RESUMO
Introduction: Developmental dysplasia of the hip (DDH) is the cause of 2.6-9.1% of all total hip prostheses implanted at any age and constitutes a challenge in revision surgeries. Objective: To present a case of severe acetabular dysplasia managed by the Stoppa-type approach. The Case: We report a case of a 26-year-old male patient with DDH initially treated with total hip replacement and then diagnosed with aseptic loosening (Paprosky 3A). Using a modified Stoppa approach; acetabular augmentation and bone autograft attached with endopelvic reconstruction plates were performed. Two years after the procedure our patient is asymptomatic, has no restrictions on his daily living activities, and is very satisfied with the result. Conclusions: The Stoppa approach was very useful for the endopelvic reconstruction of the acetabular roof, so it may be an option to treat severe acetabular defects. Level of evidence: IV.
Introducción: La displasia del desarrollo de cadera (DDH, por sus siglas en inglés) es la causa del 2,6-9,1 % del total de prótesis de cadera implantadas a cualquier edad y constituye un reto en las cirugías de revisión. Objetivo: Presentar un caso de displasia acetabular grave manejado por abordaje tipo Stoppa. El caso: Presentamos un caso de un paciente masculino de 26 años con DDH tratado inicialmente con reemplazo total de cadera y luego diagnosticado con aflojamiento aséptico (Paprosky 3A). Se utilizó un enfoque Stoppa modificado. Se realizó aumento acetabular y autoinjerto óseo unido con placas de reconstrucción endopélvica. Dos años después del procedimiento, el paciente es asintomático, no tiene restricciones en sus actividades de la vida diaria y está muy satisfecho con el resultado. Conclusiones: El abordaje de Stoppa fue muy útil para la reconstrucción endopélvica del techo acetabular, por lo que puede ser una opción para tratar defectos acetabulares graves. Grado de comprobación: IV.
RESUMO
Ð clinical case of non-union in a cat after open fracture repair by intramedullary ostheosynthesis of the radius was described. The patient was presented with non-weight bearing lameness, fistulas with purulent discharge, swelling and severe pain. During the surgical revision, after bone sequestrum removal, the bone defect was filled with cancellous and cortical bone autografts. Osteosynthesis with a modified external bone fixator, made of Duracryl® Plus - a rapidly self-curing metacrylate polymer - and 6 Kirschner wires passing perpendicularly through both radial cortices was performed. The post-operative period was smooth, and after 23 weeks the external fixator was removed. Radiography showed very good bone healing, with excellent clinical result. The use of the ulna as a donor bone was very convenient because it allowed collecting a cortical graft of larger size. The extremely light model of external bone fixator provided adequate strength of fixation elements and proved to be an efficient and not expensive technique for osteosynthesis in cat with non-union fractures of the distal radius and ulna.
Um caso clínico de correção de uma não união de uma fratura exposta em um gato após por osteossíntese intramedular do rádio foi descrito. O paciente apresentou claudicação, fístulas com secreção purulenta, edema e dor intensa. Durante a revisão cirúrgica, após a remoção do sequestro ósseo, o defeito ósseo foi preenchido com autoenxertos de osso esponjoso e cortical. Foi realizada osteossíntese com fixador ósseo externo modificado, confeccionado em Duracryl® Plus polímero metacrilato de rápida autopolimerização e 6 fios de Kirschner passando perpendicularmente por ambas as corticais radiais. O pós-operatório foi tranquilo e após 23 semanas o fixador externo foi removido. A radiografia mostrou boa consolidação óssea, com excelente resultado clínico. A utilização da ulna como osso doador foi muito conveniente, pois permitiu a coleta de um enxerto cortical de maior tamanho. O modelo extremamente leve de fixador ósseo externo proporcionou resistência adequada dos elementos de fixação e mostrou-se uma técnica eficiente e de baixo custo para osteossíntese em gatos com fraturas não consolidadas do rádio distal e ulna.
RESUMO
PURPOSE: To compare the bone fusion of freeze-dried allograft alone versus freeze-dried allograft combined autograft in spinal instrumentation due to spondylodiscitis. METHODS: A randomized prospective trial of patients with spondylodiscitis treated with surgical debridement and spinal fixation with freeze-dried bone allograft and autograft (Group 1) or freeze-dried bone allograft alone (Group 2) was performed. Patient follow-up was assessed with a CT-scan for bone fusion; consecutive serum inflammatory marker detection (C-reactive protein, [CRP], and erythrocyte sedimentation rate, [ESR]) and clinical assessment (pain, functional disability, and spinal cord injury recovery) were other outcome parameters. The primary outcome was the grade of bone allograft integration with the scale of Tan (which ranges from 1 to 4, with lower scores indicating a better fusion rate) at 1 year after surgery. RESULTS: A total of 20 patients were evaluated, 13 (65%) men and 7 (35%) women with a mean age of 47.2 (±14.3) years. Homogeneous distribution of demographic data was observed. A similar satisfactory bone graft fusion grade was observed in both graft groups at 1 year after surgery (p = 1.0000). Serum inflammatory markers gradually decreased in both groups after surgical intervention (CRP, p < 0.001; ESR, p < 0.01). At one-year follow-up, gradual improvement of pain, functional disability, and neurological spinal injury recovery in both graft groups were achieved. CONCLUSION: Freeze-dried allograft alone could be a therapeutic option for spinal fixation surgery due to spondylodiscitis since it achieves a satisfactory graft fusion rate and clinical improvement. LEVEL OF EVIDENCE: Level 1. Treatment. REGISTER: NCT03265561.
Assuntos
Discite , Fusão Vertebral , Adulto , Aloenxertos , Autoenxertos , Discite/diagnóstico por imagem , Discite/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVES: To present some immunological aspects of fresh-frozen allogeneic bone grafting for lateral bone augmentation, based on the quantitative evaluation of IL-10, IL-1ß, IFN- γ and TNF- α in patients sera. MATERIAL AND METHODS: Thirty-three partially or totally edentulous patients received fresh-frozen allogeneic bone (AL - 20 patients) or autologous bone onlay block grafts (AT - 13 patients) prior to oral implant placement. Blood samples were collected from each patient at various time-points during a 6 month-period (baseline, 14, 30, 90 and 180 days postoperatively). Quantitative evaluation of IL-10, IL-1ß, IFN- γ and TNF- α was performed by enzyme linked immunosorbent assay (ELISA). RESULTS: For all evaluated markers and at all evaluated periods, inter-group comparisons showed no statistically significant differences between the groups, while the observed values were within normal levels. For AL-treated patients, intra-group evaluation showed statistically significant increase of TNF-α from baseline to 90 (P < 0.001) and 180 (P < 0.01) days, and from 14 to 90 (P < 0.01) and 180 (P < 0.05) days. IFN- γ showed intercalated results, with a decrease from baseline to 14 days (P < 0.05), and increase from 14 to 90 days (P < 0.001) and 180 (P < 0.05) days. No differences between the periods of evaluation were found for the AT group. CONCLUSIONS: AL grafting for lateral bone augmentation, similar to AT grafting, does not seem to challenge the immune system significantly.