Anatomic study and clinical application of iliac crest chimeric tissue flap / 中国修复重建外科杂志

OBJECTIVE@#To conduct anatomical study on the iliac crest chimeric tissue flap and summarize its effectiveness of clinical application in repairing limb wounds.@*METHODS@#Latex perfusion and anatomical study were performed on 6 fresh adult cadaver specimens with 12 sides, to observe the initial location, distribution, quantity, and direction of the common circumflexa iliac artery, the deep circumflexa iliac artery, and the superficial circumflexa iliac artery, and to measure their initial external diameter. Between December 2020 and September 2022, the iliac crest chimeric tissue flap repair was performed on 5 patients with soft tissue of limbs and bone defects. There were 3 males and 2 females, with an average age of 46 years (range, 23-60 years). Among them, there were 3 cases of radii and skin soft tissue defects and 2 cases of tibia and skin soft tissue defects. The length of bone defects was 4-8 cm and the area of skin soft tissue defects ranged from 9 cm×5 cm to 15 cm×6 cm. The length of the iliac flap was 4-8 cm and the area of skin flap ranged from 12.0 cm×5.5 cm to 16.0 cm×8.0 cm. The donor sites were directly sutured.@*RESULTS@#Anatomical studies showed that there were 10 common circumflex iliac arteries in 5 specimens, which originated from the lateral or posterolateral side of the transition between the external iliac artery and the femoral artery, with a length of 1.2-1.6 cm and an initial external diameter of 0.8-1.4 mm. In 1 specimen without common circumflexa iliac artery, the superficial and deep circumflex iliac arteries originated from the external iliac artery and the femoral artery, respectively, while the rest originated from the common circumflex iliac artery. The length of superficial circumflex iliac artery was 4.6-6.7 cm, and the initial external diameter was 0.4-0.8 mm. There were 3-6 perforator vessels along the way. The length of deep circumflex iliac artery was 7.8-9.2 cm, and the initial external diameter was 0.5-0.7 mm. There were 3-5 muscular branches, 4-6 periosteal branches, and 2-3 musculocutaneous branches along the way. Based on the anatomical observation results, all iliac crest chimeric tissue flaps were successfully resected and survived after operation. The wounds at recipient and donor sites healed by first intention. All patients were followed up 8-24 months, with an average of 12 months. The tissue flap has good appearance and soft texture. X-ray film reexamination showed that all the osteotomy healed, and no obvious bone resorption was observed during follow-up.@*CONCLUSION@#The common circumflex iliac artery, deep circumflex iliac artery, and superficial circumflex iliac artery were anatomically constant, and it was safe and reliable to use iliac crest chimeric tissue flap in repairing the soft tissue and bone defects of limbs.

Feasibility analysis and nail planning ofS2 iliac crest screw placement in children / 中国骨伤

OBJECTIVE@#To evaluate the feasibility of S2 alar iliac screw insertion in Chinese children using computerized three-dimension reconstruction and simulated screw placement technique, and to optimize the measurement of screw parameters.@*METHODS@#A total of 83 pelvic CT data of children who underwent pelvic CT scan December 2018 to December 2020 were retrospectively analyzed, excluding fractures, deformities, and tumors. There were 44 boys and 39 girls, with an average age of (10.66±3.52) years, and were divided into 4 groups based on age (group A:5 to 7 years old;group B:8 to 10 years old;group C:11-13 years old;group D:14 to 16 years old). The original CT data obtained were imported into Mimics software, and the bony structure of the pelvis was reconstructed, and the maximum and minimum cranial angles of the screws were simulated in the three-dimensional view with the placement of 6.5 mm diameter S2 alar iliac screws. Subsequently, the coronal angle, sagittal angle, transverse angle, total length of the screw, length of the screw in the sacrum, width of the iliac, and distance of the entry point from the skin were measured in 3-Matic software at the maximum and minimum head tilt angles, respectively. The differences among the screw parameters of S2 alar iliac screws in children of different ages and the differences between gender and side were compared and analyzed.@*RESULTS@#In all 83 children, 6.5 mm diameter S2 iliac screws could be placed. There was no significant difference between the side of each screw placement parameter. The 5 to 7 years old children had a significantly smaller screw coronal angle than other age groups, but in the screw sagittal angle, the difference was more mixed. The 5 to 7 years old children could obtain a larger angle at the maximum head tilt angle of the screw, but at the minimum cranial angle, the larger angle was obtained in the age group of 11 to 13 years old. There were no significant differences among the age groups. The coronal angle and sagittal angle under maximum cephalic angle and minimum cranial angle of 5 to 7 years old male were (40.91±2.91)° and (51.85±3.75)° respectively, which were significantly greater than in female. The coronal angle under minimum cranial angle was significantly greater in girls aged 8-10 years old than in boys. For the remaining screw placement angle parameters, there were no significant differences between gender. The differences in the minimum iliac width, the screw length, and the length of the sacral screws showed an increasing trend with age in all age groups. The distance from the screw entry point to the skin in boys were significantly smaller than that of girls. The minimum width of the iliac in boys at 14 to 16 years of age were significantly wider than that in girls at the same stage. In contrast, in girls aged 5 to 7 years and 11 to 13 years, the screw length was significantly longer than that of boys at the same stage.@*CONCLUSION@#The pelvis of children aged 5 to 16 years can safely accommodate the placement of 6.5 mm diameter S2 alar iliac screws, but the bony structures of the pelvis are developing and growing in children, precise assessment is needed to plan a reasonable screw trajectory and select the appropriate screw length.

Donor Site Morbidity of Nonvascularized Bone Graft: A Systematic Review

ABSTRACT Objective: To evaluate the donor site morbidity of iliac and fibular nonvascularized bone graft after mandibular resection. Material and Methods: This study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in PubMed, Proquest, Science Direct, and Ebsco. A total of 12 studies met the criteria of studies in humans using iliac and fibular nonvascularized bone grafts in mandibular reconstruction after mandibular resection. Results: A greater proportion of patients received iliac nonvascularized bone graft (88.9%) than fibular nonvascularized bone graft (11.1%). Of the 385 cases of iliac bone graft, 153 cases (40%) experienced complications at the iliac donor site, whereas in 48 cases of fibular bone graft, two (4%) experienced complications at the donor site. Hemorrhage, bone fracture, infection requiring debridement, and hematoma were the major complications. Conclusion: The morbidity rate of the nonvascularized bone graft donor site of the fibula (4%) tended to be lower than that of the ilium (40%). Patient age and defect size were not significantly correlated with the occurrence of morbidity donor sites in either the ilium or fibula.

Injerto de cresta ilíaca como cirugía de revisión de Latarjet fallida por inestabilidad glenohumeral en deportistas / Iliac crest graft for previous failed Latarjet surgery with glenohumeral instability in athletes

Introducción: El objetivo de este estudio es reportar los resultados funcionales, el retorno al deporte, la tasa de consolidación y las complicaciones en deportistas jóvenes con una cirugía de Latarjet previa fallida, tratados con injerto autólogo de cresta ilíaca.Materiales y métodos: entre el 2017 y el 2020, se operaron en nuestra institución doce pacientes con inestabilidad glenohumeral recurrente luego de una estabilización previa fallida con cirugía de Latarjet, con injerto autólogo de cresta ilíaca como cirugía de revisión. La evaluación funcional se realizó con el score de Rowe, la escala visual análoga (EVA) y el score de ASOSS. Evaluamos el porcentaje de retorno al deporte, el nivel alcanzado y el tiempo que tardaron los deportistas en volver a competir. La consolidación ósea y la posición adecuada del injerto se analizó en todos los casos con radiografías de hombro frente y perfil y tomografía axial computada con reconstrucción 3D. Se registraron las complicaciones y las revisiones.Resultados: el seguimiento promedio fue de 42.6 meses (rango 24 a 92 meses). El score de Rowe, la EVA y el ASOSS mejoraron significativamente luego de la cirugía (p <0.1). Nueve pacientes retornaron al deporte, ocho de ellos al mismo nivel. El injerto óseo consolidó en todos los pacientes. No hubo recurrencias. No se reportaron complicaciones.Conclusión: el injerto autólogo de cresta ilíaca es una opción válida para el tratamiento de deportistas con inestabilidad glenohumeral recurrente luego de una estabilización previa fallida con cirugía de Latarjet. Nivel de Evidencia: IV

Introduction: The purpose of this study was to report the functional results, return to sport, consolidation rate and complications in young athletes with a previous failed Latarjet surgery, treated with an autologous iliac crest graft.Materials and methods: between 2017 and 2020, twelve patients with recurrent glenohumeral instability were operated on at our institution after previous failed stabilization with Latarjet surgery with autologous iliac crest graft as revision surgery. Functional evaluation was performed with the Rowe score, the VAS, and the ASOSS score. We evaluated the percentage of return to sport, the level reached, and the time it took the athletes to compete again. Bone consolidation and the adequate position of the graft were evaluated in all cases with front and profile X-rays of the shoulder and computed tomography with 3D reconstruction. Complications and revisions were recorded.Results: the average follow-up was 42.6 months (range 24 to 92 months). The Rowe score, visual analog scale, and ASOSS were significantly improved after surgery (p <0.1). Nine patients returned to sport, eight of them at the same level. The bone graft consolidated in all patients. There were no recurrences. No complications were reported.Conclusion: autologous iliac crest grafting is a valid option for the treatment of athletes with recurrent glenohumeral instability after previous failed stabilization with a Latarjet procedure. Level of Evidence: IV

Transiliac endoscopic assisted ilif: a cadaveric study / Ilif assistida por endoscopia por via transilíaca: estudo em cadáver / Ilif asistida por endoscopia transilíaca: estudio en cadáver

ABSTRACT Objective: Demonstrate the feasibility of endoscopic assisted L5S1 intraforaminal lumbar interbody fusion (iLIF) through a transiliac approach. Methods: Ten transiliac iLIF and ten supra iliac iLIF were performed bilaterally at L5S1 in five randomly selected fresh-frozen human cadavers. The following measurements were recorded: distances from the transiliac track to the iliac crest, posterior superior iliac spine, and superior gluteal neurovascular bundle; pelvic parameters; approach angles; cage's lateral and AP center point ratio (CPR); percentage of the cage crossing the midline in the AP and lateral views. Endplate integrity was assessed through endoscopic visualization. In addition, the facet joint, sacroiliac joint, iliolumbar ligament, and exiting and traversing nerve roots were checked for integrity through anatomic dissection. Results: In the transiliac technique, the axial and coronal approach angles were significantly decreased by 13.5º (95% CI -15.5; -11.5; p value<0.001) and 13.2º (95% CI -15.3; -11.1; p value<0.001), respectively, the sagittal approach angle was significantly increased by 5.4º (95% CI 1.8,8.9; p-value = 0.008), and the AP CPR was significantly higher (MD 0.16; 95% CI 0.12,0.20; p value<0.001). The percentage of the cage crossing the AP view's midline was increased by 31.6% (95% CI 19.8,43.4; p value<0.001). The integrity of endplates, facet joints, sacroiliac joints, iliolumbar ligament, and exiting and traversing nerve roots was maintained. Conclusion: L5S1 transiliac iLIF is a feasible surgical technique. It allows a more centrally placed interbody cage in the coronal plane without compromising the anterior position in the lateral plane. The integrity of the major anatomic structures at risk was preserved. Evidence Level III: A case-control study.

Resumo: Objetivo: Demonstrar a viabilidade da fusão intersomática lombar assistida por endoscopia (iLIF) em L5S1 através de abordagem transilíaca. Métodos: Dez iLIF por via transilíaca e dez iLIF por via suprailíaca foram realizados bilateralmente em L5S1 em cinco cadáveres selecionados aleatoriamente. Foram registadas as seguintes medidas: Distâncias da via transilíaca até a crista ilíaca, crista ilíaca póstero-superior e feixe neurovascular do glúteo superior; parâmetros pélvicos; ângulos da abordagem; relação do ponto central lateral e AP do cage (CPR); percentagem do cage cruzando a linha média nas incidências AP e perfil. A integridade das placas vertebrais foi avaliada através de visualização endoscópica. Foi verificada através de dissecção anatómica a integridade das articulações facetárias, sacroilíacas, ligamento iliolombar e raízes de L5 e S1. Resultados: Na técnica transilíaca, os ângulos de abordagem axial e coronal foram significativamente menores em 13,5º (CI 95% -15,5;-11,5; p<0,001) e 13,2º (CI 95% -15,3;-11,1; p<0,001 ), respectivamente, o ângulo de abordagem sagital aumentou significativamente em 5,4º (CI 95% 1,8,8,9; p = 0,008), e o AP CPR foi significativamente maior (MD 0,16; CI 95% 0,12,0,20; p <0,001). A percentagem do cage cruzando a linha média em AP foi superior em 31,6% (CI 95% 19,8,43,4; valor p<0,001). A integridade das placas vertebrais, articulações facetadas, articulações sacroilíacas, ligamento iliolombar e raízes de L5 e S1 foi mantida. Conclusão: A realização de iLIF L5S1 por via transilíaca é uma técnica cirúrgica viável. Permite que o cage seja colocado mais centrado no plano coronal sem comprometer a posição anterior no plano sagital. A integridade das principais estruturas anatómicas em risco foi preservada. Nível de Evidencia III: Estudo caso-controle.

Resumen: Objetivo: Demostrar la viabilidad de la fusión intersomática lumbar asistida por endoscopia (iLIF) en L5S1 con un abordaje transilíaco. Métodos: Se registraron las siguientes mediciones: distancias del abordaje transilíaco a la cresta ilíaca, la cresta ilíaca posterosuperior y el haz neurovascular glúteo superior; parámetros pélvicos; ángulos de abordaje; relación del punto medio lateral y AP del cage (CPR); porcentaje del cage que cruza la línea media en las incidencias AP y perfil. Se evaluó la integridad de las placas vertebrales por visualización endoscópica. Se comprobó la integridad de las articulaciones facetarias, las articulaciones sacroilíacas, el ligamento iliolumbar y las raíces de L5 y S1 mediante disección anatómica. Resultados: En la técnica transilíaca, los ángulos de abordaje axial y coronal fueron significativamente menores en 13,5° (IC 95% -15,5;-11,5; p<0,001) y 13,2º (IC 95% -15,3;-11,1); p<0,001 ), respectivamente, el ángulo de aproximación sagital aumentó significativamente en 5,4º (IC 95% 1,8,8,9; p = 0,008), y el AP CPR fue significativamente mayor (MD 0,16; IC 95% 0,12,0,20; p <0,001). El porcentaje del cage que cruzaba la línea media en AP era mayor en un 31,6% (IC 95% 19,8,43,4; valor p <0,001). Se mantuvo la integridad de las placas vertebrales, las articulaciones facetarias, las articulaciones sacroilíacas, el ligamento iliolumbar y las raíces de L5 y S1. Conclusión: La iLIF transilíaca L5S1 es una técnica quirúrgica viable. Permite colocar el cage más centrado en el plano coronal sin comprometer la posición anterior en el plano sagital. Se preservó la integridad de las principales estructuras anatómicas en riesgo. Nivel de evidencia III: Estudio de casos y controles.

Absceso del psoas ilíaco secundario a un tumor de colon izquierdo fistulizado al retroperitoneo: caso clínico y análisis de la literatura / Iliopsoas abscess resulting from penetrating left colon cancer to the retroperitoneum: case report and literature review / Abscesso do iliopsoas secundário a tumor de cólon esquerdo fistulizado para o retroperitônio: caso clínico e análise da literatura

Los abscesos del psoas ilíaco secundarios a un tumor de colon fistulizado son excepcionales y potencialmente graves. La mayoría son adenocarcinomas de tipo mucinoso. Su tratamiento es complejo ya que, para lograr una resección oncológica pretendidamente curativa, es necesario realizar una resección ampliada con mayor morbimortalidad. Presentamos el caso de una paciente con un adenocarcinoma mucinoso de colon izquierdo fistulizado al músculo ilíaco y la pared anterolateral del abdomen en la que se realizó una resección multivisceral que incluyó el colon izquierdo, el músculo y la cresta ilíaca y parte de la pared anterolateral del abdomen.

Iliopsoas abscess secondary to perforation of colon cancer is an extremely rare and potentially life-threatening condition. Most tumors are mucinous adenocarcinomas. Its treatment its complex, as most patients need radical extended resections to achieve good oncological results, which are in turn, graved with higher morbidity and mortality. We present the case of a patient with a left colon mucinous adenocarcinoma penetrating to the iliopsoas muscle and the anterolateral abdominal wall that required a multivisceral resection including left colon, iliac muscle and crest and part of the anterolateral abdominal wall.

Abscessos do iliopsoas secundários a um tumor de cólon fistulizado são raros e potencialmente graves. A maioria são adenocarcinomas do tipo mucinoso. Seu tratamento é complexo, pois, para se obter uma ressecção oncológica supostamente curativa, é necessário realizar uma ressecção ampliada com maior morbimortalidade. Apresentamos o caso de um paciente com adenocarcinoma mucinoso de cólon esquerdo fistulizado para o músculo ilíaco e parede ântero-lateral do abdome no qual foi realizada ressecção multivisceral que incluiu cólon esquerdo, músculo e crista ilíaca e parte do a parede anterolateral do abdome.

Diverticulitis apendicular, como diagnóstico diferencial / Appendiceal diverticulitis as differential diagnosis

RESUMEN La diverticulitis apendicular (DA) es una patología poco frecuente, considerada clínicamente indistinguible de la apendicitis aguda, aunque podría presentar una sintomatología más leve. Este es el caso de un paciente masculino de 59 años, que concurre al Servicio de Urgencias presentando signos y síntomas sugestivos de una apendicitis aguda; una ecografía informa un asa tubular parcialmente compresible de 7,8 mm de diámetro y una fina banda de líquido laminar, compatible con proceso apendicular agudo. La apendicectomía se realizó de manera convencional evidenciándose un apéndice inflamado principalmente en su región distal. La histología reveló diverticulitis apendicular complicada con rotura. El paciente evolucionó favorablemente y se externó a las 24 horas. Existe una asociación de DA y neoplasia apendicular, por lo que se recomienda una colonoscopia y el seguimiento de este tipo de pacientes.

ABSTRACT Appendiceal diverticulitis (AD) is a rare condition considered clinically identical to acute appendicitis although it may present milder symptoms. We report the case of a 59-year-old male patient who visited the emergency department due to signs and symptoms suggestive of acute appendicitis. An abdominal ultrasound showed partially compressible tubular loop with a diameter of 7.8 mm and a thin band of laminar fluid, consistent with acute appendiceal process. During conventional appendectomy the appendix had signs of inflammation, mainly in the distal region. The histology revealed appendiceal diverticulitis complicated with rupture. The patient had favorable outcome and was discharged 24 hours later. As, there is a clear association between AD and appendiceal neoplasms, colonoscopy and patient monitoring is recommended.

Incidência de alterações posturais em indivíduos participantes de ação social no município de Nova Iguaçu, RJ / Incidence of postural changes in individuals participating in social action at Nova Iguaçu City, RJ

O presente estudo tem como objetivo principal estimar a incidência de alterações postural em indivíduos participantes da ação social UNIG Portas Abertas, ocorrida no campus da Universidade Iguaçu, novembro de 2018 e maio de 2019. É um estudo transversal e descritivo. Foram avaliados 75 indivíduos. A avaliação postural foi realizada através do posturógrafo, com os participantes em posição ortostática, com os pés descalços e cabelos presos. As análises foram feitas na vista anterior, posterior e lateral. Os resultados mostraram que 89,5% da amostra apresentou algum tipo de alteração postural. As principais alterações posturais encontradas foram: desvio na altura das mãos (52,6%), hiperlordose lombar (47,3%), desvio na altura da crista ilíaca, gibosidade torácica, ombro retraído e joelho recurvatum (36,8%). (AU)

Comparison between two methods of measuring pelvic obliquity in cerebral palsy and myelomeningocele / Comparação entre dois métodos de medida de obliquidade pélvica em paralisia cerebral e mielomeningocele / Comparación entre dos métodos de medición de la oblicuidad pélvica en parálisis cerebral y mielomeningocele

ABSTRACT Objective: To evaluate the intra- and inter-observer reproducibility of the evaluation of the pelvic obliquity (PO) in patients with neuro-muscular deformities via the method that uses the iliac crests and the method that uses the upper endplate of S1 and to determine whe ther there is a relationship between the methods. Methods: The digitized panoramic radiographies of thirty patients with cerebral paralysis or myelomeningocelein outpatient monitoring were evaluated by four examiners: two experienced spinal surgeons and two fellows. Two radiographs were excluded because analysis was impossible. All exams were obtained in accordance with the periodic monitoring protocol in the sitting position, using digitized film and a film-focus distance of 110 cm Results: High intra- and inter-observer agreement was observed both for method that uses the iliac crests and the method that evaluates the S1 endplate. However, no significant relationship between the two methods was observed. Conclusions: The methods evaluated had good reproducibility and agreement among the observers. It was confirmed that, on account of the existent linear relation, it is possible to estimate the value of the iliac crest method knowing the value obtained by the S1 plateau multiplied by 0.76. There was no agreement between the iliac crest and S1 plateau PO evaluation methods. Level of evidence IV; Retrospective cross-sectional study.

RESUMO Objetivo: Estimar a reprodutibilidade intra e interobservadores da avaliação da obliquidade pélvica (OP) nos pacientes com deformidades neuromusculares pelo método que usa as cristas ilíacas e pelo método que usa o platô superior de S1e avaliar se há relação entre os métodos. Métodos: Trinta radiografias panorâmicas digitalizadas de pacientes com paralisia cerebral e mielomeningocele acompanhados em ambulatório foram avaliadas por quatro examinadores, sendo dois cirurgiões de coluna experientes e doisfellows. Foram excluídas duas radiografias que impossibilitavam a análise. Todos os exames foram obtidos conforme protocolo de acompanhamento periódico, na posição sentada, em filme digitalizado e distância foco-filme de 110 cm. Resultados: Observou-se alta concordância intra e interobservadores tanto do método que usa as cristas ilíacas quanto do método que avalia o platô de S1. No entanto, não foi observada relação significativa entre os dois métodos. Conclusões: Os métodos avaliados apresentam boa reprodutibilidade e concordância entre os observadores. Verificou-se que, por conta da relação linear existente, é possível estimar o valor do método das cristas ilíacas conhecendo o valor obtido pelo método do platô de S1 multiplicado por 0,76. Não houve concordância entre o método de avaliação da OP pelas cristas ilíacas em comparação com o método de avaliação pelo platô de S1. Nível de evidência IV; Estudo transversal retrospectivo.

RESUMEN Objetivo: Estimar la reproducibilidad intra e interobservador de la evaluación de la oblicuidad pélvica (OP) en pacientes con deformidades neuromusculares por el método que utiliza las crestas ilíacas y por el método que utiliza la meseta superior de S1 y evaluar si existe una relación entre los métodos. Métodos: Treinta radiografías panorámicas digitales de pacientes con parálisis cerebral y mielomeningocele acompañadosen clínica ambulatoria fueron evaluados por cuatro examinadores, dos cirujanosde columna de vasta experiencia y dos fellows. Se excluyeron dos radiografías porque imposibilitaban el análisis. Todos los exámenes se obtuvieron según el protocolo de acompañamiento periódico, en posición sentada, sobre película digitalizada y distancia foco-película de 110 cm. Resultados: Se observó una alta concordancia intra e interobservador tanto en el método que utiliza las crestas ilíacas como en el que evalúa la meseta de S1. Sin embargo no se observó ninguna relación significativa entre los dos métodos. Conclusiones: Los métodos evaluados presentaron buena reproducibilidad y concordancia entre los observadores. Se observó que, debido a la relación lineal existente, es posible estimar el valor del método de las crestas ilíacas conociendo el valor obtenido por el método demeseta de S1 multiplicado por 0,76. No hubo concordancia entre el método de evaluación de la OP por las crestas ilíacas en comparación conel método de evaluación por meseta de S1. Nivel de evidencia IV; Estudio transversal retrospectivo.

Cura quirúrgica de pseudoartrosis atrófica infectada de diáfisis tibial / Surgical Cure of Infected Atrophic Nonunion of the Tibial Shaft

Introducción: La fractura de un hueso se define como la solución de continuidad de cierta porción ósea. Las fracturas diafisarias representan un bajo porcentaje de todas las fracturas, y el hueso tibial es el más afectado, debido a su escasa vascularidad, poca protección y existencia de diversos factores que hacen más propensos algunos problemas como pseudoartrosis y osteomielitis, que complican el tratamiento. Objetivo: Demostrar la eficacia de los resultados clínicos funcionales con la cura quirúrgica de pseudoartrosis infectada de diáfisis tibial con aporte de injerto óseo heterólogo de cadáver, y autoinjerto cortical esponjoso de cresta iliaca. Presentación del caso: Se presenta el caso de un paciente varón de 42 años que ingresa con diagnóstico de fractura expuesta II postraumática. Se realiza fijación externa en 2 ocasiones, con un intervalo de 6 días para corrección de valgo. El paciente se ausenta de sus controles clínicos y reingresa después de 10 meses aproximadamente por diagnóstico de pseudoartrosis atrófica infectada de tibia izquierda, según clasificación anatómica de Cierny-Mader IV. Se hospitaliza para cura quirúrgica y reconstrucción con aloinjerto óseo y autoinjerto de cresta iliaca, lo que da lugar a la consolidación y controles favorables. Actualmente el paciente ha recuperado la funcionalidad de su pierna izquierda, y queda como secuela una fístula con exposición de aloinjerto. Conclusiones: La cura quirúrgica de pseudoartrosis infectada de diáfisis tibial con aporte de injerto óseo heterólogo de cadáver, y autoinjerto cortical esponjoso de cresta iliaca presenta buenos resultados clínicos y funcionales, lo que constituye un método eficaz(AU)

Introduction: The fracture of a bone is defined as the solution of continuity of a certain bone portion. Diaphyseal fractures represent a low percentage of all fractures, and the tibial bone is the most affected, due to its scarce vascularity, little protection and the existence of various factors that make them more prone to some problems such as pseudoarthrosis and osteomyelitis, which complicate treatment. Objective: To demonstrate the efficacy of functional clinical results with the surgical cure of infected pseudoarthrosis of the tibial shaft with the contribution of heterologous cadaveric bone graft, and cortical cancellous autograft of the iliac crest. Case report: The case of a 42-year-old male patient admitted with a diagnosis of post-traumatic exposed fracture II is reported here. External fixation was performed on 2 occasions, with an interval of 6 days for valgus correction. The patient was absent from his clinical check-ups and was readmitted after approximately 10 months due to a diagnosis of infected atrophic nonunion of the left tibia, according to the anatomical classification of Cierny-Mader IV. He was hospitalized for surgical cure and reconstruction with bone allograft and iliac crest autograft, resulting in consolidation and favorable controls. Currently, the patient has recovered the functionality of his left leg, and a fistula with allograft exposure remains. Conclusions: Surgical treatment of infected tibial shaft pseudoarthrosis with provision of heterologous cadaveric bone graft and cortical cancellous autograft of iliac crest presents good clinical and functional results, which constitutes an effective method(AU)

Traumatic recurrent hip dislocation associated with femoral head fracturere constructed with iliac crest autograft / Luxación recurrente de cadera asociada a fractura de cabeza femoral reconstruida con autoinjerto de cresta iliaca

Hip femoral head fractures are extremely uncommon, but likely associated with traumatic hip dislocations. Both lesions require emergent treatment to avoid further complications.19-year-old male patient was received after a high-energy motor vehicle accident with severe brain and thoraco-abdominal trauma and a displaced femoral head fracture with posterior hip dislocation with no acetabular fracture. An emergent open reduction and internal fixation with 2 headless screws was performed, as well as posterior capsule repair. After 1 month as an inpatient in Intensive Care Unit, he sustained a new episode of posterior hip dislocation. Consequently, a second successful surgical reduction was obtained, and hip stability was achieved by posterior reconstruction with iliac crest autograft fixed with cannulated screw and posterior structure repair. Two years later, he was able to walk independently and he does not present any signs of degenerative joint disease nor avascular necrosis.

Las fracturas de la cabeza femoral son extremadamente raras y están asociadas comúnmente con una luxación de cadera traumática. Ambas lesiones requieren tratamiento urgente con el objetivo de evitar complicaciones posteriores. Un paciente varón de 19 años fue trasladado tras un accidente de tráfico de alta energía en el que sufrió un traumatismo craneoencefálico y toracoabdominal grave, además de una fractura de cabeza femoral desplazada junto a una luxación posterior de cadera sin afectación acetabular. De manera urgente, fue intervenido mediante una reducción abierta y fijación interna de la fractura con dos tornillos canulados sin cabeza y reparación de la cápsula articular posterior. Tras un mes de ingreso en la unidad de cuidados intensivos, sufrió un nuevo episodio de luxación posterior de cadera. Debido a ello, se realiza una segunda intervención quirúrgica con reducción abierta y en la que se obtiene una adecuada estabilidad de la cadera mediante reconstrucción posterior con la adición de autoinjerto tricortical de cresta ilíaca y reparación capsular posterior. Después de dos años de seguimiento, el paciente deambula de manera independiente, sin dolor y sin signos degenerativos ni de necrosis avascular en las pruebas de imagen.

Reconstrução mandibular com enxerto livre de crista ilíaca: relato de caso / Mandibular reconstruction with iliac crest free graft: case report

Os defeitos ósseos nos maxilares podem ser causados por patologias como ameloblastoma, carcinoma de células escamosas e sarcomas, bem como, por traumatismos faciais que vão desde acidentes de trânsito a agressões por arma de fogo. As reconstruções de tais defeitos ósseos não deverão apenas devolver a anatomia e contorno da região, mas também, restabelecer a estética e função. A escolha do melhor tipo de enxerto para reconstrução mandibular deverá ser feita de acordo com a característica do defeito e, principalmente, a observação do seu tamanho. O presente trabalho relata o caso clínico de um paciente que procurou o serviço de CTBMF do Hospital da Restauração, queixando-se de deformidade em terço inferior de face após agressão por projétil de arma de fogo (PAF) há, aproximadamente, 2 anos. Ao exame físico apresentava perda de continuidade óssea em região de parassínfise mandibular direita, oclusão pouco funcional e com prometimento funcional. Para o caso foi proposta cirurgia para reconstrução do defeito mandibular com enxerto livre de crista ilíaca. Diante disso, um diagnóstico preciso, planejamento minucioso e boa execução da técnica de reconstrução mandibular com enxerto livre de crista ilíaca proporcionam resultados estéticos satisfatórios, contorno e volume ósseos adequados possibilitando um restabelecimento funcional da área receptora... (AU)

Bone defects in the jaws can be caused by pathologies such as ameloblastoma, squamous cell carcinoma, and sarcomas, as well as facial trauma ranging from traffic accidents to gunshot wounds. Reconstructions of such bone defects should not only restore the anatomy and contour of the region, but also restore aesthetics and function. The choice of the best graft type for mandibular reconstruction should be made according to the characteristic of the defect and, especially, the observation of its size. The present study reports the clinical case of a patient who sought the CTBMF service of the Hospital da Restauração, complaining of deformity in the lower third of the face after aggression by FAP for approximately 2 years. Physical examination showed loss of bone segment in a region of right mandibular paresis, malocclusion and functional impairment. For the case, surgery was proposed to reconstruct the mandibular defect with free iliac crest graft. Therefore, a precise diagnosis, careful planning and good execution of the mandibular reconstruction technique with free iliac crest graft provide satisfactory aesthetic results, adequate bone contour and volume allowing a functional reestablishment of the receiver area... (AU)

Fibroma condromixoide en el iliaco. Reporte de caso / Chondromyxoid fibroma in the iliac. Case report

Se trata de un paciente masculino de 31 años con diagnóstico de fibroma condromixoide del ilíaco derecho manejado en el Hospital Universitario San Ignacio en febrero del 2018. El paciente fue llevado inicialmente a biopsia abierta para confirmación histológica, posteriormente fue llevado a embolización preoperatoria, manejo intralesional con curetaje, fresado extendido, manejo adyuvante local y aplicación de cemento óseo. Se realiza seguimiento postoperatorio por 18 meses sin evidencia clínica ni radiográfica de recidiva tumoral. El objetivo de este trabajo es hacer una revisión de la literatura sobre el fibroma condromixoide con énfasis en su localización pélvica y su tratamiento.

We report a case of a 31-year-old male patient with diagnosis of chondromyxoid fibroma (CMF) of the iliac bone diagnosed at Hospital Universitario San Ignacio in february 2018; an open biopsy allowed recognizement and description of cytologic features, forward diagnosis and treatment with combination of pre-operative embolization, local and extended curettage, local adyuvance and bone cement as described. At 18 months follow-up have found the patient remains without clinical or radiologic recurrence of CMF. We made a review of literature on chondromixoid fibroma emphasizing on pelvic bones compromise regarding diagnosis and management options.

Lumbar and para-iliac hernias: an alternative technique / Hérnias lombares e para-ilíacas: uma alternativa técnica

ABSTRACT Lumbar and para-iliac hernias are rare and occur after removal of an iliac bone graft, nephrectomies, retroperitoneal aortic surgery, or after blunt trauma to the abdomen. The incidence of hernia after the removal of these grafts ranges from 0.5 to 10%. These hernias are a problem that surgeons will face, since bone grafts from the iliac crest are being used more routinely. The goal of this article was to report the technique to correct these complex hernias, using the technique of fixing the propylene mesh to the iliac bone and the result of this approach. In the period of 5 years, 165 patients were treated at the complex hernia service, 10 (6%) with hernia in the supra-iliac and lumbar region, managed with the technique of fixing the mesh to the iliac bone with correction of the failure. During the mean follow-up of 33 months (minimum of 2 and maximum of 48 months), there was no recurrence of the hernias.

RESUMO Hérnias lombares e para-ilíacas são raras e ocorrem após a retirada de enxerto ósseo ilíaco, nefrectomias, cirurgia aórtica retroperitoneal, ou ainda, após traumas contusos sobre o abdômen. A incidência de hérnia após a retirada destes enxertos varia de 0,5 a 10%. Essas hérnias constituem um problema com o qual os cirurgiões irão se defrontar, uma vez que os enxertos ósseos da crista ilíaca estão sendo usados mais rotineiramente. O objetivo desse artigo foi relatar a técnica para correção dessas hérnias, consideradas complexas, utilizando-se a técnica de fixação de tela de propileno ao osso ilíaco e o resultado dessa abordagem. No período de 5 anos, 165 pacientes foram atendidos no serviço de hérnias complexas, 10 (6%) com hérnia da região suprailíaca e lombar, manejados com a técnica de fixação de tela ao osso ilíaco corrigindo a falha. Durante o seguimento médio de 33 meses (mínimo de 2 e máximo de 48 meses), não houve recidiva das hérnias.

Neoplasia Mucinosa de apéndice. Abordaje laparoscópico. Reporte de caso / Neoplastic appendiceal mucinous lesion. Laparoscopic approach. Case report

El mucocele apendicular es la dilatación quística del apéndice con acumulación de material mucinoso. Su forma de presentación más frecuente es dolor en fosa ilíaca derecha, sin embargo, la mitad de los casos son asintomáticos. En el presente trabajo se presenta caso de un paciente con diagnóstico incidental de mucocele apendicular, al cual se le realizó apendicectomía laparoscópica como tratamiento definitivo. Caso clínico: Paciente masculino de 44 años sin antecedentes patológicos conocidos, quien se realiza ultrasonido abdominal que informa tumor quístico en fosa ilíaca derecha. Se decide resolución quirúrgica laparoscópica. Informe histológico: mucocele apendicular sin evidencia de malignidad y recuperación satisfactoria del paciente. Conclusión: La neoplasia mucinosa del apéndice es una patología poco frecuente, puede presentarse con una variedad de manifestaciones clínicas hasta un hallazgo incidental. El tratamiento es fundamentalmente quirúrgico y el abordaje laparoscópico es de elección en pacientes sin evidencia de ruptura y diseminación de la enfermedad(AU)

The appendicular mucocele is a cystic dilation of the appendix with accumulation of mucinous material. The most frequent form of presentation is pain in the right iliac fossa; however, half of the cases are asymptomatic patients. In the present work we present a case of a patient with an incidentally diagnosis of appendicular mucocele who underwent laparoscopic appendectomy as definitive treatment. Clinical case: A 44-year-old male patient with no known pathological history, who underwent an abdominal ultrasound that reported a cystic tumor in the right iliac fossa. Laparoscopic surgical resolution was decided, the histological examination revealed appendicular mucocele without evidence of malignancy and satisfactory recovery of the patient. Conclusion: Mucinous neoplasia of the appendix is an uncommon pathology, patients are often asymptomatic or have nonspecific symptoms, and the diagnosis is made incidentally in the course of other examination. Treatment is primarily surgical and the laparoscopic approach is the choice in patients without evidence of rupture and dissemination of the disease(AU)

Iliofemoral technique modification using an anchor screw as treatment of canine traumatic hip luxation - case report / [Modificação da técnica de sutura iliofemoral com uso de parafuso âncora no tratamento da luxação coxofemoral traumática em cães - relato de caso]

Twelve dogs with traumatic hip luxation were selected for surgical intervention with a modified iliofemoral suture technique using an anchor screw to substitute the passage of suture material through a perforated tunnel in the ilium. Six procedures were performed with non-absorbable suture and other six with absorbable suture materials. These cases were evaluated at 15, 30, 60, and 90 days after surgery by performing an ambulation analysis and palpation of the joint. In all cases, there was a return of partial and total limb support in an average of 3 and 19 postoperative, respectively. The fixation strategy of the suture material in the ilium using an anchor screw proved to be efficient with a smaller surgical approach and lesser surgical difficulty, maintaining joint congruence in acute as chronic luxation cases. The use of absorbable and non-absorbable sutures had excellent clinical results, but there was a subjective superiority of the first ones, once 4 dogs of the non-absorbable group presented some discomfort during the postoperative palpation of the joint, 90 days after surgery.(AU)

Doze cães com luxação coxofemoral traumática foram submetidos à intervenção cirúrgica de sutura iliofemoral modificada com uso de parafuso âncora substituindo a passagem de fio através de túnel perfurado no ílio. Seis procedimentos foram realizados com fio não absorvível, e outros seis com fio absorvível. Os casos foram avaliados aos 15, 30, 60 e 90 dias após a cirurgia, por meio de análise de deambulação e palpação articular. Em todos os casos, houve retorno de suporte parcial e total do peso no membro operado, em média, aos três e 19 dias de pós-operatório, respectivamente. A estratégia de fixação do fio de sutura no ílio com parafuso âncora se mostrou eficaz, permitindo uma abordagem cirúrgica menos invasiva, com menor dificuldade na execução, garantindo manutenção da congruência articular tanto em quadros de luxação aguda como crônica. O uso de fio absorvível e não absorvível teve bons resultados clínicos, porém houve uma superioridade subjetiva do primeiro, uma vez que quatro pacientes do grupo fio inabsorvível mostraram desconforto à palpação da articulação aos 90 dias após a cirurgia.(AU)

Age determination in subadults using histological analysis of bones / Determinación de la edad en subadultos usando análisis histológico de los huesos

Abstract Introduction: According to the literature, the amount of osteons has been suggested as a good proxy to determine the age of death in adults. However in subadults research has not been carried out yet. Objective: To determine the accuracy of the histomorphometric technique predicting the age at death in subadults using bone remains. Methodology: The information of static histomorphometric parameters from about 120 iliac bones retrieved from the exhumed remains of subadults whose age at death was known was taken from the Granada collection. In order to predict the age at death we performed a step by step linear regression to estimate the fittest model. Results: The most closely and significantly associated biopsy findings with age were: the osteon count, the internal cortical width, and the trabecular bone volume. Pearson's correlation index indicated a weak linear association among these variables. To assess the accuracy of the model we used a coefficient of determination with a 0.32 value. 32% of the age variation in the subadults was explained by the three variables. Conclusion: This regression model explains a percentage of the total age variation in the subadult population. However this model is not enough to determine the age at death.

Resumen Introducción: La capacidad de predicción de las osteonas para determinar la edad de muerte de los individuos ha sido descrito en la literatura científica. No obstante, no se ha determinado dicha capacidad en individuos subadultos. Objetivo: Determinar la eficacia de lo parámetros histomorfometricos en población subadulta. Metodología: Se realizaron biopsias de hueso ilíaco en los restos de 120 subadultos, de la Colección Osteológica de Granada, con edad conocida en el momento de la muerte. Para establecer la capacidad de predicción se utilizó el R2 obtenido a partir de regresión lineal múltiple. Resultados: Las variables con mayor nivel predictivo y significativo para la estimación de la edad fueron: recuento de osteonas tipo 2 de la cortical interna y externa, y el volumen óseo trabecular; En la evaluación del modelo, se obtuvo un coeficiente de determinación de 0.32, es decir, el 32% de la variación en la edad de los subadultos se explica por el modelo. Sin embargo, se evidenció diferencias en la capacidad de predicción por sexo. Conclusión: Este modelo de regresión explica un porcentaje sustancial de la varianza de la edad de los individuos en la muestra. No obstante, no es suficiente para garantizar una adecuada predicción de la edad al momento de muerte de los individuos subdultos.

Morbilidad de la zona dadora de injerto óseo autólogo de cresta ilíaca por vía posterior: Análisis de dos técnicas quirúrgicas / Autologous donor site morbidity after posterior iliac crest bone harvest. Comparative analysis of two surgical techniques

Introducción: El injerto óseo autólogo tomado de la cresta ilíaca posterior para artrodesis de columna presenta ventajas: es osteogénico, osteoinductor y osteoconductor, y sus desventajas son ofrecer una cantidad limitada y las complicaciones del sitio dador (8-39%), como dolor de la zona dadora, lesión neurovascular y fracturas de pelvis. Los objetivos de este estudio fueron comparar la toma de injerto cortico-esponjoso de cresta ilíaca posterior mediante técnica con escoplo gubia frente a la toma con cureta; evaluar las complicaciones intraoperatorias y posoperatorias; cuantificar la cantidad recolectada y graduar el dolor en la zona dadora. Materiales y Métodos: Estudio prospectivo aleatorizado de 34 pacientes consecutivos para artrodesis posterolateral de columna torácica y lumbosacra (26 mujeres y 8 hombres, de entre 15 y 79 años de edad). Se los dividió en dos grupos: grupo 1, cureta y grupo 2, escoplo gubia. Se evaluaron el peso obtenido, el tiempo requerido y las complicaciones. Resultados: Grupo 1: 19 pacientes (14 mujeres y 5 hombres). Se requirieron, en promedio, 9.94 min para obtener 9,26 g. En el primer control, 13 pacientes presentaron un valor 1; 5, un valor 2 y uno, un valor 3. En el tercer control, 15 tuvieron un puntaje 1; 2, un puntaje 2 y 2, un puntaje 3. Grupo 2: 15 pacientes (12 mujeres y 3 hombres). Se tomaron 11,26 g en 8,6 min. En puntaje de dolor en el primer control fue: 10 pacientes con un valor 1; 2, con un valor 2 y 3, con un valor 3, todos tuvieron un puntaje 1 en el tercer control. Conclusiones: La toma de injerto de cresta ilíaca posterior utilizando escoplo gubia es más rápida, recolecta más injerto y provoca menos dolor a los 60 días. Nivel de Evidencia: II

Introduction: The autologous bone graft harvested from the posterior iliac crest for spinal fusion presents osteogenic, osteoinductive and osteoconductive advantages; however, its disadvantages include a limited amount of available material and an incidence of donor site complications ranging from 8% to 39%, including donor site pain, neurovascular injury and pelvic fractures. Objectives: To compare the posterior iliac crest corticoancellous harvest using a chisel-gouge approach versus a curette approach; to evaluate intra-operative and post-operative complications; to quantify the harvested bone; to grade donor site pain. Materials and Methods: Prospective randomized study in 34 consecutive patients for posterolateral fusion of the thoracic and lumbosacral spine; 26 women and 8 men, between 15 and 79 years of age. Subjects were divided into two groups. Group 1: curette approach; and Group 2: chiselgouge approach. The evaluation included: the amount of bone harvested, the time required and complications. Results: Group 1: 19 patients, 14 women and 5 men. The procedure lasted an average of 9.94 min, and the harvested material averaged 9.26 g. Denis Pain Scale scores at the first follow-up survey: 13 patients scored 1; 5 scored 2; 1 scored 3. Denis Pain Scale scores at the third follow-up survey: 15 patients scored 1; 2 scored 2; 1 scored 3. Group 2: 15 patients, 12 women and 3 men. The procedure lasted an average of 8.6 min, and the harvested material averaged 9.26 g. Denis Pain Scale scores at their first follow-up: 10 patients scored 1; 2 scored 2; 3 scored 3. At the third follow-up, all patients scored 1. Conclusions: We observed that the posterior iliac crest graft harvested using the chisel-gouge approach is faster, provides more graft and results in less pain at 60 days. Level of Evidence: II

Injertos óseos en el fisurado labio-alvéolo-palatino (FLAP): casos clínicos / Bone grafts in the cleft lip and palate (CLP) patient: clinical cases

Objetivo: mostrar el tratamiento que realizamos en comunicaciones a nivel del reborde alveolar en los FLAP, tanto para pacientes con fisura unilateral como bilateral, realizados con cresta ilíaca tomada del paciente y basados en nuestra experiencia de más de 40 años. Casos clínicos: nuestro protocolo está dentro de lo que es el tratamiento que proponemos para FLAP, ortopédico y quirúrgico, teniendo en cuenta el crecimiento y desarrollo del maxilar superior, realizando dentro de éste lo que son las periostioplastías y los injertos óseos, con el correspondiente seguimiento de pacientes en el tiempo. Conclusión: se realiza un protocolo adecuado para cada paciente, para realizar el cierre de la comunicación bucosinusal, teniendo siempre en cuenta el crecimiento y desarrollo de cada paciente y no un tiempo fijo en general para todos ellos. Nos diferenciamos de otras personas que lo hacen en forma sistemática en tiempos quirúrgicos preestablecidos, igual para todos los pacientes (AU)

Microanatomy of the nerve to iliacus muscle and its clinical significance / Microanatomía del nervio del músculo ilíaco y su importancia clínica

The iliacus muscle, arising from iliac fossa is innervated chiefly by nerves to iliacus and femoral nerve. The tendon of iliacus muscle in the caudal part fuses with the tendon of psoas major muscle to form iliopsoas tendon As the iliacus/iliopsoas is responsible for flexing of the thigh and the forward tilting of the pelvis, body posture, Olympic lifts, daily activities like walking and running, so impairment of above functions, due to spinal cord injury or injury to nerves to iliacus, remained a grey area to explore manifestation of nerve lesions at fascicular level. Therefore an experimental study was designed to map the complex fascicular pathways suffering from splits, fusions and multiplexing coupled with measurement of distances of closely sampled histological slides. Tracking, correlation and interpretation of fascicles, in these slides of a cropped femoral nerve in iliacus region from a 70 year old female cadaver were analyzed. The study resulted in three schematic models of fascicular pathways in 3 nerves to iliacus and 2 tabular models of 2 remaining nerves to iliacus revealing complete picture of fascicles interrupted by dynamic transformational processes. These results would facilitate MRI neurographic interpretation at fascicular level and neurosurgical treatment through identification. The fascicular identification and setup would also discover anatomical complications and location of injury. Besides the huge data volume evolved off this experiment, the study would not only open up grey area for neuroanatomical research but also would revolutionize the neurosurgical repair and grafting of nerves to iliacus at fascicular level.

El músculo ilíaco, que se inserta en la fosa ilíaca, está inervado principalmente por los nervios ilíaco y femoral. El tendón del músculo ilíaco en la parte caudal se fusiona con el tendón del músculo psoas mayor para formar el tendón del músculo iliopsoas. Los músculos ilíaco e iliopsoas son responsables de la flexión del muslo y la inclinación hacia delante de la pelvis, la postura del cuerpo, los levantamientos olímpicos, las actividades diarias como caminar y correr, por lo que el deterioro de las funciones anteriores, debido a lesiones de la médula espinal o de los nervios ilíacos, constituyen una dificultad para explorar la manifestación de lesiones nerviosas a nivel fascicular. Por lo tanto, se diseñó un estudio experimental para mapear las complejas vías fasciculares que presentan divisiones, fusiones y multiplexación, junto con medición en muestras histológicas. Se analizó el seguimiento, correlación y la interpretación de los fascículos en muestras de secciones del nervio femoral en la región ilíaca de un cadáver femenino de 70 años. Se obtuvieron tres modelos esquemáticos de vías fasciculares en 3 ramos del nervio ilíaco y dos modelos tabulares de los 2 ramos nerviosos restantes del nervio ilíaco, que muestran una imagen completa de los fascículos interrumpidos por procesos de transformación dinámica. Estos resultados facilitarían la interpretación neurográfica de la resonancia nuclear magnética a nivel fascicular y el tratamiento neuroquirúrgico a través de su identificación. La identificación y configuración del fascículo también permitirían descubrir complicaciones anatómicas y la localización de la lesión. Además del enorme volumen de datos que se desprendió de este estudio, éste no solo contribuiría a la investigación neuroanatómica, sino también puede aportar a la reparación neuroquirúrgica y al injerto de nervios al músculo ilíaco a nivel fascicular.