Morphological features of healing of experimental defect of long bones diaphysis under the conditions of implantation of biphasic osteoplastic material / Características morfológicas del proceso de reparación de un defecto experimental en diáfisis de huesos largos postimplantación de material bifásico osteoplástico

Purpose: to study the healing process of a defect of the compact bone tissue after the implantation of osteoplastic material «easygraft CRYSTAL¼. Methods: the experiment was conducted on 24 Wistar rats. In the middle third of the diaphysis of the femur we created a perforated defect of 2.5 mm diameter in the medullary canal, which was filled with osteoplastic material «easy-graft CRYSTAL¼. Fragments of the injured bones were studied on the 60th and 120th days by light microscopy with morphometry and scanning electron microscopy. Results: it was found that in the area of the defect of the compact bone tissue «easy-graft CRYSTAL¼ shows high biocompatibility, osteoconductive properties and provides stability to the volume of the defect due to good integration with the bone tissue of regenerate and absence of signs of resorption of osteoplastic material throughout the period of experiment. (AU)

Objetivo: estudiar el proceso de reparación de un defecto del tejido óseo compacto después de la implantación de material osteoplástico (easy-graft CRYSTAL). Métodos: el experimento se realizó en 24 ratas Wistar. Se realizó en el tercio medio de la diáfisis del fémur un defecto de 2,5 mm de diámetro en el canal medular que se rellenó de material de osteoplástico (easy-graft CRYSTAL). Los huesos lesionados fueron estudiados en los días 60ª y 120ª mediante microscopía óptica y microscopía electrónica de barrido. Resultados: se encontró que en la zona del defecto del tejido óseo compacto el injerto mostró alta biocompatibilidad y propiedades osteoconductivas y proporcionó estabilidad al volumen del defecto debido a la buena integración con el tejido óseo y ausencia de signos de resorción de material osteoplástico durante todo el período experimental. (AU)

Electromagnetic stimulation as coadjuvant in the healing of diaphyseal femoral fractures: a randomized controlled trial / Estimulación electromagnética como coadyuvante en el tratamiento de fracturas diafisarias de fémur: Ensayo clínico aleatorio

Introduction: There is controversy in medical literature regarding the use of electromagnetic fields to promote bone healing. Methods: After designing and building devices capable of generating an electromagnetic field for this study, their safety was confirmed and the electromagnetic therapy was randomly allocated and compared to placebo in patients with fracture of the femoral diaphysis. Treatment began six weeks after the fracture and it was administered once a day, during 1 h, for eight consecutive weeks. Twenty devices were built, 10 of which were placebo-devices. Between June 2008 and October 2009, 64 patients were randomized in two different hospitals and were followed for 24 weeks. The mean age was 30 years (18-59) and 81% were males. Results: Healing observed at week 12 was 75% vs. 58% (p= 0.1); at week 18, it was 94% vs. 80% (p= 0.15); and at week 24, it was 94% vs. 87% (p= 0.43) for the device group and the placebo group, respectively. Discussion: This study suggests that an electromagnetic field stimulus can promote earlier bone healing compared to placebo in femoral diaphyseal fractures. Faster bone healing translates into sooner weight bearing, which - in turn - permits quicker return to normal daily activities.

Introducción: El uso de estimulación electromagnética como coadyuvante en la consolidación de fracturas es controversial en la literatura médica. Métodos: Para este estudio, se diseñó y construyó un dispositivo capaz de generar un campo electromagnético. Tras confirmar su seguridad se asignaron pacientes aleatoriamente con fractura diafisaria de fémur a recibir terapia electromagnética o placebo. La estimulación inició a las seis semanas de la fractura, 1 h diaria, por ocho semanas consecutivas. Se construyeron 20 dispositivos, 10 reales y 10 dispositivos-placebo. Entre junio 2008 y octubre 2009, ingresaron 64 pacientes al estudio de dos instituciones y fueron seguidos durante 24 semanas. El promedio de edad de los pacientes fue de 30 años (rango 18-59) y 81% eran de sexo masculino. Resultados: La consolidación observada para el grupo con el dispositivo y el grupo placebo fue: en la semana 12, 75% vs. 58% (p =0.1); en la semana 18, 94% vs. 80% (p =0.15) y en la semana 24, 94% vs. 87% (p =0.43). Discusión: Este estudio muestra una tendencia a la consolidación más temprana al estar expuesto a un campo electromagnético frente a placebo. Una consolidación más temprana permite un apoyo precoz y, así, más rápida reincorporación al trabajo y a las actividades cotidianas.

Osteopatia hipertrófica em sete cães / Hypertrophic osteopathy in seven dogs

Os achados clínico-patológicos de sete casos de osteopatia hipertrófica em cães foram estudados. Os cães afetados apresentavam sinais clínicos indicativos de envolvimento ósseo e lesões macroscópicas principalmente nos ossos longos dos membros. As lesões consistiram de neoformação óssea periosteal detectada em exame radiográfico, na inspeção óssea durante a necropsia e, com grande nível de detalhamento, em espécimes ósseos macerados. A proliferação óssea observada era parcialmente circunferencial e ocorreu principalmente na diáfise dos ossos longos. Era constituída por trabéculas ósseas de tamanho e espessura irregulares que estavam dispostas de forma perpendicular ao córtex ósseo original. Em todos os casos as lesões de osteopatia hipertrófica foram associadas a neoplasmas pulmonares (primários ou metastáticos).

Clinical and pathological aspects of hypertrophic osteopathy in seven dogs were studied. Affected dogs had clinical signs of bone involvement and lesions mainly in the long bones of the limbs. The lesions consisted of periosteal new bone formation detected on radiographic examination, inspection of bones during the necropsy, and with great detail, in macerated bone specimens. The bone proliferation observed was partially circumferential and occurred mainly in the diaphysis of long bones. It consisted of bone trabeculae of irregular size and thickness that were arranged perpendicularly to the original bone cortex. In all cases the lesions were associated with lung neoplasms (primary or metastatic).

Changes in morphology of long bone marrow tissue of rats submitted to cryotherapy with liquid nitrogen / Alterações na morfologia do tecido medular de ossos longos de ratos submetido à crioterapia com nitrogênio líquido

PURPOSE: To study the main effects of local use of liquid nitrogen on bone marrow tissue in rats. METHODS: The femoral diaphyses of 42 Wistar rats were exposed to three local and sequential applications of liquid nitrogen for one or two minutes, intercalated with periods of five minutes of passive thawing. The animals were sacrificed after one, two, four and 12 weeks and the specimens obtained were analyzed histomorphologically. RESULTS: In the second experimental week of one-minute protocol, histological degree of inflammation obtained a mean score of one (mild), ranging from 0 (absent or scarce) and two (moderate) (Kruskal-Wallis test p=0.01). In the second experimental week of two-minute protocol, degree of inflammation to the medullar tissue obtained an average score of two (Kruskal-Wallis test p=0.01). CONCLUSION: The degree of inflammation of the bone marrow tissue was higher in protocol of three applications of two minutes compared to protocol of three applications of one minute.

OBJETIVO: Investigar os principais efeitos do uso local de nitrogênio líquido sobre o tecido medular ósseo em ratos. MÉTODOS: As diáfises femorais de 42 ratos Wistar foram expostas a três aplicações sequenciais locais de nitrogênio líquido por um ou dois minutos, intercaladas por períodos de cinco minutos de degelo espontâneo. Os animais foram sacrificados após uma, duas, quatro e 12 semanas e os espécimes obtidos foram analisados histomorfologicamente. RESULTADOS: Na segunda semana experimental do protocolo de um minuto, o grau histológico de inflamação obteve um escore médio de um (leve) variando entre 0 (ausente ou escarço) a dois (moderado) (Teste de Kruskal-Wallis p=0.01). Na segunda semana experimental do protocolo de dois minutos, o grau histológico de inflamação do tecido medular obteve um escore máximo de dois (moderado) (Teste de Kruskal-Wallis p=0.01). CONCLUSÃO: O grau de inflamação do tecido medular ósseo foi maior no protocolo de três aplicações de dois minutos comparado ao protocolo de três aplicações de um minuto.

Histomorphometric assessment of bone necrosis produced by two cryosurgery protocols using liquid nitrogen: an experimental study on rat femurs

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.

Correlación entre los índices radiológicos preoperatorios y la pérdida ósea periprotésica determinada por densitometría ósea en artroplastia de cadera no cementada IAHULA 2007-2009 / Correlation between radiologic index and perioprostethic bone loss determined by bone densiometry in cementless total hip arthroplasty IAHULA 2007-2009

Se realizó un estudio observacional descriptivo en 43 caderas intervenidas por artroplastia total no cementada en el Hospital Universitario de Los Andes entre Enero de 2007 y Agosto de 2009, para determinar la correlación existente entre los índices corticodiafisario (ICD), corticometafisario (ICM) y la relación canal-cálcar (CC) preoperatorios con la pérdida ósea periprotésica evaluada mediante densitometría ósea (DEXA) postoperatoria en las zonas de Gruen. Se incluyó igualmente como variable interviniente el uso del ácido zoledrónico en dosis de 5 mg postoperatorios en 24 de los casos para determinar su asociación al aumento de la densidad mineral ósea periprotésica. Se obtuvo correlación entre el índice corticometafisario y la densidad mineral ósea en las zonas 1 y 7 de Gruen, y entre la relación canal-cálcar y la densidad mineral ósea en la zona 2 de Gruen. Por otra parte, el uso del ácido zoledrónico mostró aumento de la densidad mineral ósea en la zona 1 de Gruen.

This is a descriptive observational study of 43 hips which underwent uncemented total arthroplasty at Los Andes University Hospital since January 2007 to August 2009, to determinate correlation among preoperatory corticodiaphysary index (CDI), corticometaphysary index (CMI) and canal to calcar ratio (CCR) with periprosthetic bone loss evaluated through postoperatory bone densitometry (DEXA) in the seven Gruen´s zones. Use of postoperatory 5 mg of zoledronic acid in 24 cases was included as intervening variant to determinate its association with increase in periprosthetic bone mineral density. Correlation was obtained between corticometaphysary index and bone mineral density in Gruen´s zones 1 and 7, and canal to calcar ratio and bone mineral density in Gruen´s zone 2. Besides, it was show increased bone mineral density in Gruen´s zone 1, in patients who received zoledronic acid.

Tratamiento de las fracturas del fémur con sistemas de enclavado endomedular Centro de Innovación Tecnológica de la Universidad de Los Andes (CITEC-ULA) estudio tipo serie clínica / Fractures of the femur after intramedullary nailing systems Technology Innvation Center at the University of The Andes (CITEC-ULA) clinical series study type

Actualmente las fracturas de huesos largos como fémur y tibia se han convertido en un problema de slaud pública. Por lo cual nos plantemos como objetivo evaluar el sistema de enclavado endomedular del Centro de Innovación Tecnológica de la Universidad de Los Andes (CITEC-ULA) en pacientes con fracturas diafiarias de fémur ingresados en el servicio de cirugía ortopédica y traumatología del Hospital Universitario de Los Andes (IAHULA) durante el periodo junio 2004 a mayo 2009. En un total de 27 pacientes sólo 23 cumplieron con el segumiento adecuado del protocolo de estudio. Obtuvimos 96 por ciento pacientes masculinos, con una edad promedio de 30 años, como causa de fractura predominaron los hechos vialrs con 72 por ciento, y sólo un 28 por ciento de los casos presentaron fracturas asociadas. El promedio de espera preoperatorio fue 10,35 días. Y el 60 por ciento de las fracturas según su tipo correspondió a trazos complejos tipo B según la AO; se logro la consolidación en 95 por ciento de los casos y se presentaron un 13 por ciento de complicacuones representadas en 3 casos por fatiga de los pernos. Podemos evidenciar que los resultados obtenidos son comparables con otros sistemas de enclavado ya conocidos con la ventaja de tener menor costo y mayor disponibilidad por ser de producción local.

Currently fractures of long bones as the femur and tibia have become a public health problem. Therefore we set the objetive of evaluating the system of intramedullary nailing of the Tecnological Innovation Center at the Universitary of The Andes (CITEC-ULA) in patients with femoral shaft fractures admitted to the service of Orthopedic Surgery, University Hospital of The Andes (IAHULA) during june 2004 in may 2009. In a total of 27 patients, only 23 met the fracture predominated facts vials with 72 percent and only 28 percent of cases had associated fractures. The average waiting time was 10.35 days preoperatively. And 60 percent of fractures according to type complex traits corresponded to type B as the AO, the consolidationwas achieved in 95 percent of cases and presentd a 13 percent complication represented by 100 percent due to fatigue of the bolts. We show that the results are comparable to other well-known embedded systems with the advantage of lower cost and greater availability to be locally produced.

Osteoartropatia hipertrófica primária (paquidermoperiostose): relato de casos em dois irmãos / Primary hypertrophic osteoarthropathy (pachydermoperiostosis): case report of two sibling

Neste artigo apresentamos dois irmãos acometidos pela osteoartropatia hipertrófica primária (paquidermoperiostose). Esta representa somente 3 por cento a 5 por cento de todos os casos de osteoartropatia hipertrófica. Nos nossos pacientes as alterações nos ossos longos são evidenciadas em radiografias convencionais, constando-se em neoformação óssea periosteal e alargamento das diáfises.

We report a case of two siblings with primary hypertrophic osteoarthropathy (pachydermoperiostosis). Pachydermoperiostosis represents only 3 to 5 per cent of all cases of hypertrophic osteoarthropathy. These patients presented long bone changes on conventional x-ray films including periosteal new bone formation and expansion of the diaphysis

Unreamed interlocking nail for management of recent diaphyseal tibial fractures

Different methods were described for treatment of closed and open fractures of the tibial diaphysis, yet each method has its own pros and cons. Interlocking tibial nails had proved to be an effective and superior to other methods of fixation of the tibial shaft with the lowest rate of complications. Unreamed interlocking nails had advantages in that they cause less thermal and mechanical impairment of cortical and medullary cavity circulation. In this study, 3 types of nails were used [Richard's Russell and Taylor, Biomet-Klemm and Schellman, and Orthofix] without reaming in 22 patients. The Orthofix nail with its distal aiming device reduced both the surgical and the irradiation exposure times. There was 100% union rate, this was superior to the reported results with the reaming techniques. Statistical results revealed that there was significant relation between age of the patient and time needed for fracture union, and that the distal aiming device technique took significantly shorter operative time than free hand technique

L' abces de brodie intra-cortical diaphysaire des os longs

Intra-cortical Brodies abscess location is exceptionnal and can mimic other cortical lesions, particularly malignant tumour. We report 4 cases treated in M.T. Kassab orthopeadic's institute during 25 years period. The abscess are located in tibial shaft in 3 cases and humeral in one case. As regards clinical symptoms patients have a painless swelling which progress quietly. These patients are successfully treated with excision. The follow up examination showed no recurrence 3 years after surgery