Prognóstico pulpar após lesões por luxação em dentes permanentes: uma análise de riscos competitivos / A retrospective cohort study of pulp prognosis in luxated permanent teeth: a competing risk analysis

As lesões por luxação representam o grupo de lesões traumáticas dento-alveolares (LTDA) caracterizadas pelo dano simultâneo ao feixe vásculo-nervoso periapical e estruturas de sustentação dentária, em diferentes graus de complexidade, dependendo da força e direção do impacto. A patogenia das alterações pulpares decorrentes das luxações é resultado da extensão da lesão do feixe vásculo-nervoso apical e de sua capacidade de reparo, que determinam os seguintes desfechos para a polpa: manutenção da vitalidade pulpar, manutenção da vitalidade pulpar com obliteração da cavidade pulpar (OCP) ou a necrose pulpar. Entretanto, o processo de reparo pulpar pode envolver fenômenos intermediários cujos sinais e sintomas se modificam ao longo do período de acompanhamento até um diagnóstico definitivo. Sendo assim, do ponto de vista clinico, o tempo até a observação destas respostas, bem como seus fatores determinantes, representa uma informação tão importante quanto o próprio desfecho, pois tem influência direta na tomada de decisão sobre as condutas clinicas mais adequadas. A presente pesquisa consistiu num estudo clínico longitudinal retrospectivo com o objetivo de avaliar o prognóstico pulpar de dentes permanentes portadores de lesões por luxação, seu padrão cronológico e fatores determinantes, entre os pacientes atendidos na Clínica de Traumatismos Dentários da Faculdade de Odontologia da Universidade Federal de Minas Gerais no período de 2014 a 2022. Foram analisados prontuários de 224 pacientes com 427 dentes permanentes portadores de luxações, acompanhados por um período mediano de 1,4 anos (variação de 11 dias a 6,9 anos). O padrão de resposta pulpar foi classificado como manutenção da vitalidade pulpar, OCP e necrose pulpar através da avaliação clínica e radiográfica. Uma análise de sobrevivência utilizando-se o modelo de riscos competitivos foi realizada e curvas de função de incidência acumulada (FIA) foram construídas para se avaliar as taxas de cada um dos desfechos pulpares utilizando-se o estimador de Aalen-Johansen. O efeito de variáveis independentes, incluindo sexo, idade do paciente no momento do trauma, estágio de desenvolvimento radicular, grupo dentário, tipo de luxação, presença de fratura coronária concomitante e prescrição de antibioticoterapia sistêmica (ATS), foi avaliado utilizando-se um modelo multivariado de Cox causa-específico. Os dados foram analisados no programa estatístico R (versão 4.0.4, Viena, Áustria, 2021). Os resultados demonstraram manutenção da vitalidade pulpar em 38,2% da amostra (163 dentes), necrose pulpar em 28,1% (120 dentes) e OCP em 12,9% da amostra (55 dentes). O tempo mediano para o diagnóstico de necrose pulpar foi de 3 meses, enquanto o tempo para vitalidade pulpar foi de 8 meses e para OCP foi de 16 meses A probabilidade de manutenção de vitalidade pulpar diminuiu significativamente com a ocorrência de fraturas coronárias de esmalte e dentina concomitantes (HR 0,38 IC 95% [0,2 ­ 0,8] p = 0,006). A taxa de necrose pulpar foi significativamente menor em dentes com forame apical amplo (HR 0,62 IC 95% [0,4 ­ 0,96] p = 0,03) mas aumentou significativamente em dentes com luxações associadas às fraturas coronárias (HR 4,0 IC 95% [2,6 - 6,1] p = 0,001) e em dentes portadores de luxações intrusivas (HR 2,3 IC 95% [1,2 - 4,1] p = 0,007). Dentes portadores de luxações laterais ou extrusivas (HR 3,0 IC 95% [1,3 ­ 6,9] p = 0,001) ou com forame amplo (HR 2,4 IC 95% [1,2 ­ 4,7] p=0.01) apresentaram as maiores taxas de OCP.

Luxation injuries are a group of traumatic dental injuries (TDI) that involve damage to both the pulp and periodontium, with different degrees of complexity. Pulp damage results from injury to the apical neuro-vascular bundle and, depending on the repair potential, may result in the following outcomes: maintenance of pulp vitality, maintenance of pulp vitality with pulp canal obliteration (PCO) or pulp necrosis. However, the pulp healing process may involve intermediate and reversible phenomena whose signs and symptoms mimic pulp necrosis, rendering the timing of these events critical for decision-making during the follow-up period. The present study consisted in a retrospective cohort to evaluate the pulpal prognosis of luxated permanent teeth, its chronological pattern and predictive factors, among patients treated at the Dental Trauma Clinic of the Federal University of Minas Gerais, from 2014 to 2021. Records of 224 patients with 427 permanent teeth with luxations, followed up for a median period of 1.4 years (ranging from 11 days to 6.9 years) were analysed. Pulp outcomes - maintenance of pulp vitality, PCO and pulp necrosis were defined trough clinical and radiographic evaluation. A competing risk survival analysis was performed and cumulative incidence function (CIF) curves were build using the Aalen-Johansen estimator to assess the rates of each of the pulp outcomes during the follow-up period. The effect of independent variables including patient's gender and age at the time of trauma, tooth group and stage of root development, type of luxation, concomitant injuries, systemic antibiotic therapy (SAT) prescription, was evaluated using a cause-specific Cox regression model. Data were analysed in the R statistical program (version 4.0.4, Vienna, Austria, 2021). The results showed maintenance of pulp vitality in 38.2% of the sample (163 teeth), pulp necrosis in 28.1% (120 teeth) and OCP in 12.9% of the sample (55 teeth). The median time for the diagnosis of pulp necrosis was 3 months, while the time for pulp vitality was 8 months and for PCO was 16 months. The hazards of pulp vitality significantly decreased with the occurrence of concomitant coronal fractures (HR 0 .38 95% CI [0.2 ­ 0.8] p = 0.006). The hazards of pulp necrosis was significantly lower in teeth with a wide apical foramen (HR 0.62 95% CI [0.4 ­ 0.96] p = 0.03) but increased significantly in teeth with luxations associated with crown fractures (HR 4.0 CI 95% [2.6 - 6.1] p = 0.001) and in teeth with intrusive displacement (HR 2.3 CI 95% [1.2 - 4.1] p = 0.007). Teeth with lateral or extrusive luxations (HR 3.0 CI 95% [1.3 ­ 6.9] p = 0.001) or with a wide foramen (HR 2.4 CI 95% [1.2 ­ 4.7] p =0.01) showed the highest rates of PCO.

Exodoncia de tercera y cuarta molar fusionadas. Reporte de caso / Fused third and fourth molar exodontia. Case report

RESUMEN Las anomalías dentarias son producidas por alteraciones en la odontogénesis que se refleja en la variación de tamaño, número y forma de los dientes. Dentro de estas alteraciones se encuentra la fusión dentaria que se considera como la unión de dos gérmenes dentarios que forman una estructura dentaria grande y única. La fusión de las molares es poco habitual tiene una prevalencia muy baja. En el presente caso el diagnóstico fue tercera molar fusionada a cuarta molar retenida en posición vertical. El tratamiento quirúrgico fue la exodoncia a colgajo; para el éxito de la misma se tuvo en cuenta: 1) visualización completa de la corona y 2) eliminación de trabas que impidan la luxación y la avulsión de las piezas fusionadas. Finalmente, la exodoncia se llevó a cabo de manera exitosa.

ABSTRACT Dental anomalies are produced by alterations in odontogenesis which is reflected in the variation in size, number and shape of the teeth. Among these alterations is dental fusion, which is considered as the union of two dental germs that form a large and unique dental structure. The fusion of the molars is rare and has a very low prevalence. In the present case, the diagnosis was that the third molar fused to the fourth retained molar in an upright position. The surgical treatment was flap extraction. For a successful extraction, the following was considered: 1) full visibility of the crown and 2) elimination of obstacles that prevent dislocation and avulsion of the fused pieces. At last, the extraction was carried out successfully.

Clinical observation of 25G vitrectomy and phacoemulsification combined with intrascleral fixated IOL implantation for treatment of complete lens luxation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate efficacy, safety and complications of 25G vitrectomy, phacoemulsification combined with intrascleral fixated intraocular lens(IOL)implantation for treatment of lens luxation.<p>METHODS: Totally 20 patients(20 eyes)with complete lens luxation and the hardness of lens nucleus was grade 3 or above who underwent 25G vitrectomy, phacoemulsification combined with intrascleral fixated IOL implantation between May 2018 and December 2020 were analyzed retrospectively. The uncorrected visual acuity, best corrected visual acuity, intraocular pressure, the count of corneal endothelium cell, central corneal thickness and complications were observed. <p>RESULTS: The uncorrected visual acuity and best corrected visual acuity after operation were improved than those before treatment(<i>P</i><0.05). The number of corneal endothelial cells in the central part of cornea after operation was lower than that before operation(<i>P</i> >0.05). There was no significant difference in central corneal thickness 2wk after operation compared with that before operation(<i>P</i> >0.05). There were 3 cases of low intraocular pressure and 2 cases of high intraocular pressure, but they all returned to normal at the end of follow-up. The IOL were all centered and there were no obvious eccentricity and inclination. No other complications such as vitreous hemorrhage and retinal detachment occurred.<p>CONCLUSION: 25G vitrectomy, phacoemulsification combined with intrascleral fixated IOL implantation is a fast, safe and simple method for the treatment of complete lens luxation.

Factores de riesgo de luxación en una serie de 2732 prótesis totales de cadera / Risk Factors for Dislocation in a Series of 2732 Total Hip Replacements

Introducción: La luxación de la prótesis total de cadera puede afectar los resultados del implante, la calidad de vida del paciente, y el costo del proceso. Su etiología es multifactorial. Objetivos: Identificar posibles factores de riesgo relacionados con la aparición de luxación en prótesis total de cadera en una serie de casos. Métodos: En una serie de 2732 prótesis total de cadera, en la que hubo 92 luxaciones (3,4 por ciento), se compararon factores relacionados con el paciente, el implante, y la técnica quirúrgica uilizada en el Hospital La Paz-IDIPaz de Madrid entre los años 2000 y 2016. Se utilizó el análisis de regresión para la significación de dichos factores. Resultados: De las 92 luxaciones, 62 fueron tratadas de manera conservadora (67,4 por ciento) y 30 pacientes precisaron de cirugía de revisión (32,6 por ciento). El estudio multivariado mostró significación estadística en los siguientes factores de riesgo: estado de la columna lumbar (p < 0,001), y una pobre reconstrucción del centro de rotación de la cadera (p= 0,035), y cúpulas posicionadas fuera de las ventanas de Lewinnek (p < 0,001) y del mecanismo abductor (p < 0,001) en relación con la técnica quirúrgica. No hubo factores significativos en relación con el tipo de implante, diámetro de la cabeza femoral o par de fricción. Conclusiones: La patología lumbar aumenta el riesgo de luxación en la prótesis total de cadera. Una adecuada reconstrucción de la cadera, que incluya la posición de la cúpula y el centro de rotación de la cadera, así como del mecanismo abductor ayudaría a mejorar la tasa de inestabilidad(AU)

Introduction: The dislocation of the total hip replacement can affect the results of the implant, the quality of life of the patient, and the cost of the process. Its etiology is multifactorial. Objectives: To identify possible risk factors related to the appearance of dislocation in total hip replacement in a series of cases. Methods: In a series of 2732 total hip prostheses, in which there were 92 dislocations (3.4percent), factors related to the patient, the implant, and the surgical technique used at La Paz-IDIPaz Hospital in Madrid were compared, from 2000 to 2016. Regression analysis was used for the significance of these factors. Results: Out of 92 dislocations, 62 were treated conservatively (67.4 percent) and 30 patients required revision surgery (32.6 pecent). The multivariate study showed statistical significance in the following risk factors: state of the lumbar spine (p <0.001), and poor reconstruction of the center of rotation of the hip (p = 0.035), and domes positioned outside Lewinnek windows (p <0.001) and the abductor mechanism (p <0.001) in relation to the surgical technique. There were no significant factors in relation to the type of implant, diameter of the femoral head or friction torque. Conclusions: Lumbar pathology increases the risk of dislocation in total hip replacement. Proper hip reconstruction, including the position of the dome and the center of rotation of the hip, as well as the abductor mechanism, would help to improve the rate of instability(AU)

Reconstrucción del ligamento patelofemoral medial con tendón del aductor mayor en pacientes pediátricos con inestabilidad de rótula / Reconstruction of the Medial PatellofemoralLigament with Adductor Magnus Tendon in Pediatric Patients with Patella Instability

Introducción: El ligamento patelofemoral medial se considera el principal estabilizador medial de la rótula. La reconstrucción está indicada en pacientes con luxación recidivante, cuando el tratamiento conservador ha fallado. Objetivo: Describir y evaluar una técnica de reconstrucción del ligamento patelofemoral medial con el tendón del aductor mayor en pacientes con esqueleto inmaduro. Métodos: Estudio anatómico y descriptivo de pacientes en los que se empleó el tendón del aductor mayor para reconstruir el ligamento patelofemoral medial. Después de la cirugía se evaluó reluxación, inestabilidad y satisfacción, con escala de Kujala. Resultados: Se disecaron 5 piezas de cadáveres frescos. El tendón del aductor mayor fue de 8 a 9 cm de longitud. Se realizaron ocho cirugías en siete pacientes entre 8-17 años, uno de ellos con síndrome de Down. El seguimiento mínimo fue 12 meses. No hubo reluxación, el paciente con síndrome de Down presentó subluxación rotuliana. La flexión y extensión de rodillas fue completa. Conclusiones: En pacientes con esqueleto inmaduro con placa de crecimiento del fémur distal presente y cercana al punto isométrico del ligamento, acarrea dificultades para la reconstrucción del ligamento patelofemoral medial. La técnica descrita por Avikainen permite reconstrucción no anatómica del ligamento sin realizar túneles femorales que pongan en riesgo la físis. Este trabajo describe la técnica con aductor mayor. De las ocho rodillas operadas, en solo una se presentó subluxación, en las otras se obtuvo buen resultado, sin luxación, y los pacientes quedaron satisfechos con el resultado(AU)

Introduction: The medial patellofemoral ligament is considered the main medial stabilizer of the patella. Reconstruction is indicated in patients with recurrent dislocation, when conservative treatment has failed. Objective: To describe and evaluate a reconstruction technique of the medial patellofemoral ligament with the adductor magnus tendon in patients with an immature skeleton. Methods: Anatomical and descriptive study of patients in which the adductor magnus tendon was used to reconstruct the medial patellofemoral ligament. After surgery, reluxation, instability and satisfaction were evaluated with Kujala scale. Results: Five pieces of fresh corpses were dissected. The adductor magnus tendon was 8 to 9 cm long. Eight surgeries were performed in seven patients between 8-17 years old, one of them with Down syndrome. The minimum followup period was 12 months. There was no relaxation. The patient with Down syndrome had patellar subluxation. The flexion and extension of the knees was complete. Conclusions: The reconstruction of the medial patellofemoral ligament causes difficulties in patients with immature skeleton, plate growth of the distal femur close to the isometric point of the ligament. The technique described by Avikainen allows non-anatomical reconstruction of the ligament without performing femoral tunnels that put the physis at risk. This paper describes the adductor magnus technique. Only one knee, out of the eight operated, had subluxation. The rest had good result, with no dislocation, and the patients were satisfied with the result(AU)

Luxations traumatiques du coude de l'enfant: aspects épidémiologiques, thérapeutiques et évolutifs / Traumatic dislocations of the elbow in children: epidemiological, therapeutic and progressive aspects

Contexte. Les luxations traumatiques du coude de l'enfant sont des lésions peu fréquentes. Elles nécessitent une prise en charge en urgence afi n d'éviter les complications fonctionnelles. Le but de cette étude était de décrire les aspectsépidémiologiques, thérapeutiques et évolutifs. Méthodes. Il s'agissait d'une étude rétrospective descriptive et analytique des luxations récentes traumatiques du coude. Elle a concerné les patients de moins de 15 ans. Elle a été réalisée du 1er janvier 2016 au 31 décembre 2019 aux urgences de chirurgie. Les données étudiées étaient : les aspects épidémiologiques, thérapeutiques et évolutifs. Un test exact de Fisher a été réalisé pour rechercher les facteurs pouvant infl uencer le résultat fonctionnel. Résultats. Dix-huit luxations traumatiques du coude ont été colligéesdans le service des urgences chirurgicales. Elles représentaient 0,08 % des traumatismes du coude. L'âge moyen était de 10±3,1ans (7-12 ans).Les accidents de jeu étaient l'étiologie la plus fréquente (n=15). La forme convergente postéro-latérale était observée dans tous les cas. La fracture de l'épicondyle médiale (n=3) et la parésie du nerf ulnaire (n=1) étaient associées. Le délai moyen du traitement était de 150±6,8 minutes (60- 360min).Le traitement a été orthopédique. La durée moyennecontention plâtrée était de 25±4,6 jours (21-45 jours).Les résultats fonctionnels globaux selon les critères de Robert étaient excellents dans 14 cas au recul moyen de 06 ±4,7 mois (3-13 mois).Il n'existait aucun lien entre le résultat fonctionnel, le délai de réduction et la présence ou non de lésions associées. Conclusion. Les luxations traumatiques du coude étaient peu fréquentes. La réduction en urgence a donné un bon pronostic fonctionnel.

Evaluation of trochlear dysplasia in dogs with medial patellar luxation: comparative studies

Medial patellar luxation (MPL) is one of the commonest orthopaedic diseases in small dog breeds. Although the bone deformities associated with canine medial patellar luxation are described in numerous studies, the pathogenesis of the condition is still disputable. What is more, there is no categorical evidence that luxation of the patella is associated to a shallow trochlear groove as no objective method for determination of trochlear depth and shape has been proposed. The aim of the present study was to evaluate the depth and shape of femoral trochlear groove on radiographs obtained from healthy dogs and dogs affected with grade II and grade III MPL. A total of 45 dogs (33 with MPL and 12 healthy) from 4 small breeds (Mini-Pinscher, Pomeranian, Chihuahua and Yorkshire terrier) were included in the study. After deep sedation, stifle radiographs were obtained in tangential projection (skyline view). The dogs were positioned in ventral recumbency, the examined stifle bent as much as possible, and the central beam focused on the patella between femoral condyles. Six morphometric parameters associated with the onset of trochlear dysplasia similar to those used in human medicine were measured: trochlear sulcus angle (SA), lateral and medial trochlear inclination angles (LTI; MTI), trochlear groove depth (TD), patellar thickness (PaT) and the ratio between trochlear depth and patellar thickness (PaT/TD). The non-parametric Mann-Whitney test was used for evaluation of differences between healthy joints and those affected with grade II and III MPL. The association between measured variables was evaluated via the Spearman's rank-order correlation. TD was greater in healthy joints as compared to those affected with MPL grade II and III (P < 0.001). In healthy stifles, PaT value exceeded significantly (P < 0.01) that in joints with grade III MPL. The TD/PaT ratio was significantly greater in healthy joints vs both those with grade II (P < 0.01) and grade III MPL (P < 0.001). In healthy joints, there was a significant negative relationship (rho­0.508; P = 0.0113) between SA and TD: smaller sulcus angles corresponded to deeper trochleas. This correlation was even stronger in joints with patellar luxation (rho ­0.723; P < 0.0001). The LTI and MTI showed a very strong positive correlation in healthy joints (rho 0.854; P < 0.0001) and at the same time, lack of significant association in joints affected with MPL (rho -0.163; P = 0.327 for grade II MPL and rho 0.175; P = 0.448 for grade III MPL) was demonstrated. The altered trochlear shape and depth were more pronounced in joints with grade III MPL. As MPL grade increased, the SA became statistically significantly greater. In grade III MPL it was accompanied with considerably reduced trochlear depth, medial trochlear inclination angle and trochlear depth/patellar thickness ratio. Five of the measured morphometric parameters for radiographic detection of trochlear dysplasia in dogs were found to be important in the evaluation of trochlear morphology in dogs. The obtained results indicated the presence of trochlear dysplasia in dogs with MPL. A 3-stage classification system for assessment of abnormal trochlear development in small dog breeds: mild; moderate and severe trochlear dysplasia, was proposed. The occurrence of shallow trochlear groove and medial femoral condyle's hypoplasia could be accepted as signs of mild and moderate trochlear dysplasia. The pre-operative measurements of these parameters could improve surgical planning and decisions-making.

Ex-vivo evaluation of the three-column concept in canine thoracolumbar fractures / [Avaliação em ex-vivo do conceito dos três compartimentos em fraturas toracolombares da coluna]

Traumatic events such as a motor vehicle accident or falling from heights are very common in veterinary medicine and often lead to vertebral fracture-luxation with concomitant spinal cord injuries, mostly in the thoracolumbar spine. The purpose of this cadaveric biomechanical study was to determine the feasibility of the three-column concept in canine thoracolumbar segments with induced fractures. Eighteen Functional Spinal Units (FSU) of the thoracolumbar segments (T12-L2) were collected from 18 medium-sized adult dog cadavers and were subjected to flexion-extension and lateral bending tests so that range of motion (ROM) was recorded with a goniometer. Fractures were induced by compressive loads applied by a universal testing machine (EMIC®). After this, specimens were screened using computed tomography (CT) and the fractures were graded as affecting one, two or three columns, and divided into groups A, B, and C, respectively. Post-fracture range of motion (ROM) was compared with the previous results. Groups B and C (with fractures in two or three columns) had instability in the two axes evaluated (P<0.05). The outcomes of this study support the applicability of the three-column theory to thoracolumbar spines of dogs, as the FSUs that suffered fractures in two or more columns showed axial instability.(AU)

Eventos traumáticos, como acidentes automobilísticos ou quedas, são muito comuns na medicina veterinária e, frequentemente, levam a fraturas ou luxações vertebrais, associadas a lesões medulares concomitantes, mais frequentemente na coluna toracolombar. O propósito deste estudo biomecânico em cadáveres foi determinar a viabilidade da teoria dos três compartimentos em fraturas induzidas em segmentos toracolombares de cães. Dezoito unidades espinhais funcionais (UEF) de segmentos toracolombares (T12-L2) foram coletadas de 18 cadáveres de cães adultos de médio porte e submetidas a testes de flexão-extensão e curvamento lateral, de modo que a amplitude de movimento (ADM) foi registrada com um goniômetro. Fraturas foram induzidas por meio de cargas compressivas aplicadas por uma máquina universal de ensaios (EMIC®). As amostras foram submetidas à tomografia computadorizada (TC), e as fraturas foram classificadas como afetando um, dois ou três compartimentos e divididas nos grupos A, B e C, respectivamente. A ADM pós-fratura foi comparada com os resultados prévios. Os grupos B e C (com fraturas em dois ou três compartimentos) apresentaram instabilidade nos dois eixos avaliados (P<0,05). Os resultados deste estudo corroboram a aplicabilidade da teoria dos três compartimentos para segmentos de coluna toracolombar em cães, uma vez que as UEF que sofreram as fraturas em dois ou mais compartimentos apresentaram instabilidade axial.(AU)

Lateral luxation of incisor - a case report of using a new cone-beam computed tomography software and reposition guideline

Abstract Lateral luxation injuries are one of the most severe periodontal injuries in dental trauma. The correct diagnosis followed by repositioning of the tooth on the right position is fundamental for the periodontal ligament healing. This study reported a clinical case of lateral luxation of maxillary central incisor involving a new cone beam computed tomography (CBCT) software for reconstruction (e-Vol DX) to confirm the lateral luxation after no conclusive dental trauma injury definition by using conventional exam. The lateral luxation injury was digitally reduced by insertion of tooth back to its alveolus, and at the same session, the tooth was stabilized with a rigid splint and further changed to a semi-rigid nylon splint. During the pulpal status monitoring, the pulp was diagnosed necrotic, then the root canal was treated to prevent root resorption. External office-bleaching and restorative procedure was performed. The 4-years follow up and new imaging exam and digital reconstruction confirmed bone healing and no complication. CBCT images analyzed by eVol DX can be used to determine and to guide lateral luxation treatment.

Resumo Lesões de luxação lateral são uma das lesões periodontais mais graves no traumatismo dental. O diagnóstico seguido do reposicionamento do dente na posição correta é fundamental para o reparo do ligamento periodontal. Este estudo relata um caso clínico de luxação lateral do incisivo central superior envolvendo um novo software de reconstrução (e-Vol DX) por tomografia computadorizada de feixe cônico (TCFC) para confirmar a luxação lateral após nenhuma definição de lesão por trauma dental conclusivo pelo exame convencional. A lesão de luxação lateral foi reduzida digitalmente pela inserção do dente de volta ao seu alvéolo e, na mesma sessão, o dente foi estabilizado com uma contenção rígida e posteriormente trocada para uma contenção de nylon semirrígida. Durante o monitoramento da condição pulpar, foi diagnosticada necrose da polpa e, em seguida, o canal radicular foi tratado para evitar a reabsorção radicular. Procedimento externo de clareamento e restauração foi realizado. O acompanhamento de 4 anos e o novo exame de imagem e reconstrução digital não confirmaram reparo ósseo e nenhuma complicação. Imagens de TCFC analisadas pelo e-Vol DX podem ser utilizadas para determinar e orientar lesão de luxação lateral.

Dimensões da patela relacionadas à massa corporal do cão para emprego na confecção de prótese: estudo em cadáver / Patellar dimensions related to canine body mass for use in the manufacture of prosthesis: cadaver study

O objetivo deste trabalho foi mensurar as dimensões da patela de cadáveres caninos e avaliar sua relação com a massa corporal. Para a realização das medidas patelares, foram utilizados 70 cadáveres de cães adultos, com massa corpórea de 1 a 50kg, sem evidência clínica de afecção na articulação femorotibiopatelar. Com auxílio de um paquímetro, foram mensurados os comprimentos externo e interno, a largura externa no terço médio, a largura e a espessura internas nos terços proximal, médio e distal das patelas. Também foram mensuradas a largura nos terços proximal, médio e distal, a profundidade nos terços proximal, médio e distal do sulco troclear; essas medidas foram exclusivamente internas. Observou-se, de forma geral, forte correlação entre as medidas patelares e a massa corporal de cadáveres de cães. Nas condições deste estudo, pode-se concluir que o tamanho da patela varia segundo a massa corporal do cão e que essas medidas devem ser consideradas ao se planejar uma substituição protética.(AU)

The aim of this study was to measure the canine cadaver patellar dimensions and evaluate its relationship with body mass. 70 cadavers of adult dogs were used, with a body mass between 1 and 50kg, without clinical evidence of affection in the stifle joint. The external and internal lengths, external width in the middle third, width and thickness of the proximal, middle and distal thirds were measured using a pachymeter. The width was also measured in the proximal third, middle third and distal third, depth in the proximal third, middle third and distal third of the trochlear groove; these measurements were exclusively internal. A strong correlation was observed between the patellar dimension and body mass of canine cadavers. Under this study conditions, it is possible to conclude that the patellar size varies according to the canine body mass and these measures should be considered when planning a prosthetic replacement.(AU)

Luxación erecta expuesta de hombro en un niño: reporte de un caso / Erect shoulder dislocation in a child: case report / Erecto luxação do ombro em uma criança: relato de caso

La luxación erecta expuesta de hombro es una asociación lesional de muy baja frecuencia en la edad pediátrica. Son más frecuentes las lesiones fisarias y epifisarias que las luxaciones y lesiones ligamentarias. Esto es debido a la presencia de un tejido óseo con gran poder de deformidad elástica y un periostio grueso. Presentamos un caso clínico de un paciente de 11 años de edad que sufrió una luxación erecta expuesta de hombro derecho, producto de una caída de 1 metro y medio de altura. El tratamiento consistió en una limpieza quirúrgica de urgencia, reducción gleno humeral y antibioticoterapia empírica, penicinila 400.000 UI/kg/día fraccionado cada 6 hs y gentamicina 3mg/Kg/día fraccionada cada 8 h por 10 días, inmovilización por 3 semanas con cabestrillo seguido de rehabilitación, y un follow up de 2 años al final del cual el paciente no presento secuelas funcionales en la articulación glenohumeral derecha.

The exposed erect dislocation of the shoulder is a very low frequency lesion association in the pediatric age. The physical and epiphyseal lesions are more frequent than the dislocations and ligament injuries. This is due to the presence of a bone tissue with great elastic deformity power and a thick periosteum. We present a clinical case of an 11-year-old patient who suffered an exposed erect dislocation of the right shoulder, due to a fall of 1 meter and a half high. The treatment consisted of emergency surgical cleaning, humeral gleno reduction and empirical antibiotic therapy, penicinila 400,000 IU/kg/day divided every 6 hours and gentamicin 3mg/Kg/day divided every 8 hours for 10 days, immobilization for 3 weeks with a sling followed by rehabilitation, and a follow-up of 2 years at the end of which the patient did not present functional sequelae in the right glenohumeral joint.

A luxação ereta exposta do ombro é uma associação de lesão de freqüência muito baixa na idade pediátrica. As lesões físicas e epifisárias são mais freqüentes que as luxações e lesões ligamentares. Isto é devido à presença de um tecido ósseo com grande poder de deformidade elástica e um periósteo espesso. Apresentamos um caso clínico de um paciente de 11 anos de idade que sofreu uma luxação ereta exposta do ombro direito, devido a uma queda de 1 metro e meio de altura. O tratamento consistiu em limpeza cirúrgica de emergência, redução de gleno umeral e antibioticoterapia empírica, penicinila 400.000 UI / kg / dia dividida a cada 6 horas e gentamicina 3mg / Kg / dia dividida a cada 8 horas por 10 dias, imobilização por 3 semanas com tipóia seguida de reabilitação e seguimento de 2 anos no final dos quais o paciente não apresentava sequela funcional na articulação glenoumeral direita.

Trauma dentario en una adolescente / Dental trauma in an adolescent

Se describe el caso clínico de una paciente de 15 años de edad, quien producto de un trauma, sufrió luxación intrusiva del 12 y lateral del 11 con pérdida de la vitalidad de ambos dientes. Recibió tratamiento inmediato en cuerpo de guardia con lenta evolución y debido a otras manifestaciones clínicas acudió a la consulta de Estomatología General Integral de la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba. Se le realizó tratamiento endodóntico en ambos dientes y fue remitida a la consulta de Ortodoncia donde se le colocó aparatología fija hasta lograr un resalte y sobrepase funcional.

The case report of a 15 year-old patient is described who as a result of a trauma, suffered intrusive luxation of the 12 and lateral of the 11 with loss of vitality of both teeth. She received immediate treatment in the emergency room with slow course and due to other clinical manifestations she visited the Comprehensive General Stomatology service of Mártires del Moncada Teaching Provincial Stomatological Clinic in Santiago de Cuba . Endodontic treatment was carried out in both teeth and it was referred to the Orthodontics service where fixed aparatology was placed up to achieving a functional resalte y sobrepase.

Traumatismos dentoalveolares: reporte de casos clínicos / Dentoalveolar trauma: report of clinical cases

Los traumatismos dentoalveolares que afectan a escolares pueden involucrar a los tejidos blandos y/o duros de las piezas primarias y permanentes jóvenes. Las causas por las que se producen son múltiples e incluyen caídas, accidentes en el hogar, actividad deportiva en el colegio o el club, accidentes de tránsito. El objetivo de este trabajo es presentar la resolución y el seguimiento a dos años de dos situaciones clínicas de traumatismos dentoalveolares en pacientes escolares que concurrieron a la Universidad de Buenos Aires, Facultad de Odontología, Odontología Integral Niños (AU)

Dentoalveolar trauma in schoolchildren can involve soft and/or hard tissues of deciduous and young permanent teeth. It has multiple causes, including falls, home accidents, sports accidents at school or at a club, and car accidents. The aim of the present work was to show treatmentand two-year clinical follow up of dentoalveolar trauma in schoolchildren seen at the Universidad de Buenos Aires, Facultad de Odontología, Odontología Integral Niños (AU)

Luxação extrusiva de um incisivo central Permanente jovem: relato de caso clínico / Extrusive luxation of an immature permanent central incisor: clinical case report

Objetivo: O objetivo deste artigo é apresentar o relato de um caso clínico de luxação extrusiva de dente permanente com rizogênese incompleta, onde não foi necessária a realização de intervenção endodôntica. Relato de caso: Paciente de 6 anos de idade compareceu ao serviço de urgência da Policlínica Odontológica da Universidade do Estado do Amazonas (UEA) para atendimento após queda durante atividade de lazer, apresentando traumatismo direto na boca. Foi informado durante a consulta inicial que o incidente havia ocorrido há cerca de três dias, e que o atendimento imediato logo após o trauma foi realizado em um Serviço de Pronto Atendimento, porém, nenhum tipo de procedimento na cavidade oral foi realizado. Após exames clínico e radiográfico observou-se que o dente 21 apresentava deslocamento parcial para fora do alvéolo dentário no sentido axial, com alteração da oclusão, dor local à palpação e mobilidade dentária. Foi realizada profilaxia da área afetada, e anestesia do dente luxado e tecidos adjacentes. O reposicionamento do dente foi realizado em seguida, pressionando-o e tracionando-o de forma suave e contínua até a sua correta posição dentro do alvéolo. A área afetada foi limpa com gaze estéril embebida em soro fisiológico, e foi instalada uma contenção rígida confeccionada com fio ortodôntico e resina composta. Conclusão: O reposicionamento da maneira adequada do dente traumatizado dentro do alvéolo dentário, num período de tempo hábil, seguido de sua proservação, permitiram a manutenção da vitalidade do tecido pulpar, e consequentemente, o desenvolvimento do segmento radicular.

Objective: The objective of this article is to present a clinical case of extrusive luxation of an immature permanent tooth, with no endodontic management. Case report: A 6-year-old patient was provided to emergency treatment at the State University of Amazonas, as a result of a fall, with a direct trauma to the mouth. It was informed during the initial consultation that the incidente has occurred three days after. Emergency examination had been carried out by an Emergency Service; however, any type of procedure in the oral cavity was performed in ths occasion. After clinical and radiographic examinations, it was observed that tooth 21 presented partial displacement from the alveolar socket in the axial direction, with occlusion alteration, local pain to palpation and dental mobility. Cleaning of the affected area and anesthesia of the dislocated tooth and adjacent tissues were performed. Then, tooth repositioning was performed by pressing and tracing it smoothly and continuously until its correct position within the alveolar socket. The affected area was cleaned with sterile gauze soaked in saline solution, and a rigid containment made of orthodontic wire and composite resin was installed. Conclusion: A proper repositioning of the traumatized tooth within the alveolar socket, followed by its clinical followup, allowed the pulp tissue to remain vital, and consequently, the complete development of the root portion

Luxofractura tarsometatarsiana asociada a luxación mediotarsiana y subastragalina / Fracture-luxation tarsométatarsienne associée à luxation médiotarsienne et sous-astragalienne / Tarsometatarsian luxofracture associated with midtarsal dislocation and subastragalina

Las lesiones del pie son difíciles de tratar por la complejidad anatómica de la región y por su infraestimación diagnóstica y terapéutica. Por lo general, se producen por traumas de alta energía. Se presenta un paciente del sexo masculino, blanco, de 56 años de edad, que llegó al cuerpo de guardia de emergencia con múltiples traumas producto de un accidente automovilístico. Se diagnosticó una luxofractura tarsometatarsiana asociada a luxación mediotarsiana y luxación subastragalina. Con criterio de tratamiento quirúrgico de urgencia fue llevado al salón de operaciones y se le realizó la reducción cerrada de la articulación mediotarsiana y subastragalina, y la estabilización con clavo de Steimann. La evolución fue satisfactoria tras el tratamiento quirúrgico(AU)

Foot injuries are difficult to treat due to the anatomical complexity of the region and the diagnostic and therapeutic underestimation. Generally, high-energy trauma produced this kind of injuries. We present a 56 year-old, white, male patient, who arrived at the emergency room with multiple traumas resulting from a car accident. The diagnosis was a tarsometatarsal luxo-fracture associated with midtarsal dislocation and subtalar dislocation. He underwent an emergency surgical treatment to closed reduce of the midtarsal and subtalar joint, and stabilization was achieve with Steinmann Pins. The evolution was satisfactory after the surgical treatment(AU)

Les lésions du pied sont difficiles à traiter due à la complexité anatomique de cette région et à leur faible estimation diagnostique et thérapeutique. En général, ces lésions résultent des traumatismes à haute énergie. Le cas d'un patient âgé de 56 ans, blanc, arrivé au service d'urgence avec plusieurs traumatismes causés dans un accident de route, est présenté. Une fracture-luxation tarsométatarsienne, associée à une luxation médiotarsienne et une luxation sous-astragalienne, a été diagnostiquée. Répondant à un critère d'urgence chirurgicale, il a subi une réduction fermée de l'articulation médiotarsienne et sous-astragalienne et une stabilisation par clou de Steinmann. Son évolution a été satisfaisante après ce geste chirurgical(AU)

Patellar luxation and articular lesions in dogs: a retrospective: study research article / Luxação de patela e lesões articulares em cães: estudo retrospectivo

This study describes lesions that occur in the stifle joints of dogs with patellar luxation. These lesions are associated with the animal's age, body weight, and degree of luxation. The rate of redislocation was also evaluated. The patellar lesions found include articular cartilage erosion, subchondral bone exposure, a flattened or concave patellar surface, and enthesophytes. Extra-patellar lesions included synovitis, osteophytes, blunting of the trochlear groove, an absent trochlea, erosion of the condylar margins, capsule thickening, a long digital extensor tendon injury, cranial cruciate ligament rupture, and meniscal prolapse. Such lesions were frequently found in animals with Grade II or III luxation who were aged 24 months or more, and they were more severe in dogs weighing more than 15 kg. Patellar luxation causes changes that favor articular degeneration and should be treated surgically. Conservative treatment relieves pain, but does not address tissue alterations.(AU)

O estudo descreve as lesões articulares em cães com luxação de patela. Elas foram associadas com a idade do animal, massa corporal e grau de luxação. Foi avaliada também a porcentagem de casos com recidiva. As lesões patelares observadas foram erosão da cartilagem articular, exposição óssea subcondral, superfície patelar achatada ou côncava e entesófitos. As lesões extra patelares incluíram sinovite, osteófitos, ausência do sulco troclear, erosão das bordas condilares, espessamento da cápsula, lesão do tendão do músculo extensor digital, ruptura do ligamento cruzado cranial e prolapso de menisco. As lesões foram encontradas com maior frequência em animais com luxação de Grau II ou III e idade de 24 meses ou mais, sendo mais graves em cães com massa corporal superior a 15 kg. A luxação patelar ocasiona alterações que favorecem a degeneração articular e devem ser tratadas cirurgicamente. O tratamento conservativo alivia a dor, mas não corrige as alterações teciduais.(AU)

Luxo-fractura de Chopart / Fracture-luxation de l'articulation de Chopart / Chopart luxo-fracture

La articulación de Chopart o transversa del tarso está constituida por la articulación calcaneocuboidea y la astragaloescafoidea. Las lesiones que ocurren en estas articulaciones se conocen como luxo-fractura de Chopart y son extremadamente raras. Entre las causas más frecuentes se encuentran los accidentes en motocicletas y las caídas de altura. El tratamiento es la reducción anatómica y fijación estable. La necrosis avascular del astrágalo, así como la artritis postraumática son las complicaciones más temidas. Con este trabajo se pretende describir la conducta y evolución perioperatoria de dos pacientes con luxo-fractura de Chopart, atendidos en el Servicio de Urgencias del Hospital Militar Central Dr Luis Díaz Soto. Fueron diagnosticados tempranamente y se les realizó reducción abierta más fijación interna con una recuperación en los primeros tres meses. La baja prevalencia de la luxo-fractura de Chopart requiere un diagnóstico adecuado y correcto para lograr un buen resultado clínico(AU)

The Chopart joint or transverse tarsus is constituted by the calcaneocuboid and the astragaloescafoidea joints. The injuries that occur in these joints are known as Chopart luxo-fracture and are extremely rare. Motorcycle accidents and falls from heights are among the most frequent causes of Chopart luxo-fractures. The treatment is the anatomical reduction and stable fixation. The avascular necrosis of the talus, as well as post-traumatic arthritis are the most feared complications. This paper aims to describe the behavior and perioperative evolution of two patients with Chopart luxo-fracture, treated in the Emergency Service at Dr Luis Díaz Soto Central Military Hospital. They were early diagnosed and underwent open reduction and internal fixation. They recovered in the first three months. The low prevalence of Chopart luxo-fracture requires adequate and correct diagnosis to achieve good clinical results(AU)

L'articulation de Chopart, ou médio-tarsienne, est constituée de deux articulations distinctes: l'articulation calcanéo-cuboïdienne et l'articulation astragalo-scaphoïdienne. Les lésions produites dans ces articulations sont connues comme des fractures-luxations de l'articulation de Chopart, et sont assez rares. Parmi les causes les plus fréquentes, on peut trouver les accidents du trafic (surtout, de moto) et les chutes de haut. Le traitement consiste généralement à une réduction anatomique et une fixation stable. La nécrose avasculaire de l'astragale et l'arthrite post-traumatique sont les complications les plus souvent à craindre. Le but de ce travail est de décrire le comportement et l'évolution péri-opératoire de deux patients atteints d'une fracture-luxation de l'articulation de Chopart, et traités au service d'urgence de l'hôpital militaire Dr Luis Díaz Soto. Ils sont rapidement diagnostiqués, et traités par réduction ouverte et fixation interne. Leur récupération est réussie en trois mois. La faible prévalence de la fracture-luxation de l'articulation de Chopart exige un diagnostic précis pour atteindre de bons résultats cliniques(AU)

Estudo clínico e epidemiológico em cães com fraturas e luxações vertebrais toracolombares / Clinical and epidemiological study in dogs with thoracolumbar vertebrae fractures and luxations

Fraturas e luxações vertebrais (FLV) estão dentre as principais afecções que acometem a coluna vertebral em cães, com elevado risco de danos permanentes às estruturas neurais. Objetivou-se estudar as características e implicações associadas às FLV toracolombares em 37 cães, visando auxiliar uma melhor abordagem clínica em pacientes com esta afecção. As FLV foram mais comuns em machos não castrados com acesso a rua. Dentre a etiologia, 32 cães foram acometidos por acidente automobilístico. 14 cães apresentaram lesões não neurológicas em outros sistemas orgânicos. A presença de fraturas instáveis foi a alteração radiográfica mais comum. Em 16,2% dos animais, observaram-se lesões vertebrais fora do foco principal. O tempo até o atendimento neurológico inicial variou de um a 720 dias, no qual a maioria foi encaminhada sem imobilização externa. Houve diferença estatisticamente significante quanto à recuperação neurológica ao se comparar os graus de deslocamento de 0 a 25% e de 76 a 100%.(AU)

Vertebral fractures and luxations (VFL) are one of the most common and severe neurological issues found in clinical practice, with an elevated risk of permanent damage to the spinal cord. Our objective was to study the characteristics and implications associated with thoracolumbar VFL in 37 dogs, aiming assist a better clinical approach to patients with this disease. The VFL were more common in intact males with access to the street. Regarding etiology, 32 dogs were involved in car accidents. Of the dogs included in this research, 14 had non-neurological issues in other systems. The presence of unstable fractures was the most common radiographic change. In 16.2% of the dogs, vertebral lesions were observed outside the main site. Mean time until initial neurologic exam varied between one and 720 days, and most dogs were referred without external coaptation. There was a significant difference in recovery of the dogs when comparing a degree of dislocation of 0 to 25% and 76 to 100%.(AU)

Caudoventral hip luxation in a miniature pig / Luxação caudoventral de quadril em um mini-pig

ABSTRACT: A miniature pig was examined because of left pelvic limb lameness after falling from a short height. Clinical examination and radiographs of the pelvic region revealed a left caudoventral hip luxation. Surgical reduction of luxation was performed on the patient under general anesthesia using a transarticular pinning technique. Postoperative radiographs confirmed that the luxation was reduced, the joint was aligned, and the transarticular pinning was correct. The transarticular pin was removed 21 days after it was surgically inserted. The limb was fully functional in the immediate postoperative period. Nine months after the surgery, the patient could use the limb properly, but mild degenerative joint disease was observed via radiographic follow-up. This technique may be a viable treatment option for the repair of caudoventral hip luxation in miniature pigs.

RESUMO: Um mini-pig foi atendido devido à claudicação do membro pélvico esquerdo após pequena queda. O exame clínico e radiografias da região pélvica revelaram uma luxação caudoventral de quadril no lado esquerdo. A redução cirúrgica da luxação foi realizada, com o paciente sob anestesia geral, usando um pino transarticular. As radiografias pós-operatórias confirmaram que a luxação foi reduzida, com alinhamento e fixação transarticular corretos. O pino transarticular foi removido cirurgicamente 21 dias após de ter sido inserido. O membro se tornou totalmente funcional já no período pós-operatório imediato. Nove meses após a cirurgia, o paciente utilizava o membro corretamente, porém foi detectada doença articular degenerativa leve através de acompanhamento radiográfico. A técnica empregada foi uma opção viável de tratamento para a reparação da luxação caudoventral de quadril em mini-pig.

Análisis de las complicaciones en pacientes con fractura-luxación de Lisfranc / Complication analysis in Lisfranc fracture-dislocation

Resumen: Objetivo: Valorar las complicaciones y secuelas del tratamiento de la fractura-luxación de Lisfranc (FLL). Material y métodos: Se realizó un estudio de cohortes ambispectivo trasversal de 83 pacientes con diagnóstico de fractura-luxación de Lisfranc. Se utilizó un protocolo de recopilación de datos con variables relacionadas con la lesión, parámetros clínicos, terapéuticos, complicaciones y escalas de valoración clínica. Resultados: 66 pacientes (79.5%) presentaron complicaciones tanto precoces como tardías. Las complicaciones precoces sumaron nueve casos de edema postoperatorio, tres de infección superficial, dos de necrosis cutánea que precisó injerto libre de piel (ILPH), uno de lesión vascular, uno de tromboembolismo pulmonar (TEP), uno de pérdida de reducción en el postoperatorio precoz, uno de mala reducción que precisó de nueva intervención. Entre las complicaciones tardías, 41 pacientes (49.40%) presentaron signos radiológicos de artrosis en la articulación tarsometatarsiana, cinco con enfermedad de Sudeck que precisó tratamiento, ocho con descalcificación por desuso, 12 con edema residual, uno con pérdida de reducción en fase tardía, uno con cicatriz hipertrófica y brida retráctil, uno con osteomielitis crónica, uno con seudoartrosis, tres con intolerancia/infección tardía al material de osteosíntesis; también hubo reintervención de siete pacientes en fase de secuelas donde se les realizó artrodesis. No se observó ninguna rotura de material de osteosíntesis. Casi la mitad de los pacientes (49.4%) recibieron algún tipo de indemnización económica tras el accidente. Conclusiones: El tratamiento de las FLL debe realizarse lo antes posible, ya que la estabilización en un breve plazo de tiempo puede ayudar a mejorar los resultados. La reducción anatómica no predice los buenos resultados. Un número importante de pacientes refirió dolor residual.

Abstract: Objective: To value the complications and sequels for patients with Lisfranc's fracture-luxation (FLL). Material and methods: A transverse ambispective study of cohorts was realized of 83 patients by diagnosis of Lisfranc's fracture-luxation. There was in use a protocol of withdrawal of information with variables related to the injury, clinical, therapeutic parameters, complications and scales of clinical valuation. Results: 66 patients (79.5%) presented complications grouping early and late. Analyzing the early complications, we observe 9 cases of postoperatory edema with inflammation and swelling, 3 cases of superficial infection, 2 cases of necrosis cutaneous that precise graft should free of skin (ILPH), 1 case of vascular complication, 1 case of pulmonary embolis (TEP), 1 case of loss of reduction in the precocious postoperatory, 1 case of bad reduction that was necessary new intervention. The late complications presented the following distribution: 41 patients (49.40%) presented radiological signs of degenerative osteoarthritis in the tarsometatarsal joint, 5 cases of Sudeck's disease that needed treatment, 8 cases of decalcification for disuse, 12 cases of edema and residual inflammation, 1 case of loss of reduction in late phase, 1 case of hypertrophic scar with retractable bridle, 1 case of chronic osteomyelitis, 1 case of seudodegenerative osteoarthritis, 3 cases of late intolerance/infection to the osteosynthesis material, reintervention of 7 patients in phase of sequels where they were realized artrodesis. No break of material was observed of osteosynthesis. Almost the half of the patients (49.4%) they received some type of economic indemnification after the accident. Conclusions: The treatment of the FLL must be realized as soon as possible, providing that the general condition of the patient and of the soft parts allows it, since the stabilization in the brief space of time can help to improve the results. The anatomical reduction cannot grant a good result. An important number of patients had residual pain.