RESUMO
The purpose of this article is to examine complications in patients who underwent bone grafting from the calcaneus between December 2001 and June 2010. This retrospective, single-practice study included 247 procedures in 242 patients, including 200 (82.64%) female and 42 (17.36%) male patients, ranging in age from 13 to 89 (median 49) years. Overall, the incidence of experiencing any form of complication was 2.43% (6 of 247); these included 5 (2.02%) feet that displayed donor site sural neuritis and 1 (0.41) that displayed a painful, hypertrophic scar at the donor site. The only statistically significant risk factor associated with the development of a calcaneal donor site complication was white race (being African American was protective). These findings indicate that procurement of autogenous bone graft from the calcaneus, as described in this report, is safe and dependable with a low incidence of complications, and irritation of the sural nerve is the most common complication associated with the procedure. Further clinical and long-term follow-up studies controlling for confounding variables need to be performed to fully determine the overall safety and efficacy of this procedure.
Assuntos
Transplante Ósseo/efeitos adversos , Calcâneo/transplante , Complicações Pós-Operatórias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etnologia , Estudos Retrospectivos , Fatores de Risco , Coleta de Tecidos e Órgãos , Transplante Autólogo/efeitos adversos , População Branca , Adulto JovemRESUMO
BACKGROUND: Structural allografts have been used to correct deformities or to fill bone defects secondary to tumor excisions, trauma, osteochondral lesions, or intercalary arthrodesis. However, the quality of published evidence supporting the use of allograft transplantation in foot and ankle surgery has been reported as fair. The purpose of this study was to report the overall survival of structural allograft in the foot and ankle after tumor resection, and the survival according to the type of allograft and the complication rates in the medium to long term. MATERIALS AND METHODS: From January 1989 to June 2011, 44 structural allograft reconstructions of the foot and ankle were performed in 42 patients (28 men and 14 women) due to musculoskeletal tumor resections. Mean age at presentation was 27 years. Mean follow-up was 53 months. Demographic data, diagnosis, site of the neoplasm, operations performed, operative complications, outcomes after surgery, date of last follow-up evaluation, and local recurrences were reviewed for all patients. Regarding the type of 44 allograft reconstructions, 16 were hemicylindrical allografts (HA), 12 intercalary allografts (IA), 10 osteoarticular allografts (OA), and 6 were total calcaneal allograft (CA). RESULTS: The overall allograft survival rate, as calculated with the Kaplan-Meier method, at 5 and 10 years was 79 % (95 % CI 64-93 %). When allocated by type of allograft reconstruction the specific allograft survival at 5 and 10 years was: 83 % for CA, 80 % for HA, 77 % for OA, and 75 % for IA. The complications rate for this series was 36 % including: articular failure, local recurrence, infection, fracture and nonunion. CONCLUSION: This study showed that structural allograft reconstruction in the foot and ankle after tumor resection may be durable with a 79 % survival rate at 5 and 10 years. The two types of allografts that showed better survival rate were hemicylindrical allografts (80 %) and calcaneus allografts (83 %). The highest complication rates occurred after calcaneus allografts and osteoarticular allografts. LEVEL OF EVIDENCE: IV.
Assuntos
Articulação do Tornozelo/cirurgia , Neoplasias Ósseas/cirurgia , Transplante Ósseo/métodos , Deformidades Adquiridas do Pé/cirurgia , Doenças do Pé/cirurgia , Salvamento de Membro/métodos , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Adolescente , Adulto , Idoso , Aloenxertos , Articulação do Tornozelo/diagnóstico por imagem , Transplante Ósseo/estatística & dados numéricos , Calcâneo/transplante , Criança , Pré-Escolar , Criopreservação , Feminino , Deformidades Adquiridas do Pé/diagnóstico por imagem , Sobrevivência de Enxerto , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Preservação de Órgãos , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Adulto JovemRESUMO
Se presenta el caso de un paciente politraumatizado con múltiples fracturas de ambas extremidades inferiores entre las cuales se incluye una fractura expuesta de calcáneo grado IIIB. Se expone el tratamiento realizado a cada una de las lesiones y se hace énfasis en el tratamiento de la lesión calcánea que consistió en osteosíntesis y cobertura del defecto de piel con un colgajo fasciocutáneo sural. Se hace una revisión de la literatura sobre este tema.
The case of a multi-trauma patient with various fractures in both lower limbs including IIIB exposed heel fracture was presented. The treatment provided to each of the lesions, making emphasis on the treatment of the lesion including osteosynthesis and coverage of soft tissue defect with sural fasciocutaneous flap, was explained. A literature review on this topic was made.
Le cas d'un patient polytraumatisé avec de multiples fractures, y compris une fracture exposée du calcanéum grade IIIB au niveau de tous les deux membres inférieurs, est présenté. Le traitement de chacune des lésions est exposé, en mettant l'accent sur le traitement de la lésion calcanéenne qui a consisté en l'ostéosynthèse et la couverture du défaut cutané avec un lambeau fasciocutané sural. Une analyse de la littérature est faite à propos de ce sujet.
Assuntos
Humanos , Masculino , Adolescente , Calcâneo/lesões , Calcâneo/transplante , Fixação Interna de Fraturas/métodos , Relatos de CasosRESUMO
PURPOSE: Secure methods of graft attachment ensure safe early motion after flexor tendon grafting. This has been achieved at the proximal graft juncture using Pulvertaft's technique. For secure distal attachment, we investigate the results of flexor tendon grafting using the plantaris tendon with a fragment of attached bone fixed with a screw to the distal phalanx. METHODS: Thirteen digits from 10 patients with longstanding flexor tendon injuries in zone II had surgical reconstruction. A plantaris tendon-bone graft was attached to the distal phalanx using a mini-screw. This was followed by immediate active motion. At 3 and 8 months after surgery, total active motion was calculated as the sum of the degrees of active flexion in the proximal and distal interphalangeal joints minus the sum of the degrees of extension deficits for each of these joints. The results of total active motion were compared to the normal contralateral digit. RESULTS: Three months after surgery, the mean rate of recovery, relative to the normal contralateral finger, was 74%, whereas 8 months after surgery, this value was 70%. This difference was statistically significant. There were no failures or poor results (ie, less than 50% recovery). CONCLUSIONS: The tendon-bone plantaris graft employed here ensured immediate active motion and early use of the involved hand in daily activities. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.