RESUMO
Background: The gold standard for osseointegration remains the autogenous bone graft, but biomaterials such as Beta - tricalcium phosphate (ß - TCP) in its pure-phase showed promising results to be practical bone substitutes. This kind of implants are optimal candidates for bone integration due to their osseoconductive, biocompatibility, bioactivity, and absorptive properties. Methods: A systematic review was conducted using 5 databases (Cochrane Library, PubMed, Scielo, Medline-Bireme and Google Scholar) for searching published studies between January 1st 2011 and June 15th 2021. Only clinical and experimental studies, and case reports were included in this research. Human and animal studies published only in Portuguese or English with clinical, radiologic, and histologic evidence of new bone formation, osseoconduction, and osseointegration were included. This systematic review was reported according to PRISMA guidelines. Results: Approximately 14.554 articles were initially found, but after advanced searching using specific including and excluding keywords, matching Boolean operators "AND," "OR" and "NOT," and after excluding duplicates, a total of 12 articles were included for this systematic review, including experimental works, a retrospective study, a randomized controlled clinical study, a randomized prospective study, a prospective observational study, and a case report. All articles showed 100% effectiveness in bone integration after ß - TCP implantation by clinical, image and/or histologic assessment. Implant shape and porosity seem to have influence in osseointegration process. ß - TCP can give predictable, sustainable, and adequate new bone formation with the least infection rates in implant placement cases and patient morbidity, which is the current goals for bone integration, augmentation and replacement. Conclusion: ß - TCP in its pure-phase is widely used in dentistry and maxillofacial surgery, but there is a lack of information about the use of this biomaterial for filling critical segmental defects of long bones in veterinary medicine. In this area, only experimental studies in small defects were carried out, with no clinical cases performed in animals with a longer observation time. ß - TCP can produce predictable, sustainable, and adequate bone formation, with minimal infection rates and low patient morbidity. But more clinical studies in the future, demonstrating specific metric measurements in relation to bone consolidation, as well as showing results using other shapes of this implant are needed to evaluate further in depth osseoconductive and osseointegrative characteristics of this biomaterial, in order to develop new comparisons and quantitative analyses for its use in veterinary medicine as a bone replacement.
RESUMO
The aim of this study is to report a long term follow up of a congenital luxation of the radial head (CLRH) case of a young Bulldog treated by radio head ostectomy (RHO). CLRH is an uncommon condition in dogs, but it is the most commom form of elbow dislocation (grade I). An English Bulldog, male, 6 months, 14 kilograms, was suspected of elbow dislocation. Physical examination revealed a lateral proeminence on the lateral surface of the right elbow, as well as grade I lameness and mild pain. Range of motion was normal. Previous radiographs and tomography confirmed CLHR. RHO was chosen instead of corrective techniques, due to the age of the animal at the time of the procedure and the difficulty in repositioning the radial head in the joint. Three and a half years after surgery, new clinical and radiographic examaminations were performed. The patient had no pain, good limb support and good range of motion, allowing good elbow movement. There was a partial regrowth of the proximal segment of the radial head causing better readjustment of it in the joint. Mild signs of joint degeneration were present. RHO proved to be effective in this case, proving to be a good technique to be used in cases of CLRH when conservative treatment or reduction techniques can no longer be used.
O objetivo deste relato foi o de apresentar o acompanhamento tardio de um caso de luxação congênita de cabeça de rádio (LCCR) em um Buldog Inglês jovem, tratada por ostectomia da cabeça radial (OCR). A LCCR é uma condição incomum nos cães, mas é a forma mais comum de luxação de cotovelo nos mesmos (grau I). Um Bulldog Inglês, macho, 6 meses, 14 quilos, foi atendido com suspeita de luxação do cotovelo. Exame físico revelou uma proeminência na superfície lateral do cotovelo direito, além de claudicação grau I e dor leve. Amplitude de movimento apresentava-se normal. Radiografias e tomografia prévias confirmaram LCCR. Optou-se pela OCR ao invés de técnicas corretivas, devido à idade do animal à época do procedimento e à dificuldade no reposicionamento do rádio na articulação. Após 3 anos e meio de pós-operatório, foram realizados novos exames clínicos e radiográficos. O paciente não apresentava dor, apresentava bom apoio do membro e boa amplitude de movimento, permitindo bom movimento do cotovelo. Houve um novo crescimento parcial do segmento proximal da cabeça do rádio ocasionando melhor readequamento do mesmo na articulação. Sinais leves de degeneração articular estavam presentes. A OCR se mostrou efetiva neste caso, provando ser uma boa técnica a ser utilizada nos casos de LCCR quando tratamento conservativo ou técnicas de redução já não podem ser mais utilizados.
