RESUMEN
Tibial tubercle avulsion fractures (TTAFs) are rare but typical in children and adolescents and Osgood-Schlatter disease (OSD) may be involved in their pathogenesis. However, few publications have reported the relationship between OSD and TTAF. A 16-year-old healthy male adolescent presented with pain, swelling and limited range of motion of the right knee following sudden acceleration while running. Based on the radiographic evidence, the patient was diagnosed with an avulsion fracture of the right tibial tubercle and OSD. Open reduction and internal fixation were performed using two cannulated screws and two Kirschner wires. The patient returned to preinjury activity levels at the 12-month follow-up postoperatively. This case report aimed to highlight this unique injury pattern. For patients with TTAFs, not only should the fracture be treated, but the cause of the fracture, such as OSD, should also be given appropriate treatment.
Asunto(s)
Fijación Interna de Fracturas , Fracturas por Avulsión , Osteocondrosis , Fracturas de la Tibia , Humanos , Adolescente , Masculino , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/diagnóstico por imagen , Fracturas por Avulsión/cirugía , Fracturas por Avulsión/diagnóstico por imagen , Osteocondrosis/cirugía , Osteocondrosis/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Tibia/diagnóstico por imagen , Tibia/cirugía , Tibia/lesiones , Tibia/patología , Tornillos ÓseosRESUMEN
While infrequently reported, isolated injuries to the proximal tibiofibular (TF) joint primarily occur in young, athletic patients participating in sporting activities requiring explosive, high-impact movements, increasing the risk for potential twisting injuries, especially across a hyperflexed knee. The proximal TF joint is stabilized by bony, muscular and ligamentous structures, including both the anterior and posterior proximal TF complexes, with the anterior complex providing more robust stability. Proximal TF injuries frequently involve anterior and lateral displacement of the proximal fibula relative to its native articulation with the tibia. Proper diagnosis is dependent on careful and meticulous history and physical examination, as missed injuries are common, leading to the potential for continued pain, weakness and disability, especially in athletic patients. While spontaneous joint reduction has been reported, injuries may require formal closed reduction, with irreducible and chronic injuries requiring open reduction and stabilization, with recent investigations reporting satisfactory outcomes following anatomic reconstruction of the proximal TF ligament.
Asunto(s)
Traumatismos en Atletas , Peroné , Traumatismos de la Rodilla , Tibia , Humanos , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/diagnóstico , Peroné/lesiones , Traumatismos de la Rodilla/cirugía , Tibia/cirugía , Tibia/lesiones , Ligamentos Articulares/lesiones , Ligamentos Articulares/cirugíaRESUMEN
This study investigates the impact of exosomes on bone fracture healing in a rat tibial model, distinguishing between fast and slow healing processes. Bone healing and protein expression were assessed through X-ray examinations, hematoxylin and eosin staining, and immunohistochemical staining. Exosomes were isolated, characterized and subjected to liquid chromatography-mass spectrometry for protein analysis. Molecular differences were explored using differentially expressed protein analysis, Kyoto Encyclopedia of Genes and Genomes pathway enrichment and protein-protein interaction networks. Differential bone healing patterns and protein expressions were observed between the control and model groups. Exosomes were successfully isolated and characterized, revealing 2004 identified proteins, including distinct expression profiles. Notably, ribosomal proteins, ferritin and beta-actin emerged as pivotal players in bone fracture healing. This study unveils dynamic changes in bone healing and underscores the role of exosomes in the process. Identified proteins and pathways offer valuable insights for developing innovative therapeutic strategies for bone healing.
Asunto(s)
Curación de Fractura , Tibia , Fracturas de la Tibia , Proteómica , Tibia/lesiones , Tibia/metabolismo , Animales , Ratas , Masculino , Ratas Sprague-Dawley , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/metabolismo , Exosomas/metabolismo , Proteoma/metabolismo , Mapas de Interacción de ProteínasRESUMEN
BACKGROUND: Repetitive impacts during running are associated with some running injuries. Tibial acceleration is a proxy for tibial loading, and interventions that can decrease it are likely to be of interest to the running community. RESEARCH QUESTION: What effect do running gait cues have on peak vertical tibial acceleration at a comfortable and moderate running pace, and how will these cues be executed? METHODS: Twenty-seven participants ran on a treadmill according to the following cues in random order: run softly and lightly, run with shorter steps, and increase preferred step rate by 7.5 %. Participants maintained each condition for one minute before returning to their 'preferred' running pattern for two minutes. Two tibia-mounted inertial measurement unit sensors were used to collect tibial acceleration data at a 'comfortable' and 'moderate' run pace. A repeated measures analysis of variance test was used to compare the means between running conditions. RESULTS: Compared to preferred running, the decrease step length (-8 %, p = 0.002, Cohen's d=0.33) and run softly and lightly (-9 %, p = 0.040, Cohen's d=0.38) cues provided a significant reduction in peak vertical tibial acceleration during a comfortable run pace. No significant difference was observed with an increase in step rate. Compared to preferred running, there was no significant difference in peak vertical tibial acceleration with any of the running gait cues during a moderate run pace. SIGNIFICANCE: Instructing runners to decrease step length or run softly and lightly can result in small reductions in peak vertical tibial acceleration during a comfortable run pace, but running gait cues during a moderate run pace provide no effects. Differences in the execution of each cue are likely to influence overall tibial loading throughout the stride cycle. These findings provide novel biomechanical evidence for the potential effects of running retraining strategies for reducing tibial accelerations at different running paces.
Asunto(s)
Señales (Psicología) , Tibia , Humanos , Tibia/lesiones , Fenómenos Biomecánicos , Marcha , AceleraciónRESUMEN
Introducción: La avulsión de la espina tibial posterior en el adulto representa una forma infrecuente de compromiso del ligamento cruzado posterior (LCP), más común de ver en la población pediátrica. La posibilidad de consolidación de esta lesión, con el tratamiento adecuado en forma temprana, depende de un diagnóstico precoz. Caso: reportamos el caso de una paciente de veintisiete años con una lesión multiligamentaria de rodilla con inestabilidad medial y posterior, por trauma de alta energía tras sufrir un accidente de tránsito en moto. Fue tratada mediante una fijación abierta con técnica de "pull-out". Discusión: en países asiáticos es una lesión frecuente por la alta prevalencia de accidentes en moto, pero menos común en nuestro medio. Si bien el manejo quirúrgico temprano muestra mejores resultados, no existe consenso actual en cuanto a la técnica. Dos tipos de resolución (abierta y artroscópica) muestran resultados similares a largo plazo, con un mayor porcentaje de artrofibrosis en el último grupo. Conclusión: al existir controversia sobre su manejo quirúrgico, creemos que la combinación de las ventajas de ambas técnicas (abierta y artroscópica) constituye una opción reproducible, de bajo costo y con bajo índice de complicaciones.
Introduction: Avulsion of the posterior tibial spine in adults represents an infrequent form of compromise of the posterior cruciate ligament (PCL), more common to see in the pediatric population. The possibility of consolidation of this lesion, with adequate treatment early, depends on an early diagnosis.Case: we report the case of a 27-year-old patient with a multiligamentary knee injury with medial and posterior instability, due to high-energy trauma after suffering a motorcycle traffic accident. Which was treated with an open fixation with a "pull-out" technique. Discussion: in Asian countries it is a frequent injury due to the high prevalence of motorcycle accidents, being less common in our continent. Although early surgical management shows better results, there is no current consensus regarding the optimal technique. Both types of resolution (open and arthroscopic) show similar long-term results, with a higher risk of arthrofibrosis in the last group. Conclusion: as there is controversy over its surgical management, we believe that the combination of the advantages of both techniques (open and arthroscopic) constitutes a reproducible, low-cost option with a low rate of complications.
Asunto(s)
Adulto , Tibia/lesiones , Accidentes de Tránsito , Fracturas por Avulsión , Traumatismos de la Rodilla , Articulación de la Rodilla/cirugíaRESUMEN
Presentamos el caso clínico de un paciente de cuarenta y un años que ingresa por guardia con dolor agudo de rodilla luego de un traumatismo deportivo (practicando fútbol). Se diagnosticó luxación de la articulación tibioperonea proximal. El tratamiento elegido fue quirúrgico mediante fijación dinámica de la articulación tibioperonea proximal con buena evolución y retorno a la actividad deportiva. Realizamos una búsqueda bibliográfica sobre las últimas publicaciones de dicha patología y sus tratamientos. La luxación de esta articulación proximal es una patología infrecuente y requiere de su sospecha para realizar el diagnóstico inicial. La fijación interna dinámica es una opción de tratamiento válida. Nivel de Evidencia: IV
We present the clinical case of a forty-one-year-old patient who was admitted with acute knee pain after a sports injury (playing football). A diagnosis of dislocation of the proximal tibiofibular joint was made. Surgical treatment was performed by means of dynamic fixation of the superior tibiofibular joint with good evolution and return to sports activity. We carry out a search on the latest publications presented on this pathology and its treatments. The dislocation of the proximal tibiofibular joint is an infrequent pathology and requires its suspicion to make the initial diagnosis. Dynamic internal fixation is a valid treatment option. Level of Evidence: IV
Asunto(s)
Adulto , Traumatismos en Atletas , Tibia/lesiones , Luxación de la Rodilla , Volver al Deporte , Traumatismos de la RodillaRESUMEN
Abstract Recurrent stress fractures rarely affect the same athlete. We present the case of a female triathlete who suffered multiple stress fractures in both tibias, the right fibula, and the left femoral neck. Conservative treatment was instituted in all episodes, with rest, reduced training load, and physical therapy rehabilitation. The relative energy deficiency in sport syndrome, along with an eating disorder, training overload, and osteopenia, was identified as a risk factor. Although rare, multiple stress fractures can occur in female triathletes. These patients must be screened for risk factors associated with biomechanics, nutrition, and training to develop an effective prevention and treatment program.
Resumo Fraturas por estresse recorrentes num mesmo atleta são raras. Apresentamos o caso de uma triatleta que sofreu múltiplas fraturas por estresse na tíbia bilateral, na fíbula direita e no colo femoral esquerdo. O tratamento conservador foi instituído em todos os episódios, com repouso, redução da carga de treino e reabilitação fisioterápica. Foi identificada como fator de risco a síndrome da deficiência energética relativa no esporte, com distúrbio alimentar, sobrecarga de treino e osteopenia. Mesmo que seja raro, múltiplas fraturas por estresse podem ocorrer em mulheres triatletas, nas quais é importante avaliar os fatores de risco associados à biomecânica, nutrição e ao treinamento para arquitetar um programa de prevenção e tratamento efetivos.
Asunto(s)
Humanos , Femenino , Adulto , Tibia/lesiones , Fracturas por Estrés , Factores de Riesgo , Modalidades de Fisioterapia , Extremidad Inferior , Síndrome de la Tríada de la Atleta Femenina , AtletasRESUMEN
Apresenta-se um modelo experimental de ostectomia de tíbia em coelhos para estudo de biomateriais em processos de reparação óssea. Foi realizada falha segmentar de 6mm de diâmetro na região metafisária medial proximal de tíbia de 72 coelhos as quais foram preenchidas com substituto ósseo e avaliadas clinicamente, por exame radiográfico e por meio de tomografia computadorizada feixe cônico, em diferentes tempos. Conclui-se que a metáfise medial proximal de tíbia de coelhos é adequada como modelo para estudos que avaliem o comportamento de enxertos e/ou biomateriais em falhas ósseas.
Is presented an experimental model of tibial ostectomy in rabbits to study biomaterials during bone repair process. Segmental failure of 6 mm diameter was performed in the medial proximal tibial metaphyseal region of 72 rabbits, which were filled with bone substitute and evaluated by clinical exam, X-ray, and cone beam computed tomography at different times. It is concluded that the medial proximal tibial metaphysis region of rabbits is suitable as a model for studies that evaluate the behavior of grafts and/or biomaterials on bone defects.
Asunto(s)
Animales , Conejos , Conejos/cirugía , Conejos/lesiones , Sustitutos de Huesos , Tibia/lesiones , Materiales BiocompatiblesRESUMEN
Introdução: Muitos retalhos são descritos para reparar as perdas de substância nos terços médio e distal da perna. A principal vantagem do retalho de músculo hemisóleo medial é a preservação da inervação da metade do músculo sóleo no sítio doador, mantendo a força de flexão plantar. Além disso, este retalho tem um arco de rotação maior quando comparado ao retalho de músculo sóleo convencional. Novos conceitos vasculares e técnicos, descritos recentemente, aumentaram a viabilidade deste retalho. O objetivo deste estudo é relatar a utilização do retalho de hemisóleo medial enfatizando as vantagens, reafirmando as indicações e analisando as complicações. Métodos: Em dez anos, um total de nove retalhos de hemisóleo medial foram confeccionados para a reparação de feridas traumáticas com exposição da tíbia em oito pacientes. Os critérios de indicação e técnica cirúrgica são descritos detalhadamente. Resultados: A cicatrização completa da perda de substância foi alcançada em todos os pacientes. Observou-se baixo índice de complicações no leito doador e em um paciente houve necrose parcial da extremidade do retalho. O tempo médio de realização do procedimento foi de duas horas. Conclusões: Retalhos de hemisóleo medial são muito úteis na reparação destas perdas de substância e permitem a cobertura com tecido de espessura intermediária, rica vascularização, baixo índice de morbidade na área doadora, preservação da função motora plantar, reabilitação mais rápida no pós-operatório, técnica cirúrgica acessível e menor tempo operatório.
Introduction: The use of many flaps has been described to repair substance loss in the medial and distal thirds of the lower leg. The main advantage of the muscle medial hemisoleus flap is preserving one half of the innervated medial soleus muscle in situ and keeping the foot's plantar flexion power. Moreover, the flap has a longer arc of rotation. As recently described, new vascular concepts and techniques have increased flap viability. This study aimed to examine the use and advantages of the medial hemisoleus flap with emphasis on an indication and complication analysis. Methods: Over a 10-year period, nine medial hemisoleus flaps were executed to repair traumatic wounds with tibial exposure in eight patients. We describe the indications and surgical techniques in detail. Results: Complete wound healing was achieved in all patients. There was a low donor-site complications rate. One patient suffered from partial necrosis of the extremity flap. The mean operative time was 2 h. Conclusions: The medial hemisoleus flap is useful for repairing substance loss and provides coverage with intermediary thickened tissue, high vascularity, minimal donor-site morbidity, foot plantar flexion power preservation, faster rehabilitation, accessible surgical techniques, and a shorter operative time.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Complicaciones Posoperatorias , Colgajos Quirúrgicos/cirugía , Tibia/cirugía , Tibia/lesiones , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Sistema MusculoesqueléticoRESUMEN
ABSTRACT Avulsion of the tibial tubercle is an uncommon injury that occurs in the young athlete, resulting from an eccentric contraction of the extensor mechanism with the leg fixed to the ground. Concomitant injuries to the patellar tendon are very rare, with few cases reported in the literature. The authors present a case of a 15-year-old basketball player who suffered an avulsion of the tibial tubercle associated with complete distal rupture of the patellar tendon while training. It was treated with open reduction of the tibial fragment and reconstruction of the patellar tendon with mini-anchors and cannulated screws, as well as hamstring autograft tendon reinforcement. The patient showed excellent results and returned to sports after 12 months of follow-up.
RESUMO A fratura-avulsão da tuberosidade anterior da tíbia é uma lesão incomum que ocorre no jovem atleta, resultado de uma contração excêntrica do mecanismo extensor do joelho com o membro inferior fixo ao solo. Lesões concomitantes ao tendão patelar são muito raras, com poucos casos relatados na literatura. Os autores apresentam o caso de um atleta de basquete de 15 anos que sofreu uma fratura-avulsão da tuberosidade anterior da tíbia associada à ruptura completa distal do tendão patelar durante movimento de arremesso no treino esportivo. O paciente foi tratado com redução aberta da fratura e reparo do tendão patelar com miniâncoras e parafuso poste com reforço tendinoso com enxerto autólogo de semitendíneo. O paciente apresentou ótimos resultados e retornou ao esporte após 12 meses de acompanhamento.
Asunto(s)
Humanos , Masculino , Adolescente , Rotura , Tibia/lesiones , Ligamento Rotuliano , Fracturas por AvulsiónRESUMEN
Abstract The hypothesis of this study was that the peri-implant bone healing of the group of pinealectomized rats would differ from the control group. The samples were subjected to immunohistochemical, microtomographic (total porosity and connectivity density), and fluorochrome (mineralized surface) analyses. Objectives The goal of this study was to investigate the cellular changes and bone remodeling dynamics along the bone/implant interface in pinealectomized rats. Material and Methods The total of 18 adult male rats (Rattus norvegicus albinus, Wistar) was divided into three groups (n=6): control (CO), pinealectomized without melatonin (PNX) and pinealectomized with melatonin (PNXm). All animals were submitted to the first surgery (pinealectomy), except the CO group. Thirty days after the pinealectomy without melatonin, the second surgery was conducted, in which all animals received an implant in each tibia (36 titanium implants with surface treatment were installed - Implalife® São Paulo, SP, Brazil). By gavage, the rats of the PNX group received the vehicle solution, and the procedure. Results Immunohistochemical analysis for runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), osteopontin (OP) and osteocalcin (OC) showed that the bone repair process in the PNXm group was similar to that of the CO group, whereas the PNX group showed a delay. The microtomographic parameters of total porosity [Po(tot)] and bone surface (BS) showed no statistically significant differences, whereas for the connective density (Conn.Dn) a statistical difference was found between the CO and PNXm groups. Fluorochrome analysis of the active mineralized surface showed statistically significant difference between the CO and PNX and between the CO and PNXm groups. Conclusion The absence of the pineal gland impaired the bone repair process during osseointegration, however the daily melatonin replacement was able to restore this response.
Asunto(s)
Animales , Masculino , Glándula Pineal/cirugía , Oseointegración/efectos de los fármacos , Conservadores de la Densidad Ósea/farmacología , Interfase Hueso-Implante , Melatonina/farmacología , Tibia/efectos de los fármacos , Tibia/lesiones , Tibia/patología , Titanio , Inmunohistoquímica , Osteocalcina/análisis , Reproducibilidad de los Resultados , Resultado del Tratamiento , Ratas Wistar , Implantes Experimentales , Implantación Dental Endoósea , Fosfatasa Alcalina/análisis , Subunidad alfa 1 del Factor de Unión al Sitio Principal/análisis , Osteopontina/análisis , Microtomografía por Rayos X , Colorantes FluorescentesRESUMEN
Abstract Purpose: To assess the efficacy of allogeneic mesenchymal stem cells and xenogenic platelet rich plasma in the treatment of bone failure of osteoporotic rabbits secondary to estrogenic deprivation and iatrogenic hypercortisolism. Methods: Eight female rabbits underwent ovarian resection and corticoid therapy to induce clinical status of osteoporosis. Four failures were produced in the tibiae, with each failure being treated with hemostatic sponge, allogenic mesenchymal stem cells, xenogenic platelet-rich plasma and the association between both. The animals were divided into two groups, evaluated radiographically and histopathologically at 30 and 60 days post treatment. Results: A radiographically confirmed consolidation of bone failures treated with allogeneic mesenchymal stem cells, associated with the histopathological image of mature and immature bone tissue, without evidence of osteopenia, was compared with the other groups, in which radiolucent failures with osteopenia and fibrosis were still present, denoting the satisfactory effect of the first treatment in detriment to the others. Conclusion: The treatment of bone failures of rabbits with secondary osteoporosis with allogeneic mesenchymal stem cells induced greater bone consolidation with mature and immature bone tissue production (p<0.01), when compared to the other treatments.
Asunto(s)
Animales , Femenino , Ratas , Osteoporosis/complicaciones , Tibia/patología , Regeneración Ósea/fisiología , Trasplante de Células Madre Mesenquimatosas , Plasma Rico en Plaquetas , Tibia/lesiones , Factores de Tiempo , Trasplante HeterólogoRESUMEN
There are few studies about the treatment options for cranial cruciate ligament rupture in growing dogs, especially with epiphysiodesis techniques. The aim of this study was to evaluate the electrocautery technique for proximal tibial epiphysiodesis in Labrador retriever puppies. The novel electrocautery technique was compared with the screw technique regarding the efficacy for tibial plateau leveling in growing dogs. Six healthy Labrador retriever puppies were divided into two groups. The screw technique was used in one group and the electrocautery technique was used in the other group. Both proximal tibial epiphysiodesis techniques for tibial plateau leveling were effective in achieving reduced tibial plateau angle and did not cause significant joint changes. The screw technique was more invasive and caused slightly greater morbidity than the electrocautery technique. The electrocautery technique seems to be a good alternative for proximal tibial epiphysiodesis in young dogs.(AU)
São descritos poucos estudos sobre as opções de tratamento para a ruptura do ligamento cruzado cranial em cães na fase de crescimento, especialmente em relação às técnicas de epifisiodese. O objetivo deste estudo foi avaliar a técnica de eletrocauterização para epifisiodese proximal da tíbia em cães filhotes da raça Labrador Retriever. A nova técnica de eletrocauterização foi comparada com a do parafuso em relação à eficácia para nivelamento do platô tibial em cães na fase de crescimento. Seis filhotes saudáveis da raça Labrador foram selecionados e divididos aleatoriamente em dois grupos. A técnica do parafuso foi usada em um grupo, enquanto no outro foi usada a da eletrocauterização. Ambas as técnicas de epifisiodese proximal da tíbia para nivelamento do platô tibial foram eficazes na redução do ângulo do platô tibial e não causaram alterações articulares importantes. A técnica do parafuso foi considerada mais invasiva e causou morbidade um pouco mais acentuada do que a da eletrocauterização. Assim, a técnica da eletrocauterização parece ser uma boa alternativa para a epifisiodese proximal da tíbia em cães jovens.(AU)
Asunto(s)
Animales , Perros , Electrocoagulación/métodos , Epífisis Desprendida/cirugía , Articulación de la Rodilla/cirugía , Tibia/lesiones , Electrocoagulación/veterinariaRESUMEN
A case of a girl with chronic posttraumatic osteomyelitis of the right tibia with microbiological isolation of Bacillus spp. by conventional methods and confirmation by mass spectrometry MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight mass) of Corynebacterium striatum is presented. Diagnostic methods, clinical manifestations, and resistance pattern of these infections are described.
Se presenta el caso de una adolescente con osteomielitis crónica postraumática de la tibia derecha con aislamiento microbiológico por métodos convencionales de Bacillus spp. y confirmación por espectrometría de masas MALDI-TOF de Corynebacterium striatum, microorganismo considerado generalmente saprófito. Se describen las presentaciones clínicas de estas infecciones descritas en la literatura científica, la necesidad del diagnóstico etiológico por técnicas no convencionales y el patrón de resistencia comúnmente expresado.
Asunto(s)
Humanos , Femenino , Adolescente , Osteomielitis/diagnóstico por imagen , Infección de la Herida Quirúrgica/diagnóstico por imagen , Tibia/lesiones , Corynebacterium/aislamiento & purificación , Infecciones por Corynebacterium/diagnóstico por imagen , Osteomielitis/microbiología , Infección de la Herida Quirúrgica/microbiología , Tibia/cirugía , Tibia/microbiología , Imagen por Resonancia Magnética , Espectrometría de Masa por Láser de Matriz Asistida de Ionización DesorciónRESUMEN
Introducción: Dado lo infrecuente y la falta de consenso del tratamiento de niños y adolescentes con estas lesiones, decidimos redactar esta publicación con el objetivo de presentar un caso avulsión tibial de LCP en adolescente deportista de contacto con fisis abierta y realizar una revisión de la bibliografía publicada. Materiales y Métodos: RF. masculino, 13 años, rugby, sufre tackle francés y caída sobre rodillas en flexión. Consulta 3 meses post-trauma con gonalgia izquierda, derrame y limitación deportiva. Sin inestabilidad pero no la siente bien. Al examen cajón posterior ++/++++, test gravitacional+. Rx cajón posterior: 8 mm de diferencia entre ambas rodillas. RMN: avulsión tibial LCP. Se interpreta como lesión sintomática del LCP en deportista, se decide cirugía (artroscopia + abordaje posterior) con reinserción de fragmento condral en 1 tiempo. P.OP: sin carga 4 semanas. Calza de yeso en extensión 6 semanas, luego inmovilizador 3 meses y movilidad pasiva progresiva. Resultados: Logro movilidad 0-90° en 8ª semana. Al 3ª mes cajón Rx traslación posterior de 4 mm. RMN al 4ª mes reinserción de LCP con anclaje suprafisario. Sexto mes cajón posterior mínimamente alargado con tope neto, 11ª mes actividades deportivas recreativas y continúa fortalecimiento. Discusión y Conclusión: La mayoría de avulsiones de LCP en pacientes con fisis abiertas probablemente sea por mayor fuerza y resistencia del ligamento respecto fisis y hueso a esta edad. Debemos sospecharlo en pacientes con gonalgia vaga, con o sin inestabilidad, con antecedente traumático y Rx normal, siendo indispensable un correcto examen y RMN para su diagnóstico. Creemos que en deportistas con fisis abiertas, debido al riesgo de degeneración articular, se justifica la cirugía para restaurar la cinemática, evitar artrosis y retomar la actividad previa a la lesión. Tipo de estudio: Reporte de caso y Revisión bibliográfica. Nivel de evidencia: IV
Introduction: Given the infrequency and lack of consensus in the treatment of children and adolescents with these injuries, we decided to write this report with the aim of present a case of PCL tibial avulsion in a contact athlete teen with open physis and a review of the literature published. Materials and Methods: RF. male, 13 years, rugby, suffers French tackle and fall on knees flexed. 3 months post-trauma consultation with left knee pain, joint fluid and sport limitation. Whidout instability but not feeling well. The posterior drawer test ++ / ++++, gravitational test +. Rx posterior drawer: 8mm difference between the two nenes. MRI: tibial avulsion PCL. We interpreted as symptomatic PCL injury in athletes, surgery (arthroscopy + posterior approach) is decided reintegration of chondral fragment in 1 time P.OP: no load 4 Weeks. Plaster wedge extension 6 weeks, then 3 months and passive immobilizer progressive mobility. Results: 0-90 mobility achieving in 8th week. The 3rd month drawer Rx 4 mm. MRI posterior translation of the 4th month reintegration of LCP with anchor. 6ª month later minimally elongated drawer with stop net. 11th month continuous strengthening recrearional and sports activities. Discussion and Conclusion: Most avulsion of PCL in patients with open physis probably be for greater strength and endurance ligament compared with the physis and bone at this age. We suspected in patients with vague knee pain, with or without instability, history of trauma and normal Rx a correct examination and MRI to be essential for diagnosis. We believe that athletes with open physis, because of the risk of joint degeneration, surgery is justified to restore kinematics, prevent osteoarthritis and resume activity prior to the injury. Type of study: Case report and literature review. Level of evidence: IV
Asunto(s)
Adolescente , Ligamento Cruzado Posterior/cirugía , Ligamento Cruzado Posterior/lesiones , Tibia/cirugía , Tibia/lesiones , Traumatismos de la Rodilla/cirugía , Traumatismos en Atletas/cirugía , Resultado del TratamientoRESUMEN
Ante defectos masivos a nivel de la tibia, se consideran técnicas que comprometan mínimamente las partes blandas y garanticen la viabilidad, funcionalidad de la extremidad y sea accesible para la población. Por primera vez en la literatura, a propósito de un caso, se describe la técnica de Huntington y se modifica de manera netamente percutánea, tomando como criterio de selección una extremidad severamente lesionada, con gran defecto diafisiario, para lo cual se realizó centralización del peroné de manera percutánea y fijación externa con alambres de Kirschner y retiro de material a los 5 meses. Actualmente, presenta discrepancia de miembros inferiores de 5cms, y marcha independiente soportada con suela compensatoria. Esta técnica puede ser empleada en niños y adolescentes; no se recomienda en caso de zonas metafiso-epifisiarias. Se basa en el menor compromiso de partes blandas, menor desperiostización y posibilidad de lesiones vasculonerviosas; ofrece una solución viable ante grandes defectos tibiales a ser considerado por el cirujano ortopedista(AU)
Several techniques have been considered to improve major tibia defects, all of them have been in minimally invasive surgery with less injury on the soft tissue, ensuring function and viability of the extremity, as well as and easy treatment access by patients. This is first time in literature Huntington's technique is described and modified purely to the percutaneous level, with an evidence degree type IV. In this particular case we took into consideration the selection of a severely-injured extremity with a large diaphysis defect, which experienced centralization of the fibula to Huntington's technique, was rearranged at the percutaneous level, and externally fixated temporally with Kirschner needle. Lower discrepancy less than 5 centimeters between both extremities is showed as final results; supported independent walking with compensatory sole. This technique can be used in children and adolescents; however it is not recommended in cases where metaphyseal- epiphyseal zones are affected. Aiming to goal for the least damage and compromise of the soft tissue, as well as periosteomy, and possibilities of vascular or nervous lesions, this technique offers a viable solution against major tibia defects and could be considered by the orthopedic surgeon(AU)
Asunto(s)
Humanos , Masculino , Adulto , Osteomielitis , Tibia/cirugía , Tibia/lesiones , Densidad Ósea , Fracturas Abiertas , Tejidos , Heridas y Lesiones , Diáfisis , Síndrome de Camurati-EngelmannRESUMEN
La regeneración ósea en reconstrucción del proceso alveolar junto al uso de implantes oseointegrables son ampliamente utilizados, existiendo una amplia variabilidad de productos. El objetivo de esta investigación es estudiar la reparación ósea asociada a un sustituto óseo a base de sulfato de calcio cubierto con membrana biológica en defectos creados en tibia de conejos. Se seleccionaron 12 conejos de entre 3 y 6 meses para ser intervenidos; de acuerdo a protocolos de anestesia ya conocidos se realizó la técnica con acceso a ambas tibias donde se realizaron 2 defectos de 2,6 mm de diámetro; se formaron cuatro grupos siendo el grupo I de relleno con coágulo sanguíneo, grupo II relleno con coagulo cubierto con membrana de colágeno, grupo III relleno con sulfato de calcio y grupo IV relleno con sulfato de calcio cubierto con membrana biológica. Se realizó la eutanasia a los 21 y 42 días y posteriormente se procedió a procesar y analizar láminas histológicas con tinción de hematoxilina y eosina. Se realizó la histomorfometría comparativa analizando los datos con prueba ANOVA y prueba de Turkey considerando un valor de p<0,05 para significancia estadística. Los resultados demostraron que todos los defectos mostraron patrones regulares de reparación ósea; los grupos rellenados con coágulo mostraron formación ósea estadísticamente menor que el presentado por los defectos rellenos con el sulfato de calcio, aunque estos últimos presentaron mayores indicadores de presencia de proceso inflamatorio; el grupo IV fue el que presentó los mejores niveles de reparación ósea a los 21 y 42 días. Se concluye que la reparación ósea en defectos menores es viable de ser realizada con este biomaterial y que la cobertura con membrana de colágeno puede ser útil en la regeneración ósea guiada.
Bone regeneration in the alveolar process and dental implant are widely used and there are a lot of different products. The aim of this research was to know the bone reparation associated to bone substitute with calcium sulfate and a biological membrane in created defects in rabbit tibiae. Were selected 12 rabbit between 3 and 6 month to be operated; using previous anesthesia protocols was do it a surgical defect in the right and left tibiae with 2.6 mm diameter; four groups were created: group I with blood clot fill, group II with blood clot fill plus biological membrane, group III with calcium sulfate and group IV with calcium sulfate plus biological membrane. The euthanasia was made in 21 and 42 days before surgery and was obtained histological plate using hematoxillin and eosin. The histomorphometry was made and statistical analysis using ANOVA and Turkey test with p<0.05 to obtain statistical differences. Were observed in the all created defects a regular bone reparation; the group I and II, with blood clot, showed a minor bone reparation than group III and IV with calcium sulfate, but these last one show an important inflammatory process; the group IV presented the better results at 21 and 42 euthanasia days in term of bone formation. It´s conclude that calcium sulfate can be used in bone reparation of minor defects and the biological membrane can be used in guide bone regeneration with success.
Asunto(s)
Animales , Femenino , Conejos , Tibia/cirugía , Tibia/lesiones , Sulfato de Calcio/uso terapéutico , Sustitutos de Huesos/uso terapéutico , Materiales Biocompatibles , Sulfato de Calcio/química , Sustitutos de Huesos/químicaRESUMEN
Foi realizada falha segmentar com 6mm de diâmetro na região metafisária medial de tíbias de 12 coelhos, onde foi implantado uma associação de micro e macrofragmentos de matriz óssea cortical heteróloga fragmentada conservada em glicerina (98%) e polimetilmetacrilato autoclavados, para a sua reconstrução, e avaliados radiológica e macroscopicamente aos 30, 60, 90 e 120 dias. Houve adesão, em relação ao tempo, dos micro e macrocompósitos ao leito receptor, em 100% dos casos, mostrando ser biologicamente biocompatível, pois promoveram a reparação de falhas ósseas, sem sinais de infecção, migração e/ou rejeição, podendo, dessa forma, ser mais uma opção como substituto para preencher grandes defeitos ósseos.
A segmental defect of 6mm diameter was performed in the medial metaphyseal region of the tibia of 12 rabbits. For the bone defect reconstruction there was implanted a combination of micro and macro fragments of heterologous fragmented cortical bone matrix preserved in glycerin (98%) and polymethylmethacrylate, both autoclaved. Radiological and macroscopic evaluation was performed at 30, 60, 90 and 120 days. Adhesion in relation to time of the micro and macro composites to the recipient bed was observed in 100% of the cases. This showed that this implant is biologically biocompatible, since it promoted bone defects repair, with no signs of infection, migration and/or rejection. In this way, this implant can be classified as one more option of substitute to fill large bone defects.
Asunto(s)
Animales , Matriz Ósea , Conejos/lesiones , Polimetil Metacrilato/uso terapéutico , Tibia/lesiones , Materiales Biocompatibles/uso terapéutico , Tecnología RadiológicaRESUMEN
PURPOSE: To evaluate the bone repair process in ovariohysterectomized rabbit submitted to an ovarian transplant to stomach that may supplying some quantity of estrogen occurs to improve bone healing. METHODS: In 20 female rabbits three holes of 1, 2 and 3mm diameter in tibial shaft were made and after that all animals received OHE through a ventral incision and they were randomly divided into two groups of ten rabbits each. In group one, animals received one of their self-ovaries that transplanted on serosal layer of stomach and group two did not receive treatment. Animals were kept during bone healing for a period of 45 days and radiological, biochemical, biomechanical and histopathological evaluation. RESULTS: The tibial defects in group one healed completely after 45 days and had more callous than second group. There is significant difference between two groups after operation in 21, 28 and 35 days about estrogen, progesterone and phosphatase Alkaline. The maximum forces in group one, were significantly higher than that for the group two. CONCLUSION:Ovarian transplantation prevents the effects of ovariohysterectomized on bone healing of rabbit tibia, suggesting that unilateral transplanted ovaries can substitute for the action of ovaries on the skeleton in ovariohysterectomized animals.