Bone Tissue Donation: Tendency and Hurdles.

INTRODUCTION: The aim of this study was to identify the percentage of bone tissue donation in a brain death situation and the tendency of donation rate of this tissue in an organ procurement organization in the county of Sao Paulo from 2001 to 2016. It is a retrospective and quantitative study, based on the Organ and Tissue Donation Term of donors who died of brain death between 2001 and 2016. METHODS: A logistic regression model was applied, and the odds of donation were identified throughout the years, regarding the odds ratio different from zero. Finally, it was measured the accuracy of the odds ratio through the confidence interval. RESULTS: The analysis has shown a significant change on the trend of bone donation (P < .001). In this case, the odds ratio was >1, indicating that the donation rate has increased. However, the percentage of growth is still considered low. CONCLUSIONS: The study evidences a growth trend regarding the donation of bone tissue, but the percentage is still too low to adequately meet the demand of patients who need this modality of therapeutic intervention. It is believed that educational campaigns of donation are not emphasizing the donation of tissues for transplantation, which may be directly impacting their consent rates.

Taxa de sobrevivência de implantes e biomateriais no levantamento do seio maxilar com pneumatização significativa: um estudo retrospectivo com 79 pacientes, durante seis meses a dez anos / Survival rate of immediate dental implants and biomaterials after large sinus lifting procedures: a retrospective study on 79 patients with a 6-month to 10-year follow-up

Objetivo: avaliar retrospectivamente a taxa de sucesso de implantes e biomateriais após o levantamento do seio maxilar. Material e métodos: foram utilizados prontuários de pacientes tratados entre 1998 e 2014, incluídos os que possuíam rebordo maxilar com altura menor do que 5 mm. Todos os procedimentos de enxertia foram realizados com instalação de implante de forma mediata e acesso ao seio maxilar pela janela óssea lateral, colocação do biomaterial, membrana e sutura. Resultados: foram analisados 79 pacientes, tendo sido utilizados dois biomateriais. O tempo de reavaliação variou de seis meses a dez anos. Nos dados de altura óssea radiográfica antes e depois do procedimento (70 implantes, 36 pacientes), houve um aumento médio de altura na região do seio maxilar com o Bio-Oss de 17,23 mm e com o Orthogen de 13,12 mm (p < 0,05), sendo a média geral de 15,17 mm. Na relação sobrevida do implante e enxerto utilizado (92 implantes, 43 pacientes), os valores foram de 96,8% (autógeno) e 98,3% (autógeno + biomaterial). Conclusão: os resultados permitiram concluir que tanto os enxertos autógenos como os biomateriais são alternativas viáveis para os seios maxilares com grande pneumatização.

Objective: to retrospectively evaluate the success rate of implants and biomaterials after maxillary sinus lift. Material and methods: records of patients treated between 1998 and 2014 were used, including those with maxillary ridge height less than 5 mm. All grafting procedures were performed with implant placement and access to the maxillary sinus through the lateral bony window, placement of the biomaterial, membrane and suture. Results: 79 patients were analyzed and two biomaterials were used. The follow-up period ranged from six months to ten years. In the radiographic bone height data before and after the procedure (70 implants, 36 patients), there was a mean increase in height in the maxillary sinus region with the Bio-Oss of 17.23 mm and with the Orthogen of 13.12 mm (p < 0.05), the overall mean being 15.17 mm. Regarding implant and graft survival (92 implants, 43 patients), the values were 96.8% (autogenous) and 98.3% (autogenous + biomaterial). Conclusion: both autogenous grafts and biomaterials are viable alternatives for the maxillary sinuses with great pneumatization.

Avaliação retrospectiva das características dos implantes instalados na faculdade Ingá entre 2005 e 2014 / Retrospective evaluation of the characteristics of dental implants installed in the University Inga between 2005 and 2014

Objetivo: avaliar retrospectivamente as características dos implantes colocados no curso de especialização do Centro Universitário Ingá (Uningá). Material e métodos: os prontuários dos pacientes que realizaram tratamento entre 2005 e 2014 na Uningá foram analisados quanto à saúde sistêmica, sexo, idade, local de colocação, uso de enxertos, diâmetro e comprimento dos implantes, e complicações. Resultados: neste centro, 108 pacientes receberam 307 implantes de quatro marcas comerciais diferentes (154 na maxila e 160 na mandíbula). Os implantes foram instalados mais em mulheres (67,6%), principalmente na região posterior (76,7%), tanto de maxila (49%) quanto de mandíbula (51%), com o uso de enxertos ósseos em cerca de 20% dos casos da maxila e somente 1% dos casos de mandíbula. Além disso, ainda são realizados muitos implantes longos (38,6% > 13 mm), de diâmetro regular (83,6% entre 3,75 mm e 4 mm) e com plataforma do tipo hexágono externo (97,7%). Conclusão: no local pesquisado, ainda são instalados muitos implantes na região posterior, longos e de diâmetro regular, com plataforma do tipo hexágono externo. Além disso, os enxertos ósseos são usados em um em cada dez casos de implantes, principalmente na maxila.

Objective: to retrospectively evaluate the characteristics of implants placed in the specialization course of the Inga University Center (Uningá). Material and methods: the medical records of patients who underwent treatment between 2005 and 2014 at Uningá were analyzed for systemic health, gender, age, area of installation, use of grafts, diameter and length of the implants and complications. Results: in this center, 108 patients received 307 implants (four different brands, 154 in maxilla and 160 in mandible). The implants were installed more frequently in women (67.6%), mainly in the posterior region (76.7%), in both maxilla (49%) and mandible (51%), with the use of bone grafts in 20% of maxillary cases and only 1% of cases in mandible. The prevalence of long (38.6%, 13 mm), regular diameter (83.6% between 3.75 mm and 4 mm), and external hex implants (97.7%) was great. Conclusion: at the Uningá, many implants in the posterior region, long and of regular diameter with external hexagonal platform are still installed. Moreover, bone grafts are used in 1 of each 10 cases of implants, mainly in th e maxilla.

Structural allograft reconstruction of the foot and ankle after tumor resections.

BACKGROUND: Structural allografts have been used to correct deformities or to fill bone defects secondary to tumor excisions, trauma, osteochondral lesions, or intercalary arthrodesis. However, the quality of published evidence supporting the use of allograft transplantation in foot and ankle surgery has been reported as fair. The purpose of this study was to report the overall survival of structural allograft in the foot and ankle after tumor resection, and the survival according to the type of allograft and the complication rates in the medium to long term. MATERIALS AND METHODS: From January 1989 to June 2011, 44 structural allograft reconstructions of the foot and ankle were performed in 42 patients (28 men and 14 women) due to musculoskeletal tumor resections. Mean age at presentation was 27 years. Mean follow-up was 53 months. Demographic data, diagnosis, site of the neoplasm, operations performed, operative complications, outcomes after surgery, date of last follow-up evaluation, and local recurrences were reviewed for all patients. Regarding the type of 44 allograft reconstructions, 16 were hemicylindrical allografts (HA), 12 intercalary allografts (IA), 10 osteoarticular allografts (OA), and 6 were total calcaneal allograft (CA). RESULTS: The overall allograft survival rate, as calculated with the Kaplan-Meier method, at 5 and 10 years was 79 % (95 % CI 64-93 %). When allocated by type of allograft reconstruction the specific allograft survival at 5 and 10 years was: 83 % for CA, 80 % for HA, 77 % for OA, and 75 % for IA. The complications rate for this series was 36 % including: articular failure, local recurrence, infection, fracture and nonunion. CONCLUSION: This study showed that structural allograft reconstruction in the foot and ankle after tumor resection may be durable with a 79 % survival rate at 5 and 10 years. The two types of allografts that showed better survival rate were hemicylindrical allografts (80 %) and calcaneus allografts (83 %). The highest complication rates occurred after calcaneus allografts and osteoarticular allografts. LEVEL OF EVIDENCE: IV.

Levantamento de seio maxilar utilizando osso liofilizado associado a PRF ­ relato de caso / Maxillary sinus lift using lyophilized bone associated with PRF ­ case report

Para a reabilitação de espaços edêntulos, o tratamento de escolha na maioria dos casos é a reabilitação com implantes, mas nem sempre é possível executar esse tratamento devido às limitações anatômicas como, por exemplo, a reabsorção óssea que pode ocorrer após a extração dos dentes. Isso leva à utilização de técnicas de enxerto ósseo, sendo que nesse procedimento podem ser utilizados osso autógeno, biomateriais ou a associação de ambos. Os avanços clínicos, com a utilização de substitutos ósseos alógenos, xenógenos e aloplásticos, levam a considerar essas opções como válidas para o processo de reparo tecidual, devido à ausência de reabsorção em volume, ao sítio cirúrgico unitário e ao melhor pós-operatório. Visando acelerar a neoformação óssea, tem sido pesquisada a influência de células sanguíneas em biomateriais aplicados no corpo humano, como o de plasma rico em plaquetas (PRP), seguido da segunda geração de agregados de plaquetas, fibrina rica em plaquetas (PRFf). O PRF é constituído em medula óssea de megacariócitos (grande núcleo celular), plaquetas são estruturas discoidais e anucleares. Tem uma vida útil de 8 a 10 dias e o citoplasma contém muitos grânulos, cujos conteúdos são secretados no momento da ativação, α-grânulos contêm muitas proteínas, específicas de plaquetas ou não específicas de plaquetas. Contudo, desgranulação também implica a liberação de citocinas capazes de estimular a migração e proliferação de células no interior da matriz de fibrina, lançando as primeiras fases de cicatrização.

For rehabilitation of edentulous spaces rehabilitation, the treatment of choice in most cases is the rehabilitation with dental implants. however that approach is not always possible to perform due to anatomical limitations such as bone reabsorption after tooth extraction. Such cases require bone grafting techniques that may be performed using autogenous bone, biomaterials or a combination of both. Clinical improvements with the use of allogeneic, xenogenous and alloplastic bone substitutes indicate that those are valid options for the tissue repair process due to lack of volume reabsorption, the surgical site unit and the best postoperative results. To accelerate bone formation, it has been investigated the influence of blood cells on biomaterials applied to the human body, such as platelet-rich plasma (PRP), followed by the second generation of platelet aggregates, platelet-rich fibrin (PRF). The PRF consists of megakaryocytes bone marrow (large cell nucleus), platelets are discoidal and anuclear structures. It has a life span of 8 to 10 days, and the cytoplasm contains many granules which contents are secreted at the time of activation, α-granules contain many specific or non specific platelets proteins. however, degranulation also the releases of involves which are able to stimulate the migration and proliferation of cells within the fibrin matrix, releasing the early stages of cicatrization.

Living donor bone banking: processing and discarding--from procurement to therapeutic use.

Skeletal muscle and osteoarticular tissue banks are responsible to procure, process, store and distribute tissues, from living and cadaveric donors. The procedures involve the application of protocols covering all aspects of the banking, ensuring the best tissue quality and maximum safety for the recipient. An analysis on the causes of bone tissue discarded by Biotar Tissue Bank between January 2005 and December 2012 was carried. Bone tissue was obtained from both hip and knee replacement (femoral heads and tibial plateau respectively) in living donors treated at different medical-surgical institutions in Argentina. These tissues were processed at the Bank to produce both frozen and lyophilized cancellous bone. Out of 3413 donated bones received by the Bank, 77.55 % resulted in final product, while the remaining 22.44 % was discarded in compliance with the quality standards of both the Bank and the regulatory authority. Comparing the last and the first year of the studied period, the number of discarded tissue increased 3.6 times, while the number of collected bones was approximately 10 times higher. Related to total disposed tissue, reactive serology was the most frequent cause (62.14 %), followed by inappropriate collection/storage of blood sample (30.81 %). A progressive reduction in the percentages of total discard was observed, and this was proportional to inappropriate collection/storage of blood sample. No significant differences were found in the discard rates due to positive serology throughout all the years studied. The success of a tissue bank requires full commitment of all the personnel especially the team members responsible for donor selection and the processing of allografts. It is important to critically screen donors in the early stages of donor recruitment. All of the procedures carried out by the tissue bank are parts of the quality control system which must be strictly carried out. Biotar Tissue Bank is continuously committed to ensure safety to the recipients.

Fibroma ossificante juvenil em mandíbula: relato de caso / Fibroma juvenile ossificans mandible: a case report

Lesões fibro-ósseas benignas são processos patológicos comumente encontrados em ossos do esqueleto maxilofacial. O fibroma ossificante verdadeiro é uma entidade rara, com muitos casos previamente relatados sendo reconhecidos hoje como displasia cemento óssea focal. O fibroma ossificante juvenil é uma variante dos fibromas ossificantes, tendo como características peculiares o crescimento rápido, entre 5 ­ 15 anos, e o comportamento clínico agressivo. O presente trabalho relata um caso de paciente jovem (15 anos), do sexo feminino, com diagnóstico de fibroma ossificante juvenil em região posterior de mandíbula, tratada com ressecção em bloco e reconstrução imediata com enxerto ósseo não vascularizado de crista ilíaca. A paciente encontra-se em acompanhamento ambulatorial sem indícios de recidiva da lesão. O fibroma ossificante juvenil que apresenta comportamento clínico agressivo merece atenção especial no seu tratamento, nos casos em que o crescimento é rápido e destrutivo uma abordagem mais agressiva se faz necessário

Fibro osseous lesions are pathological processes commonly found in cranial and facial bones. The real ossifying fibroma is a rare entity, with many previously reported cases being recognized today as cemento-ossifiying dysplasia. The juvenile ossifying fibroma is a variant of ossifying fibroma, with the peculiar characteristics rapid growth, between 5-15 years, and the aggressive clinical behavior. This paper reports a case of a young female patient (15 years) with diagnosis of juvenile ossifying fibroma in the posterior mandible, treated with bloc resection and immediate reconstruction with bone graft non vascularized of iliac crest. The patient is being followed up, without evidence of recurrence. The juvenile ossifying fibroma presenting aggressive clinical behavior deserves special attention in their treatment, where growth is fast and destructive a more aggressive approach is needed

Simultaneous sinus membrane elevation and dental implant placement without bone graft: a 6-month follow-up study.

BACKGROUND: Previous studies have shown that simultaneous elevation of the sinus mucosal lining and placement of dental implants without graft materials can be a predictable procedure. Nevertheless, few prospective, controlled, and randomized studies have evaluated this technique. The aim of this prospective, controlled, and randomized clinical study is to evaluate whether sinus membrane elevation and simultaneous placement of dental implants without autogenous bone graft can create sufficient bone support to allow implant success 6 months post-surgically. METHODS: Sinus membrane elevation and simultaneous placement of dental implants were performed bilaterally in 15 patients in a split-mouth design. The sinuses were assigned to two groups: the test group, with simultaneous sinus mucosal lining elevation and placement of dental implants without graft materials; and the control group, with simultaneous sinus mucosal lining elevation and placement of dental implants with intraoral autogenous bone graft. After 6 months of healing, abutments were connected. For each implant, length of implant protrusion into the sinus, resonance frequency analysis, and bone gain were recorded at baseline and 6 months follow-up. RESULTS: Clinical complications were not observed, except for two postoperative fistulas and suppuration in both groups. Only one implant of the test group was lost, reaching a success rate of 96.4% and 100% for the test and control groups, respectively. After healing, radiographic new peri-implant bone was observed in both groups ranging between 8.3 ± 2.6 and 7.9 ± 3.6 mm for the control and test groups, respectively (P >0.05). Resonance frequency analysis values were lower for the control group compared to baseline (P <0.05). However, these values were similar at 6 months (P >0.05). A significant positive correlation was found between the protruded implant length/bone gain and implant survival/sinusitis (P <0.0001). CONCLUSION: Implants placed simultaneously to sinus membrane elevation without graft material resulted in bone formation over a period of 6 months.

[Acetabular reconstruction in revision arthroplasty. Retrospective study of 76 cases. Hospital Español de México]. / Reconstrucción acetabular en la artroplastía de revisión. Estudio retrospectivo de 76 casos. Hospital Español de México.

OBJECTIVE: To review our experience with the various acetabular reconstruction techniques used during revision arthroplasty based on the defect in each patient. MATERIAL AND METHODS: We undertook a retrospective, descriptive, observational study of patients who underwent acetabular reconstruction during revision ar. throplasty, from January 1997 to January 2005. We documented the type of acetabular defect, the type of cup and graft used, the complications, and the pre- and postoperative assessment with the Harris scale. Data were analyzed with the SPSS software and the Wilcoxon test (p < 0.05). RESULTS: Seventy-six patients underwent surgery. Mean time elapsed between the primary replacement and the revision was 5 years. The acetabular defects found were: 16 type I, 22 type II, 30 type IIIA, and 8 type IIIB. The mean Harris score was 44 preoperatively and 76 postoperatively. The most frequently used technique involved the use of an autograft, a structural allograft with a porous threaded cup or a reinforcement ring. The most common complications included dislocation 5%, infection 3%, graft loss and cup loosening 21%, and loss of the hip center of rotation 15% (p < 0.05). CONCLUSIONS: Acetabular reconstruction is technically challenging and involves high failure and complication rates, thus providing little improvement in patient activity. It is important to restore the hip center of rotation to improve function. The reconstruction techniques we used are the most common ones and are described in the literature.

Resultados del relleno de defectos óseos tumorales con hidroxiapatita o injerto homólogo / Results of the filler of defects bony tumorales with hidroxiapatita or homologous implant

Durante 15 años se ha utilizando la hidroxiapatita obtenida a partir del coral Porites, en los defectos óseos subsiguientes a la cirugía de exéresis tumoral. Se realizó un estudio en 100 pacientes con diagnóstico de tumoraciones óseas benignas de las extremidades, en el período de tiempo comprendido desde el 1988 hasta el año 2000; con el objetivo de evaluar su eficacia como material de implante óseo. Se dividió la muestra aleatoriamente en dos grupos, un grupo estudio y un grupo control, con 50 pacientes cada uno. En el grupo estudio se realizó relleno de la cavidad tumoral con hidroxiapatita Coralina® HAP-200 y en el grupo control con injerto de hueso homólogo. Se constató que el 96 por ciento de los pacientes implantados con hidroxiapatita presentaron curación, mientras que en los pacientes tratados mediante injertos de hueso homólogo solo se obtuvo la curación en el 88 por ciento. Por lo que se recomienda el uso del biomaterial hidroxiapatita en el tratamiento restaurador de defectos óseos de las extremidades

Tissue banking in Mexico.

INTRODUCTION: Here, we describe our Tissue Banking experiences of 4 years of activity in Mexico. METHODS: Data of allografts provided by our Bank and bone retrievals performed by our teams between February of 2001 and August of 2004 were included. RESULTS: There were 100 bone donors, a total of 1,107 tissues were obtained with an average of 11 tissues by retrieval, samples from all tissues were obtained during retrieval and cultured for bacterial contamination, 250 tissues were positives to bacterial growth with an average of 22.58% of bacterial contamination of tissue by retrieval. A total of 4,493 allografts were provided and were utilized in 3,643 patients. The allografts were used mainly by orthopedic surgeons (62%) and dentists (30%). The most used allografts were morcellized cancellous bone 31%, pulverized 25% and chips of cancellous bone 20%. Among orthopedic patients the most frequent procedures were related with spine degenerative diseases 39.09%, followed by non-pathological fractures and its complications 28.67% and bone tumors and cystic bone lesions 11.59%. CONCLUSIONS: Sustained increase of allograft utilization in Mexico reflects a great necessity for them in our country. The increase in public awareness about tissue donation has allowed an increase in tissue donations and retrievals.

Avaliação da Quantidade de Enxerto Ósseo Homólogo Utilizado no Tratamento Cirúrgico da Escoliose com Artrodese Vertebral / Determination of the Amount of Homologue Bone graft in Treating Scoliosis by Spinal Fusion

Os autores apresentam estudo analítico e retrospectivo de 10 pacientes com diagnóstico de escoliose, submetidos ao procedimento cirúrgico de artrodese vertebral com a utilização de enxerto ósseo homólogo de Banco de Tecidos Músculo-esquelético, no periodo entre outubro de 2002 ate novembro de 2004

Contribution to the surgical treatment of patients with cervical spine cord injury using simple procedures.

Thirty-nine patients with acute cervical spine fractures and/or dislocations between C3 and C7 were submitted to an anterior approach using bone graft fixation without screw and plate systems and three required a preliminary posterior approach to reduce a dislocation. Graft dislodgement due to technical problems occurred at a rate of 7.7% postoperatively and 2.8% 1 month later. No redislodgement occurred. All fusions became solid after 3 months. Their progress was based on the Frankel scale, before surgery, at the moment of the discharge, and at 6 months follow-up. This experience shows how patients with an acute cervical injury can improve even when admitted late after trauma.

Fracturas de la meseta tibial: importancia de la clasificación para el diagnóstico, tratamiento y pronóstico / Fractures of the tibial plateau: importance of the classification for diagnosis, treatment and prognosis

Las fracturas de meseta tibial incluyen el cartílago articular, la epífisis y la metáfisis. El tratamiento es controversial, en la actualidad tiende a ser más quirúrgico y tiene como objetivo lograr estabilidad, buena alineación y prevenir los cambios degenerativos. Se analizaron las fracturas de meseta tibial manejadas en el Hospital ABC de marzo de 1995 a noviembre de 1998, incluyendo aquellas con compromiso articular relacionadas o no con otras fracturas y excluyendo aquellas sin compromiso articular, fracturas condrales únicas y pacientes que no pudieran asegurar el seguimiento. El estudio se llevó a cabo con 39 pacientes, 27 masculinos, 12 femeninos (edad promedio 44.1 años). Los resultados se analizaron con base en la clasificación de Schatzker. El tratamiento conservador reportó 67 por ciento de buenos resultados para las tipo I. Se realizó tratamiento quirúrgico en 92.65 por ciento de los pacientes. El tratamiento con pequeñas incisiones y colocación de tornillos bajo fluroscopía es adecuado en las fracturas Schatzker I y IV no lo es para fracturas con hundimiento. El tratamiento artroscópico se recomienda únicamente en trazos sin desplazamiento o con trazo simple con ligero hundimiento. El levantamiento en masa con colocación de injerto y fijación interna mediante reducción abierta es el tratamiento ideal en las fracturas Schatzker II, III, IVB, V, VI. Las complicaciones fueron infección profunda en dos casos, no consolidación en tres y hundimiento en seis.La clasificación de las fracturas de meseta tibial es importante, brinda una guía diagnóstica, terapéutica y pronóstica en una fractura controvertida.

Manejo de las fracturas del complejo órbito-cigómato-malar en 70 pacientes / Management of orbitozygomatic fractures in 70 patients

En esta comunicación preliminar se relata la experiencia clínica del manejo de las fracturas órbito-cigomático-malar en el Hospital Instituto de Seguridad del Trabajo, entre los años 1989 y 1995. Se consideran 70 pacientes y se analizan: 1º Tipos de accidentes; 2º Criterios para intervenir quirúrgicamente. En general descrito en la literatura; 3º Frecuencia de los distintos tipos de fracturas; 4º Vías de abordaje. Se discuten: el uso de los diferentes tipos de materiales de osteosíntesis, oportunidad de la intervención quirúrgica y, por último, se concluye que el tratamiento ideal debe ser lo más conservador posible y el trabajo en un equipo multidisciplinario

Pseudoartrosis de escafoides evaluación de su tratamiento con técnicas de Matti-Russe / Scaphoid pseudoarthrosis: evaluation of its treatment with Matti-Russe's technique

Se presenta documento tiene como objetivo mostrar los resultados obtenidos para el tratamiento de la pseudoartrosis del escafoides carpiano; utilizando la técnica de Matti-Russe. Dichos resultados son buenos, en razón de tener pocos pacientes con secuelas artrosicas, pero casi todos presentan limitaciones articulares y dolor residual

Banco de tejidos / Tissue bank

Los bancos de tejidos representan uno de los horizontes mas amplios de la ortopedia actual. El inicio logico de estos debe ser el proceso y almacenamiento de hueso por ser esta tecnica la mas util y a su vez la mas simple. En el Hospital Universitario del Valle iniciamos el banco de tejidos en Octubre de 1985, logrando realizarse el primer trasplante en Diciembre de 1986, habiedose beneficiado hasta el momento un total de treinta pacientes. En este trabajo revisamos los aspectos basicos del trasplante de huesos, terminologia, histologia, tecnicas y finalmente presentamos la tecnica que veniamos empleando para el proceso de huesos y tejidos donados a nuestro banco.

Análise Qualitativa e Quantitativa do Uso de Enxerto Homólogo em Artroplastia de Revisão do Joelho

Enxerto Ósseo homólogo foi utilizado para reconstrução de defeitos ósseos na tíbia, no fêmur ou em ambos em artroplastias de revisão do joelho efetuadas no HTO-INTO entre os anos de 2000 e 2004