RESUMO

A displasia de cotovelo é definida pelo desenvolvimento anormal da articulação do cotovelo, sendo a apresentação mais comum a displasia por fragmentação do processo coronoide medial. O diagnóstico é baseado no exame clínico e exames de imagem como radiografia, tomografia computadorizada, cintilografia e ressonância magnética. Em casos mais brandos, o tratamento conservativo é indicado, contudo, na maioria dos casos o tratamento cirúrgico é recomendado. O objetivo desse trabalho foi relatar o procedimento cirúrgico de coronoidectomia subtotal para correção de fragmentação do processo coronoide medial em cão. Foi encaminhado ao Hospital Veterinário Metropolitano um paciente canino, fêmea, com cinco meses idade, da raça American Bully, com diagnóstico de fragmentação do processo coronoide medial do membro torácico esquerdo realizado por avaliação radiológica e tomográfica. Além disso, também foram encaminhados os exames complementares hematológicos, bioquímicos, eletrocardiograma e ecocardiograma. Mediante a análise dos exames foi recomendado o tratamento cirúrgico através da técnica de artrotomia convencional. Após dez dias do procedimento cirúrgico, o paciente apresentava deambulação normal, sem dor e claudicação. Foi instruído ao tutor o acompanhamento do animal a cada três semanas durante 90 dias. Além disso, foi recomendado restrição das atividades físicas durante o periodo de seis semanas. Decorridos três meses, o paciente apresentava boa qualidade de vida com deambulação normal sem sinais de claudicação. Com isso, pode-se concluir que o tratamento cirúrgico da fragmentação do processo coronoide medial através da técnica de artrotomia convencional mostrou-se eficaz, com resultados satisfatórios ao paciente, possibilitando o retorno funcional do membro acometido em curto prazo.

Elbow dysplasia is defined by abnormal development of the elbow joint, the most common presentation being dysplasia due to fragmentation of the medial coronoid process. The diagnosis is based on clinical examination and imaging tests such as radiography, computed tomography, scintigraphy and magnetic resonance imaging. In milder cases, conservative treatment is indicated, however, in most cases surgical treatment is recommended. The aim of this study was to report the surgical procedure for subtotal coronoidectomy to correct fragmentation of the medial coronoid process in a dog. A canine, female, five-month-old American Bully patient was referred to the Veterinary Metropolitan Hospital, diagnosed with fragmentation of the medial coronoid process of the left thoracic limb performed by radiological and tomographic evaluation. In addition, complementary hematological, biochemical, electrocardiogram and echocardiogram tests were also sent. By examining the exams, surgical treatment using the conventional arthrotomy technique was recommended. Ten days after the surgical procedure, the patient had normal walking, without pain and lameness. The tutor was instructed to follow the animal every three weeks for 90 days. In addition, restriction of physical activities during the six-week period was recommended. After three months, the patient had a good quality of life with normal walking without signs of lameness. With this, it can be concluded that the surgical treatment of the fragmentation of the medial coronoid process using the conventional arthrotomy technique proved to be effective, with satisfactory results for the patient, allowing the functional return of the affected limb in the short term.

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RESUMO

A displasia de cotovelo é definida pelo desenvolvimento anormal da articulação do cotovelo, sendo a apresentação mais comum a displasia por fragmentação do processo coronoide medial. O diagnóstico é baseado no exame clínico e exames de imagem como radiografia, tomografia computadorizada, cintilografia e ressonância magnética. Em casos mais brandos, o tratamento conservativo é indicado, contudo, na maioria dos casos o tratamento cirúrgico é recomendado. O objetivo desse trabalho foi relatar o procedimento cirúrgico de coronoidectomia subtotal para correção de fragmentação do processo coronoide medial em cão. Foi encaminhado ao Hospital Veterinário Metropolitano um paciente canino, fêmea, com cinco meses idade, da raça American Bully, com diagnóstico de fragmentação do processo coronoide medial do membro torácico esquerdo realizado por avaliação radiológica e tomográfica. Além disso, também foram encaminhados os exames complementares hematológicos, bioquímicos, eletrocardiograma e ecocardiograma. Mediante a análise dos exames foi recomendado o tratamento cirúrgico através da técnica de artrotomia convencional. Após dez dias do procedimento cirúrgico, o paciente apresentava deambulação normal, sem dor e claudicação. Foi instruído ao tutor o acompanhamento do animal a cada três semanas durante 90 dias. Além disso, foi recomendado restrição das atividades físicas durante o periodo de seis semanas. Decorridos três meses, o paciente apresentava boa qualidade de vida com deambulação normal sem sinais de claudicação. Com isso, pode-se concluir que o tratamento cirúrgico da fragmentação do processo coronoide medial através da técnica de artrotomia convencional mostrou-se eficaz, com resultados satisfatórios ao paciente, possibilitando o retorno funcional do membro acometido em curto prazo.(AU)

Elbow dysplasia is defined by abnormal development of the elbow joint, the most common presentation being dysplasia due to fragmentation of the medial coronoid process. The diagnosis is based on clinical examination and imaging tests such as radiography, computed tomography, scintigraphy and magnetic resonance imaging. In milder cases, conservative treatment is indicated, however, in most cases surgical treatment is recommended. The aim of this study was to report the surgical procedure for subtotal coronoidectomy to correct fragmentation of the medial coronoid process in a dog. A canine, female, five-month-old American Bully patient was referred to the Veterinary Metropolitan Hospital, diagnosed with fragmentation of the medial coronoid process of the left thoracic limb performed by radiological and tomographic evaluation. In addition, complementary hematological, biochemical, electrocardiogram and echocardiogram tests were also sent. By examining the exams, surgical treatment using the conventional arthrotomy technique was recommended. Ten days after the surgical procedure, the patient had normal walking, without pain and lameness. The tutor was instructed to follow the animal every three weeks for 90 days. In addition, restriction of physical activities during the six-week period was recommended. After three months, the patient had a good quality of life with normal walking without signs of lameness. With this, it can be concluded that the surgical treatment of the fragmentation of the medial coronoid process using the conventional arthrotomy technique proved to be effective, with satisfactory results for the patient, allowing the functional return of the affected limb in the short term.(AU)

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RESUMO

Treatment of massive bone defects is one of the most difficult problems to solve in orthopedics. At present, there is no consensus on the best way to resolve these problems. The aim of our study was to evaluate the effect of a three-dimensional bioimplant over massive bone defects, and to analyse if it improves the speed and quality of integration in recipient bone compared to allograft treatment. Fifteen female lambs with massive bone defects, surgically created in their tibias, were randomly divided into three groups of five lambs each: Group I -treated with the bioimplant; Group 2 -treated with the bioimplant plus nucleated cells of autologous bone marrow; Group 3 -treated with a frozen allograft. Radiographs were taken post-treatment at weeks 1, 6, and 12. Animals were euthanized to obtain the studied bone segment for morphological analyses. TREATMENT: with bioimplants vs. bioimplant plus bone marrow nucleated cells (BMNCs) showed a notorious osteogenic effect, but with greater osteoid synthesis and cellularity in the latter. These results suggest that combined treatment with bioimplants and BMNCs have an additive effect on massive bone defects in lambs. These experimental results could be applied to repair damaged human bone.

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INTRODUCCIÓN: La impresión tridimensional de biomodelos ha demostrado en los últimos años ser de gran utilidad para el diagnóstico, tratamiento y planificación preoperatoria en prácticamente todas las especialidades quirúrgicas. En este reporte se presenta la experiencia inicial con el empleo de biomodelos tridimensionales, para la planificación pre quirúrgica de un paciente con displasia fibrosa fronto-orbitaria operado en Cuenca, Ecuador. CASO CLÍNICO: Paciente de sexo masculino de 11 años de edad que desde hace 4 años presentó una¿ masa frontal derecha dura, inmóvil, no dolorosa, de crecimiento progresivo, que produjo deformidad orbitaria con exoftalmia e hipotropia. La tomografía craneal demostró una lesión ósea de núcleo hipodenso, de 5 cm de diámetro mayor, con compromiso del techo de la órbita, porción lateral del seno paranasal frontal y extensión intracraneal extradural. EVOLUCIÓN: Para planificar la cirugía se elaboró un modelo óseo tridimensional que se usó para explicar al paciente y sus padres el objetivo del procedimiento y como se realizaría. El día de la intervención, se dibujaron las osteotomías y craneotomía en el modelo anatómico, plan que se aplicó exactamente en el paciente. El postoperatorio transcurrió sin novedades, la tomografía computarizada de control evidenció una resección completa de la lesión y una adecuada reconstrucción orbitaria. El paciente y sus familiares se mostraron muy satisfechos con las explicaciones dadas. CONCLUSIONES: La impresión 3D es una herramienta que cada vez gana más espacio en la docencia y también en la planificación quirúrgica pues permite disponer de modelos anatómicos muy precisos y simular el procedimiento operatorio, antes de realizar el procedimiento en el paciente real. (AU)

BACKGROUND: 3Dprinting of biomodels has shown in recent years to be very useful for diagnosis,treatmentandpreoperativeplanninginpracticallyall surgical specialties. Inthis reportispresentedthe initial experiencewiththeuseoftridimensionalbiomodels,forpre-surgicalplanninginapatientwithfronto-orbital fibrous dysplasia operated in Cuenca, Ecuador. CASE REPORT: An 11 years old boy presented with a 4-year history of a slow-growing, hard, non-mobile, painless rightfrontalmass which caused orbital deformity, proptosis, and hypotropia. Cranial Computer Tomography showed a 5 cm bone tumor with hypodense center compromising the orbital roof and the lateral aspect ofthe frontal paranasal sinus with intracranial extradural expansion. EVOLUTION: To design the surgery, a tridimensional bone model was elaborated and used to explain the patient and his parents the aim of the procedure and how it will be performed. The day of the intervention, the osteotomies and craniotomy were drawn on the anatomical model, plan that was exactly applied to the patient. The postoperative period was uneventful, control CT scan showed a complete resection of the lesion and an adequate orbital reconstruction. The patient and his relatives were very satisfied with the explanations given. CONCLUSIONS: 3D printing is a very useful surgical tool with wide applications in planning and education that allows simulate in very accurate biomodels an operative procedure before it was done in the actual patient(AU)

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Treatment of Blount disease (tibia vara) can be daunting in adolescents because of their obesity. The goals in performing osteotomy for Blount disease are to correct the deformity, restore joint alignment, preserve leg length, and prevent recurrent deformity and other complications, such as neurovascular injury, nonunion, and infection. In this article, we report on our treatment of 9 limbs in 8 patients (age range, 13-17 years) with Blount disease. In each case, we performed an oblique complete closing wedge osteotomy of the tibia fixed with a compression plate with oblique screw and a fibular osteotomy. Mean body mass index was 38. In 2 patients, an external fixator (instead of a cast) was used after surgery to increase stability. Mean correction was 26°. The cast was removed at 6 weeks. A hinged knee brace was worn for another 6 weeks. Return to normal activities was allowed after 4 months. The described method, using a closing wedge tibial osteotomy and an oblique fibular osteotomy, is practical and safe and has reproducible results.

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The unicortical bone defects in sheep are established model for evaluation of biological properties of graft, but their limitation is related to the defect size and the risk of fracture. However, the models of cortical defects are not well described, defined or patterned. Unicortical Circular Ostectomies in tibias were held in twelve sheep females. The diameter and length of the tibia were measured and filling the bone defect was accompanied by imaging evaluation (X-ray, ultrasound and thermography) for 60 days. In addition, the bone fragment collected was processed for histological study. The sheep of this study had tibias with diameters between 1.2 and 2.0 cm and length from 15.4 to 23.0 centimeters with a 95% confidence interval. By radiographs, ultrasound and thermography were possible to measure and compare the bone defect for up to 60 days. The proposed method can be considered efficient and reproducible.(AU)

Os defeitos ósseos unicorticais em ovinos são modelos muito utilizados para avaliação de propriedades biológicas de enxerto, porém, sua limitação está relacionada com o tamanho do defeito e o risco de fratura. No entanto, alguns modelos de defeitos corticais não estão bem descritos, definidos ou padronizados. Com o objetivo de propor um modelo experimental passível de ser reproduzido em projetos de pesquisa foram realizadas ostectomias circulares unicorticais de 5mm, em tíbias de doze ovinos fêmeas. O diâmetro e o comprimento das tíbias foram mensurados e a realização do defeito ósseo foi acompanhado por meio de exames de imagem (radiográfico, ultrassonográfico e termográfico), no transoperatório e por 60 dias. Um fragmento ósseo foi coletado e avaliado quanto à viabilidade de realização de estudo histológico por meio de microscopia de luz e eletrônica de transmissão. As ovelhas deste estudo possuíam tíbias com diâmetros entre 1,2 e 2,0 centímetros, com comprimento variando de 15,4 a 23,0 centímetros, com intervalo de confiança de 95%. Por meio de exames radiográficos, ultrassonográficos e termográficos foi possível mensurar e comparar o defeito ósseo por até 60 dias, e o método proposto pode ser considerado eficaz por ser adequadamente reprodutível.(AU)

Assuntos

RESUMO

The unicortical bone defects in sheep are established model for evaluation of biological properties of graft, but their limitation is related to the defect size and the risk of fracture. However, the models of cortical defects are not well described, defined or patterned. Unicortical Circular Ostectomies in tibias were held in twelve sheep females. The diameter and length of the tibia were measured and filling the bone defect was accompanied by imaging evaluation (X-ray, ultrasound and thermography) for 60 days. In addition, the bone fragment collected was processed for histological study. The sheep of this study had tibias with diameters between 1.2 and 2.0 cm and length from 15.4 to 23.0 centimeters with a 95% confidence interval. By radiographs, ultrasound and thermography were possible to measure and compare the bone defect for up to 60 days. The proposed method can be considered efficient and reproducible.

Os defeitos ósseos unicorticais em ovinos são modelos muito utilizados para avaliação de propriedades biológicas de enxerto, porém, sua limitação está relacionada com o tamanho do defeito e o risco de fratura. No entanto, alguns modelos de defeitos corticais não estão bem descritos, definidos ou padronizados. Com o objetivo de propor um modelo experimental passível de ser reproduzido em projetos de pesquisa foram realizadas ostectomias circulares unicorticais de 5mm, em tíbias de doze ovinos fêmeas. O diâmetro e o comprimento das tíbias foram mensurados e a realização do defeito ósseo foi acompanhado por meio de exames de imagem (radiográfico, ultrassonográfico e termográfico), no transoperatório e por 60 dias. Um fragmento ósseo foi coletado e avaliado quanto à viabilidade de realização de estudo histológico por meio de microscopia de luz e eletrônica de transmissão. As ovelhas deste estudo possuíam tíbias com diâmetros entre 1,2 e 2,0 centímetros, com comprimento variando de 15,4 a 23,0 centímetros, com intervalo de confiança de 95%. Por meio de exames radiográficos, ultrassonográficos e termográficos foi possível mensurar e comparar o defeito ósseo por até 60 dias, e o método proposto pode ser considerado eficaz por ser adequadamente reprodutível.

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El alargamiento de extremidades trata las discrepancias de longitud de extremidades superiores e inferiores. Lograr un adecuado tratamiento temprano evita secuelas irreversibles como la artrosis. El estudio de las discrepancias se realiza con una telerradiografía estandarizada, la cual entrega la información de cuál es el segmento óseo comprometido y cuál es el largo total a corregir. Menos de 15mm de discrepancia se ha demostrado que no tiene influencia sobre la mecánica de la marcha ni de las articulaciones. Más de 15mm produce una alteración en las cargas articulares, rangos de movimiento articular, compensaciones musculares, compensaciones de columna (escoliosis compensatoria), entre otras, que producen secuelas a largo plazo. Los métodos de tratamiento existentes son conservadores y quirúrgicos. Dentro de estos últimos están los fijadores externos e internos. Los fijadores externos tienen una alta frecuencia de infecciones superficiales a través de las agujas, sin embargo, son versátiles y capaces de corregir prácticamente cualquier deformidad. Los fijadores internos (por ejemplo, clavos intramedulares) no pueden corregir grandes deformidades, así como tampoco realizar grandes alargamientos, sin embargo, su frecuencia de complicaciones es mucho menor y son mucho mejor tolerados por el paciente. Estos métodos de tratamiento logran resultados muy precisos. Tienen un margen de error de 3,5 mm de longitud, lo cual no tiene consecuencias mecánicas para una extremidad. La tasa de satisfacción es de alrededor del 90 por ciento y logran un alivio del dolor significativo...

Limb lengthening can be used to correct upper and lower limb length discrepancies. To obtain an appropriate treatment early in life prevents irreversible consequences, such as arthritis. The limb length discrepancies study is performed with a standardised leg length X-ray. This X-ray shows the compromised bone segment and what the total limb length discrepancy is. A limb length discrepancy of less than 15mm has no influence on factors such as, gait mechanics, joint range of motion, or long term joint degeneration. Over 1.5cm, several consequences appear such as: joint overload, decreased joint range of motion, muscle compensations and compensatory spine malalignment. Existing treatment includes non-surgical and surgical methods. Among the latter are internal and external fixations. External fixations have a high frequency of superficial infections, but are highly versatile, being able to correct virtually any deformity. The internal fixation (e.g. intramedullary nails) cannot correct large deformities, or make big lengthenings, but its complication rate is much lower and is much better tolerated by the patient. These treatment methods achieve very accurate results. They have an error of 3.5mm in length, which has no mechanical consequences to an extremity. The satisfaction rate is high, with around 90 percent achieving a significant pain relief...

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Las displasias esqueléticas son un grupo heterogéneo de enfermedades caracterizadas por la alteración primaria del tejido óseo y/o cartilaginoso. La incidencia de muchas de estas entidades es desconocida, estimándose una incidencia general de 1 de 4.000 recién nacidos vivos. Frente a pacientes con restricción prenatal de crecimiento o que presentan talla baja durante la niñez, especialmente si existe desproporción corporal, debemos sospechar la presencia de una displasia esquelética. El estudio radiológico es fundamental para confirmar la afección ósea e intentar aproximarse a un diagnóstico preciso, pero requiere de especialistas expertos. En la actualidad contamos con estudio molecular confirmatorio y son las alteraciones de los genes FGFR3, COL2α1 y SHOX los que dan cuenta de las displasias que más frecuentemente observaremos en nuestra práctica clínica. En los últimos años la mayor precisión diagnóstica se ha acompañado de mayores oportunidades terapéuticas. El desarrollo de nuevas técnicas quirúrgicas de apoyo en casos de deformidades óseas y de técnicas menos invasivas de alargamiento han determinado mejoría en talla final, pero por sobre todo, en la calidad de vida de nuestros pacientes.

The skeletal dysplasias are a heterogeneous group of diseases characterized primarily by impaired primary bone and/or cartilage development. The incidence of many of these entities is unknown; an overall incidence of 1 in 4,000 live births is estimated. Clinically, we must suspect the presence of a skeletal dysplasia in patients with prenatal growth restriction or childhood with short stature, especially in the presence of body disproportion. The radiological study is essential to confirm the bone condition so to try approach an accurate diagnosis, and skilled experts are required. Today we have the possibility to confirm the diagnosis by molecular studies, and we know that molecular alterations in FGFR3, COL2α1 and SHOX genes account for the most frequent cases that we will observe in our clinical practice. In recent years the increased diagnostic accuracy has been accompanied by major therapeutic opportunities. The development of new surgical techniques in bone deformity management and less invasive enlargement techniques have certainly improved the final height, but above all, in the quality of life of our patients.

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The Taylor Spatial Frame (TSF) is an external-fixator that corrects deformities in 6 axes, and can successfully manage disorders involving multiplanar deformities. In the developing-world, orthopaedic surgeons are often faced with deformities from neglected trauma and birth defects more severe than those typically seen in developed-countries. This article evaluates the applicability of TSF in the challenging medical environment of Haiti. At Haiti Adventist Hospital, the authors treated 80 cases using the TSF with a minimum follow-up of 1-year. Good results were observed in 99% of the cases (79 out of 80), approaching similar outcomes than those described in literature.

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