Osteossíntese de fêmur e tíbia em veado-catingueiro (Mazama gouazoubira): relato de caso / Osteosynthesis of the femur and tibia of a brown brocket deer (Mazama gouazoubira): case report

O presente estudo relata o caso de um veado-catingueiro jovem, provindo de vida livre e com histórico de atropelamento. Posteriormente à realização de exames, o animal foi diagnosticado com fratura exposta distal de tíbia (Salter-Harris tipo I) e fratura cominutiva de metáfise distal de fêmur, ambas em membro pélvico esquerdo. Para a osteossíntese da tíbia, foram utilizados pinos intramedulares de Steinmann inseridos pelos maléolos lateral e medial, de forma cruzada. A osteossíntese do fêmur foi realizada com associação de dois pinos de Steinmann, conforme técnica modificada de Rush, e placa de compressão dinâmica. As técnicas cirúrgicas adotadas foram satisfatórias para estabilização, consolidação de ambas as fraturas e retorno funcional do membro. Após 90 dias da cirurgia, o animal foi reintroduzido à natureza.(AU)

The present study reports the case of a juvenile wild brown brocket deer, with car accident history. After a complete examination, the animal was diagnosed with open distal tibial fracture (Salter-Harris type I) and comminuted fracture of the distal metaphysis of the femur, both in the left hindlimb. For the tibial osteosynthesis, Steinmann pins were used intramedullary, inserted by the lateral and medial malleolus, crosswise. The osteosynthesis of the femur was performed with a combination of two Steinmann pins, as modified Rush technique, and a dynamic compression plate. The surgical techniques used were satisfactory for stabilization, consolidation of both fractures and function return of the member. Ninety days after surgery the animal was reintroduced to nature.(AU)

Measurements of femoral angles, femur length, and hip width in cat radiographs / Medidas dos ângulos femorais, comprimento do fêmur e largura do quadril em radiografias de gatos

Femoral angle, femur length, and hip width were measured in radiographs of 92 intact domestic cats, males and females of mixed breed from the Center for Zoonosis Control of the Federal District. The animals showed no trauma, orthopedic diseases or angular deformities and had closed physeal lines. Accordingly, we measured aLPFA (anatomical lateral proximal femoral angle, aLDFA (anatomical lateral distal femoral angle), mLPFA (mechanical lateral proximal femoral angle), mLDFA (mechanical lateral distal femoral angle), IA (femoral inclination angle), FL (femur length) and HW (hip width) using ventrodorsal radiographs, with both hindlimbs in a single exposure to an X-ray beam centered on the hip. The mean values of the variables were: mLPFA: 82.5±3.62°; aLPFA: 80.1±4.29°; mLDFA: 96.1±3.51° (males) and 97.3±2.05° (females); aLDFA: 94,3±3.43°; IA: 136.6±3.86°; FL: 12.9±0.55cm (males) and 13.4±0.66cm (females); and HW: 3.1cm±0.23 (males) and 3.5±0.26cm (females). These values will serve as a reference for the diagnosis of angular deformities and as support for planning corrective osteotomies in domestic cats.(AU)

Foram realizadas mensurações radiográficas dos ângulos femorais e medidas lineares do quadril e do fêmur em 92 gatos domésticos, machos e fêmeas, SRD, oriundos do Centro de Controle de Zoonoses do Distrito Federal, livres de traumas, doenças ortopédicas e deformidades angulares em membros pélvicos, portadores de linhas fiseais fechadas, não castrados. Para tanto, foram obtidos os ângulos aLPFA (ângulo anatômico lateral proximal do fêmur), aLDFA (ângulo anatômico lateral distal do fêmur), mLPFA (ângulo mecânico lateral proximal do fêmur), mLDFA (ângulo mecânico lateral distal do fêmur), AI (ângulo de inclinação do fêmur), CF (comprimento femoral) e LQ (largura de quadril), empregando radiografias em projeções ventrodorsais, com ambos os membros em uma única exposição ao feixe de raios-X, centrada no quadril. Após a apuração dos resultados, os valores médios obtidos foram: mLPFA: 82,5°±3,62, aLPFA: 80,1°±4,29; mLDFA: 96,1°±3.51 (machos) e 97,3°±2,05 (fêmeas), aLDFA: 94,3,6°±3,43; AI: 136,6°±3,86; CF: 136,6°±3,86; 12,9cm±0,55 (machos) e 13,4cm±0,66 (fêmeas) e LQ: 3,1cm±0,23 (machos) e 3,5cm±0,26 (fêmeas), respectivamente. Esses valores servem como referenciais para diagnósticos de deformidades angulares e apoio para planejamento de osteotomias corretivas em felinos domésticos.(AU)

Inestabilidad patelofemoral asociada a displasia severa de tróclea: presentación de un paciente tratado con trocleoplastía / Patellofemoral instability associated with severe trochlear dysplasia treated with trochleoplasty. case report

La inestabilidad rotuliana crónica, relacionada a displasia severa de la tróclea determina plantear procedimientos como la trocleoplastía para restablecer el encarrilamiento rotuliano y la anatomía funcional. Se presenta un caso luxación crónica de rótula asociado a una displasia severa de tróclea, al cual se le realizó una trocleoplastía asociada a osteotomía de la tuberosidad anterior de la tibia y reconstrucción del ligamento patelofemoral medial. Tipo de estudio: Reporte de Caso. Nivel de evidencia: V.

Chronic patellar instability related to severe trochlear dysplasia requires procedures such as trochleoplasty to restore patellar tracking and functional anatomy. We present a case of chronic knee dislocation associated with severe trochlear dysplasia, treated with a trochleoplasty associated to a Tibial Anterior Tuberosity osteotomy and Medial Patello-Femoral Ligament reconstruction. Type of study: Case Report. Level of evidence: V.

Síndrome de hipoplasia femoral y facies inusual: reporte de un caso / Femoral hypoplasia-unusual facies syndrome: A case report

Introducción: El síndrome de hipoplasia femoral y facies inusual es una enfermedad rara con expresividad hereditaria variable, aunque se han reportado casos con un patrón autosómico dominante. Afecta particularmente las estructuras de la cara asociado a hipoplasia de fémur. Si bien su etiología no ha sido bien identificada, se ha asociado con diabetes materna, exposición a drogas, infecciones virales, radiaciones y oligohidramnios. Objetivo: Presentar el caso de una recién nacida con este síndrome. Caso clínico: Recién nacida de 41 semanas de gestación con nariz pequeña, labio superior delgado, micrognatia, filtrum largo, implantación baja de orejas, epicanto, cadera displásica con flexión y aducción de miembro inferior derecho y acortamiento del mismo a expensas del muslo. En la imagen radiográfica se encontró hipoplasia de fémur derecho con techo acetabular ipsilateral displásico. Se realizó una evaluación completa por distintos especialistas que descartaron otras malformaciones asociadas. Se programó el alargamiento quirúrgico de miembros inferiores a la edad de 5 meses con la finalidad de que deambule con sus propios pies; paralelamente se inició apoyo con kinesiterapia. Conclusiones: El síndrome de hipoplasia femoral y facies inusual es un padecimiento poco frecuente, que implica la participación de un equipo médico multidisciplinario para su manejo.

Introduction: Femoral hypoplasia-unusual facies syndrome is a rare disease with variable expressivity, although cases have been reported with an autosomal dominant pattern. It particularly affects the structures of the face associated with hypoplasia of the femur. Its aetiology is relatively unknown. However, this syndrome has been associated with maternal diabetes, drug exposure, viral infections, radiation, and oligohydramnios. Objective: The case of a newborn with this syndrome is presented. Clinical case: Newborn of 41 weeks gestation with small nose, thin upper lip, micrognathia, long philtrum, low set ears, epicanthal folds, dysplastic hips showing flexion, and adduction of the right leg, and shortening at the expense of the thigh. X-ray images revealed femoral hypoplasia and dysplastic acetabular roof. Different physicians from other specialties who excluded other associated malformations performed a complete evaluation. Surgical bone lengthening of lower limb is scheduled at 5 months of age, with the purpose that she walks with her own feet; at the same time she began management with kinesiotherapy. Conclusions: Femoral hypoplasia-unusual facies syndrome is a rare condition. A multidisciplinary health care team must treat individuals with femoral hypoplasia-unusual facies syndrome.

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

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

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

Femoral Focal Deficiency: A Rare Case Report.

Proximal focal femoral deficiency is an uncommon congenital deformity characterized by defective morphogenesis of the proximal femur resulting in shortening of the affected limb. Incidence being 1/50000 to 1/200,000 populations. The etiology is unknown and idiopathic. Often the diagnosis is made by radiological evaluation, which helps in identifying and evaluation of associated limb anomalies. When in doubt magnetic resonance imaging help to find out whether the cartilaginous femoral head is present or not. Usually a disorder is unilateral, but bilateral involvement is seen rarely. May be associated with other anomalies like cleft palate, spinal anomalies, and congenital heart defects. Treatment goals being satisfactory ambulation and specific treatment depending on the age of presentation and severity of dysplasia.

Dysplasia epiphysealis hemimelica with bony and soft-tissue abnormalities: a case report and review of the literature

We report a case of a 3-year-old boy with dysplasia epiphysealis hemimelica [DEH] who presented with a hard painless swelling on the medial side of his left ankle joint. Plain X-rays, CT and MRI showed a bony tumor and associated soft-tissue abnormalities. At age one year, he had been diagnosed with an osteochondroma and underwent incomplete surgical excision at a local hospital. Due to joint impingement and restricted movement, we chose to completely excise the tumor. Pathologically, the specimen showed evidence of an osteochondroma. From its clinical, imaging, and pathological features and reports in the medical literature, a diagnosis of DEH was established. DEH is a rare variant of osteochondroma, resulting in many patients being incorrectly diagnosed or diagnosed with osteochondroma alone. It is important to low-grade malignant tumor or osteochondroma-like parosteal osteosarcoma from DEH of the talus, especially when accompanied by soft tissue abnormalities. Surgical treatment is mandatory in patients with symptoms such as pain, joint impingement and deformation. Incomplete excision of an articular lesion may lead to recurrence and additional surgery, making it less than complete excision

Diagnóstico ecográfico prenatal de sirenomelia: a propósito de un caso / Prenatal ultrasound diagnosis of Sirenomelia: about a case

RESUMEN La sirenomelia constituye una anomalía congénita rara. Su incidencia es de 1:60.000 nacidos vivos. Es causada por un defecto vascular disruptivo y caracterizado por la fusión de las extremidades inferiores, asociados a anomalías cardiacas, renales, de pared abdominal y torácica, vértebras inferiores, tubo digestivo inferiores, genitales y de las arterias umbilicales. Se presenta la experiencia de un caso de sirenomelia que se ha podido diagnosticar con la ecografia prenatal.

ABSTRACT Sirenomelia is a very rare congenic anomaly. Being its incidence of approximately 1:60.000 live born, caused by a vascular disruptive defect, characterized by the fusion of lower limbs, associated to cardiac, renal, abdominal wall, and thoracic anomalies; also characterized by inferior vertebrae, inferior digestive tract, genital and umbilical artery anomalies A case of sirenomelia has been diagnosed thanks to prenatal echography.

Revisión de conceptos actuales: actualización en pinzamiento femoroacetabular / Current concepts: labral hip impingement

Durante el último siglo múltiples autores han sugerido que la etiología de la osteoartritis (OA) de la cadera se encuentra relacionada más con la morfología que con la carga que esta recibe. Recientemente fue propuesto el concepto de pinzamiento femoroacetabular (PFA) como una explicación del papel que juegan las distintas alteraciones morfológicas de la cadera en el desarrollo de OA en pacientes jóvenes sin displasia. Históricamente se han descrito múltiples patologías (enfermedad de Legg-Calvé-Perthes, fracturas del fémur proximal, deslizamiento epifisario de la cabeza femoral, displasia del desarrollo de la cadera, etc.) capaces de desencadenar el desarrollo de OA de la cadera, pero las mismas representan un porcentaje muy bajo y la mayoría de los pacientes que la desarrollan carecen de condiciones predisponentes. Sin embargo, la evidencia reciente muestra que en pacientes activos las alteraciones morfológicas sutiles que afectan al fémur proximal o el acetábulo son la causa más común de pinzamiento femoroacetabular.

Limb Angular Deformity Correction Using Dyna-ATC: Surgical Technique, Calculation Method, and Clinical Outcome

PURPOSE: Dyna-ATC is a unilateral external fixator with angulator, lengthener, and translator, which allows for angular correction and compensation of the secondary displacement during angular correction. The purpose of this study is to introduce surgical technique and calculation methods and to evaluate the clinical outcome of angular deformity correction using Dyna-ATC. MATERIALS AND METHODS: The amounts of secondary displacement were calculated with the distances between axis of correction of angulation, Center of Rotational Angulation, and osteotomy and the amount of angular deformity. The rate of angular correction was determined to distract the corticotomy at 1 mm/day. Clinical and radiographic evaluation was performed on 13 patients who underwent deformity correction using Dyna-ATC. There were 8 proximal tibia vara, 1 tibia valga, 2 varus and 4 valgus deformities on distal femur. One patient underwent pelvic support femoral reconstruction. Concomitant lengthening was combined in all femur cases. Mean age at surgery was 17.5 years (7 to 64). RESULTS: All but one achieved bony healing and normal alignment with the index procedure. Mean mechanical axis deviation improved from 31.9 mm to 3.0 mm. The average amount of angular correction was 11.0degrees on tibiae and 10.0degrees on femora. The average length gain on femora was 6.4 cm, and the healing index averaged to 1.1 mo/cm. One patient underwent quadricepsplasty and one patient had three augmentation surgeries due to poor new bone formation. CONCLUSION: We believe that Dyna-ATC is a useful alternative to bulky ring fixators for selective patients with angular deformity less than 30 degrees in the coronal plane around the knee joint.

Distal femoral duplication and fibular agenesis associated with congenital cardiac defect.

A newborn, who had the congenital anomalies including protuberance on the right lower leg, bilateral equinovarus deformity of the feet, genu valgum with knee flexion deformity, syndactyly between the first and the second digit on the right, in addition with the absence of the fifth digit is reported here. Echocardiography revealed a secundum type atrial septal defect. The combination of these congenital defects associated with developmental anomalies of lower extremities. The clinical, radiological findings and pathogenesis of this lower extremity malformation is discussed.

Pyle metaphyseal dysplasia.

Pyle type metaphyseal dysplasia is a rare autosomal recessive disease that primarily affects metaphyses. We report a 12 year old boy with Pyles disease. He had mild facial dysmorphism, genu valgum and wasting of legs. Skeletal radiology revealed the characteristic Erlenmeyer flask sign at distal femoral and proximal tibial metaphyses along with platyspondyly.

Osteotomia de Wagner modificada para el tratamiento de la coxa vara infantil: Descripcion de la tecnica y analisis de los resultados / Modified Wagner osteotomy for the treatment of infantile coxa vara deformity: Technique description and analysis of the results

Introducción: Se han descrito múltiples procedimientosquirúrgicos para la corrección de la coxa vara infantil. En los pacientes pequeños la fijación interna es difícil por el tamaño de los fragmentos y la posibilidad de producir el cierre de la fisis. En 1978, Wagner describió una técnica utilizando numerosas clavijas de Kirschner para la estabilización. Sólo un estudio informa los resultados obtenidos con una técnica similar. El objetivo de este trabajo es describir la técnica utilizada y evaluar los resultados clínico- radiográficos obtenidos. Materiales y métodos: Se analizaron 16 osteotomías realizadas en 15 pacientes consecutivos tratados en el período comprendido entre enero de 2000 y enero de 2006. El promedio de edad fue de 6,9 años. El seguimiento promedio fue de 43,3 meses. Se evaluaron parámetros clínicos: dolor, claudicación y signo de Trendelenburg; y radiológicos: ángulo cervicodiafisario (ACD) y ángulo epifisario (AE). Resultados: Las etiologías fueron diversas: seis secuelasde artritis séptica, tres traumáticas, tres condrodisplasias metafisarias, tres displasias epifisarias múltiples y una secuela de displasia del desarrollo de la cadera. En el 82% de los casos mejoró la claudicación y el signo de Trendelenburg.Los valores radiológicos presentaron una mejoríasignificativa: ACD 137,72°; AE 34,33° (p < 0,0005). Conclusiones: En esta serie, la técnica de Wagner modificada permitió una importante mejoría clínica y radiográfica. Es un método sencillo, económico, que proporciona una fijación aceptable sin daño de la fisis.

Osteotomia de soporte pelvico y elongacion femoral distal con fijador externo monolateral / Pelvic support osteotomy and distal femoral lengthening with monolateral external fixator

Introduccion: La inestabilidad de la cadera como secuela de defectos estructurales del fémur proximal puede ser un cuadro muy incapacitante. La osteotomía de soporte pélvico (OSP) con el método de Ilizarov es una opción terapéutica válida para su tratamiento. Se ha introducido hace poco un tutor monolateral de cabezales móviles como una variante a este procedimiento, que otorga mayor comodidad al paciente. Materiales y métodos: Se evaluaron 13 pacientes consecutivos tratados entre enero de 2002 y diciembre de 2006. El promedio de edad fue de 13,7 años (rango 7-17 años). El seguimiento promedio fue de 36,4 meses (rango 12-61 meses). Los resultados fueron evaluados clínica y radiográficamente. Se utilizó el score Harris y el test de Trendelenburg para la evaluación clínica. Se analizaron radiográficamente la desviación del eje mecánico (DEM) y la discrepancia de longitud (DLM). Resultados: Todos los pacientes se encuentran sin dolor. El score de Harris mejoró significativamente de 56,6 en el preoperatorio (rango 42-72 puntos) a 85,1 (74-96 puntos) en el último seguimiento (p < 0,001). El signo de Trendelenburg se negativizó o disminuyó en todos los casos. La DEM fue de 1,01 cm promedio, en sentido medial. La DLM mejoró de 5,1 cm (rango 2,5-11 cm) a 1,3cm (rango 0-4 cm) (p = 0,001). Conclusiones: La OSP con fijador externo monolateral permite la corrección de la marcha en Trendelenburg y de la discrepancia de longitud, y la alineación de los miembros, y disminuye las complicaciones relacionadas con la utilización de un dispositivo de mayor montaje.

Femoral lengthening using the Ilizarov technique / Alargamiento Femoral Mediante la Técnica de Ilizarov

The Ilizarov method allows the surgeon to perform extended lengthening of both congenital and acquired short limbs. The technique can be difficult, time consuming and is associated with many complications. Generally, the number of complications and failures of lengthenings increases in proportion to the length of the distraction and the severity of the preoperative problems. The rate of major complications decreases substantially as the experience of the surgeon increases.

Total hip arthroplasty in patients with proximal femoral deformity

In the period between October, 2000 and November, 2002, a prospective study was conducted involving 22 patients with 24 hips who underwent primary hip arthroplasty in the presence of a proximal femoral deformity. The indication for total hip replacement was intolerable pain interfering with the activities of daily living. The patients were followed up for a mean of 15.3 months. At last follow up, the average Harris hip score [HHS] was 86 [range from 57 to 100] compared with average preoperative HHS of 28.9 [range from 1 to 57]

Additional malformations in femoral hypoplasia: unusual facies syndrome.

This syndrome comprises of bilateral femoral hypoplasia and unusual facies comprises of short nose with broad tip, elongated philtrum, thin upper lip, small lower jaw, cleft palate and antimongolian slant of palpebral fissure. Etiology is idiopathic, sporadic, few families have been reported to have autosomal dominant inheritance. We report a case with the additional finding of unilateral complete aplasia of femur, encephalocele, complete cleft lip, bilateral absence of 5th metatarsal and toe and hypospadias. The mode of inheritance appears to be sporadic mutation in this case.