RESUMO
As fraturas do terço distal de rádio e ulna apresentam uma alta incidência na rotina ortopédica veterinária, principalmente em cães de pequeno porte. Frequentemente são encontradas dificuldades na reparação dessas, como a não união ou união retardada, tornando-se ainda mais desafiadoras quando acometidas bilateralmente. Neste relato, foi atendido um cão de pequeno porte com fratura bilateral completa transversa distal de rádio e ulna sendo reparada por redução aberta e fixação com placa bloqueada na face cranial do rádio associada ao enxerto β-TCP. Essa técnica proporcionou estabilidade satisfatória, rápido retorno à função dos membros e tempo favorável de consolidação óssea, concluindo-se ser efetiva na reparação dessas fraturas.(AU)
The distal third of radius and ulna fractures are highly frequent in the veterinary orthopedics routine, mainly in small breed dogs. There are often difficulties in repair which may result in non union or delayed union. Healing becomes even more challenging in case of bilateral distal radius and ulna fractures. This case reports a complete transverse bilateral distal radius and ulna fracture in a small breed dog. The treatment consists of open reduction and cranial locking bone plate fixation on the radius associated with β-TCP bone graft. This technique promoted satisfactory stabilization, rapid function return and favorable time of bone consolidation, implying that this procedure ís effective in healing the analyzed fracture types.(AU)
Las fracturas dei tercio distal de radio y ulna presentan una alta incidencia en la rutina ortopédica veterinária, principalmente en perros de porte pequeno. Frecuentemente son encontradas dificultades en sus reparaciones, como la no unión o unión retardada, haciéndose aún más desafiadora cuando acometidas bilateralmente. En este relato, fue atendido un perro de pequeno porte con fractura bilateral completa transversa distal de radio y ulna siendo corregida por reducción abierta y fijación con placa bloqueada en la faz craneal del radio asociada ai injerto β-TCP. Esta técnica proporcionó estabilidad satisfactoria, rápido retorno a Ia función de los miembros y tiempo favorable de consolidación ósea, concluyéndose ser efectiva en la reparación de estas fracturas.(AU)
Assuntos
Animais , Masculino , Cães , Fixação Interna de Fraturas/métodos , Fraturas da Ulna/reabilitação , Rádio (Anatomia)/lesões , Substitutos Ósseos/uso terapêutico , Fixação Interna de Fraturas/veterinária , Placas ÓsseasRESUMO
As fraturas do terço distal de rádio e ulna apresentam uma alta incidência na rotina ortopédica veterinária, principalmente em cães de pequeno porte. Frequentemente são encontradas dificuldades na reparação dessas, como a não união ou união retardada, tornando-se ainda mais desafiadoras quando acometidas bilateralmente. Neste relato, foi atendido um cão de pequeno porte com fratura bilateral completa transversa distal de rádio e ulna sendo reparada por redução aberta e fixação com placa bloqueada na face cranial do rádio associada ao enxerto β-TCP. Essa técnica proporcionou estabilidade satisfatória, rápido retorno à função dos membros e tempo favorável de consolidação óssea, concluindo-se ser efetiva na reparação dessas fraturas.
The distal third of radius and ulna fractures are highly frequent in the veterinary orthopedics routine, mainly in small breed dogs. There are often difficulties in repair which may result in non union or delayed union. Healing becomes even more challenging in case of bilateral distal radius and ulna fractures. This case reports a complete transverse bilateral distal radius and ulna fracture in a small breed dog. The treatment consists of open reduction and cranial locking bone plate fixation on the radius associated with β-TCP bone graft. This technique promoted satisfactory stabilization, rapid function return and favorable time of bone consolidation, implying that this procedure ís effective in healing the analyzed fracture types.
Las fracturas dei tercio distal de radio y ulna presentan una alta incidencia en la rutina ortopédica veterinária, principalmente en perros de porte pequeno. Frecuentemente son encontradas dificultades en sus reparaciones, como la no unión o unión retardada, haciéndose aún más desafiadora cuando acometidas bilateralmente. En este relato, fue atendido un perro de pequeno porte con fractura bilateral completa transversa distal de radio y ulna siendo corregida por reducción abierta y fijación con placa bloqueada en la faz craneal del radio asociada ai injerto β-TCP. Esta técnica proporcionó estabilidad satisfactoria, rápido retorno a Ia función de los miembros y tiempo favorable de consolidación ósea, concluyéndose ser efectiva en la reparación de estas fracturas.
Assuntos
Masculino , Animais , Cães , Fixação Interna de Fraturas/métodos , Fraturas da Ulna/reabilitação , Rádio (Anatomia)/lesões , Substitutos Ósseos/uso terapêutico , Fixação Interna de Fraturas/veterinária , Placas ÓsseasRESUMO
O objetivo do estudo foi avaliar o efeito da matriz porosa do biovidro 60S (BV60S) associada a células osteoprogenitoras (CO) alógenas no tratamento de defeitos ósseos críticos de cães. Foram utilizados 20 cães, machos, sem raça definida, com dois anos de idade e massa corporal média de 25kg. Com os cães sob anestesia geral, foram criados defeitos ósseos críticos no terço médio dos ossos rádios. Procedeu-se à fixação óssea com uma placa em ponte, e os defeitos foram tratados de acordo com cada grupo experimental. Constituíram-se três grupos experimentais, em que os defeitos ósseos foram preenchidos com: BV60S associado a CO alógenas (grupo BV60S+CO), osso autógeno (grupo C+), ou não preenchidos (grupo C-). A regeneração óssea foi avaliada por meio de exames radiográficos, densitométricos e histomorfométricos ao longo de 90 dias. Os grupos C- e BV60S+CO mostraram preenchimento ósseo parcial do defeito de, no máximo, 56,68% e 35,23%, respectivamente, sem a formação de ponte óssea entre as extremidades, e o controle positivo (C+) mostrou regeneração óssea completa. Conclui-se que a matriz porosa do BV60S associada às células osteoprogenitoras não é eficiente no tratamento de defeitos ósseos críticos em rádios de cães.(AU)
The objective of this study was to evaluate the effect of the porous matrix of bioglass 60S (BV60S) associated with allogenic osteoprogenitor cells (CO) in the treatment of critical bone defects of dogs. 20 male mongrel dogs at two years old and mean weight of 25kg were used. Dogs were anesthetized and critical bone defects were created in the middle third of the radios bones. With dogs under general anesthesia, critical bone defects were created in the middle third of bone radios. Bone fixation was done with a bridge plate and defects treated according to each experimental group. Three experimental groups were formed according to the treatment. The defects filled with BV60S associated with allogenic CO (Group-BV60S+CO), autogenous bone (Group-C+) or unfilled (Group-C-). Bone regeneration was evaluated by radiography, bone densitometry and histomorphometry over 90 days. The BV60S+CO and C- groups showed partial bone filling of the defect of at most 56.68% and 35.23%, respectively. No bone bridge formation was observed between the extremities in the BV60S+CO and C- groups. Positive control showed complete bone regeneration at 90 days. It was concluded that the porous matrix of BV60S associated with osteoprogenitor cells was not effective in the treatment of critical bone defects in the radius of dogs.(AU)
Assuntos
Animais , Cães , Rádio (Anatomia)/lesões , Materiais Biocompatíveis/uso terapêutico , Regeneração Óssea , Terapia Baseada em Transplante de Células e Tecidos/métodos , Terapia Baseada em Transplante de Células e Tecidos/veterináriaRESUMO
O objetivo do estudo foi avaliar o efeito da matriz porosa do biovidro 60S (BV60S) associada a células osteoprogenitoras (CO) alógenas no tratamento de defeitos ósseos críticos de cães. Foram utilizados 20 cães, machos, sem raça definida, com dois anos de idade e massa corporal média de 25kg. Com os cães sob anestesia geral, foram criados defeitos ósseos críticos no terço médio dos ossos rádios. Procedeu-se à fixação óssea com uma placa em ponte, e os defeitos foram tratados de acordo com cada grupo experimental. Constituíram-se três grupos experimentais, em que os defeitos ósseos foram preenchidos com: BV60S associado a CO alógenas (grupo BV60S+CO), osso autógeno (grupo C+), ou não preenchidos (grupo C-). A regeneração óssea foi avaliada por meio de exames radiográficos, densitométricos e histomorfométricos ao longo de 90 dias. Os grupos C- e BV60S+CO mostraram preenchimento ósseo parcial do defeito de, no máximo, 56,68% e 35,23%, respectivamente, sem a formação de ponte óssea entre as extremidades, e o controle positivo (C+) mostrou regeneração óssea completa. Conclui-se que a matriz porosa do BV60S associada às células osteoprogenitoras não é eficiente no tratamento de defeitos ósseos críticos em rádios de cães.(AU)
The objective of this study was to evaluate the effect of the porous matrix of bioglass 60S (BV60S) associated with allogenic osteoprogenitor cells (CO) in the treatment of critical bone defects of dogs. 20 male mongrel dogs at two years old and mean weight of 25kg were used. Dogs were anesthetized and critical bone defects were created in the middle third of the radios bones. With dogs under general anesthesia, critical bone defects were created in the middle third of bone radios. Bone fixation was done with a bridge plate and defects treated according to each experimental group. Three experimental groups were formed according to the treatment. The defects filled with BV60S associated with allogenic CO (Group-BV60S+CO), autogenous bone (Group-C+) or unfilled (Group-C-). Bone regeneration was evaluated by radiography, bone densitometry and histomorphometry over 90 days. The BV60S+CO and C- groups showed partial bone filling of the defect of at most 56.68% and 35.23%, respectively. No bone bridge formation was observed between the extremities in the BV60S+CO and C- groups. Positive control showed complete bone regeneration at 90 days. It was concluded that the porous matrix of BV60S associated with osteoprogenitor cells was not effective in the treatment of critical bone defects in the radius of dogs.(AU)
Assuntos
Animais , Cães , Rádio (Anatomia)/lesões , Materiais Biocompatíveis/uso terapêutico , Regeneração Óssea , Terapia Baseada em Transplante de Células e Tecidos/métodos , Terapia Baseada em Transplante de Células e Tecidos/veterináriaRESUMO
La seudoartrosis congénita de antebrazo es una entidad clínica rara que se asocia a habitualmente a neurofibromatosis de tipo 1. La lesión de ambos huesos del antebrazo asociada con luxación de la cabeza del radio es extremadamente inusual. Se presenta el caso de una niña de 8 años con neurofibromatosis de tipo 1 y seudoartrosis de ambos huesos del antebrazo asociada a luxación de la cabeza del radio, que fue sometida a resección del cúbito distal, escisión amplia de la seudoartrosis y reconstrucción mediante antebrazo de un hueso con placa. La primera cirugía fracasó y fue necesaria una revisión con retiro del implante, injerto óseo autólogo y fijación con enclavado endomedular. Tras la segunda cirugía, la niña tenía un antebrazo de un hueso estable, con un acortamiento de 7 cm. En el último control, 4 años después, no tiene síntomas y utiliza el miembro superior con una mínima limitación de la flexo-extensión de la muñeca. La reconstrucción mediante antebrazo de un hueso es una opción razonable para la seudoartrosis de ambos huesos del antebrazo con luxación de la cabeza radial en niños. El procedimiento de salvataje produce un miembro superior estable, con una función satisfactoria de la muñeca y el codo.
Congenital forearm pseudarthrosis is a rare clinical entity which is often linked with neurofibromatosis type 1. Involvement of both bones associated with dislocation of the radial head is extremely rare, and few cases have been reported in the literature. We present a case of an 8-year-old girl with neurofibromatosis type 1 and pseudarthrosis of both forearm bones associated with dislocation of the radial head. She underwent resection of the distal ulna, excision of the pseudarthrosis, and a one-bone forearm procedure fixed with a plate. The first surgery failed to achieve bone union, and she required revision with bone grafting, plate removal, and intramedullary nailing. After the second surgery, she had a stable forearm that was shortened approximately 7 cm. At the last follow-up, 4 years postoperatively, the patient is asymptomatic, and has a mild limitation of wrist flexion-extension. The one-bone forearm is a reasonable option for forearm pseudarthrosis with radial head dislocation in children. This salvage procedure produces a stable upper limb with a satisfactory wrist and elbow function.
Assuntos
Humanos , Criança , Antebraço , Luxações Articulares , Neurofibromatose 1/cirurgia , Rádio (Anatomia)/lesões , Pseudoartrose/cirurgia , Recuperação de Função Fisiológica , Resultado do TratamentoRESUMO
There is uniform agreement in the literature that radial neck fracture with <30 degrees of angulation and minimal translation in younger children can be managed by casting alone, without the need for closed reduction. For more severe fractures, closed manipulation techniques followed by percutaneous reduction technique (in case closed reduction fails) should be performed before switching to an open reduction technique. Debate still exists regarding the best treatment protocol for severely displaced fractures. Although some surgeons favor open reduction with the argument that repeat manipulations may cause iatrogenic injuries, and stiffness, others believe that open reduction is one of the most contributing factors for poor outcome. On the basis of this paradigm, we present our treatment algorithm based on the data demonstrating that percutaneous reduction of displaced radial neck fractures achieve better results than open reduction.
Assuntos
Redução Fechada , Fratura-Luxação , Redução Aberta , Fraturas do Rádio , Rádio (Anatomia) , Adolescente , Algoritmos , Criança , Redução Fechada/efeitos adversos , Redução Fechada/instrumentação , Redução Fechada/métodos , Fratura-Luxação/diagnóstico , Fratura-Luxação/cirurgia , Humanos , Redução Aberta/efeitos adversos , Redução Aberta/instrumentação , Redução Aberta/métodos , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/lesões , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/cirurgia , Estudos Retrospectivos , Índices de Gravidade do Trauma , Resultado do TratamentoRESUMO
Longitudinal radioulnar dissociation, also known as the Essex-Lopresti lesion, is a potentially debilitating condition causing painful instability of the forearm that often results from high-injury trauma with compromise of the proximal radius, triangular fibrocartilage complex, and the interosseous membrane. Indications for reconstruction of the interosseous membrane primarily include chronic instability of the forearm. Our reconstructive technique utilizes an anatomic allograft reconstruction with intraosseous fixation, in an effort to biologically reconstruct and anatomically tension the central band of the interosseus membrane.
Assuntos
Traumatismos do Antebraço/cirurgia , Ligamentos/lesões , Ligamentos/cirurgia , Rádio (Anatomia)/cirurgia , Tenodese/métodos , Ulna/cirurgia , Parafusos Ósseos , Antebraço/cirurgia , Humanos , Instabilidade Articular/cirurgia , Rádio (Anatomia)/lesões , Procedimentos de Cirurgia Plástica/métodos , Âncoras de Sutura , Ulna/lesõesRESUMO
BACKGROUND: Intra-articular (IARH) and extra-articular (EARH) radial head fractures in skeletally immature patients are rare injuries that have not been well studied. The objective of this study was to investigate the rate of complications associated with IARH fractures relative to EARH fractures in pediatric patients treated at a tertiary referral children's hospital. METHODS: With IRB approval, Current-Procedural Terminology codes were used to identify all patients who underwent management of radial head and/or neck fractures between 2005 and 2012. A retrospective chart review was used to collect variables related to: demographics, fracture type, treatment method(s), complications, need for physical/occupational therapy, and the need for subsequent surgery. Mid-P exact tests and logistic regression analyses were used to compare differences in the incidence of complications, need for physical therapy (PT), and need for revision surgery between the IARH and EARH fracture groups. RESULTS: Among the 311 patients included in the cohort, 12 (3.86%) were affected by IARH fractures and 299 (96.14%) were affected by EARH fractures. The mean age at the time of injury was 11.46 (±3.09) years and 8.32 (±3.31) years in the IARH and EARH group, respectively. The estimated incidence of complications was significantly (P<0.0001) higher in the IARH group (50 per 100) compared with the EARH group (1.34 per 100). A significantly (P<0.0001) greater proportion of the subjects with IARH fractures also required revision surgery (25% IARH vs. 0% EARH) and PT (50% IARH vs. 19.59% EARH). CONCLUSIONS: Compared with EARH fractures, IARH fractures were associated with a significantly higher rate of complications, greater need for PT, and greater need for surgical intervention. The significant complication rate associated with pediatric IARH fractures necessitates an increased awareness of this fracture pattern and prompt, aggressive diagnostic and treatment modalities. LEVEL OF EVIDENCE: Therapeutic studies: Level III.
Assuntos
Fixação de Fratura , Fraturas Ósseas , Complicações Pós-Operatórias/epidemiologia , Rádio (Anatomia) , Adolescente , Criança , Pré-Escolar , Gerenciamento Clínico , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Epífises/crescimento & desenvolvimento , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Incidência , Masculino , Modalidades de Fisioterapia , Radiografia , Rádio (Anatomia)/lesões , Rádio (Anatomia)/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
We assessed the repair of transverse, 3-mm wide bone gaps created at the distal radius in 28 dogs that were randomly divided into two 14-animal groups; one was the control group and the other received a daily, 20-min application of low-intensity pulsed ultrasound for 100 days. Sequential radiographs, histomorphometrics, bone fluorescent histology and bone vascularity assessments found that all animals from both groups obtained a stage of hypertrophic-type nonunion with fibrocartilage tissue formation throughout the region of osteotomy. However, treated animals exhibited areas of endochondral ossification within the fibrocartilage region. There was no difference in type of vascularity or the newly formed bone process obtained by tetracycline labeling. Application of low-intensity ultrasound was not capable of significantly changing the reparative process and it may not be sufficiently powerful to overcome a combination of local deleterious effects on bone healing, created by gapping, excessive motion and periosteal resection.
Assuntos
Rádio (Anatomia)/lesões , Terapia por Ultrassom/métodos , Cicatrização/fisiologia , Animais , Modelos Animais de Doenças , Cães , Dureza , Distribuição Aleatória , Estatísticas não ParamétricasRESUMO
BACKGROUND: At present, there is no conclusive evidence regarding the best treatment method for reducible unstable fractures of the distal radius. This study compared the effectiveness of two methods used in surgical treatment of such fractures: percutaneous pinning and external fixation. METHODS: We randomly allocated 100 patients into two groups treated surgically with modified De Palma percutaneous pinning and bridging external fixation. Independent but not blinded evaluators administered the DASH quality-of-life questionnaire at postoperative months 6 and 24, performed functional assessment of pain, range of motion, and palm grip strength, and radiographic examinations (volar and radial angle, and height of the radius) before the operation, immediately afterwards, and at 6 and 24 months postoperative. Modified De Palma percutaneous pinning patients used an above-elbow cast whereas external fixation group had unrestricted elbow motion after surgery. Patients who for any reason demonstrated treatment failure or required additional interventions were followed up and their results were included in the group into which these patients had initially been randomised according to the intention-to-treat principle. A significance level of 5% (alpha = 0.05). was used for all statistical tests, such that tests presenting a p-value less than 0.05 were considered statistically significant. RESULTS: Ninety one (58.8 mean age and 66 participants were female) were included in the final assessment at 24 months. The DASH questionnaire evaluation showed a statistically significant result favouring the De Palma group (mean difference = -7.1 p = 0.044) after six months, but this was not maintained at 24 months. There were no statistically differences between the groups with respect to palm grip strength. Analysis of the range-of-motion limitation index (uninjured side minus affected side motion of) showed a statistical difference (mean difference = 2.4 p = 0.043) favoring the external fixator group with regard to the supination movement 6 months after the operation; however, this was not maintained at 24 months. The final results of the radiographic evaluation were similar for the two groups. Overall, five patients developed complications: two with De Palma pinning and three with external fixation. CONCLUSION: There was a small statistically significant difference favouring the De Palma method in early functional at 6 months according to the DASH questionnaire, and for supination movement favouring the fixator group. However, both were not clinical relevant. By 24 months the groups were similar for all outcomes TRIAL REGISTRATION: Current Controlled Trials ISRCTN04892785.