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1.
J Pediatr Orthop B ; 31(1): e95-e100, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34380988

RESUMO

Congenital pseudarthrosis of the tibia (CPT) is characterized by anterolateral tibial bowing and hamartomatous periosteum that predisposes it to fracture. Fassier-Duval telescopic rods can improve the structural integrity of bone segments after reconstruction. We present our experience treating CPT with the Fassier-Duval rod and a novel technique for Fassier-Duval exchange that was developed after extraction failed in one patient. Patients were identified who underwent treatment with Fassier-Duval rods for CPT between 2007 and 2016 and had undergone their first rod exchange. Medical records were reviewed, and complications were classified using the system of Cherkashin. Four patients had an average age at the initial insertion of 6 years 4 months (4-9 years). The average follow-up duration after initial Fassier-Duval implantation was 5.4 years (2.7-8.1 years). Seven Category 2 complications were associated with the Fassier-Duval rod: interlocking K-wire migration (2), lengthening failure (2), explant failure (1), distal migration of female rod through physis (1) and male rod portion proximally migrating through physis (1). Three patients underwent one rod exchange [average 3.2 years after implantation (range, 2.7-3.9 years)]. One patient underwent two rod exchanges (2.9 and 6.9 years after initial implantation). The second attempt at exchange failed; this failure prompted the development of custom trephines to remove the hard bone that can encase the distal male segment. The use of custom trephines was made necessary by dense sclerotic bone at the previous pseudarthrosis site. We recommend that custom trephines be available during Fassier-Duval rod extraction to avoid failed retrieval. Level of evidence: Level IV (Case series).


Assuntos
Fraturas Ósseas , Osteogênese Imperfeita , Pseudoartrose , Feminino , Humanos , Masculino , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/cirurgia , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
2.
Unfallchirurg ; 124(9): 755-767, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34398278

RESUMO

Congenital pseudarthrosis of the tibia (CPT) is a rare disease that has challenged trauma and orthopedic surgeons for a long time. Clinically CPT mostly presents with progressive varus and antecurvation malformation of the tibia in infancy and childhood. In many cases CPT is associated with neurofibromatosis or fibrous dysplasia. Without knowledge of the clinical picture a discontinuity of the tibia and/or fibula visible on an X­ray can be misinterpreted as a simple fracture. Histopathological investigations have revealed that a pathological alteration of the periosteum in the region of the pseudarthrosis, a hamartoma, may be essentially responsible for this disorder. Consequently, to treat the CPT a resection of the hamartoma must also be carried out. Multimodal treatment approaches combining pharmacological and surgical treatment, such as the cross-union technique of Paley, seem to have improved the prognosis of CPT.


Assuntos
Neurofibromatose 1 , Pseudoartrose , Criança , Fíbula , Humanos , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/cirurgia , Doenças Raras , Tíbia
3.
J Pak Med Assoc ; 71(5): 1499-1502, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34091645

RESUMO

Neurofibromatosis type 1 is an autosomal dominant, common genetic disorder that affects many systems, including the skeleton and neurocutaneous system. Skeletal involvement is seen in 38% of patients with NF1. Bowing deformity and pseudarthrosis are observed in 5.7% of the long bones, most of which are common in the tibia. A 13-year-old Somalian girl visited our orthopaedic clinic with complaints of deformity, inability to walk and pain in both legs. The deformity in both legs was present at birth and progressed further. A pathological fracture in the right tibia and a wide range of pseudarthrosis, hamartomatous bone tissues, medullary canal and diaphyseal narrowing towards the pseudoarthrosis range and cortical thickening were observed on her radiographs. Ilizarov technique was used for the case in this study.


Assuntos
Neurofibromatose 1 , Pseudoartrose , Adolescente , Feminino , Humanos , Recém-Nascido , Neurofibromatose 1/complicações , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Radiografia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Caminhada
4.
Plast Reconstr Surg ; 148(2): 443-453, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34181596

RESUMO

BACKGROUND: Treating chronic osteomyelitis of the lower extremities is challenging. The treatment of acute lower limb trauma by orthoplastic teams has shown good results over the past few decades. This study aimed to characterize surgical outcomes of leg and heel chronic osteomyelitis by an orthoplastic team. METHODS: The cases of 113 consecutive leg and heel chronic osteomyelitis patients undergoing soft-tissue reconstruction with an orthopedic procedure were reviewed in this retrospective single-center observational study. The main objective was to assess surgical outcomes of skin healing and gait recovery at the 1-year follow-up. The secondary objective was to evaluate the global success rate at the last follow-up. RESULTS: The median follow-up was 19.7 months. A free flap was performed for 33 patients (29.2 percent) and a locoregional flap was used in 79 patients (69.9 percent). Seventy-two patients (63.7 percent) had chronic osteomyelitis on continuous bone. The others had a septic pseudarthrosis with a mean bone defect length of 42.9 mm. Forty-four patients (38.9 percent) underwent curettage only, eight (7.1 percent) underwent curettage and cement, 20 (17.7 percent) underwent curettage and bone fixation, and 39 (34.5 percent) underwent the Masquelet technique. At the 1-year follow-up, 72 patients (63.7 percent) had achieved skin healing and had recovered their gait. The success rate at all follow-up time points was 82.3 percent. The median time to achieve skin healing was 6.5 months and that to bone union in cases of septic pseudarthrosis was 7.9 months. CONCLUSION: Orthoplastic management of leg and heel chronic osteomyelitis patients with combined soft-tissue reconstruction using an orthopedic procedure was a viable strategy that offered good results even though the time to complete healing was long. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Curetagem/métodos , Osteomielite/cirurgia , Pseudoartrose/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Pele/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos Ósseos/uso terapêutico , Criança , Pré-Escolar , Doença Crônica/terapia , Curetagem/estatística & dados numéricos , Feminino , Seguimentos , Ossos do Pé/microbiologia , Ossos do Pé/patologia , Ossos do Pé/cirurgia , Marcha/fisiologia , Calcanhar/patologia , Calcanhar/cirurgia , Hospitais Universitários/estatística & dados numéricos , Humanos , Perna (Membro)/patologia , Perna (Membro)/cirurgia , Ossos da Perna/microbiologia , Ossos da Perna/patologia , Ossos da Perna/cirurgia , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/microbiologia , Osteomielite/patologia , Pseudoartrose/microbiologia , Pseudoartrose/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Pele/microbiologia , Pele/patologia , Resultado do Tratamento , Cicatrização , Adulto Jovem
5.
World Neurosurg ; 152: 107-112, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34129982

RESUMO

OBJECTIVE: This study aims to demonstrate the efficacy of salvage oblique lumbar interbody fusion (OLIF) surgery for pseudarthrosis after posterior/transforaminal lumbar interbody fusion (PLIF/TLIF). METHODS: The study group were patients with leg or back pain induced by pseudarthrosis after PLIF/TLIF. These patients underwent salvage OLIF surgeries in our institutions between July 2015 and Oct 2019. We retrospectively evaluated their clinical and radiographic outcomes. RESULTS: Seven consecutive patients (all male; mean age 68.4 ± 9.3 years, range 53-81 years) were included in this study. There was no intraoperative complications in all cases. Six of 7 patients achieved bone union (at average 33.4 months follow-up) and had a successful postoperative course. Only 1 patient failed to gain bony fusion and required additional revision surgery due to progression of sagittal and coronal malalignment at 18 months after salvage OLIF surgery. CONCLUSIONS: The salvage OLIF approach was useful option for pseudarthrosis after PLIF/TLIF. It enabled us to build a rigid anterior support, allowed for extensive curettage of intervertebral scar tissue, and reduced the rate of the complications associated with dealing with posterior scar tissue.


Assuntos
Complicações Pós-Operatórias/cirurgia , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Terapia de Salvação/métodos
6.
Injury ; 52 Suppl 3: S18-S22, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34088464

RESUMO

INTRODUCTION: In the pathogenesis of femoral pseudoarthrosis, the arched shape of the bone is important when determining traction force on the anterolateral plane and posteromedial compression. In plate osteosynthesis, flexion forces affect the implant and can determine its breakdown and osteosynthesis failure. The wave plate seeks to solve the problem by transferring the support to the cortex under the plate or creating the resistance of a leaf spring. OBJECTIVES: To evaluate the bone healing pattern of femoral pseudoarthrosis treated with wave plate and its effectiveness in consolidation. MATERIALS AND METHODS: We retrospectively evaluated 18 patients with femoral pseudoarthrosis treated with wave plate. RESULTS: Three months after surgery, one patient presented healing of pseudoarthrosis, six months after surgery, 16 patients presented healing of pseudoarthrosis and at 12 months, all patients had complete bone healing. Regarding the type of pseudoarthrosis, nine patients had avascular and nine vascular pseudoarthrosis. Fifteen patients had medial cortical failure and three, lateral cortical failure. In all cases, consolidation started where there was bone failure, be it medial or lateral. DISCUSSION: The wave plate technique is well indicated for the existence of cortical bone failure, both in fractures and in pseudoarthrosis. Objective is to stabilize the fragments by transferring and allowing contact between them. The formation of the bone callus occurred in our sample from the region of the bone defect to the region of bone contact, using either a tricortical or cancellous bone graft. The elastic force of the wave and the eccentric distribution of loads in the femur favored the formation of a callus where it was distracted (bone failure) and the location with concentration of movement (proximity between the fragments) was the end of bone healing. CONCLUSION: The wave plate technique was effective in bone healing of femoral pseudoarthrosis, promoting consolidation from the cortical failure to the bone contact zone.


Assuntos
Fraturas do Fêmur , Pseudoartrose , Placas Ósseas , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fêmur/cirurgia , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/cirurgia , Estudos Retrospectivos
7.
Neurosurg Focus ; 50(6): E6, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34062497

RESUMO

OBJECTIVE: The use of osteobiologics, engineered materials designed to promote bone healing by enhancing bone growth, is becoming increasingly common for spinal fusion procedures, but the efficacy of some of these products is unclear. The authors performed a retrospective, multi-institutional study to investigate the clinical and radiographic characteristics of patients undergoing single-level anterior cervical discectomy with fusion performed using the osteobiologic agent Osteocel, an allograft mesenchymal stem cell matrix. METHODS: The medical records across 3 medical centers and 12 spine surgeons were retrospectively queried for patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with the use of Osteocel. Pseudarthrosis was determined based on CT or radiographic imaging of the cervical spine. Patients were determined to have radiographic pseudarthrosis if they met any of the following criteria: 1) lack of bridging bone on CT obtained > 300 days postoperatively, 2) evidence of instrumentation failure, or 3) motion across the index level as seen on flexion-extension cervical spine radiographs. Univariate and multivariate analyses were then performed to identify independent preoperative or perioperative predictors of pseudarthrosis in this population. RESULTS: A total of 326 patients met the inclusion criteria; 43 (13.2%) patients met criteria for pseudarthrosis, of whom 15 (34.9%) underwent revision surgery. There were no significant differences between patients with and those without pseudarthrosis, respectively, for patient age (54.1 vs 53.8 years), sex (34.9% vs 47.4% male), race, prior cervical spine surgery (37.2% vs 33.6%), tobacco abuse (16.3% vs 14.5%), chronic kidney disease (2.3% vs 2.8%), and diabetes (18.6% vs 14.5%) (p > 0.05). Presence of osteopenia or osteoporosis (16.3% vs 3.5%) was associated with pseudarthrosis (p < 0.001). Implant type was also significantly associated with pseudarthrosis, with a 16.4% rate of pseudarthrosis for patients with polyetherethereketone (PEEK) implants versus 8.4% for patients with allograft implants (p = 0.04). Average lengths of follow-up were 27.6 and 23.8 months for patients with and those without pseudarthrosis, respectively. Multivariate analysis demonstrated osteopenia or osteoporosis (OR 4.97, 95% CI 1.51-16.4, p < 0.01) and usage of PEEK implant (OR 2.24, 95% CI 1.04-4.83, p = 0.04) as independent predictors of pseudarthrosis. CONCLUSIONS: In patients who underwent single-level ACDF, rates of pseudarthrosis associated with the use of the osteobiologic agent Osteocel are higher than the literature-reported rates associated with the use of alternative osteobiologics. This is especially true when Osteocel is combined with a PEEK implant.


Assuntos
Pseudoartrose , Fusão Vertebral , Aloenxertos , Matriz Óssea , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
8.
Eur Spine J ; 30(11): 3225-3232, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33950287

RESUMO

PURPOSE: Highlight risk factors for pseudarthrosis in long-segment spinal fusions, collect the approaches carried to address this complication. METHODS: Patients with ASD and fusion of ≥ 4 levels with minimum follow-up (FU) of ≥ 2 years were included. Full-body X-rays were done preoperatively, < 3 months and ≥ 2 years. Oswestry disability index (ODI), Scoliosis Research Society-22 and SF36 assessed pre- and postoperatively. The relationship between demographic, surgical and radiological variables with the development of pseudarthrosis was evaluated. RESULTS: Out of 524 patients included, 65 patients (12.4%) developed pseudarthrosis and 53 underwent revision surgery. Notably, 88% of pseudarthrosis cases are associated with fusion length (OR = 1.17, 95% CI = 1.05-1.292, p = 0.004), osteotomy requirement (OR = 0.28, 95% CI = 0.09-0.85, p = 0.025), pelvic fixation (OR = 0.34, 95% CI = 0.13-0.88, p = 0.026) and combined approaches (OR = 3.29, 95% CI = 1.09-9.91, p = 0.034). Sagittal alignment is not related to the rate of pseudarthrosis. Health related and quality of life scores were comparable at last FU between patients revised for pseudarthrosis and those that didn't require revision surgery (ODI = 28% no revision and 30% revision group). CONCLUSIONS: Pseudarthrosis is not related to malalignment, but with the surgical techniques employed for its treatment. Anterior approaches with anterior support decrease the rate by 30%, while long fusions, osteotomies and pelvic fixation increase its rate.


Assuntos
Pseudoartrose , Fusão Vertebral , Adulto , Humanos , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
9.
J Orthop Surg Res ; 16(1): 301, 2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-33964943

RESUMO

BACKGROUND: Congenital pseudoarthrosis of the clavicle (CPC) is an uncommon entity. Owing to its scarce presentation, treatment of this disorder has not been well established. This study aimed (1) to compare surgical treatment methods that included excision of pseudoarthrosis and iliac crest bone graft and fixate with either the elastic stable intramedullary nail (ESIN) or K-wires or plate and screws, and (2) to assess the clinical outcomes of two different surgical methods. METHODS: A multi-central retrospective study was performed between 2013 and 2017 in four tertiary teaching hospitals. Fifteen clavicles of 11 children were identified as CPC. All patients underwent pseudarthrosis resection and iliac crest bone autograft. They were divided into two groups as per the surgical treatment they underwent-plate stabilization as group A and elastic stable intramedullary nailing (ESIN) or K-wires as group B. Nine clavicles in 6 patients in group A and 6 clavicles in 5 patients in group B, were included. The Quick Disabilities of the Arm and Shoulder (QuickDASH) score was used to assess patients' satisfaction and function following treatment at each follow-up. RESULTS: There were eight boys and three girls, with an average age of 4.7 years. All patients, except one with intellectual impairments, had radiological healing. Implant removal time was significantly shorter in group B compared to group A. No statistically significant differences existed in terms of age at surgery, time of radiological healing, complication, and clinical outcome between different groups. CONCLUSION: Surgical resection of pseudoarthrosis with an iliac crest bone graft was an effective means of surgical treatment in CPC. However, ESIN or K-wires can achieve shorter union time compared to the plate. Hence, surgical treatment is recommended for congenital pseudarthrosis of clavicular in pediatric patients. LEVEL OF EVIDENCE: Retrospective comparative study; Level III.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Parafusos Ósseos , Transplante Ósseo/métodos , Fios Ortopédicos , Fixação Intramedular de Fraturas/métodos , Ílio/transplante , Procedimentos Ortopédicos/métodos , Pseudoartrose/congênito , Pseudoartrose/cirurgia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Resultado do Tratamento
10.
Clin Imaging ; 78: 214-216, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34049141

RESUMO

Congenital pseudoarthrosis of the forearm is an extremely rare condition. It is most commonly associated with neurofibromatosis type I (NF1). Patients with NF1-associated pseudoarthrosis have complex medical management and often require surgical intervention due to higher failure rates of union. In this case report, we present a unique case of a newborn baby with congenital pseudoarthrosis of both the radius and ulna that was manifested at birth and shortly thereafter, was diagnosed with NF type 1.


Assuntos
Neurofibromatose 1 , Pseudoartrose , Antebraço/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico por imagem , Pseudoartrose/congênito , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Radiografia
11.
BMC Musculoskelet Disord ; 22(1): 490, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049518

RESUMO

BACKGROUND: Difficulty in obtaining union, recurrent fractures, and residual deformities remain the problems challenging the management of congenital pseudarthrosis of the tibia (CPT). We applied the "Eiffel Tower" double titanium elastic nails (TENs) in the existing combined approach, which takes advantages of TEN's mechanical stability with the protection against refracture, Ilizarov's high fusion rate with alignment control and the biologic environment provided by bone grafting for bony union. The results of this procedure are presented and discussed. METHODS: Seventeen patients with CPT treated by combined surgery including pseudarthrosis resection, the "Eiffel Tower" double TENs technique, autogenous iliac bone grafting, and Ilizarov fixation between 2013 and 2019 were retrospectively investigated. Signs of bone union, limb length discrepancy (LLD), rate of refracture, and degree of residual deformities were reviewed. The AOFAS Ankle Hindfoot scale and measurement of ankle motion were used to evaluate ankle function. The mean follow-up time was 40.5 (11 to 91) months. RESULTS: The mean age at index surgery was 6.2 (2.5 to 15) years. Union of the pseudarthrosis was achieved in 100% of cases. Among them, 15 (88.2%) patients obtained union of the pseudarthrosis on the first attempt (primary union). The average time to primary union was 3.8 (2 to 6) months. The rest 2 cases achieved union after additional surgeries (secondary union). In terms of complications, refracture occurred in 2 patients (11.8%) and 4 patients (23.5%) developed pin infection. The mean limb length discrepancy at the final follow up was 33.4 (6-141) mm. The average AOFAS score improved from 38.2 (27 to 51) pre-operatively to 77 (63 to 87) post-operatively (p < 0.01). CONCLUSIONS: The "Eiffel Tower" double TENs technique is an ideal intramedullary fixation method in the surgical treatment of CPT. The combination of TENs technique with bone grafting and Ilizarov fixation has the advantages of early bone union, less injury on metaphysis, and early functional recovery. LEVEL OF EVIDENCE: Level IV.


Assuntos
Fixação Intramedular de Fraturas , Técnica de Ilizarov , Pseudoartrose , Fixação Intramedular de Fraturas/efeitos adversos , Humanos , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/cirurgia , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Titânio
12.
Int Orthop ; 45(6): 1517-1522, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33792758

RESUMO

PURPOSE: This study aims to evaluate the effect of lengthening speed on the quality of callus and complications during distraction osteogenesis and describe an optimal lengthening speed in patients with congenital pseudarthrosis of tibia (CPT). METHODS: Twenty-seven patients with CPT with a minimum follow-up of 36 months who underwent limb lengthening surgery between 1997 and 2016 with external fixator only were included in this study. All patients underwent lengthening procedures after achieving complete bone union in this study. Regenerate quality is evaluated according to the Li classification on the X-ray taken one month after the end of the distraction period. Complications were noted in post-operative follow-up period. Receiver operator characteristics (ROC) curve analysis was performed to obtain optimal lengthening speed for these patients. RESULT: The mean age at the time of surgery was 5.74 years. The mean lengthening speed was 0.596 mm/day. Follow-up period of 136.14 months with a mean lengthening period of 92.4 days. Mean amount of lengthening was 5.44 cm for patients with CPT. Total rate of callus with good morphological quality was calculated as 66%. According to ROC analysis, optimal cut-off values of lengthening speed for the obtaining good morphological quality callus was 0.564 mm/day for tibial lengthening in CPT. There was a significantly positive correlation between complication rate and lengthening speed for each group. CONCLUSION: We recommend a mean lengthening rate of 0.56mm/day for the lengthening procedures with external fixator in patients with CPT who had complete bone union at the area of pseudarthrosis.


Assuntos
Osteogênese por Distração , Pseudoartrose , Calo Ósseo/diagnóstico por imagem , Calo Ósseo/cirurgia , Fixadores Externos , Humanos , Osteogênese por Distração/efeitos adversos , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
13.
World Neurosurg ; 151: 29-38, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33862295

RESUMO

BACKGROUND: Esophageal fistulae are rare, though serious, complications of anterior cervical surgery. Hardware-related issues are important etiologic factors. Patient-specific implants (PSIs) have increasingly been adapted to spinal surgery and offer a range of benefits. Zero-profile implants are a recent development primarily aimed at combating postoperative dysphagia. We report the first use of a 3-dimensional (3D)-printed zero-profile PSI in managing implant failure with migration and a secondary esophageal fistula. METHODS: A 68-year-old female had a prior C5-7 corpectomy with cage and plate fixation, as well as posterior C3-T1 lateral mass fixation, complicated by anterior plate displacement, resulting in pseudoarthrosis and an esophageal fistula. A 3D-printed zero-profile PSI was designed and implanted as part of a revision procedure to assist in recovery, prevent recurrence, and facilitate bony fusion. RESULTS: Optimal implant placement was achieved on the basis of preoperative virtual surgical planning. By 1 month postoperatively the patient had significantly improved, with evidence of esophageal fistula resolution and radiographic evidence of optimal implant placement. CONCLUSIONS: Zero-profile 3D-printed PSIs may combat common and serious complications of anterior cervical surgery including postoperative dysphagia and esophageal fistulae. Further research is required to validate their widespread use for either cervical corpectomy or diskectomy and interbody fusion.


Assuntos
Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Complicações Pós-Operatórias/cirurgia , Impressão Tridimensional , Próteses e Implantes , Reoperação/métodos , Fusão Vertebral/métodos , Idoso , Vértebras Cervicais/cirurgia , Discotomia , Feminino , Humanos , Planejamento de Assistência ao Paciente , Pseudoartrose/cirurgia , Resultado do Tratamento
14.
Spine (Phila Pa 1976) ; 46(18): E1006-E1013, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-33534522

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to investigate the prognosis of symptomatic pseudarthrosis observed at 1 year after lateral lumbar interbody fusion (LLIF) surgery and to analyze the risk factors for persistent pseudarthrosis for 2 years postoperatively. SUMMARY OF BACKGROUND DATA: Few articles have evaluated the prognosis of symptomatic pseudarthrosis following LLIF surgery. METHODS: One hundred fifty-two patients with a minimum follow-up of 2 years were screened. Fusion status was assessed at 1 year postoperatively, and unfused segments were reevaluated at 2 years postoperatively. Dynamic x-rays and computed tomography images were acquired to evaluate the fusion status. Demographic data were evaluated to identify the risk factors associated with persistent pseudarthrosis. Clinical outcomes, including the visual analog scale (VAS) for back/leg pain and the Oswestry disability index (ODI), were evaluated preoperatively and at 1 and 2 years postoperatively. RESULTS: Symptomatic pseudarthrosis was detected in 42 patients at 1 year postoperatively. Among them, 23 patients (54.8%) exhibited solid bony fusion 2 years postoperatively without further intervention. Fourteen patients (33.3%) showed asymptomatic pseudarthrosis, and the remaining five patients (11.9%) showed symptomatic pseudarthrosis. Multivariable analysis showed that diabetes (adjusted odds ratio [OR]: 2.817, P = 0.007), smoking (adjusted OR: 6.497, P = 0.008), and fusion at more than three levels (adjusted OR: 2.525, P = 0.031) were risk factors for persistent pseudarthrosis. Improvements in the VAS scores for back pain and ODI scores were significantly lower in the persistent pseudarthrosis group than in the final solid fusion group at 2 years postoperatively. CONCLUSION: It is not necessary to intervene for all patients in whom symptomatic pseudarthrosis is detected at 1 year postoperatively because only 11.9% of them will show persistent symptomatic pseudarthrosis. However, early revision surgery should be considered when severe symptomatic pseudarthrosis associated with diabetes, smoking, and fusion at more than three levels is present.Level of Evidence: 4.


Assuntos
Pseudoartrose , Fusão Vertebral , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Prognóstico , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
16.
Jt Dis Relat Surg ; 32(1): 224-229, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33463441

RESUMO

OBJECTIVES: This study reports the surgical outcomes in a patient cohort with congenital pseudarthrosis of the clavicle (CPC). PATIENTS AND METHODS: A total of nine pediatric patients (5 males, 4 females; mean age: 4.43 years; range, 2 to 12 years) who were diagnosed with CPC and treated surgically with a minimum one-year follow-up between January 1996 and December 2018 were retrospectively analyzed. The patients were divided into two groups according to the fixation method as the Kirschner wire (K-wire; Group A, n=2) or stabilization with a plate (Group B, n=7). The physical function and symptoms were evaluated using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scale. RESULTS: The mean age at the time of diagnosis was 2.95 (range, 0 to 12) years. Six cases were atrophic pseudarthrosis and three cases were hypertrophic. Radiographic consolidation occurred in all cases with a mean duration of 103.8±39.1 days, indicating no significant difference between the groups (p>0.05). Complications registered were a K-wire breakage in a patient in Group A and an internal fixation plate loosening in a patient in Group B. The mean postoperative follow-up was 2.98±1.82 years. The QuickDASH score was 0 points in all patients. CONCLUSION: The early surgical indication based on refreshment of the pseudarthrosis focus, with bone autograft interposition when a failure exists to restore adequate clavicular length, and fixation are reliable alternatives with favorable clinical and radiological results in the mid- and long-term with fewer complications.


Assuntos
Clavícula , Fixadores Internos , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Pseudoartrose/congênito , Placas Ósseas , Fios Ortopédicos , Pré-Escolar , Clavícula/anormalidades , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Estudos de Coortes , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/cirurgia , Radiografia/métodos , Estudos Retrospectivos
17.
J Pediatr Orthop ; 41(3): 164-170, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33448723

RESUMO

BACKGROUND: Vascularized fibular grafting (VFG) is currently accepted as one of the best treatments for congenital tibial pseudoarthrosis (CPT). However, with longer follow-up, functional results deteriorate, and some problems become evident. METHODS: Thirty-nine patients with CPT were treated with VFG. Their age at surgery averaged 5.2 years. Twenty-one cases aged 3 years or less at the time of surgery. All cases were Crawford type IV affected by neurofibromatosis-1. Fourteen patients had 1 to 7 previous surgeries with an average of 4.2 procedures. The length of the fibula used averaged 9.9 cm, and the fibula was fixed by intramedullary wires in 26 cases, and transfixion screws in 11 cases. RESULTS: Follow-up averaged 8.1 years. Seventeen cases (43.6%) reached skeletal maturity before the final follow-up. Primary bone union was achieved in 37 cases (96%) after an average of 3.2 months. Stress fracture occurred in 21 cases (51.3%) and was recurrent in 11 cases. Twenty-one cases (53.8%) developed tibial shaft deformities with an average valgus angle of 13.8 degrees and procurvatum angle of 18.8 degrees. The overall final limb length discrepancy (LLD) averaged 2.2 cm. Ipsilateral ankle valgus deformity occurred in 21 cases (53.8%) and averaged 10 degrees. A total of 17 cases required an average of 2 secondary procedures. The tibial deformity did not appear to remodel with age, but the LLD and the angle of ipsilateral ankle valgus deformity continued to significantly increase until skeletal maturity. CONCLUSION: This study reports the largest single center experience of CPT cases treated with VFG. Free VFG is an excellent treatment option for CPT. Best results are achieved when the procedure is performed at or before the age of 3 years, in the absence of previous surgeries, and with the use of intramedullary fixation. The resulting LLD and the degree of ipsilateral ankle valgus increase with age until skeletal maturity, however, tibial deformity does not remodel and should be corrected at any age if it is excessive. Donor side mild ankle valgus may occur despite sound tibiofibular synostosis. LEVEL OF EVIDENCE: Level IV.


Assuntos
Transplante Ósseo/estatística & dados numéricos , Fíbula/transplante , Retalho Perfurante , Pseudoartrose/congênito , Tíbia/cirurgia , Adolescente , Transplante Ósseo/métodos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Neurofibromatose 1/complicações , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Estudos Retrospectivos , Adulto Jovem
18.
Spine J ; 21(3): 370-376, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33080375

RESUMO

BACKGROUND CONTEXT: Pseudarthrosis after attempted spinal fusion is yet not sufficiently understood and presents a surgical challenge. Occult infections are sometimes observed in patients with pseudarthrosis and no inflammatory signs of infection. The prevalence of such occult infection and its association with patient demographics and inflammatory markers are largely unknown. PURPOSE: To determine the prevalence of unexpected low-grade infection in spinal pseudarthrosis revision surgery, and to evaluate whether such infection is associated with patient demographics and inflammatory markers. STUDY DESIGN: Retrospective observational study. PATIENT SAMPLE: One-hundred-and-twenty-eight patients who underwent thoracolumbar revision surgery due to presumed aseptic pseudarthrosis after spinal instrumentation. OUTCOME MEASURES: Culture-positive infections or noninfectious pseudarthrosis. METHODS: Samples were routinely taken for microbiological examination from all adults (n=152) who underwent revision surgery for presumed aseptic thoracolumbar pseudarthrosis between 2014 and 2019. A full intraoperative microbiological workup (at least three intraoperative tissue samples) was done for 128 (84%) patients, and these patients were included in further analyses. Patient characteristics, medical history, inflammatory markers, and perioperative data were compared between those with and without microbiologically-confirmed infection based on samples obtained during pseudarthrosis revision. RESULTS: The microbiological workup confirmed infection in 13 of 128 cases (10.2%). The predominant pathogen was Cutibacterium acnes (46.2%), followed by coagulase-negative staphylococci (38.5%). The presence of infection was associated with the body mass index (30.9±4.7 kg/m2 [infected] vs. 28.2±5.6 kg/m2 [controls], p=.049), surgery in the thoracolumbar region (46% vs. 18%, p=.019), and a slightly higher serum C-reactive protein level on admission (9.4±8.0 mg/L vs. 5.7±7.1 mg/L, p=.031). Occult infection was not associated with age, sex, prior lumbar surgeries, number of fused lumbar levels, American Society of Anesthesiologist score, Charlson Comorbidity Index, presence of diabetes mellitus, and smoking status. CONCLUSIONS: Occult infections were found in 10% of patients undergoing pseudarthrosis revision after spinal fusion, even without preoperative clinical suspicion. Occult infection was associated with higher body mass index, fusions including the thoracolumbar junction, and slightly higher C-reactive protein levels. Intraoperative microbiological samples should be routinely obtained to exclude or identify occult infection in all revision surgeries for symptomatic pseudarthrosis of the spine, as this information can be used to guide postoperative antibiotic treatment.


Assuntos
Pseudoartrose , Doenças da Coluna Vertebral , Fusão Vertebral , Adulto , Humanos , Vértebras Lombares/cirurgia , Pseudoartrose/epidemiologia , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Reoperação , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Coluna Vertebral , Resultado do Tratamento
19.
Oper Neurosurg (Hagerstown) ; 20(2): 164-173, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33035339

RESUMO

BACKGROUND: The treatment of pseudarthrosis after transforaminal lumbar interbody fusion (TLIF) can be challenging, particularly when anterior column reconstruction is required. There are limited data on TLIF cage removal through an anterior approach. OBJECTIVE: To assess the safety and efficacy of anterior lumbar interbody fusion (ALIF) as a treatment for pseudarthrosis after TLIF. METHODS: ALIFs performed at a single academic medical center were reviewed to identify cases performed for the treatment of pseudarthrosis after TLIF. Patient demographics, surgical characteristics, perioperative complications, and 1-yr radiographic data were collected. RESULTS: A total of 84 patients were identified with mean age of 59 yr and 37 women (44.0%). A total of 16 patients (19.0%) underwent removal of 2 interbody cages for a total of 99 implants removed with distribution as follows: 1 L2/3 (0.9%), 6 L3/4 (5.7%), 37 L4/5 (41.5%), and 55 L5/S1 (51.9%). There were 2 intraoperative venous injuries (2.4%) and postoperative complications were as follows: 7 ileus (8.3%), 5 wound-related (6.0%), 1 rectus hematoma (1.1%), and 12 medical complications (14.3%), including 6 pulmonary (7.1%), 3 cardiac (3.6%), and 6 urinary tract infections (7.1%). Among 58 patients with at least 1-yr follow-up, 56 (96.6%) had solid fusion. There were 5 cases of subsidence (6.0%), none of which required surgical revision. Two patients (2.4%) required additional surgery at the level of ALIF for pseudarthrosis. CONCLUSION: ALIF is a safe and effective technique for the treatment of TLIF cage pseudarthrosis with a favorable risk profile.


Assuntos
Pseudoartrose , Fusão Vertebral , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Reoperação
20.
J Pediatr Orthop ; 41(1): e90-e93, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32852366

RESUMO

Congenital tibial pseudarthrosis is a rare condition seen in neurofibromatosis type 1 (NF1), and treatment is complex. A randomized, placebo-controlled trial of bone morphogenetic protein (rhBMP-2; INFUSE bone graft) at time of tibial surgery was developed by the Neurofibromatosis Clinical Trials Consortium. Patients were randomized to receive rhBMP-2 that would, or would not, be added to the standard surgical procedure consisting of resection of pseudarthrosis tissue, insertion of a rigid intramedullary rod, and placement of autogenous iliac crest bone graft. Despite involvement of 16 centers with wide experience with NF1 orthopaedic management, only 5 patients (of 54 required) were able to be enrolled in the study during a 3-year time period. Because of the inability to recruit sufficient patients, this study was closed in June 2019, with plans to terminate. The obstacles that were encountered during the study are summarized. The authors question whether a randomized, placebo-controlled trial of a rare pediatric orthopaedic condition is possible to accomplish. Recommendations are provided to guide future studies of orthopaedic manifestations of NF1.Level of Evidence: Level V.


Assuntos
Proteína Morfogenética Óssea 2/farmacologia , Neurofibromatose 1/cirurgia , Procedimentos Ortopédicos/métodos , Seleção de Pacientes , Pseudoartrose , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Fator de Crescimento Transformador beta/farmacologia , Proteínas Morfogenéticas Ósseas/farmacologia , Humanos , Neurofibromatose 1/complicações , Pseudoartrose/congênito , Pseudoartrose/cirurgia , Doenças Raras , Proteínas Recombinantes/farmacologia , Tamanho da Amostra , Tíbia/anormalidades , Tíbia/cirurgia
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