Técnica de Eden Hybinette en inestabilidad anterior de hombro con pérdida de stock óseo en paciente con epilepsia: reporte de caso / Eden Hybinette technique in anterior instability of the shoulder with bone loss in a patient with epilepsy: case report

La inestabilidad de hombro es una lesión de incidencia relevante en trauma, ocasionalmente asociada con pérdida ósea glenoidea en pacientes con epilepsia. Ha habido pocos artículos que describan tratamientos quirúrgicos específicos para este tipo de lesión y en este grupo de pacientes. Este reporte de caso muestra un enfoque quirúrgico exitoso utilizado en un paciente epiléptico con múltiples luxaciones de hombro derecho que ocurrieron principalmente durante convulsiones, a través de la técnica Eden Hybinette, en donde se utilizó un autoinjerto de cresta ilíaca. El paciente ha sido seguido en un año de postoperatorio, sin nuevos episodios de luxación de hombro derecho, sin quejas de dolor, con buen rango de movimiento del hombro sin limitaciones para actividades cotidianas o laborales. Se han publicado diferentes métodos quirúrgicos para estos pacientes, incluidas las operaciones de reparación de tejidos blandos, así como las reconstrucciones esqueléticas con terapias de injerto óseo, siendo Eden Hybinette una de estas. Esta cirugía es una opción válida, ya que permite una posición adecuada del injerto en el defecto glenoideo, disminuyendo potencialmente el riesgo de lesiones neurovasculares y miotendinosas; aunque, de manera más importante, reduce las recurrencias de luxación de hombro en pacientes con epilepsia no controlada y les da la oportunidad de una buena calidad de vida.

Shoulder instability is occasionally associated with glenoid bone loss in patients with epilepsy. There have been few articles that describe specific surgical treatments for this type of injury. This case report shows a successful surgical approach used in an epileptic patient with multiple right shoulder dislocations that occurred mainly during seizures, through the Eden Hybinette technique, performed using an iliac crest autograft. The patient has been followed up for one year postoperatively, without new episodes of right shoulder dislocation, without complaints of pain, with good range of movement of the shoulder without limitations for daily or work activities. Different surgical methods have been published for these patients, including soft tissue repair operations, as well as skeletal reconstructions with bone graft, Eden Hybinette being one of these. This surgery is a valid option, since it allows an adequate position of the graft in the glenoid defect, potentially reducing the risk of neurovascular and myotendinous lesions; although, more importantly, it reduces the recurrences of shoulder dislocation in patients with uncontrolled epilepsy and gives them the opportunity for a good quality of life.

Radiographic evaluation of infra-bony defects treated by bone graft procedures / 대한치주과학회지

PURPOSE: A number of techniques and materials have been used for periodontal regeneration and bone graft procedures with guided tissue regeneration(GTR) have been suggested as alternatives to osseous surgery in the management of local infra-bony defects. However, the long-term stability and treatment outcome following bone graft procedure of infra-bony defects is poorly documented. The purpose of this study was to assess radiographic change in infra-bony defects over 2 years after bone graft procedures with various graft materials. MATERIAL AND METHODS: Patients attending the department of periodontics of Kyungpook National University Hospital were studied. Patients showed clinical and radiographic evidence of infra-bony defect(s). 44 sites of 34 patients aged 31 to 69 (mean age 48.3) were treated by bone graft procedure with a bone graft material. Baseline and 2-year follow-up radiographs were collected and evaluated for this study. Radiographic assessment includes a bone fill, bone crest change, defect resolution, and % of defect resolution. Pre- and post-treatment differences between variables (maxilla and mandible, defect depth, defect angle, bone graft materials) using the paired t-test were examined. RESULT: We observed 1.15+/-1.95 mm of bone fill, 0.40+/-1.19 mm of crestal resorption, 1.55+/-1.77 mm of defect resolution, and 40+/-44% of percentage of defect resolution. Deeper initial defect depth, narrower initial defect angle showed significantly greater bone fill, defect resolution, and % of defect resolution. But no significant difference was observed in graft sites and graft materials. CONCLUSION: If good oral hygiene maintenance and periodic recall check of patients is assured, bone graft procedure using various graft materials is one of the appropriate treatment modality for regenerative therapy of infra-bony defects.