Use Of The Vascularized Iliac-crest Flap In Musculoskeletal Lesions.

Bone loss was in the past treated by several methods, such as bone distraction and the use of nonvascularized or tissue-bank bone grafts. With the advent of modern microsurgical techniques, the vascularized bone flap has been used with good results; it resolves local nutritional problems, repairs soft tissue that is often damaged by severe trauma, and treats bone loss due to tumors, pseudarthroses, and osteomyelitis. This paper reports the authors' experience with the use of vascularized iliac-crest flaps to treat orthopedic pathologies in five patients with traumatic bone loss (<10 cm), three with osteomyelitis, and three with atrophic nonunion. In all cases, the same surgeon obtained a vascularized iliac-crest flap with a pedicle based on the deep iliac circumflex artery. All flaps consolidated within a mean period of 3 months. These findings demonstrate that the use of an iliac-crest flap is a treatment option in cases of bone loss and that it is associated with good functional results and minimal donor-site morbidity.201323714

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

Lower limb amputation in children: report and experience in 21 cases

It is reported the experience in 21 patients, average age of 6 years old, who were submitted to 26 lower limb amputation due to congenital malformation (14), infection (6) and others. It is discussed the procedures, complications, advantages and disadvantages of each amputation level. It is concluded that amputation in children is still an option to be considered, mainly for allowing the patent a rapid recovery both functional and social.Os autores apresentam os resultados de 21 pacientes, com idade média de 6 anos, submetidos à 26 amputações do membro inferior por malformações congênitas (14), infecções (06) e outras. Discute-se os procedimentos, as complicações, as vantagens e desvantagens de cada nível de amputação. Concluem que a amputação na criança continua sendo uma opção a ser considerada, principalmente por propiciar rápida recuperação funcional e social do paciente.61

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

Sensate composite calcaneal flap in leg amputation: a full terminal weight-bearing surface—experience in eight adult patients

Despite modern reconstruction techniques and replantation, the preservation of a severely traumatised limb, or even a limb affected by a congenital malformation, usually gives poorer functional results compared with amputation and prosthetisation. The aim of this study was to describe a hind foot (including the calcaneum and fat pad) sensate flap with a surface that allows full terminal weight bearing in transtibial amputations in adults. Between June 2007 and September 2008, eight patients underwent leg amputations with a sensate composite calcaneal flap reconstruction of the stump. Patients consisted of four men and four women with a mean age of 46.5 (26–66) years. All amputations were unilateral. The mean follow-up was 28.3 (25–42) months. There were no complications. Calcaneum tibial fusion was observed in all patients in a mean time of 3.5 (3–4) months. A below-knee prosthesis was adapted at 16 weeks postoperatively in all cases, and no need for stump revision occurred in this series during the entire follow-up period. A transtibial amputation covered with a sensate plantar flap preserving the calcaneum was proposed. In theory, the anatomic structures spared in this technique provide a strong, full, weight-bearing terminal surface of the stump that will last a lifetime

Functional outcomes and quality of life one year after surgical management of trochanteric fractures

OBJECTIVE: Evaluate the impact that trochanteric hip fractures produce on life quality of elderly patients, treated surgically, during one year of monitoring. METHODS: Were selected 73 elderly with transtrochanteric femur fracture, aged equal or over than 65 years and of both sexes. All participants underwent a standardized questionnaire which obtained information on lifestyle habits, functionality, physical activity, ambulation and cognitive state. Were excluded patients who died, not walking, with neurological diseases and pathological fractures. RESULTS: The average age was 80.17 ± 7.2 years and 75% was female. When comparing the summation of activities of daily living (p = 0.04) and instrumental daily living (p = 0.004) obtained before and after fracture, the patients become more dependent after fracture. Activities of daily living that worsened after fracture were bathing (p = 0.04), toileting (p = 0.02) and dressing (p = 0.04). All instrumental activities of daily living showed a significant difference, with functional dependence after fracture, increased need for walking aid (p = 0.00002), aged (p = 0.01) and not doing housework (p = 0.01). The low score on the test Minimental was associated with a greater dependence to perform activities of daily living before (p = 0.00002) and after (p = 0.01) fracture. CONCLUSION: After a year, activities of daily living that depended on the lower limbs worsened significantly, all instrumental activities of daily living were significantly worse in more than 50% of patients and more than half of patients who walked without support lost this ability.OBJETIVO: Avaliar o impacto que as fraturas transtrocanterianas produzem sobre a qualidade de vida de pacientes idosos, tratados cirurgicamente, durante o período de um ano de acompanhamento. MATERIAL E MÉTODO: Foram selecionados 73 idosos com fratura transtrocanterina, com idade igual ou superior a 65 anos de ambos os sexos. Foi aplicado questionário padronizado, para se obter informações quanto aos hábitos de vida, atividade física, funcionalidade, deambulação e estado cognitivo. Foram excluídos os óbitos ocorridos durante o estudo, pacientes que não deambulavam, com doenças neurológicas ou fraturas patológicas. RESULTADOS: A média de idade foi 80,17 ± 7,2, sendo 75% do sexo feminino. Ao comparar as somatórias das atividades de vida diária (p=0,04) e instrumentais da vida diária (p=0,004), obtidas na pré e pós-fratura, os pacientes tornaram-se mais dependentes pós-fratura. Atividades de vida diária que apresentaram piora pós-fratura foram: tomar banho (p=0,04), ir ao banheiro (p=0,02) e vestir-se (p=0,04). Todas as atividades instrumentais da vida diária apresentaram diferença significativa, apresentando maior dependência funcional pós-fratura, assim como aumento da necessidade de auxílio a deambulação (p=0,00002), idade avançada (p=0,01) e não realizar atividades domésticas (p=0,01). A baixa pontuação no teste Minimental estava associada com uma maior dependência para realizar as atividades da vida diária na pré-fratura (p=0,00002) e pós-fratura (p=0,01). CONCLUSÃO: Após um ano, as atividades de vida diária que dependiam dos membros inferiores pioraram significativamente, todas as atividades instrumentais de vida diária apresentaram piora significativa em mais de 50% dos pacientes e mais da metade dos pacientes que andavam sem apoio perderam esta capacidade.485

VIGOR: Sviluppo geotermico nelle Regioni della Convergenza

La valutazione del potenziale geotermico. Quadro normativo e iter autorizzativo per la ricerca e la coltivazione di risorse geotermiche. Accettabilità sociale della geotermia. Il caso tipo di Termini Imeres

Fractures of the distal third of the humerus with palsy of the radial nerve : management using minimally-invasive percutaneous plate osteosynthesis

Orientador: William Dias BelangeroTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: O tratamento das fraturas do terço distal da diáfise do úmero associadas a lesão do nervo radial ainda é assunto de controvérsia. Especialmente nesta região o nervo pode estar comprimido ou encarcerado por fragmentos ósseos. A osteossíntese com redução indireta da fratura e fixação interna, nesses casos, pode resultar em lesão nervosa permanente. O autor descreve uma técnica cirúrgica com a utilização da placa em ponte, introduzida percutaneamente nessas situações específicas. Seis pacientes foram operados evoluindo com a consolidação da fratura e a recuperação neurológica num tempo médio de 03 meses. Nessa casuística a única complicação foi um caso de infecção com fístula na cicatriz distal que resolveu completamente com a retirada do material de implanteAbstract: Fractures of the distal third of the humerus may be complicated by complete lesions of the radial nerve which may be entrapped or compressed by bone fragments. Indirect reduction and internal fixation may result in a permanent nerve lesion. The author describe the treatment of these lesions by insertion of a bridge plate using the minimally-invasive percutaneous technique. Six patients were operated on and showed complete functional recovery. Healing of the fractures occurred at a mean of 2.7 months (2 to 3) and complete neurological recovery by a mean of 2.3 months (1 to 5). In one patient infection occurred wich resolved after removal of the implanteDoutoradoPesquisa ExperimentalDoutor em Cirurgi