Minimal Invasive Ostheosintesis For Treatment Of Diaphiseal Transverse Humeral Shaft Fractures

Objective: To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique. Methods: Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures. Results: In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury. Conclusion: It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft. Level of Evidence III, Therapeutic Study.2229498Angelini, A.J., Livani, B., Flierl, M.A., Morgan, S.J., Belangero, W.D., Less invasive percutaneous wave plating of simple femur shaft fractures. A prospective series (2010) Int Orthop., 41 (6), pp. 624-628Heitemeyer, U., Claes, L., Hierholzer, G., Körber, M., Significance of postoperativestability for bony reparation of comminuted fractures. An experimental study Arch Orthop Trauma Surg., 1990 (3), pp. 144-149Gerber, C., Mast, J.W., Ganz, R., Biological internal fixation of fractures (1990) Arch Orthop Trauma Surg., 109 (6), pp. 295-303Miclau, T., Martin, R.E., The evolution of modern plate osteosynthesis (1997) Injury., 28 (SUPPL. 1), pp. A3-6Farouk, O., Krettek, C., Miclau, T., Schandelmaier, P., Guy, P., Tscherne, H., Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study (1997) Injury, 28 (SUPPL. 1), pp. A7-12Farouk, O., Krettek, C., Miclau, T., Schandelmaier, P., Guy, P., Tscherne, H., Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique? (1999) J Orthop Trauma., 13 (6), pp. 401-406Perren, S.M., Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology (2002) J Bone Joint Surg Br., 84 (8), pp. 1093-1110Livani, B., Belangero, W.D., Bridging plate osteosynthesis of humeral shaft fractures (2004) Injury., 35 (6), pp. 587-595Apivatthakakul, T., Arpornchayanon, O., Bavornratanavech, S., Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report (2005) Injury., 36 (4), pp. 530-538Apivatthakakul, T., Patiyasikan, S., Luevitoonvechkit, S., Danger zone for locking screw placement in minimally invasive plate osteosynthesis (MIPO) of humeral shaft fractures: a cadaveric study (2010) Injury., 41 (2), pp. 169-172Livani, B., Belangero, W.D., Castro de Medeiros, R., Fractures of the distal third of the humerus with palsy of the radial nerve: management usingn minimally- invasive percutaneous plate osteosynthesis (2006) J Bone Joint Surg Br., 88 (12), pp. 1625-1628Ziran, B.H., Belangero, W., Livani, B., Pesantez, R., Percutaneous plating of the humerus with locked plating: technique and case report (2007) J Trauma., 63 (1), pp. 205-210Schwarz, N., Windisch, M., Mayr, B., Minimally Invasive anterior plate osteosynthesis in humeral shaft fractures (2009) Eur J Trauma Emerg Surg., 35 (3), pp. 271-276Concha, J.M., Sandoval, A., Streubel, P.N., Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible? (2010) Int Orthop., 34 (8), pp. 1297-1305Hudak, P.L., Amadio, P.C., Bombardier, C., Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG) (1996) Am J Ind Med., 29 (6), pp. 602-608Thompson (1918) e Henry (1924 e 1966) - The humerus (2003) Surgical Exposures in Orthopaedics, pp. 67-103. , in: Hoppenfeld S., De Boer P., The anatomic Approach 3rd Ed;Charpter 2Livani, B., Belangero, W.D., Osteossíntese de fratura diafisária do úmero com placa em ponte: apresentação e descrição da técnica (2004) Acta Ortop Bras., 12 (2), pp. 113-117Gustilo, R.B., Anderson, J.T., Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses (1976) J Bone Joint Surg Am., 58 (4), pp. 453-458Gustilo, R.B., Mendoza, R.M., Williams, D.N., Problems in the management of type III (severe) open fractures: a new classification of type III open fractures (1984) J Trauma., 24 (8), pp. 742-746Benegas, E., Amódio, D.T., Correia, L.F.M., Malavolta, E.A., Ramadan, L.B., Ferreira Neto, A.A., Estudo comparativo prospectivo e randomizado entre o tratamento cirúrgico das fraturas diafisárias do úmero com placa em ponte e haste intra medular bloqueada (analise preliminar) (2007) Acta Ortop Bras., 15 (2), pp. 87-92Kobayashi, M., Watanabe, Y., Matsushita, T., Early full range of shoulder and elbow motion is possible after minimally invasive plate osteosynthesis for humeral shaft fractures (2010) J Orthop Trauma., 24 (4), pp. 212-216Hunsaker, F.G., Cioffi, D.A., Amadio, P.C., Wright, J.G., Caughlin, B., The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population (2002) J Bone Joint Surg Am., 84 (2), pp. 208-21

Analysis of the interface formed among the poli (viniilidene) fluoride (piezoelectric and non-piezoelectric) and the bone tissue of rats

The objective of this study was to evaluate the interface formed between the poli (viniilidene) fluoride (PVDF-piezoelectric and non-piezoelectric) and cap rats' bone tissue. Twenty tubes of PVDF [P (VDF-TrFE)] piezoelectric, (d3h = 2,5 pC/N and capacitance 800 pF/m), and twenty tubes of non-piezoelectric PVDF were implanted in the intercondilian notch of the left femur of 40 rats. The animals of both groups were subdivided in four subgroups, followed up for 7 days, 3, 6 and 12 weeks. The interface found between bone and tubes was studied by conventional optical microscopy (MOC) (n=28) and by backscattered electronic scanning microscopy (MEV) (n=12). Bone tissue growth was observed inside the tubes of piezoelectric PVDF followed up during 12 weeks, both by MOC and by MEV backscattering. The results indicate that the piezoelectric effect had an important role in the new bone tissue formation inside the piezoelectric tubes. Probably, that bone formation was a result from the electrets effect or from micro deformations produced in the piezoelectric tubes, due to the intra-articular pressure variation on the knee movement during gait.O objetivo deste estudo foi analisar a interface formada entre o polifluoreto de vinilideno (PVDF - piezelétrico e não piezelétrico) e o tecido ósseo do rato. Foram implantados em 40 ratos, na região intercondiliana do fêmur esquerdo, vinte tubos de PVDF [P(VDF-TrFE)] piezelétricos, (d3h = 2,5 pC/N e capacitância 800 pF/m), e vinte tubos de PVDF não piezelétricos. Os animais de ambos os grupos foram subdivididos em quatro subgrupos, seguidos por 7 dias, 3, 6 e 12 semanas. A interface formada pelos tubos com o tecido ósseo foi estudada por microscopia óptica convencional (MOC) (n=28) e pela microscopia eletrônica de varredura (MEV) por retroespalhamento (n=12). No interior dos tubos de PVDF piezelétricos seguidos por 12 semanas foi constatado, tanto pela MOC como pela MEV por retroespalhamento, crescimento de tecido ósseo. Os resultados indicam que a piezeletricidade teve papel importante na neoformação do tecido ósseo no interior dos tubos piezelétricos. Provavelmente, essa formação óssea foi decorrente ou do efeito eletreto, ou das microdeformações produzidas nos tubos piezelétricos, devido à variação da pressão intra articular do joelho durante a marcha.16016

Biomechanical and histological evaluation of hydrogel implants in articular cartilage

We evaluated the mechanical behavior of the repaired surfaces of defective articular cartilage in the intercondylar region of the rat femur after a hydrogel graft implant. The results were compared to those for the adjacent normal articular cartilage and for control surfaces where the defects remained empty. Hydrogel synthesized by blending poly(2-hydroxyethyl methacrylate) and poly(methyl methacrylate-co-acrylic acid) was implanted in male Wistar rats. The animals were divided into five groups with postoperative follow-up periods of 3, 5, 8, 12 and 16 weeks. Indentation tests were performed on the neoformed surfaces in the knee joint (with or without a hydrogel implant) and on adjacent articular cartilage in order to assess the mechanical properties of the newly formed surface. Kruskal-Wallis analysis indicated that the mechanical behavior of the neoformed surfaces was significantly different from that of normal cartilage. Histological analysis of the repaired defects showed that the hydrogel implant filled the defect with no signs of inflammation as it was well anchored to the surrounding tissues, resulting in a newly formed articular surface. In the case of empty control defects, osseous tissue grew inside the defects and fibrous tissue formed on the articular surface of the defects. The repaired surface of the hydrogel implant was more compliant than normal articular cartilage throughout the 16 weeks following the operation, whereas the fibrous tissue that formed postoperatively over the empty defect was stiffer than normal articular cartilage after 5 weeks. This stiffness started to decrease 16 weeks after the operation, probably due to tissue degeneration. Thus, from the biomechanical and histological point of view, the hydrogel implant improved the articular surface repair.30731

Survival Rates Of The Himex Extensible Nail In The Treatment Of Children With Osteogenesis Imperfecta

Objective: To evaluate the performance of an extensible nail with hooks, named HIMEX, in osteogenesis imperfecta (OI) deformities. Methods: All child patients were operated on with HIMEX from 1990 to 2004. The number of fractures, reappearance of deformities, improvement of motor development before and after the use of HIMEX, and the incidence of the migration and nail survival were compared. Results: Fourteen patients, with ages from 2 to 18 years, including 8 females, underwent 46 procedures, 39 primary and 7 re-operations. The average age at the first fracture was 148.21 days, and there was an average of 42.6 fractures per patient prior to HIMEX placement. Of the forty-six bones affected, 28 were femurs and 18 were tibias. Average follow-up care lasted 80.21±36.71 months. There was a statistically significant decrease (0.78) in the number of fractures per patient and an improvement in walking in seven of the fourteen patients. Revision occurred in 18% of patients and migration of the nail occurred in 12% (5/39). Eighty percent of the nails remained in situ until 108 months, with femoral procedures lasting significantly longer than tibial procedures. The type of OI and the age at the procedure did not significantly affect the incidence of revision. Conclusion: HIMEX significantly reduced the number of fractures, presenting lower incidence of migration and higher survival rates than those described in literature.186343348Sofield, H.A., Millar, E.A., Fragmentation, realignment, and intramedullary rod fixation of deformities of the long bones in children. A ten-year appraisal (1959) J Bone Joint Surg Am, 41, pp. 1371-1391Williams, P.F., Fragmentation and rodding in osteogenesis imperfecta (1965) J Bone Joint Surg Br, 47, pp. 23-31King, J.D., Bobechko, W.P., Osteogenesis imperfecta. An orthopaedic description and surgical review (1971) J Bone Joint Surg Br, 53, pp. 72-89Williams, P.F., Cole, W.H., Bailey, R.W., Dubow, H.I., Solomons, C.C., Millar, E.A., Current aspects of the surgical treatment of osteogenesis imperfecta (1973) Clin Orthop Relat Res, 0 (96), pp. 288-298Tiley, F., Albright, J.A., Osteogenesis imperfecta: treatment by multiple osteotomy and intramedullary rod insertion. Report on thirteen patients (1973) J Bone Joint Surg Am, 55, pp. 701-713Li, Y.H., Chow, W., Leong, J.C., The Sofield-Millar operation in osteogenesis imperfecta. A modified technique (2000) J Bone Joint Surg Br, 82, pp. 11-16Santilli, C., Akkari, M., Waisberg, G., Andrade, A.L.L., Costa, U., Silva, A.L.M., A operação de Sofield e Millar no tratamento da osteogênese imperfeita (2004) Acta Ortop Bras, 12, pp. 226-232Bailey, R.W., Dubow, H.I., Evolution of the concept of an extensible nail accom- modating to normal longitudinal bone growth: clinical considerations and im- plications (1981) Clin Orthop Relat Res, 0 (159), pp. 157-170Rodriguez Jr., R.P., Wickstrom, J., Osteogenesis imperfecta: a preliminary report on resurfacing of long bones with intramedullary fixation by an extensible intramedullary device (1971) South Med J, 64, pp. 169-176Rodriguez, R.P., Report of multiple osteotomies and intramedullary fixation by an extensible intramedullary device in children with osteogenesis imperfecta (1976) Clin Orthop Relat Res, 0 (116), p. 261Marafioti, R.L., Westin, G.W., Elongating intramedullary rods in the treatment of osteogenesis imperfecta (1977) J Bone Joint Surg Am, 59, pp. 467-472Rodriguez, R.P., Bailey, R.W., Internal fixation of the femur in patients with osteo- genesis imperfecta (1981) Clin Orthop Relat Res, 0 (159), pp. 126-133Lang-Stevenson, A.I., Sharrard, W.J., Intramedullary rodding with Bailey-Dubow extensible rods in osteogenesis imperfecta. An interim report of results and complications (1984) J Bone Joint Surg Br, 66, pp. 227-232Gamble, J.G., Strudwick, W.J., Rinsky, L.A., Bleck, E.E., Complications of intramedulla- ry rods in osteogenesis imperfecta: Bailey-Dubow rods versus nonelongating rods (1988) J Pediatr Orthop, 8, pp. 645-649Ryöppy, S., Alberty, A., Kaitila, I., Early semiclosed intramedullary stabilization in osteogenesis imperfecta (1987) J Pediatr Orthop, 7, pp. 139-144Stockley, I., Bell, M.J., Sharrard, W.J., The role of expanding intramedullary rods in osteogenesis imperfecta (1989) J Bone Joint Surg Br, 71, pp. 422-427Nicholas, R.W., James, P., Telescoping intramedullary stabilization of the lower extremities for severe osteogenesis imperfecta (1990) J Pediatr Orthop, 10, pp. 219-223Porat, S., Heller, E., Seidman, D.S., Meyer, S., Functional results of operation in os- teogenesis imperfecta: elongating and nonelongating rods (1991) J Pediatr Orthop, 11, pp. 200-203Jerosch, J., Mazzotti, I., Tomasevic, M., Complications after treatment of patients with osteogenesis imperfecta with a Bailey-Dubow rod (1998) Arch Orthop Trauma Surg, 117, pp. 240-245Luhmann, S.J., Sheridan, J.J., Capelli, A.M., Schoenecker, P.L., Management of lower- extremity deformities in osteogenesis imperfecta with extensible intramedullary rod technique: a 20-year experience (1998) J Pediatr Orthop, 18, pp. 88-94Wilkinson, J.M., Scott, B.W., Clarke, A.M., Bell, M.J., Surgical stabilisation of the lower limb in osteogenesis imperfecta using the Sheffield Telescopic Intramedullary Rod System (1998) J Bone Joint Surg Br, 80, pp. 999-1004Zionts, L.E., Ebramzadeh, E., Stott, N.S., Complications in the use of the ailey-Dubow extensible nail (1998) Clin Orthop Relat Res, 0 (348), pp. 186-195Janus, G.J., Vanpaemel, L.A., Engelbert, R.H., Pruijs, H.E., Complications of the Bailey- Dubow elongating nail in osteogenesis imperfecta: 34 children with 110 nails (1999) J Pediatr Orthop B, 8, pp. 203-207Karbowski, A., Schwitalle, M., Brenner, R., Lehmann, H., Pontz, B., Wörsdörfer, O., Experience with Bailey-Dubow rodding in children with osteogenesis imper- fecta (2000) Eur J Pediatr Surg, 10, pp. 119-124Mulpuri, K., Joseph, B., Intramedullary rodding in osteogenesis imperfecta (2000) J Pediatr Orthop, 20, pp. 267-273Sillence, D., Osteogenesis imperfecta: an expanding panorama of variants (1981) Clin Orthop Relat Res, 0 (159), pp. 11-25Shapiro, F., Consequences of an osteogenesis imperfecta diagnosis for survival and ambulation (1985) J Pediatr Orthop, 5, pp. 456-462Hoffer, M.M., Bullock, M., The functional and social significance of orthopedic rehabilitation of mentally retarded patients with cerebral palsy (1981) Orthop Clin North Am, 12, pp. 185-191Root, L., The treatment of osteogenesis imperfecta (1984) Orthop Clin North Am, 15, pp. 775-790Gerber, L.H., Binder, H., Weintrob, J., Grange, D.K., Shapiro, J., Fromherz, W., Rehabilitation of children and infants with osteogenesis imperfecta (1990) A program for ambulation. Clin Orthop Relat Res., 0 (251), pp. 254-26

Minimal invasive ostheosintesis for treatment of diaphiseal transverse humeral shaft fractures

OBJECTIVE:To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique.METHODS:Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures.RESULTS:In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury.CONCLUSION:It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft.Level of Evidence III, Therapeutic Study.Universidade de Campinas Hospital das Clinicas Department of Orthopedics and TraumatologySwedish Medical CenterUniversidade Federal de São Paulo (UNIFESP) Departament of Orthopedics and TraumatologyUNIFESP, Departament of Orthopedics and TraumatologySciEL

Comparing The In Vitro Stiffness Of Straight-dcp, Wave-dcp, And Lcp Bone Plates For Femoral Osteosynthesis.

The objective of this study was to compare the Locking Compression Plate (LCP) with the more cost-effective straight-dynamic compression plate (DCP) and wave-DCPs by testing in vitro the effects of plate stiffness on different types of diaphyseal femur fractures (A, B, and C, according to AO classification). The bending structural stiffness of each plate was obtained from four-point bending tests according to ASTM F382-99(2008). The plate systems were tested by applying compression/bending in different osteosynthesis simulation models using wooden rods to simulate the fractured bone fragments. Kruskal-Wallis test showed no significant difference in the bending structural stiffness between the three plate models. Rank-transformed two-way ANOVA showed significant influence of plate type, fracture type, and interaction plate versus fracture on the stiffness of the montages. The straight-DCP produced the most stable model for types B and C fractures, which makes its use advantageous for complex nonosteoporotic fractures that require minimizing focal mobility, whereas no difference was found for type A fracture. Our results indicated that DCPs, in straight or wave form, can provide adequate biomechanical properties for fixing diaphyseal femoral fractures in cases where more modern osteosynthesis systems are cost restrictive.201330875

Survival rates of the HIMEX extensible nail in the treatment of children with osteogenesis imperfecta

OBJECTIVE: To evaluate the performance of an extensible nail with hooks, named HIMEX, in osteogenesis imperfecta (OI) deformities. METHODS: All child patients were operated on with HIMEX from 1990 to 2004. The number of fractures, reappearance of deformities, improvement of motor development before and after the use of HIMEX, and the incidence of the migration and nail survival were compared. RESULTS: Fourteen patients, with ages from 2 to 18 years, including 8 females, underwent 46 procedures, 39 primary and 7 re-operations. The average age at the first fracture was 148.21 days, and there was an average of 42.6 fractures per patient prior to HIMEX placement. Of the forty-six bones affected, 28 were femurs and 18 were tibias. Average follow-up care lasted 80.21±36.71 months. There was a statistically significant decrease (0.78) in the number of fractures per patient and an improvement in walking in seven of the fourteen patients. Revision occurred in 18% of patients and migration of the nail occurred in 12% (5/39). Eighty percent of the nails remained in situ until 108 months, with femoral procedures lasting significantly longer than tibial procedures. The type of OI and the age at the procedure did not significantly affect the incidence of revision. CONCLUSION: HIMEX significantly reduced the number of fractures, presenting lower incidence of migration and higher survival rates than those described in literature.OBJETIVO: avaliar o desempenho da haste extensível ancorada por ganchos (HIMEX) em deformidades da osteogênese imperfeita (OI). MÉTODOS: Todas as crianças operadas com HIMEX entre 1990 - 2004. Foi comparado o número de fraturas, reaparecimento de deformidades e capacidade de deambulação antes e após a HIMEX; incidência de migração e sobrevida da haste por curvas de sobrevivência. RESULTADOS: 14 pacientes (2 a 18 anos), oito do sexo feminino, incluindo 46 procedimentos, 39 primários e sete re-operações. Idade média na primeira fratura de 148,21 dias e média de 42,6 fraturas/paciente pré colocação da HIMEX. Dos 46 procedimentos, 28 no fêmur e 18 na tíbia. Tempo médio de seguimento de 80,21 ± 36,71 meses. Houve diminuição significativa de fraturas/paciente (0,78) e melhora na deambulação em sete dos 14 pacientes. Porcentagem de re-operação de 18% e migração do implante em 12% (05/39). 80 % dos implantes in situ até 108 meses. Implantes na tíbia tiveram sobrevida significativamente menor que os do fêmur. O tipo da OI e a idade na época da cirurgia não influenciaram significativamente a incidência de re-operação. CONCLUSÃO: A HIMEX levou à redução significativa no número de fraturas, incidência menor de migração e sobrevida maior da haste do que a referida na literatura.34334

Biomechanical And Histological Evaluation Of Hydrogel Implants In Articular Cartilage.

We evaluated the mechanical behavior of the repaired surfaces of defective articular cartilage in the intercondylar region of the rat femur after a hydrogel graft implant. The results were compared to those for the adjacent normal articular cartilage and for control surfaces where the defects remained empty. Hydrogel synthesized by blending poly(2-hydroxyethyl methacrylate) and poly(methyl methacrylate-co-acrylic acid) was implanted in male Wistar rats. The animals were divided into five groups with postoperative follow-up periods of 3, 5, 8, 12 and 16 weeks. Indentation tests were performed on the neoformed surfaces in the knee joint (with or without a hydrogel implant) and on adjacent articular cartilage in order to assess the mechanical properties of the newly formed surface. Kruskal-Wallis analysis indicated that the mechanical behavior of the neoformed surfaces was significantly different from that of normal cartilage. Histological analysis of the repaired defects showed that the hydrogel implant filled the defect with no signs of inflammation as it was well anchored to the surrounding tissues, resulting in a newly formed articular surface. In the case of empty control defects, osseous tissue grew inside the defects and fibrous tissue formed on the articular surface of the defects. The repaired surface of the hydrogel implant was more compliant than normal articular cartilage throughout the 16 weeks following the operation, whereas the fibrous tissue that formed postoperatively over the empty defect was stiffer than normal articular cartilage after 5 weeks. This stiffness started to decrease 16 weeks after the operation, probably due to tissue degeneration. Thus, from the biomechanical and histological point of view, the hydrogel implant improved the articular surface repair.33307-1

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Thinking on orthopedics and traumatology research methodology

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