Double-column Die-punch fractures of distal radius treated with butterfly plate fixation via Henry approach / 中国骨伤

OBJECTIVE@#To explore clinical effect of open reduction and internal fixation with Henry's approach butterfly plate in treating double-column Die-punch fractures of distal radius.@*METHODS@#From January 2018 to June 2021, 26 patients with double-column Die-column distal radius were treated with open reduction and internal fixation through Henry's surgical approach and using distal radius volar column plate(butterfly plate), including 14 males and 12 females, aged from 20 to 75 years old with an average age of (44.2±3.4) years old. Postopertaive complications were observed, Gartland-Werley score at 12 months after opertaion was used to evaluate wrist joint function.@*RESULTS@#All 26 patients were followed up from 10 to 18 months with an average of(13.4±0.8) months. All fractures were obtained fracture union, the time ranged from 8.5 to 15.8 weeks with an average of (11.4±0.5) weeks. All incisions healed at stageⅠwithout infection, nerve injury and internal fixation failure occurred. Postoperative Gartland-Werley score at 12 months was (3.65±0.36), and 16 patients got excellent result, 8 good and 2 moderate.@*CONCLUSION@#Open reduction and internal fixation with butterfly plate for the treatment of double-column Die-punch fractures of the distal radius through volar Henry approach could obtain satisfactory clinical outcomes.

Clinical analysis of distal radius core decompression for chronic wrist pain / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies.@*METHODS@#A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI.@*RESULTS@#All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences ( P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up ( P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up.@*CONCLUSION@#For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment.

Reconstruction with a Custom made Prosthetic Wrist Arthrodesis after Bone Tumor Resections of the Distal Radius. Single Centre Experience / Reconstrução com implante metálico personalizado de artrodese após ressecções de tumor ósseo do rádio distal. Experiência em um único centro

Abstract Objective The present study aimed at analyzing the clinical, radiological and functional results of the reconstruction of the distal radius after tumor resection with a custom-made metal arthrodesis implant and compare them with other types of distal radius reconstruction, as presented in the literature. To our best knowledge, this is the first article describing this particular type of implant and patient functionality. Methods Functional outcomes of reconstruction of the distal radius were assessed in a series of 4 patients. Three of the patients having had resection of giant cell tumors (GCTs), one patient having had resection of osteosarcoma. Results There were no major implant-related complications like infection, nonunion or loosening. Two patients had to undergo further surgery for protruding metalwork. Overall function was good according to the Musculoskeletal Tumor Society MSTS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Conclusion The present study shows that custom-made metal arthrodesis implant benefits from the fact that it can be used as a salvage option when other treatments have failed, or it can be used as a primary option in cases in which there is limited bone stock after distal radius tumor resection.

Resumo Objetivo O presente estudo teve como objetivo analisar os resultados clínicos, radiológicos e funcionais da reconstrução do rádio distal após a ressecção do tumor com implante metálico personalizado de artrodese e compará-los com outros tipos de reconstrução do rádio distal, conforme apresentado na literatura. Pelo que conhecemos, este é o primeiro artigo descrevendo esse tipo particular de implante e funcionalidade no paciente. Métodos Os desfechos funcionais de reconstrução do rádio distal foram avaliados em uma série de 4 pacientes. Três dos pacientes tiveram ressecção de tumores de células gigantes (TCGs), sendo um paciente com ressecção de osteossarcoma. Resultados Não houve complicações relacionadas ao implante, como infecção, não sindicalidade ou afrouxamento. Dois pacientes tiveram que passar por uma nova cirurgia para a protusão da prótese metálica. A função geral foi boa de acordo com as pontuações da Musculoskeletal Tumor Society (MSTS) e Disabilities of the Arm, Shoulder, and Hand (DASH). Conclusão O estudo mostra que o implante metálico personalizado de artrodese se beneficia do fato de que pode ser usado como opção de salvamento quando outros tratamentos falharam, ou pode ser usado como opção primária nos casos em que há estoque ósseo limitado após a ressecção do tumor do rádio distal.

Clinical observation of different surgical methods for metaphyseal sequelae of ulna / 中国骨伤

OBJECTIVE@#To investigate the effect and safety of ulnar osteochondroma resection, ulnar minimally invasive osteotomy, external fixation and ulnar lengthening in the treatment of forearm deformity of metaphyseal extension of ulna.@*METHODS@#From August 2005 to December 2013, there were 20 cases of ulnar metaphyseal sequelae, including 15 males and 5 females, aged from 7 to 13(10.00±2.34) years, the course of disease ranged for 6 to 11(8.10±1.52) months. The clinical manifestations were shortening of the affected forearm and bending to the ulnar side. The postoperative evaluation included pain, activities of daily living, orthopedic effect and the range of motion of wrist, elbow and forearm. The radiological evaluation included ulnar length, radial joint inclination angle and wrist epiphysis growth.@*RESULTS@#All patients healed without infection. The only operation related to complications was ulnar lengthening, including 1 case of nonunion, 2 cases of ulnar lengthening callus fracture and 1 case of temporary radial nerve palsy. All patients were followed up for 4 to 7.5 years, with an average of (6.03±1.33) years. There were statistically significant differences in changes of wrist radial deviation, ulnar deviation, forearm pronation and supination in all cases (@*CONCLUSION@#Ulnar lengthening is not beneficial to prevent the development of long-term deformity. Simple resection of osteochondroma of distal ulna is beneficial to prevent the development of deformity. Patients with limited rotation of wrist joint and forearm and strong demand for improvement of appearance can be actively treated.

Tumor de células gigantes en el antebrazo / Forearm giant cell tumor

RESUMEN El tumor de células gigantes se define como un tumor óseo benigno que invade las partes blandas localmente de forma agresiva. Se presenta una paciente con un tumor de células gigantes recidivante en el tercio distal del radio derecho, con signos de necrosis superficial e infección sobreañadidos, la cual, dada la magnitud y severidad de la lesión, requirió una amputación supracondílea de la extremidad. Presentó una evolución postoperatoria favorable, con recuperación física y psicológica(AU)

ABSTRACT Giant cell tumor is defined as a benign bone tumor that aggressively invades soft tissue locally. We present a patient with a recurrent giant cell tumor in the distal third of the right radius, showing signs of superimposed necrosis and infection, which, given the injury magnitude and severity, required supracondylar amputation of the limb. Her postoperative evolution was favorable, and this patient underwent physical and psychological recovery(AU)

RÉSUMÉ La tumeur à cellules géantes est définie comme une tumeur osseuse bénigne qui envahit agressivement les parties molles locales. Une patiente atteinte de tumeur récidivante à cellules géantes au niveau du tiers distal du radius droit, avec signes de nécrose superficielle et d'infection surajoutés, laquelle a requis une amputation supracondylienne du membre, due à la magnitude et à la sévérité de la lésion, est présentée. Elle a montré une évolution postopératoire favorable, avec une bonne récupération physique et psychologique.

Complicaciones a mediano plazo de la prótesis monopolar modular de cabeza radial / Mid-term complications of the monopolar, modular radial head prosthesis

Resumen: Introducción: El objetivo de este estudio es evaluar el tipo, la frecuencia y la gravedad de las complicaciones después de la implantación de la prótesis monopolar modular de cabeza radial. Material y métodos: Se revisaron retrospectivamente 47 pacientes con 48 prótesis de cabeza radial implantadas entre 2009 y 2017 durante una media de 43.55 meses (rango: 12-89). Resultados: Se implantó el mismo tipo de prótesis en cada paciente (Ascension Modular Radial Head) . La puntuación media obtenida en la clasificación Mayo Elbow Performance Score fue de 88.29 ± 9.9 puntos. Durante el seguimiento tres pacientes (6.25%) sufrieron dolor continuo. Doce casos (25.5%) mostraron sobredimensión radiológica, aunque sólo cinco fueron sintomáticos. Se detectó osificación heterotópica en 27 casos (57.4%), 11 pacientes (23.4%) desarrollaron rigidez postoperatoria, 19 casos (40.42%) mostraron osteólisis periprotésica, de los cuales siete fueron sintomáticos, 13 pacientes (27%) presentaron complicaciones: tres casos de infección, cuatro casos de aflojamiento sintomático, dos neuroapraxias, una inestabilidad y tres casos de sobredimensionamiento con rigidez asociada. Nueve pacientes (18.75%) fueron reintervenidos. Discusión: Presentamos 27% de complicaciones globales, principalmente relacionadas con la sobredimensión y el aflojamiento protésico y 19% de reintervenciones. Estos resultados son similares a los descritos en estudios previos con variaciones en función del tiempo de seguimiento. Asimismo, se requieren nuevos estudios para evaluar los resultados a largo plazo y la posible progresión de los hallazgos radiográficos. Conclusión: En conjunto, estos datos ponen de manifiesto la necesidad de mejoría tanto de la técnica quirúrgica como del diseño de los implantes.

Abstract: Introduction: The objective of this study is to assess the type, frequency and severity of complications after the implantation of the modular monopolar radial head prosthesis. Material and methods: Forty-seven patients with 48 radial head prostheses implanted between 2009 and 2017 were reviewed retrospectively. Patients were evaluated clinical and radiographically for a mean follow-up of 43.55 months (range: 12-89). Results: The same type of prosthesis was implanted in every patient (Ascension Modular Radial Head). The average score in the Mayo Elbow Performance Score was 88.29 ± 9.9 points. During the follow-up, three patients (6.25%) suffered from continuous pain. Twelve cases (25.5%) showed radiological oversizing, though only five were symptomatic. Heterotopic ossification was detected in twenty-seven cases (57.4%). Eleven patients (23.4%) developed postoperative stiffness. Nineteen cases (40.42%) showed periprosthetic osteolysis, from which seven were symptomatic. Thirteen patients (27%) developed surgery-related complications: three cases of infection, four cases of symptomatic loosening, two neurapraxies, one instability and three cases of oversizing with associated stiffness. Nine patients (18.75%) required reintervention. Discussion: Our study obtains a 27% of overall complications, mostly related to oversizing and prosthetic loosening, and 19% of reinterventions. These results are similar to those presented in previous studies, with variations depending on the time of follow-up. Further research is also required to evaluate long-term results and the potential progression of the radiographic findings. Conclusion: Taken together, these data stress the need for improvement in both the surgical technique and the design of the implants.

Formación de un solo hueso en el antebrazo / Formation of a single bone in the forearm

En 1921 se describió la formación de un solo hueso del antebrazo como un proceder de rescate para una pseudoartrosis en el radio distal. Se presentan dos casos con un defecto óseo significativo en el antebrazo, secundario a procesos sépticos, a los que se les realizó la técnica de "un solo hueso". A un paciente se le transfirió la diáfisis del cúbito proximal a la metáfisis distal del radio con fijación de la articulación radiocubital distal para garantizarle estabilidad a la muñeca. Al segundo caso se le fijó la metáfisis proximal del cubito con la diáfisis distal del radio. Ambos presentaron una evolución posoperatoria favorable, con recuperación funcional y estética de la extremidad(AU)

In 1921, the formation of a single forearm bone was described as a rescue procedure for a pseudoarthrosis in the distal radius. We present two cases with significant bone defect in the forearm, secondary to septic processes, to which the "single bone" technique was performed. A patient was transferred the diaphysis of the proximal ulna to the distal metaphysis of the radius with fixation of the distal radioulnar joint to ensure stability to the wrist. In the second case, the proximal metaphysis of the ulna was fixed with the distal diaphysis of the radius. Both patients had favorable postsurgical evolution, with functional and aesthetic recovery of their limb(AU)

The measurement of dorsal radial tilt by x-ray and computed tomography

SUMMARY OBJECTIVE: We conducted this study to define and measure the dorsal radial tilt, and to guide the reduction of distal radius fractures and the pre-bending of steel plates used in surgery. METHODS: The dorsal radial tilt was measured using both computed tomography (CT) and x-ray from both left and right side. The differences and correlations of the data measured by those two methods and from two sides were analyzed. RESULTS: The tilts measured by x-ray were significantly bigger than those measured by CT from the left side (t=55.51, p < 0.01) and from the right side (t=49.81, p < 0.01). The tilts measured by those two methods from the left and right sides were correlated (r=0.85, p < 0.01; r=0.81, p < 0.01). The dorsal radial tilts measured from the left side were not significantly different from those measured from the right side by CT (t=1.49, p > 0.05) and by x-ray (t=1.51, p > 0.05). The dorsal radial tilts measured from the left side by CT were significantly different from those measured from the right side by x-ray (t=43.07, p < 0.01), and these two sets of data were correlated (r=0.71, p < 0.01). The dorsal radial tilts measured from the left side by x-ray was significantly different from that measured from right side by CT (t=40.43, p < 0.01), and those two sets of data were also correlated (r=0.75, p < 0.01). Conclusions: The dorsal radial tilts measured from one side by one method can be used to estimate the tilts measured from the other side / the same side by the same method / the other method.

RESUMO OBJETIVO: Realizamos este estudo para definir e medir a inclinação radial dorsal, e para orientar a redução das fraturas do raio distal e a pré-flexão das chapas de aço utilizadas na cirurgia. MÉTODOS: A inclinação radial dorsal foi medida usando tomografia computadorizada (TC) e raios X dos lados esquerdo e direito. As diferenças e correlações dos dados medidos por esses dois métodos e de dois lados foram analisadas. RESULTADOS: As inclinações medidas por raios X foram significativamente maiores que as medidas pela TC do lado esquerdo (t=55,51, p<0,01) e do lado direito (t=49,81, p<0,01). As inclinações medidas por esses dois métodos dos lados esquerdo e direito foram correlacionadas (r=0,85, p<0,01; r=0,81, p<0,01). As inclinações radiais dorsais medidas a partir do lado esquerdo não foram significativamente diferentes das medidas do lado direito por CT (t=1,49, p>0,05) e por raios X (t=1,51, p>0,05). As inclinações radiais dorsais medidas a partir do lado esquerdo por TC foram significativamente diferentes das medidas a partir do lado direito por raios X (t=43,07, p<0,01), e esses dois conjuntos de dados foram correlacionados (r=0,71, p<0,01). As inclinações radiais dorsais medidas a partir do lado esquerdo por raios X foram significativamente diferentes das medidas do lado direito por CT (t=40,43, p<0,01), e esses dois conjuntos de dados também foram correlacionados (r=0,75, p<0,01). CONCLUSÕES: As inclinações radiais dorsais medidas de um lado por um método podem ser usadas para estimar as inclinações medidas do outro lado/o mesmo lado pelo mesmo método/o outro método.

A 3D printed model for radius curvus surgical treatment planning in a dog / Modelo impresso em 3D usado num planeamento cirúrgico de um cão com radius curvus

An 8 month-old, 10 kg male Azawakh dog was presented due to worsening forelimb gait and exercise intolerance. The right forelimb presented gross angular limb deformity with carpal valgus and radial procurvatum. Surgical planning based on radiographs allowed calculation of the centers of rotation and angularity (CORAs). The computer tomography data were used to generate 3D reconstructions of the antebrachium to aid the detection of the orthopaedic problems. With proper imaging software, the nature of the deformity and its degree were quantified using a previously unreported method based on the CORAs as a 3D printed model of anatomical area of interest. This 3D printed model was used by the surgeon to simulate the surgery with all orthopaedic steps, which included a partial ulna osteotomy and a double cuneiform osteotomy of the radius performed at the level of CORAs and stabilized with bone plates and screws. After 7 weeks, radiographs revealed bone union. At 8 months after surgery the animal presented a complete recovery of the involved forelimb. CORAs method combined with computed tomography and 3D model was useful to plan and simulate surgical procedures, including the corrective surgery of forelimb deformities in a dog which improved the surgical efficiency comparatively to the conventional pre-operative study.(AU)

Um cão com 8 meses de idade, 10kg de peso vivo, macho da raça Azawakh foi apresentado à clínica devido à intolerância ao exercício e agravamento da marcha do membro anterior. O membro anterior direito apresentou uma deformidade angular com valgus carpal e com um procarvatum radial. O planeamento cirúrgico inicialmente baseado em exames radiográficos possibilitou o cálculo dos centros de rotação e angulação articulares (CORAs). O exame de tomografia computadorizada foi utilizado juntamente com um software de imagiologia para obter o modelo 3D virtual da área anatómica de interesse que foi posteriormente impresso em 3D e que permitiu quantificar micrometricamente a deformação óssea presente. Este modelo 3D foi utilizado pelos cirurgiões para executar uma simulação cirúrgica completa que englobou todos os procedimentos cirúrgicos, que incluiu a realização de várias osteotomias e aplicação do material cirúrgico (placas e parafusos). Com base na simulação cirúrgica foi executada a cirurgia ao animal. Decorridas sete semanas, as radiografias demonstraram uma correta regeneração óssea. Oito meses após a cirurgia o animal apresentou uma recuperação completa. O método dos CORAs juntamente com a tomografia computadorizada e com a utilização do modelo 3D revelou-se útil no planeamento e na simulação dos vários procedimentos cirúrgicos, resultando numa melhoria significativa da eficiência cirúrgica.(AU)

Descompresión ósea metafisaria del radio distal para estadios tempranos de la enfermedad de Kienböck: Seguimiento mínimo de 10 años / Metaphyseal bone decompression of distal radius for early stages of Kienböck's disease. Minimum follow-up of 10 years

Introducción: El objetivo de este estudio es analizar los resultados clínicos y radiológicos a largo plazo de una serie de pacientes con enfermedad de Kienböck en estadios II y IIIA de la clasificación de Lichtman, tratados mediante descompresión metafisaria del radio distal. Materiales y Métodos: Estudio retrospectivo y descriptivo que incluyó a 23 pacientes con enfermedad de Kienböck (estadios II y IIIA de Lichtman) tratados mediante descompresión metafisaria del radio distal con, al menos, 10 años de seguimiento. Al final del seguimiento, se evaluaron el rango de movilidad de la muñeca, la fuerza de puño, mediante la escala de la Clínica Mayo modificada y el dolor, según la escala analógica visual. Se valoró a los pacientes radiográficamente según la clasificación de Lichtman y el índice de altura carpiana. Resultados: El seguimiento promedio fue de 14 años (rango 10-19). Nueve pacientes eran mujeres y catorce, hombres. Quince casos correspondían al estadio IIIA y ocho, al estadio II. Según la escala de la Clínica Mayo, los resultados fueron excelentes en 9 pacientes, buenos en 11 pacientes, moderados en 2 y pobres en uno. El puntaje en la escala analógica visual preoperatoria fue 7 (rango 6-10) y 1,1 (rango 0-6) al final del seguimiento. El arco de flexión/extensión promedio fue del 78% y la fuerza de puño, del 81%. Según la clasificación de Lichtman, hubo progresión en 4 pacientes, mientras que los otros 19 permanecieron en la misma etapa que en el preoperatorio. Conclusión: La descompresión metafisaria del radio distal logró resultados favorables a largo plazo para los estadios II y IIIA de la enfermedad de Kienböck. Nivel de Evidencia: IV

Introduction: The purpose of this study is to analyze the long-term clinical and radiological results of a series of patients with early stages of Kienböck disease treated with radius core decompression. Methods: This retrospective study included 23 patients with Kienböck's disease (Lichtman stage II and IIIA) who underwent distal radius metaphyseal core decompression, and were controlled for at least 10 years. At the last follow-up, wrist range of motion and grip strength using the modified Mayo wrist score and pain using the visual analogue scale were evaluated. Patients were also radiographically evaluated with the Lichtman classification and the modified carpal height ratio. Results: The mean follow-up period was 14 years (range 10-9). Nine patients were women and fourteen were men. Fifteen cases belonged to IIIA stage and 8 to II stage. Based on the modified Mayo wrist score, results were excellent in 9 patients, good in 11 patients, fair in 2 and poor in one patient. Preoperative pain score according to VAS was 7 (range 6-10) and 1.1 (range 0-6) at the final follow-up. Average flexion/extension arc was 78% and the grip strength was 81%. Radiographic disease progression according to Lichtman classification occurred in four wrists, while the remaining 19 patients remained without changes. Conclusion: Radius core decompression achieved long-term favorable results in the early stages of Kienböck disease. Level of Evidence: IV

Osteossíntese de rádio e ulna em Gavião Caboclo (Buteogallus meridionalis) / Radius and ulna osteosynthesis in a Savanna Hawk (Buteogallus meridionalis)

Foi atendido um Gavião Caboclo (Buteogallus meridionalis), de vida livre e histórico desconhecido. O paciente apresentava impotência funcional da asa direita e solução de continuidade de aspecto recente envolvendo a região de rádio e ulna direitos caracterizando fratura aberta grau II. Os achados radiológicos foram fratura completa cominutiva de diáfise média de ulna e fratura completa tranversa de diáfise média de rádio. A estabilização da fratura de rádio foi realizada com miniplaca de 1,5mm de 6 orifícios, com 2 parafusos proximais e 2 parafusos distais e, osteossíntese de ulna com placa bloqueada de 2,0mm de 12 orifícios, com 3 parafusos proximais e 2 parafusos distais. Aos 180 dias de pós-operatório, os implantes ortopédicos foram removidos e o paciente recebeu alta. Conclui-se que o emprego de placa bloqueada para tratamento de fraturas abertas em ulna de Gavião Caboclo, pode propiciar adequada consolidação e retorno à função do membro sendo capaz de voar.(AU)

A wild Savanna Hawk (Buteogallus meridionalis) of unknown history, was seen at the veterinary hospital. The patient presented with a dropped right wing and soft tissue damage that appeared to be a recent wound involving the right radius and ulna region, characterizing an open fracture grade II. The radiological findings were a comminuted complete fracture of the ulnar diaphysis and complete transverse fracture of the radial diaphysis. Stabilization of the radius fracture was performed with a 1.5mm miniplate with 6 holes, with 2 proximal screws and 2 distal screws, and ulna osteosynthesis with a 2.0mm locking plate with 12 holes, with 3 proximal screws and 2 distal screws. At 180 postoperative days, the implants were removed and the patient was discharged. The use of locking plate for the treatment of open fractures in ulna of Savanna Hawks may provide adequate healing and return to limb function being able to fly.(AU)

Avaliação histológica e por microscopia eletrônica de varredura da biocerâmica de fosfato de cálcio nano-estruturada micromacro porosa em grânulos em defeito crítico de rádio de coelhos / Histological and nano-structured calcium phosphate bioceramic micro-macro porous granules in critical defect rabbits radius scanning electron microscopy evaluation

Objetivou-se avaliar, histologicamente e por microscopia eletrônica de varredura (MEV), a evolução de defeitos críticos experimentais em rádio de coelhos preenchidos ou não com biocerâmica fosfocálcica nanoestruturada micromacro porosa em grânulos. Utilizaram-se 70 coelhos, Nova Zelândia, adultos jovens, machos, e realizou-se um defeito crítico nos rádios. Os membros constituíram os grupos: GI, biocerâmica lenta, GII, biocerâmica moderada e GIII, controle negativo. Após cada período experimental, os animais foram sacrificados, e os rádios coletados. As avaliações histológicas foram realizadas aos oito, 15, 30, 45, 60, 90 e 120 dias, e as análises de MEV aos 60, 90 e 120 dias. Histologicamente, observou-se processo de reparação óssea mais adiantado nos grupos GI e GII comparando-se ao GIII. Na MEV, constatou-se maior proporção de osso maduro e presença de ósteons secundários nos GI e GII, sendo mais evidente no GII, confirmando os achados histológicos. As cerâmicas promoveram preenchimento completo do defeito, enquanto no grupo controle houve preenchimento no centro do defeito, permanecendo espaços vazios nas laterais. Conclui-se que o emprego das biocerâmicas de absorção lenta e moderada favorece a regeneração óssea completa em defeitos críticos sendo indicadas como substituto ósseo. A maturação óssea ocorre mais precocemente quando se emprega a cerâmica de absorção moderada.(AU)

The objective was to evaluate, through histologic exam and by scanning electron microscopy (SEM), the evolution of experimental critical defects in radio or not filled with nano-structured calcium phosphate micro-macro porous bioceramic granules rabbits. We used 70 rabbits, New Zealand, young adults, males, there was a critical defect in radio. The members were the groups: GI, slow bioceramic, GII, GIII and bioceramic moderate, negative control. After each experimental period, the animals were sacrificed and the radios harvested. Histological evaluations were performed at eight, 15, 30, 45, 60, 90 and 120 days and SEM analyzes at 60, 90 and 120 days. Histologically there was bone healing process earlier in GI and GII compared to GIII. In SEM we observed a higher proportion of mature bone and presence of secondary osteons in GI and GII, being more evident in the GII, confirming the histological findings. Ceramic promoted complete filling of the defect, while the control group was filling in the center of the defect, with empty spaces remaining on the sides. In conclusion, the use of bioceramics, slow and moderate absorption favor complete bone regeneration in critical defects being indicated as a bone substitute. The maturation occurs earlier when employing the ceramic moderate absorption.(AU)

Microsurgical reconstruction in limb salvage due to a giant cell tumor of the distal radius. Case report / Reconstrucción microquirúrgica de la extremidad asociada a un tumor de células gigantes del extremo distal del radio. Reporte de caso

Abstract: The giant cell tumor of bone is one of the most controversial neoplasms due to growth patterns that may present. The case reported shows a very aggressive tumor in a classic location, but key to hand function. Rather than treat with radical surgery, was planned and performed a wide resection with an ulnar-carpus arthrodesis and microsurgical reconstruction of the defect throught an anterolateral thigh flap. The multidisciplinary approach of bone neoplasms produce a positive impact on patients.

Resumen: El tumor óseo de células gigantes es una de las neoplasias más controversiales debido a los patrones de crecimiento que pueden presentar. El caso reportado muestra un tumor muy agresivo en una localización clásica, pero clave para la función de la mano. En lugar de tratarla mediante cirugía radical, se planeó y realizó una resección amplia con artrodesis cúbito-carpiana y la reconstrucción microquirúrgica del defecto mediante un colgajo anterolateral de muslo. El abordaje multidisciplinario de las neoplasias óseas repercute positivamente en los pacientes.

Experiencia inicial en un centro de alta complejidad con el injerto vascularizado de peroné en defectos óseos segmentarios del miembro superior / Early experience in a high complexity hospital with the vascularized fibular graft in segmentalbone defects of the upper limb

Introducción: Los defectos óseos >6 cm en los huesos largos plantean un problema difícil de solucionar en la reconstrucción del miembro superior. El peroné vascularizado se ha convertido en el principal método de reconstrucción por sus ventajas biológicas. El objetivo de este estudio fue evaluar la tasa y el tiempo de consolidación ósea, y las complicaciones asociadas en una serie continua de pacientes. Materiales y Métodos: Se realizó una revisión durante un período de 5 años. Se incluyeron los pacientes que fueron tratados por defectos >6 cm en el miembro superior. Se analizaron variables preoperatorias, intraoperatorias y posoperatorias inmediatas y alejadas. Resultados: Durante el período de evaluación, 6 pacientes (4 hombres/2 mujeres) cumplían con los criterios de inclusión. La edad promedio fue de 47 años. El tiempo transcurrido entre el trauma inicial y la cirugía reconstructiva varió de 2 a 21 años. El defecto óseo promedio fue de 10 cm. El tiempo de seguimiento promedio fue de 17 meses. Se logró la consolidación ósea en todos los casos, como promedio, en 16 semanas. Dos pacientes sufrieron complicaciones posoperatorias. Ninguno presentó complicaciones o secuelas funcionales en la zona dadora. Conclusiones: El injerto óseo vascularizado de peroné es una opción válida para el tratamiento quirúrgico reconstructivo de defectos óseos segmentarios >6 cm en el miembro superior, con una tasa alta de consolidación, aun en casos con múltiples cirugías previas o con una lesión de larga evolución. Los detalles técnicos previenen las complicaciones en la zona dadora.

Introduction: Reconstruction of bone defects >6 cm in the upper limb poses a problem. The vascularized fibular graft has become the most popularized method to treat these bone defects, because of their biological advantages. The aim of this study was to evaluate the rate of bone union, time to accomplish this union and complications associated with this technique in a continuous series of patients. Methods: A review was performed during a period of five years. All patients who were treated for defects >6 cm on upper limbs were included. Preoperative, intraoperative, and immediate and long-term postoperative variables were analyzed. Results: During the assessment period, 6 patients (4 males/2 females) met the inclusion criteria. The average age was 47 years. Time between the initial trauma and reconstructive surgery ranged from 2 to 21 years. The average bone defect was 10 cm. The average follow-up was 17 months. Bone healing was achieved in all cases at a mean of 16 weeks. Two patients had postoperative complications. None of the patients had complications or functional sequelae in the donor site. Conclusions: The vascularized fibular graft is a valid option in reconstructive surgery of segmental bone defects >6 cm in the upper limb. It achieves a high consolidation rate, even in cases with multiple previous surgeries or a long-standing lesion. The technical details prevent complications in the donor site.

Treatment of a forelimb fracture and rehabilitation of a free-ranging iberian wolf (canis lupus signatus) / Osteossíntese de fratura localizada no membro torácico num lobo ibérico (canis lupus signatus) selvagem e sua reabilitação

The surgical treatment of an exposed compounded comminuted fracture of the right radius and ulna in a free-ranging adult female Iberian Wolf (Canis lupus signatus) with an osteosynthesis plate and screws and subsequent post-operative care are described. The evolution of the fracture healing was very similar to those expected in a dog of the same size. The prompt surgical intervention and a proper housing, feeding and wound management adapted to a free-ranging wolf, in view to reduce manipulation and post-operative complications, allowed the subsequent rehabilitation and release of the animal. After 10th post-operative weeks the wolf was fitted with a Global Positioning System (GPS) for wildlife tracking collar and released in the same area where it has been caught. GPS telemetry data showed that the animal covered increasingly large distances confirming a complete functionality of the right thoracic limb and its successfully return to the wild. This report could constitute the first detailed report of a long bone fracture treatment in a free-ranging wolf and its successfully rehabilitation, release and adaptation to the wild.

O objetivo do presente artigo é a descrição da realização da estabilização de uma fratura cominutiva exposta do rádio e ulna do membro torácico direito em Lobo Ibérico selvagem por meio de osteossíntese com placa e parafusos ósseos bem como o manejo pós-operatório. A evolução da cicatrização da fratura óssea foi similar à esperada num canídeo doméstico de porte idêntico. A intervenção cirúrgica realizada rapidamente, bem como o alojamento adequado, alimentação e manejo adaptado a um lobo selvagem, visando minimizar a manipulação e o aparecimento de possíveis complicações pós-operatórias permitiram o sucesso na reabilitação e posterior libertação do animal. Na 10ª semana pós-operatória foi colocado um colar GPS no animal para deteção permanente da sua localização, tendo sido o animal libertado na mesma área onde havia sido capturado. Os dados obtidos por telemetria GPS demostraram que o lobo percorreu distâncias consideráveis, confirmando a completa recuperação do membro torácico direito e o sucesso da sua reintrodução na natureza. Este artigo poderá constituir a primeira descrição pormenorizada sobre a estabilização de fratura de ossos longos em um lobo selvagem com a sua posterior reintrodução na vida selvagem com sucesso.

Prótesis de cúpula monopolar en el tratamiento de fracturas y luxofracturas del radio / Monopolar radial head arthroplasty in the treatment of fracture and fracture-dislocation of the radius

Objetivo: Evaluar retrospectivamente los resultados clínicos y radiológicos de una serie consecutiva de pacientes con fracturas y luxofracturas de la cúpula radial a quienes se les realizó el reemplazo por una prótesis monopolar. Materiales y Métodos: Se incluyeron 20 pacientes. Criterios de inclusión: <18 años, con fracturas o luxofracturas de la cúpula radial, tratados con prótesis monoblock de titanio y seguimiento mínimo de un año. Quince eran mujeres, edad promedio 59 años. Siete eran fracturas aisladas y 13, luxofracturas. Se evaluaron el grado de aflojamiento protésico, la erosión capitelar, el ensanchamiento del espacio articular humeral lateral y las calcificaciones heterotópicas. El seguimiento fue de 26 meses. Resultados: La flexo-extensión fue de 139º-5º y la pronosupinación, de 79-79°. El arco total fue de 134°. Fuerza de puño: 84% del lado contralateral. El dolor según la escala analógica visual fue de 2, DASH: 11 puntos, 13 resultados excelentes y 6 buenos. Se detectó aflojamiento del implante (12 casos), aumento de la radiolucidez capitelar (4 casos) y ensanchamiento del espacio ulnohumeral lateral (2 casos). Hubo 2 complicaciones: una neurodocitis cubital que debió ser operada y una extracción de implante por aflojamiento y dolor. Conclusiones: El reemplazo de la cúpula radial en lesiones no reconstruibles es una opción terapéutica viable, con buenos resultados funcionales a corto y mediano plazo. La recuperación de la estabilidad articular fue posible en todos los casos y el índice de aflojamiento protésico asintomático fue elevado.

Objective: To retrospectively evaluate the clinical and radiological results of a consecutive series of patients with fracture and fracture-dislocations of the radius, treated with a monopolar radial head arthroplasty. Methods: Twenty patients were included. Inclusion criteria: <18 years old, with fracture and fracture-dislocations of the radius, treated with a titanium monopolar radial head arthroplasty and a minimun follow-up of one year. Fifteen were female, average age of 59 years old. Seven were isolated radial head fractures and 13 were fracturedislocations. Loosening of the implant, capitelar erosion, overstuffing and heterotopic ossification were evaluated. Average follow-up was 26 months. Results: Flexo-extension was 139°-5° and prono-supination 79°-79°. Total arc of motion was 134°. Grip strength was 84% of the contralateral side. Pain according to a visual analogue scale was 2, DASH: 11 points. Thirteen patients had excellent results and 6 good. Loosening of the implant (12 patients), capitelar erosion (4 patients) and overstuffing (2 patients) were detected. One patient had an ulnar neuropathy and he was operated on and one patient required implant removal due to loosening and pain. Conclusions: The replacement of the radial head in a non-reconstructable fracture is a feasible treatment option, with good functional results in a short and medium term. Joint stability was restored in all cases and the index of asymptomatic implant loosening was elevated.

Effect of autologous stem cells on regenerated bone during distraction osteogenesis by Ilizarov technique in the radius of dogs: histomorphometric analysis

PURPOSE:To investigate by histomorphometry the distraction osteogenesis by Ilizarov technique in dog radius with the use of autologous stem cells in regenerated bone. METHODS:Ten dogs (20 radiuses) underwent the osteotomy of 20% of extension of their radiuses, and osteogenic distraction using the Ilizarov technique after this procedure at rate of 1mm per day divided into 0.5mm every 12 hours. The elongation was performed until the regeneration reached 20% of the total length of the radius. The stem cells were isolated, concentrated and injected in the regenerated bone, when it reached 10% of the length of the entire radius. The regenerated bone was evaluated using histomorphometric analysis when the elongation was 20% the size of radius. RESULTS: The bone formation was evidenced by histomorphometric indices were significantly greater in the study group. In the histology evaluation the type of healing was mixed in 80% (intra membrane and endocondral) in both groups; the osteoblastic activity from moderate to intense was greater in the study group; and the space occupied by the newly-formed bone tissue was more evident in the study group. CONCLUSIONS:The histomorphometric indices in this study expressing the microarchitecture, trabecular thickness, trabecular spacing, number of trabecula and quantity of bone that was significant in the group study. These data suggest that the use of undifferentiated stem cells autologous bone marrow in the regenerate bone induces osteogenesis and bone quality.

Implante de biomateriais e a consolidação óssea em cadelas submetidas à ovariossalpingo-histerectomia / Influence of biomaterials on the bony consolidation in spayed female dogs

Avaliou-se a hidroxiapatita com alandronato e hidroxiapatita com colágeno na aceleração da consolidação óssea do rádio de cadelas adultas submetidas à ovariossalpingo-histerectomia (OSH). Utilizaram-se 14 cadelas adultas, distribuídas aleatoriamente em dois grupos: grupo-controle e grupo OSH (submetidas à OSH). Quatro meses após a OSH, as cadelas dos dois grupos foram submetidas à cirurgia para produção de uma falha óssea de 4mm de diâmetro nos terços distal e proximal do rádio. No terço distal do membro direito, foi utilizada a hidroxiapatita com alandronato e, no membro esquerdo, a hidroxiapatita com colágeno; no terço proximal, não se utilizou nenhum biomaterial. Houve retardo na consolidação das falhas ósseas nas cadelas submetidas à OSH comparadas com as não submetidas. A hidroxiapatita com alandronato acelerou o processo de reparação e, em todos os animais dos dois grupos, a densidade óssea foi significativamente maior no terço distal onde foi implantada. Os dois biomateriais apresentaram biocompatibilidade, constatada pela ausência de reação inflamatória ou outra reação indesejável.

The hydroxyapatite with alendronate and hydroxyapatite with collagen were evaluated in the acceleration of the bony consolidation of adult spayed bitch radius. For that, 14 adult bitches were distributed in two groups (control and spayed). Four months after ovariohysterectomy, the groups were submitted to the surgery for production of a 4mm diameter bony flaw in the distal and proximal third regions of the radius. In the distal region of the right thoracic limb, hydroxyapatite with alendronate was used. In the distal region of the left thoracic limb, hydroxyapatite with collagen was used. Any biomaterial was used in proximal part of the limb. There was a retard in bony flaws consolidation in the spayed bitches. Hydroxyapatite with alendronate showed better result, since the place it was implanted considerably increased the bony formation. Both biomaterials presented biocompatibility, verified by the absence of inflammatory reaction or other undesirable reaction.

Anatomic Reconstruction of the Distal Radioulnar Ligament for Posttraumatic Distal Radioulnar Joint Instability

BACKGROUND: To analyze clinical outcomes after anatomical reconstruction of distal radioulnar ligaments in patients with chronic post-traumatic instability of the distal radioulnar joint. METHODS: Anatomical reconstruction was performed in 16 patients with subluxation or dynamic instability of distal radioulnar joint following trauma. Osteotomy was performed simultaneously in 10 patients with radial malunion. The average follow-up period was 18.9 months. For clinical outcome assessment, we performed the anteroposterior stress test, measured the range of motion and grip strength, and performed radiological examination. For assessment of the pain and function, we used the Patient Rated Wrist Evaluation, the Disabilities of the Arm, Shoulder and Hand, and the Modified Mayo Wrist Score. RESULTS: Anteroposterior stress test performed at the last follow-up showed normal in 12 patients, mild laxity in 3, and residual subluxation in one. The average Patient Rated Wrist Evaluation was 9.1 for pain and 11.2 for function. The average Disabilities of the Arm, Shoulder and Hand score was 10.5. The average Modified Mayo Wrist Score was 92.8; there were 10 excellent, 5 good, and 1 poor case. The average grip strength improved from 69.7 1b to 80.9 1b. A revision osteotomy was performed on the patient with residual subluxation in order to obtain normal alignment of the joint. CONCLUSIONS: Anatomical reconstruction of the distal radioulnar ligaments is recommended to restore distal radioulnar joint stability. In addition to ligament reconstruction, realignment of the distal radioulnar joint seems critical when the instability is combined with malunion of the radius.