gelatina. Nos grupos controles näo houve preenchimento ósseo da falha, enquanto que nos grupos tratados a correçäo foi mais rápida e completa com o enxerto DS do que com o enxerto DR

Asunto(s)

Animales , Femenino , Conejos , Radio (Anatomía)/trasplante , Trasplante Óseo/métodos , Técnica de Descalcificación , Fluorescencia , Osteogénesis , Fotomicrografía , Trasplante Homólogo , Trasplante Óseo/patología

RESUMEN

Foi investigado um enxerto alternativo para correçäo de falhas ósseas diafisárias. Cilindros tubulares descalcificados de rádio de coelhos doadores foram implantados durante quatro semanas no músculo reto abdominal de coelhos receptores. Depois disso foram transferidos para uma falha óssea equivalente no rádio destes mesmos animais. O processo de reparaçäo foi seguido durnte oito semanas por radiografia, histológica e fluorescência óssea. Quando comparada com os controles (falha vazia e preenchimento com gelfoam), a falha óssea preenchida pelo enxerto descalcificado foi mais rápida e intensamente preenchida por osso neoformado

Asunto(s)

Conejos , Animales , Huesos/trasplante , Matriz Ósea/patología , Osteogénesis , Radio (Anatomía)/trasplante , Trasplante Homólogo