RESUMO
INTRODUCTION: Controversy exists regarding the use of reamed interlocking nailing in femoral shafts with extremely narrow medullary canals (diameter ≤ 9â¯mm). The aims of this study were to (1) investigate the association of age and sex on femoral canal diameter in patients with a simple femoral shaft fracture and (2) compare the outcomes and complications of interlocking nailing between wide and extremely narrow intramedullary canals. PATIENTS AND METHODS: For the purposes of this retrospective cohort study, consecutive patients with simple femoral shaft fractures were recruited between January 2009 and December 2016. The patient demographic data were analyzed. Then, fractures treated with interlocking nailing were divided into the wide group (canal diameter > 9â¯mm) and narrow group. The primary outcome was union rate, and the secondary outcomes were complications such as thermal necrosis, fat embolism syndrome, iatrogenic fracture, and implant failure. RESULTS: This study included 340 femoral shaft fractures. The average canal diameter was 9.97⯱â¯1.79â¯mm, with significantly wider canals in men than in women. Overall, 289 of the patients had undergone interlocking nail fixation, and a similar union rate and complications were noted between the wide canal and narrow canal groups, with the exception of the incidence of iatrogenic fracture. CONCLUSIONS: Femoral shaft fractures associated with extremely narrow medullary canals are more common in women than in men. There was a similar union rate found when using interlocking nailing in a femoral shaft fracture in cases with extremely narrow and wider canals. Iatrogenic fracture is the only significant risk when using interlocking nailing in femoral shafts with extremely narrow canals.
Assuntos
Pinos Ortopédicos/efeitos adversos , Fraturas do Fêmur , Fêmur , Fixação Intramedular de Fraturas , Complicações Intraoperatórias , Complicações Pós-Operatórias/epidemiologia , Adulto , Diáfises/diagnóstico por imagem , Diáfises/cirurgia , Feminino , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/patologia , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Tamanho do Órgão , Estudos Retrospectivos , Risco Ajustado/métodos , Fatores Sexuais , Taiwan/epidemiologiaRESUMO
Introducción: La diáfisis del antebrazo es el sitio más frecuente de refracturas en niños. Estas lesiones suelen ocurrir en el tercio medio o proximal antes del año de la fractura inicial. Hay poca información sobre el tratamiento de este tipo de lesiones. El objetivo de este estudio fue evaluar los resultados y las complicaciones en pacientes con refracturas de antebrazo que requirieron fijación interna con clavos elásticos endomedulares. Materiales y Métodos: Se registró la siguiente información: datos demográficos, mecanismo de lesión, clasificación, tiempo desde la consolidación de la fractura original hasta la refractura, tipo de reducción y tiempo de consolidación. Los resultados fueron evaluados según la escala propuesta por Martus y las complicaciones, con una adaptación de la clasificación de Clavien-Dindo. Resultados: Se evaluaron 17 pacientes (14 varones) con 17 refracturas de antebrazo (15 cerradas y 2 expuestas). La edad era de 11 años (RIC 7, mín.-máx. 5-15). La lesión ocurrió a las 12 semanas de la fractura inicial (RIC 4.7, mín.-máx. 4-28). El 47% requirió reducción abierta. El tiempo de consolidación fue de 8 semanas (RIC 4, mín.-máx. 6-28). El seguimiento fue de 43 meses (RIC 47, mín.-máx. 12-103). Fue posible evaluar clínicamente a 16 pacientes (1 pérdida en el seguimiento). El resultado fue excelente en 15 casos y regular en uno. Un paciente tuvo pérdida del rango de movilidad (15º); uno, retraso de la consolidación (cúbito) y 3 sufrieron una segunda refractura. Conclusiones: La fijación interna con clavos elásticos endomedulares fue una técnica eficaz para tratar las refracturas de antebrazo en niños. Si bien un alto porcentaje necesita reducción abierta, el tiempo de consolidación y la tasa de complicaciones serían similares a los de las fracturas primarias tratadas con la misma técnica. Nivel de Evidencia: IV
Introduction: Forearm diaphysis is the most frequent site of re-fractures in children. These lesions usually occur in the middle or proximal third within a year of the initial fracture. There is little information on the treatment of this type of lesions. The aim of this study was to evaluate outcomes and complications in patients with forearm re-fractures requiring internal fixation with elastic stable intramedullary nails. Methods: Demographic data, mechanism of injury, classification, time from consolidation of the original fracture to refracture, type of reduction and time of consolidation were documented. Outcomes were evaluated according to Martus scale, and complications were evaluated with an adaptation of Clavien-Dindo classification. Results: Seventeen patients (14 men) with 17 forearm re-fractures (15 closed and 2 open) were identified. Median age was 11 years (IQR 7, min-max 5-15). Lesion occurred 12 weeks after the initial fracture (RIC 4.7, min-max 4-28). Fortyseven percent required open reduction. Union was achieved at 8 weeks (IQR 4, min-max 6-28). Follow-up was 43 months (IQR 47, min-max 12-103). Sixteen patients were clinically evaluated (1 lost at follow-up). Fifteen patients presented excellent results and one had a fair result. One had 15º loss of motion, one had delayed union (ulna) and three patients had a second re-fracture. Conclusions: In this series, elastic stable intramedullary nails represented an effective technique for the treatment of forearm re-fractures in children. Although many require open reduction, time to union and complication rate seem to be similar to primary fractures treated with the same technique. Level of Evidence: IV
Assuntos
Criança , Adolescente , Pinos Ortopédicos , Diáfises/cirurgia , Diáfises/lesões , Traumatismos do Antebraço/cirurgia , Fixação Intramedular de Fraturas/métodos , Recidiva , Resultado do TratamentoRESUMO
INTRODUCTION: Diaphyseal fractures of the forearm comprise 6%-10% of all fractures in children. The treatment depends on the age and type of displacement, and conservative and surgical management with fixation of intramedullary nails, among other techniques, is valid. The aim is to show the radiological and functional outcomes, and complications of intramedullary fixation with Kirschner nails in children. MATERIALS AND METHODS: A retrospective descriptive case series of patients treated with intramedullary fixation of forearm fractures. The radiological and functional results, and complications are correlated. RESULTS: Of the 117 patients operated, 59 met the inclusion criteria. The average age was 10 years. Eighty-four point seven percent were males and the left side was the most affected (62.7%). In 88.1% both bones were fractured and 11 cases had open fractures. An open reduction was performed in 72.8% of the cases, the main indications for this being instability, failed reduction and refracture. There were 52 excellent outcomes, 2 good, and 4 regular and 1 bad. There were 13.5% minor complications. DISCUSSION: This study shows that intramedullary fixation with Kirschner nails in radius and ulna diaphysis fractures in children is a safe, low-cost procedure and offers adequate short and medium term functional outcomes, with a low prevalence of serious complications with only 6 cases of non-consolidation and refracture. Larger preoperative angulations in the anteroposterior and lateral planes, and lateral postoperative angulations, could be considered predictors of less satisfactory functional results.
Assuntos
Fios Ortopédicos , Fixação Intramedular de Fraturas/métodos , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Adolescente , Criança , Pré-Escolar , Diáfises/diagnóstico por imagem , Diáfises/lesões , Diáfises/cirurgia , Feminino , Seguimentos , Fixação Intramedular de Fraturas/instrumentação , Humanos , Masculino , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Fraturas da Ulna/diagnóstico por imagemRESUMO
A fratura é definida como a interrupção da continuidade óssea, sendo uma afecção bastante comum na clínica de pequenos animais. Suas causas são muito variadas e o diagnóstico é geralmente obtido no exame clínico e pelas radiografias, as quais trazem informações fundamentais em relação ao tipo e complexidade da fratura. De modo geral, para o tratamento da fratura de ossos longos, são indicadas a redução aberta e a fixação interna, podendo-se associá-las com outros métodos secundários quando houver instabilidade. No presente trabalho relata-se o caso de um cão macho, sem raça definida, de cinco meses de idade, atendido em uma clínica veterinária particular do município de Criciúma, SC, com fratura bilateral de diáfise femoral decorrente de um trauma automobilístico. Devido às características desse tipo de fratura, o paciente em questão foi submetido à cirurgia de osteossíntese femoral usando-se pinos intramedulares múltiplos, associados com cerclagem, como método de estabilização. A técnica mostrou-se eficiente para estabilizar a fratura, sem apresentar complicações pós-operatórias no paciente.(AU)
Fractures are interruptions in bone continuity of frequent occurrence in small animal clinics. Causes vary widely and diagnosis is usually obtained during clinical examination and by means of radiography, which provide fundamental information regarding the type and complexity of the fracture. Long bone fractures are generally treated by open reduction and internal fixation; secondary methods may be associated in case of instability. The present study reports the case of a 5-month-old male mongrel dog with bilateral fracture of the femoral diaphysis caused by a car accident. The animal was attended at a private veterinary clinic in the city of Criciúma, SC, where it underwent surgery. Femoral osteosynthesis was obtained by means of multiple intramedullary pins associated with cerclage as a stabilization method, which was needed due to the characteristics of the fracture. The technique proved efficient to stabilize the fracture, without postoperative complications.(AU)
Enfermedad bastante frecuente en pequeños animales, las fracturas se definen como una interrupción en la continuidad ósea. Sus causas son muy variadas y generalmente el diagnostico se obtiene por examen clínico y radiografías, que aportan datos fundamentales en cuanto al tipo y complejidad de la fractura. En términos generales, la indicación para fracturas de huesos largos es la reducción abierta y fijación interna, pudiendo estar asociadas con otros métodos secundarios en casos de inestabilidad. En este trabajo se relata el caso de un perro mestizo de cinco meses que fue atendido en una clínica particular del municipio de Criciúma - estado de Santa Catarina, Brasil - que presentó una fractura bilateral de diáfisis femoral como consecuencia de un accidente automovilístico. Dadas las características de la fractura, la osteosíntesis femoral se realizó con clavos intramedulares múltiples y cerclaje a fin de estabilizar el foco de fractura. La técnica se mostró eficiente, sin complicaciones postoperatorias.(AU)
Assuntos
Animais , Cães , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/veterinária , Fraturas do Fêmur/cirurgia , Fraturas do Fêmur/veterinária , Diáfises/cirurgiaRESUMO
A fratura é definida como a interrupção da continuidade óssea, sendo uma afecção bastante comum na clínica de pequenos animais. Suas causas são muito variadas e o diagnóstico é geralmente obtido no exame clínico e pelas radiografias, as quais trazem informações fundamentais em relação ao tipo e complexidade da fratura. De modo geral, para o tratamento da fratura de ossos longos, são indicadas a redução aberta e a fixação interna, podendo-se associá-las com outros métodos secundários quando houver instabilidade. No presente trabalho relata-se o caso de um cão macho, sem raça definida, de cinco meses de idade, atendido em uma clínica veterinária particular do município de Criciúma, SC, com fratura bilateral de diáfise femoral decorrente de um trauma automobilístico. Devido às características desse tipo de fratura, o paciente em questão foi submetido à cirurgia de osteossíntese femoral usando-se pinos intramedulares múltiplos, associados com cerclagem, como método de estabilização. A técnica mostrou-se eficiente para estabilizar a fratura, sem apresentar complicações pós-operatórias no paciente.
Fractures are interruptions in bone continuity of frequent occurrence in small animal clinics. Causes vary widely and diagnosis is usually obtained during clinical examination and by means of radiography, which provide fundamental information regarding the type and complexity of the fracture. Long bone fractures are generally treated by open reduction and internal fixation; secondary methods may be associated in case of instability. The present study reports the case of a 5-month-old male mongrel dog with bilateral fracture of the femoral diaphysis caused by a car accident. The animal was attended at a private veterinary clinic in the city of Criciúma, SC, where it underwent surgery. Femoral osteosynthesis was obtained by means of multiple intramedullary pins associated with cerclage as a stabilization method, which was needed due to the characteristics of the fracture. The technique proved efficient to stabilize the fracture, without postoperative complications.
Enfermedad bastante frecuente en pequeños animales, las fracturas se definen como una interrupción en la continuidad ósea. Sus causas son muy variadas y generalmente el diagnostico se obtiene por examen clínico y radiografías, que aportan datos fundamentales en cuanto al tipo y complejidad de la fractura. En términos generales, la indicación para fracturas de huesos largos es la reducción abierta y fijación interna, pudiendo estar asociadas con otros métodos secundarios en casos de inestabilidad. En este trabajo se relata el caso de un perro mestizo de cinco meses que fue atendido en una clínica particular del municipio de Criciúma - estado de Santa Catarina, Brasil - que presentó una fractura bilateral de diáfisis femoral como consecuencia de un accidente automovilístico. Dadas las características de la fractura, la osteosíntesis femoral se realizó con clavos intramedulares múltiples y cerclaje a fin de estabilizar el foco de fractura. La técnica se mostró eficiente, sin complicaciones postoperatorias.
Assuntos
Animais , Cães , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/veterinária , Fraturas do Fêmur/cirurgia , Fraturas do Fêmur/veterinária , Proteína Coestimuladora de Linfócitos T Induzíveis , Diáfises/cirurgiaRESUMO
INTRODUCTION: Despite an adequate orthopedic treatment with functional bracing, some patients develop a delayed union in humeral shaft fractures. The objective of the present study was to determine the bone consolidation time among patients with delayed union of diaphyseal humeral fractures who were managed with locking compression plate (LCP) fixation combined with an iliac crest autograft using platelet-rich plasma (PRP) as a co-adjuvant. MATERIALS AND METHODS: This study was a controlled, randomized, experimental, longitudinal, comparative, prospective, blind clinical trial. Patients diagnosed with delayed union of a diaphyseal humeral fracture with at least 4 months of evolution were treated with an open reduction and LCP osteosynthesis combined with an iliac crest autograft. The experimental group also received PRP. The patients were assessed radiographically until 36 weeks of evolution. RESULTS: A total of 16 patients were included. Both groups had similar demographic characteristics. The patients treated with PRP had an earlier beginning of bone consolidation. Furthermore, these same patients exhibited bone consolidation at 19.9 weeks, on average, in contrast to 25.4 weeks in the control group. CONCLUSIONS: The use of PRP promotes earlier bone consolidation in patients with delayed union of the humeral shaft.
Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Ílio/transplante , Plasma Rico em Plaquetas , Transplante Autólogo/métodos , Diáfises/lesões , Diáfises/cirurgia , HumanosRESUMO
OBJECTIVES: To compare outcomes and costs between titanium elastic nails (TENs), stainless steel elastic nails (SENs), and Kirschner wires (K-wires) in the treatment of pediatric diaphyseal forearm fractures with intramedullary fixation. DESIGN: Retrospective cohort study. SETTING: Level 1 Pediatric Trauma Center. PATIENTS/PARTICIPANTS: A total of 100 patients (65 male and 35 female) younger than 18 years with diaphyseal forearm fractures treated with intramedullary fixation were included in the study. INTERVENTION: Patients received single or both bone intramedullary fixation with either TENs, SENs, or K-wires. MAIN OUTCOME MEASUREMENTS: Time to radiographic union, complication rate, surgical time, and average cost per implant. RESULTS: One hundred patients were included in the study. Thirty-one patients were treated with TENs, 30 with SENs, and 39 with K-wires. No significant difference in time to radiographic union, complication rate, or surgical time was found between the 3 types of fixation. Average time to union was 9.4 ± 5.4 weeks, and complication rate was 12.9% for TENs, 10.0% for SENs, and 12.8% for K-wires. There was a significant difference in cost per implant, with an average cost of $639, $172, and $24 for TENs, SENs, and K-wires, respectively (P < 0.001). CONCLUSIONS: This study demonstrates no difference between TENs, SENs, and K-wires in the treatment of pediatric diaphyseal forearm fractures with regards to outcome, time to union, surgical time, or complication rates. Given the significant cost difference between these implants, we recommend that surgeons consider modifying their implant selection to help mitigate cost. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Pinos Ortopédicos , Fios Ortopédicos , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Adolescente , Criança , Estudos de Coortes , Diáfises/lesões , Diáfises/cirurgia , Feminino , Traumatismos do Antebraço/diagnóstico por imagem , Traumatismos do Antebraço/cirurgia , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Fraturas do Rádio/diagnóstico por imagem , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Aço Inoxidável , Titânio , Fraturas da Ulna/diagnóstico por imagemRESUMO
PURPOSE: The aim of our study is to show the functional outcomes and complication rates of humeral complex fractures in adults, using osteosynthesis with two bridging orthogonal submuscular plates. METHODS: The study consists of a prospective case series of 13 patients with isolated humeral complex fractures treated with two bridging orthogonal submuscular plates. Functional assessment was performed using disabilities of the arm, shoulder, and hand (DASH) score with 30 items. The age ranged from 22 to 68 years, with a mean age of 39 years. Functional assessment with DASH score was performed at the twelfth postoperative week. RESULTS: All patients presented fracture healing in the fourth postoperative month. Of the 13 patients, five (38%) had a DASH score of zero (best function possible). One patient developed neuropraxis and presented with a score of 100 (worst possible). One case developed superficial infection, which was treated with oral antibiotics and local debridement. CONCLUSIONS: This study demonstrated satisfactory functional outcome in patients with distal-third diaphyseal humeral complex fractures treated with two locked submuscular plates. The authors consider it as a safe method and an efficient alternative, especially in younger patients who require early functional recovery.
Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Adulto , Idoso , Placas Ósseas , Diáfises/lesões , Diáfises/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura , Humanos , Fraturas do Úmero/fisiopatologia , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
INTRODUCCIÓN: la seudoartrosis de la diáfisis del húmero es una de las complicaciones más desafiantes para los ortopédicos. OBJETIVO: mostrar las alternativas quirúrgicas ante una seudoartrosis de húmero incluida la impactación intramedular. CASO CLÍNICO: paciente de 39 años de edad, femenina, que al año y seis meses de una fractura diafisiaria conminuta del húmero derecho fue operada de una seudoartrosis. CONCLUSIONES: la impactación ósea intramedular en la seudoartrosis de la diáfisis del húmero se convierte en una opción más por su fácil aplicación y sus buenos resultados(AU)
INTRODUCTION: Pseudoarthrosis of the humeral shaft is one of the most challenging complications for orthopedists. OBJECTIVE: Show alternatives to surgical humeral pseudoarthrosis including intramedullary impaction. CASE REPORT: 39-year-old female patient. She underwent pseudoarthrosis surgery after a year and six months fracture of the right humerus in a comminuted shaft. CONCLUSIONS: Intramedullary impaction bone pseudoarthrosis of the humeral shaft becomes a choice for its easy implementation and good results(AU)
Assuntos
Humanos , Feminino , Pseudoartrose/cirurgia , Diáfises/cirurgia , Fixação Intramedular de Fraturas , Fraturas do Úmero/cirurgia , Fraturas do Úmero/terapiaRESUMO
The induced membrane technique was first described by Masquelet in 1986. It was initially used for the reconstruction of long bone shaft defects, particularly of the femur and tibia. The technique consists of two stages. During the first stage a membrane is induced to provide support to the grafts and supply growth factors that contribute to provide a favorable receiving bed for the future graft. During the second stage the poly-methyl-methacrylate spacer is removed and replaced with bone grafts, usually harvested from the iliac crest. Given that this technique has proven good results, it started to be used at other bone sites. We present herein the case of a patient with a large bone defect in the midfoot in whom the Masquelet technique was used with iliac crest grafts. Arthrodesis with a distal radius plate was performed to improve medial column stability, with favorable clinical and functional results.
Assuntos
Cimentos Ósseos/uso terapêutico , Transplante Ósseo/métodos , Traumatismos do Pé/cirurgia , Luxações Articulares/cirurgia , Articulação Metatarsofalângica/lesões , Polimetil Metacrilato/uso terapêutico , Acidentes de Trânsito , Adulto , Antibacterianos/uso terapêutico , Moldes Cirúrgicos , Curetagem , Desbridamento , Diáfises/lesões , Diáfises/cirurgia , Humanos , Ílio/transplante , Imobilização , Masculino , Membranas , Articulação Metatarsofalângica/cirurgia , Polimetil Metacrilato/administração & dosagem , Desenho de Prótese , Retalhos Cirúrgicos , Técnicas de Sutura , Irrigação Terapêutica , Transplante Autólogo/métodos , Vancomicina/uso terapêutico , Infecção dos Ferimentos/complicações , Infecção dos Ferimentos/cirurgiaRESUMO
The most frequent foot and ankle anatomical alterations in the pediatric population are found in the little toes. Several treatments are proposed for these conditions, ranging from total phalangeal resections, phalangeal osteotomies, osteosynthesis, and soft tissue management. We propose a surgical technique based on the diaphysectomy of the proximal phalanx and the release of soft tissues that are under tension. The purpose is to assess the functional foot results after surgical treatment consisting of proximal phalanx diaphysectomy and soft tissue release using the functional AOFAS scale in pediatric patients. A prospective, longitudinal, descriptive, non-comparative clinical study was conducted from March 2008 to December 2010, with a follow-up of up to six months. Twenty patients (35 toes) were included; 15 females and five males, with a mean age of 14.65 years. Fifteen (30 toes) had bilateral involvement; 88.56% had greater involvement of the fifth toe. The surgical indication was determined based on the degree of functional disability for gait and the type of footwear. The functional assessment was conducted using the AOFAS criteria and a subjective assessment scale with a total score of 100 to assess the metatarsophalangeal and the interphalangeal joints of the smallest toes. Scores were as follows: < 50 points, poor; 51-70 points, fair; 71-90, good, and > 91, excellent. The assessment was done preoperatively and at postoperative month six. The mean preoperative score was 73.55 and the mean postoperative score was 85.75, with a 12.2 point difference (p > 0.5). Results were: 11 excellent, seven good and two fair. There were four relapses, so a salvage procedure was performed with the Ruiz-Mora technique; excellent results were obtained in all four. One case had soft tissue infection. Proximal phalanx diaphysectomy and soft tissue release provides appropriate alignment of the affected toes and relief of soft tissues under tension, thus avoiding broad resections leading to both esthetic and functional alterations. This is a simple and effective technique for the treatment of little toe deformities as it improves function and alignment.
Assuntos
Deformidades Congênitas do Pé/cirurgia , Síndrome do Dedo do Pé em Martelo/cirurgia , Procedimentos Ortopédicos/métodos , Falanges dos Dedos do Pé/cirurgia , Adolescente , Anestesia Local , Diáfises/cirurgia , Feminino , Pé/cirurgia , Deformidades Adquiridas do Pé/cirurgia , Humanos , Masculino , Estudos Prospectivos , Recuperação de Função Fisiológica , Reoperação , Índice de Gravidade de Doença , Dedos do Pé/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study was to evaluate the effects of liquid nitrogen cryosurgery on the femoral diaphysis of rats. MATERIAL AND METHODS: The femoral diaphyses of 42 Wistar rats were exposed to three local and sequential applications of liquid nitrogen for 1 or 2 min, intercalated with periods of 5 min of passive thawing. The animals were sacrificed after 1, 2, 4 and 12 weeks and the specimens obtained were processed and analyzed histomorphometrically. RESULTS: The depth and extent of peak bone necrosis were 124.509 µm and 2087.094 µm for the 1-min protocol, respectively, and 436.424 µm and 12046.426 µm for the 2-min protocol. Peak necrosis was observed in the second experimental week with both cryotherapy protocols. CONCLUSIONS: The present results indicate that the 2-min protocol produced more marked bone necrosis than the 1-min protocol. Although our results cannot be entirely extrapolated to clinical practice, they contribute to the understanding of the behavior of bone tissue submitted to different cycles of liquid nitrogen freezing and may serve as a basis for new studies.
Assuntos
Animais , Masculino , Ratos , Criocirurgia/efeitos adversos , Necrose da Cabeça do Fêmur/patologia , Fêmur/cirurgia , Nitrogênio/uso terapêutico , Criocirurgia/métodos , Modelos Animais de Doenças , Diáfises/patologia , Diáfises/cirurgia , Necrose da Cabeça do Fêmur/induzido quimicamente , Fêmur/patologia , Ratos Wistar , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: This study tested the hypothesis that early integration of plateau root form endosseous implants is significantly affected by surgical drilling technique. MATERIALS AND METHODS: Sixty-four implants were bilaterally placed in the diaphysial radius of 8 beagles and remained 2 and 4 weeks in vivo. Half the implants had an alumina-blasted/acid-etched surface and the other half a surface coated with calcium phosphate. Half the implants with the 2 surface types were drilled at 50 rpm without saline irrigation and the other half were drilled at 900 rpm under abundant irrigation. After euthanasia, the implants in bone were nondecalcified and referred for histologic analysis. Bone-to-implant contact, bone area fraction occupancy, and the distance from the tip of the plateau to pristine cortical bone were measured. Statistical analyses were performed by analysis of variance at a 95% level of significance considering implant surface, time in vivo, and drilling speed as independent variables and bone-to-implant contact, bone area fraction occupancy, and distance from the tip of the plateau to pristine cortical bone as dependent variables. RESULTS: The results showed that both techniques led to implant integration and intimate contact between bone and the 2 implant surfaces. A significant increase in bone-to-implant contact and bone area fraction occupancy was observed as time elapsed at 2 and 4 weeks and for the calcium phosphate-coated implant surface compared with the alumina-blasted/acid-etched surface. CONCLUSIONS: Because the surgical drilling technique did not affect the early integration of plateau root form implants, the hypothesis was refuted.
Assuntos
Implantação Dentária Endóssea/métodos , Implantes Dentários , Planejamento de Prótese Dentária , Osseointegração/fisiologia , Osteotomia/métodos , Condicionamento Ácido do Dente/métodos , Ligas , Óxido de Alumínio/química , Animais , Fosfatos de Cálcio/química , Materiais Revestidos Biocompatíveis/química , Ligas Dentárias/química , Corrosão Dentária/métodos , Diáfises/patologia , Diáfises/cirurgia , Cães , Masculino , Osteogênese/fisiologia , Gases em Plasma/química , Rádio (Anatomia)/patologia , Rádio (Anatomia)/cirurgia , Cloreto de Sódio , Propriedades de Superfície , Irrigação Terapêutica , Fatores de Tempo , Titânio/química , Cicatrização/fisiologiaRESUMO
OBJECTIVE: The aim of this study was to evaluate the effects of liquid nitrogen cryosurgery on the femoral diaphysis of rats. MATERIAL AND METHODS: The femoral diaphyses of 42 Wistar rats were exposed to three local and sequential applications of liquid nitrogen for 1 or 2 min, intercalated with periods of 5 min of passive thawing. The animals were sacrificed after 1, 2, 4 and 12 weeks and the specimens obtained were processed and analyzed histomorphometrically. RESULTS: The depth and extent of peak bone necrosis were 124.509 µm and 2087.094 µm for the 1-min protocol, respectively, and 436.424 µm and 12046.426 µm for the 2-min protocol. Peak necrosis was observed in the second experimental week with both cryotherapy protocols. CONCLUSIONS: The present results indicate that the 2-min protocol produced more marked bone necrosis than the 1-min protocol. Although our results cannot be entirely extrapolated to clinical practice, they contribute to the understanding of the behavior of bone tissue submitted to different cycles of liquid nitrogen freezing and may serve as a basis for new studies.
Assuntos
Criocirurgia/efeitos adversos , Necrose da Cabeça do Fêmur/patologia , Fêmur/cirurgia , Nitrogênio/uso terapêutico , Animais , Criocirurgia/métodos , Diáfises/patologia , Diáfises/cirurgia , Modelos Animais de Doenças , Fêmur/patologia , Necrose da Cabeça do Fêmur/induzido quimicamente , Masculino , Ratos , Ratos Wistar , Fatores de Tempo , Resultado do TratamentoRESUMO
El objetivo del trabajo es evaluar los resultados clínicos, funcionales y radiográficos en el tratamiento con cirugía mínimamente invasiva (MIPO) para las fracturas de la diáfisis humeral, el trabajo fue diseñado bajo la modalidad de serie clínica, del tipo prospectivo, realizado en el Hospital Coromoto durante diciembre del 2007 a enero del 2009, con una población de 11 fracturas de la diáfisis humeral, a los cuales se les realizó técnica MIPO con placas LCP de 4,5 fijada en la anterior de la diáfisis humeral, los resultados se manejaron de acuerdo a las escuelas de valoración de la UCLA para el hombro y de la Clínica de Mayo para el codo (MEPS), obteniendo 82 por ciento de excelentes y 18 por ciento de buenos resultados según la escala de la UCLA, y 73 por ciento de excelentes y 27 por ciento de buenos resultados según la escala MEPS, no se obtuvieron resultados regulares y/o malos tampoco lesiones iatrogénicas del N. radial, no hubo revisiones quirúrgicas ni casos de seudoartrosis, tampoco fallas del implante. La cirugía MIPO es una alternativa segura y eficaz que se corresponde con los nuevos conceptos biológicos.
Evaluate clinical outcomes, functional and radiological treatment minimally invasive surgery (MIPO) for fractures of the humeral diaphysis, the work was designed in the form of clinical series, conducted in a prospective Coromoto Hospital during december 2007 to january 2009, with a population of 11 fractures of the humeral diaphysis, which plate LCP 4.5 set in the front of the humeral diaphysis, the results will be handled according to the assessment scales at UCLA for the men the Mayo Clinic for the elbow, getting 82 percent and 18 percent excellent success according to the scale of UCLA an 73 percent excellent and 27 percent of good performance as the scale of the Mayo Clinic, were not iatrogenic injuries of the N. radio, there was no case of surgical revisions pseudoarthrosis or failure of the implant. Minimally invasive surgery for percutaneous techniques is a safe and effective alternative tha corresponds to new biological concepts.
Assuntos
Humanos , Masculino , Feminino , Diáfises/cirurgia , Fraturas do Úmero/cirurgia , Fraturas do Úmero/terapia , Ortopedia , Fenômenos BiológicosRESUMO
Se presente estudio tipo descriptivo de corte transversal, prospectivo, realizado a 41 pacientes con fracturas diafisiarias cerradas tratadas con clavado endomedular en el Hospital Militar Escuela Dr. Alejandro Dávila Bolaños en el período de enero del 2006 a diciembre del 2007. Se observó que las fracturas oblicuas cortas fueron el trazo fractuario mas frecuente en 41.6 porciento de los pacientes, relacionados con los accidentes por automotres (moticicletas). Se encontró que del 100 porciento de pacientes operados sólo el 14.6 porciento, sufrieron complicaciones, no hubo relación directa con el tipo de trazo de fractura, pero si se encontró relación de las complicaciones con la estancia intrahospitalaria ya que los que permanecieron de 4 a 6 días fueron lo que mas se relacionaron con las infecciones superficiales. En relación al tiempo quirúrgico con las complicaciones se encontró que el 66.6 porciento de las infecciones superficiales se relacionaron con tiempo quirúrgico mayores de 60 minutos. Se puedo observar que los resultados han sido satisfactorios con respecto a las complicaciones ya que se trata de fracturas cerradas, en donde el tiempo quirúrgico es menos que si realiza un RAFI (reducción abierta fijación interna) hay menos daño de las partes blandas, no hay desperiotización, lo que nos conlleva todo ello a uan evolución satisfactoria para el paciente. La incorporación laboral d elos pacientes la mayoría fue entre los 3 a 6 meses con un total de 32 (78 porciento) pacientes, 4 (9.8 porciento) se incorporaron a sus labores entre los 6 a 8 mese y 5 (12.2 porciento) no se han incorporado a sus labores. La distribución de los pacientes según los resultados finales fue de bueno en 35 (85.4 porciento), regular en 4 (9.7 porciento) y malo en 2 (4.9 porciento) de los pacientes...
Assuntos
Pinos Ortopédicos , Diáfises/cirurgia , Diáfises/lesões , Fraturas Fechadas/cirurgia , Fraturas Fechadas/complicações , Fraturas Fechadas/terapiaRESUMO
A Brazilian orthopaedic company designed a stainless steel plate called Synthesis Pengo System (S.P.S.), which has one fixed and one changeable extremity. According to the assembly of the changeable extremity, it is possible to obtain dynamization or neutralization of the fracture site. Since the S.P.S. plate was developed for use in human patients, the aim of this study was to evaluate this system in long-bone diaphyseal fractures in dogs. Eight dogs with closed diaphyseal fractures of the femur (n= 1), radius and ulna (n=5), and tibia (n=2) were used. Patients were aged seven months to three years and weighed 18 to 31.2 kg. The S.P.S. plate was assembled with one fixed extremity and one changeable extremity in dynamization mode. The trail bar was positioned for synthesis modules with holes for cortical screws. The modules were positioned close to one another in two fractures and far away from the fracture site in the others. The bone healing occurred by external callus. Since motion at the fracture site determines the amount of callus required, the secondary bone healing that was observed in all of the cases indicated less rigid fixation of this system. A potential benefit of this system was a lesser interface contact with the bone since it was only done by trail bar. The major disadvantage was the prominence of the implant. It was possible to conclude that the S.P.S. plate appears to be a suitable method for the treatment of diaphyseal fractures in dogs.
Assuntos
Placas Ósseas/veterinária , Cães/lesões , Cães/cirurgia , Fixação Interna de Fraturas/veterinária , Fraturas Fechadas/veterinária , Animais , Parafusos Ósseos/veterinária , Diáfises/lesões , Diáfises/cirurgia , Fraturas do Fêmur/cirurgia , Fraturas do Fêmur/veterinária , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Fraturas Fechadas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/veterinária , Estudos Prospectivos , Fraturas do Rádio/cirurgia , Fraturas do Rádio/veterinária , Fraturas da Tíbia/cirurgia , Fraturas da Tíbia/veterinária , Resultado do Tratamento , Fraturas da Ulna/cirurgia , Fraturas da Ulna/veterináriaRESUMO
OBJECTIVE: To compare the locked, unreamed intramedullary nail with Ender pins in the treatment of open Gustilo grade I or II or closed tibial diaphyseal fractures of type A, B, or C2 of the AO classification. MATERIALS AND METHODS: Forty-four patients with unilateral tibial diaphyseal fractures were treated with intramedullary nails or Ender pins. Twenty patients were treated with an unreamed intramedullary nail with access via the patellar tendon with static locking. Twenty-four patients were treated with Ender pins introduced medially and laterally with respect to the tuberosity of the tibia. The main parameters analyzed were type of reduction, complications, union rate, deformities, joint mobility, pain, gait, effort capacity, presence of neurovascular disorders, and complaints related to the synthesis material. RESULTS: During 1 year of follow-up, the fractures of 90.0% of the patients with intramedullary nails and 95.7% of patients with Ender pins healed within an average of 21.5 weeks and 20.9 weeks, respectively. The significant findings were as follows: patients treated with Ender pins had less mobility of the subtalar joint; patients treated with intramedullary nails were more likely to have pain in the knee; both groups showed shortening of the tibia at the end of 1 year of treatment. CONCLUSIONS: The two methods are similar in the treatment of type A, B, and C2 tibial diaphyseal fractures.
Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/instrumentação , Fraturas da Tíbia/cirurgia , Adulto , Diáfises/lesões , Diáfises/cirurgia , Feminino , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Humanos , Escala de Gravidade do Ferimento , Masculino , Radiografia , Fraturas da Tíbia/diagnóstico por imagem , Resultado do TratamentoRESUMO
OBJECTIVE: To compare the locked, unreamed intramedullary nail with Ender pins in the treatment of open Gustilo grade I or II or closed tibial diaphyseal fractures of type A, B, or C2 of the AO classification. MATERIALS AND METHODS: Forty-four patients with unilateral tibial diaphyseal fractures were treated with intramedullary nails or Ender pins. Twenty patients were treated with an unreamed intramedullary nail with access via the patellar tendon with static locking. Twenty-four patients were treated with Ender pins introduced medially and laterally with respect to the tuberosity of the tibia. The main parameters analyzed were type of reduction, complications, union rate, deformities, joint mobility, pain, gait, effort capacity, presence of neurovascular disorders, and complaints related to the synthesis material. RESULTS: During 1 year of follow-up, the fractures of 90.0 percent of the patients with intramedullary nails and 95.7 percent of patients with Ender pins healed within an average of 21.5 weeks and 20.9 weeks, respectively. The significant findings were as follows: patients treated with Ender pins had less mobility of the subtalar joint; patients treated with intramedullary nails were more likely to have pain in the knee; both groups showed shortening of the tibia at the end of 1 year of treatment. CONCLUSIONS: The two methods are similar in the treatment of type A, B, and C2 tibial diaphyseal fractures.
OBJETIVO: Comparar a haste intramedular bloqueada não-fresada com os pinos de Ender no tratamento das fraturas da diáfise da tíbia tipos A, B ou C2 da classificação AO, fechadas ou expostas graus I ou II de Gustilo. MATERIAIS E MÉTODOS: 44 pacientes com fratura unilateral da diáfise da tíbia, tratados com HIB ou com pinos de Ender. Vinte pacientes foram tratados com uma haste intramedular bloqueada não fresada por acesso através do tendão patelar e com bloqueio estático; vinte e quatro pacientes com pinos de Ender introduzidos medial e lateralmente à tuberosidade da tíbia. Principais parâmetros analisados: tipo de redução, complicações, consolidação, deformidades, mobilidade articular, dor, marcha, capacidade para esforços, distúrbios neuro-vasculares e desconforto pelo material de síntese. RESULTADOS: No seguimento de um ano, 90,0 por cento das hastes intramedulares e 95,7 por cento dos pinos Ender dos pacientes apresentaram consolidação da fratura com tempo médio de 21,5 e 20,9 semanas, respectivamente. Os achados significantes foram: mobilidade da articulação subtalar menor nos pacientes tratados com pinos de Ender; dor no joelho mais freqüente nos pacientes tratados com HIB; encurtamento da tíbia nos dois grupos ao final de um ano de tratamento. CONCLUSÕES: Os dois métodos são semelhantes no tratamento das fraturas da diáfise da tíbia tipos A, B e C2.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pinos Ortopédicos , Fixação Intramedular de Fraturas/instrumentação , Fraturas da Tíbia/cirurgia , Diáfises/lesões , Diáfises/cirurgia , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Escala de Gravidade do Ferimento , Resultado do Tratamento , Fraturas da TíbiaRESUMO
OBJECTIVE: A prospective, randomized study to compare patients with closed, multi-fragmented tibial diaphyseal fractures treated using one of two fixation methods undertaken during minimally invasive surgery: nonreamed interlocking intramedullary nails or bridging plates. MATERIALS AND METHODS: Forty-five patients were studied; 22 patients were treated with bridging plates, 23 with interlocking nails without reaming. All fractures were Type B and C (according to the AO classification). RESULTS: Clinical and radiographic healing occurred in all cases. No cases of infection occurred. The healing time for patients who received nails was longer (4.32 weeks on average) than the healing time for those who received plates (P = 0.026). No significant differences were observed between the two methods regarding ankle mobility for patients in the two groups. CONCLUSIONS: The healing time was shorter with the bridging plate technique, although no significant functional differences were found.