ABSTRACT
Comunicamos un caso de seudoartrosis infectada de fémur secundaria a una fractura expuesta de tipo IIIC, tratada con osteogénesis por distracción. Hombre de 32 años con una fractura expuesta de fémur derecho con lesión arterial por disparo de escopeta. Es operado de urgencia y se le efectúa limpieza quirúrgica, fijación externa y reparación arterial. Evoluciona con una seudoartrosis infectada femoral distal, por lo que, a los 24 meses de evolución, es sometido a una resección amplia y queda un defecto óseo de 12 cm, que se resuelve mediante distracción osteogénica. La osteogénesis por distracción es útil para obtener la reparación y la consolidación de variados defectos óseos. Requiere de un paciente comprometido con un proceso terapéutico demandante. Nivel de Evidencia: IV
We report a case of infected nonunion secondary to a type IIIC open femoral fracture, treated by distraction osteogenesis. A 32-year-old man with a gunshot open fracture of the distal right femur with arterial injury. Surgical debridement, external fixation and arterial repair are performed as emergency procedure. The patient develops a femoral infected nonunion, so 24 months later a wide resection is performed leaving a 12 cm bone defect that is regenerated by distraction osteogenesis. Distraction osteogenesis is a useful procedure for the repair and consolidation of several bone defects. It requires patient´s commitment to a demanding therapeutic process. Level of Evidence: IV
Subject(s)
Adult , Pseudarthrosis/therapy , Bone Lengthening/methods , Femoral Fractures/surgery , Femoral Fractures/therapy , Fractures, Open/complications , Treatment OutcomeABSTRACT
Cartilage has poor regeneration capacity due to the scarcity of endogenous stem cells, its low metabolic activity and the avascular environment. Repair strategies vary widely, including microfracture, autologous or allogenic tissue implantation, and in vitro engineered tissues of autologous origin. However, unlike the advances that have been made over more than two decades with more complex organs, including vascular, cardiac or bone tissues, similar advances in tissue engineering for cartilage repair are lacking. Although the inherent characteristics of cartilage tissue, such as the lack of vascularity and low cellular diversity, suggest that it would be one of the more simple tissues to be engineered, its functional weight-bearing role and implant viability and adaptation make this type of repair more complex. Over the last decade several therapeutic approaches and innovative techniques show promise for lasting and functional regeneration of hyaline cartilage. Here we will analyze the main strategies for cartilage regeneration and discuss our experience.