ABSTRACT
In the treatment of unstable pelvic ring fractures, external fixators have the limitation of not adequately stabilizing the injured posterior elements. This article presents a novel and simple technique of temporary external fixation of the pelvic ring, able to produce compression of both the anterior and posterior pelvic elements. A curved flexible carbon-fiber rod is used, pre-tensioned before attachment to supra-acetabular Schanz screws. Although more extensive clinical experience is required, favorable preliminary results in a series of 13 patients with unstable pelvic fracture were encouraging: the aim of closing the posterior and anterior elements of the pelvic ring was achieved in all cases treated with this technique, and 12 patients survived. Radiological results were excellent in 3 cases and good in 9 cases. No major complications, such as secondary displacement, vertical re-displacement or deep infection, were observed. Mean operative time was 25min, compatible with emergency management.
Subject(s)
External Fixators , Fracture Fixation/methods , Fractures, Bone/surgery , Joint Dislocations/surgery , Pelvic Bones/surgery , Acetabulum/surgery , Adult , Aged , Bone Screws , Female , Fracture Fixation/instrumentation , Fractures, Bone/diagnostic imaging , Humans , Joint Dislocations/diagnostic imaging , Male , Middle Aged , Operative Time , Pelvic Bones/diagnostic imaging , Pelvic Bones/injuries , RadiographyABSTRACT
Objetivo: Analizar el efecto de la proteína BMP-7 en el tratamiento de los defectos óseos con transporte óseo. Pacientes y metodología: Efectuamos un estudio prospectivo aleatorizado de 29 pacientes con defectos óseos segmentarios (DOS), en tibia, tratados mediante transporte óseo con fijador externo monolateral. La media de edad fue 33 años con predominio del sexo masculino (26 pacientes) y una media de seguimiento de 24 meses. En 15 casos se utilizó en la zona de compresión aporte de injerto autólogo de cresta ilíaca (grupo control) y en los 14 restantes se añadió proteína morfogenética ósea (BMP-7) (grupo de estudio). Los criterios de exclusión para este segundo grupo fueron hipersensibilidad conocida al colágeno o al principio activo, enfermedad autoinmunitaria conocida y pacientes en tratamiento con quimioterapia o radioterapia. Resultados: A los 7 meses en el grupo control se consiguió la consolidación en 13 casos (86,6%), mientras que en el grupo de estudio se obtuvo la consolidación en 12 pacientes (85,6%). El estudio demostró resultados clínicos equivalentes en los dos grupos y tasas de eficacia globales comparables para el autoinjerto y para la BMP-7. Conclusiones: el uso de Osigraft® en la zona de compresión del transporte estimula la consolidación de la misma manera que el aporte de injerto óseo autólogo, pero evita la morbilidad que supone su obtención de la cresta ilíaca (AU)
Objective: To analyze the effect of BMP-7 in the treatment of bone defects with osseous transport. Treatment and methodology: We performed a prospective, randomized trial of 29 patients with segmental bone defects of the tibia treated through bone transport with monolateral external fixator. The mean age was 33 years with a predominance of men (26 patients) and a mean follow-up of 24 months. Autologous iliac crest bone graft was used in the compression area in 15 patients (control group) while BMP-7 was added in the 14 remaining patients (study group). Exclusion criteria for this second group was known hypersensitivity to collagen or the active ingredient, known autoimmune disease and treatment with chemotherapy or radiotherapy. Results: At 7 months, bone consolidation was achieved in 13 patients (86.6%) in the control group and in 12 patients (85.6%) in the study group. Clinically equivalent results were found in the two groups and overall efficacy rates were comparable for autograft and BMP-7. Conclusion: The use of Osigraft® in the compression area stimulates similar bone consolidation to the use of autologous bone grafting but avoids the morbidity associated with iliac crest bone harvesting (AU)
