Enríquez CJA, García HA, López VA, Romo CFJ, González TA

Idioma: Español
Referencias bibliográficas: 46
Paginas: 217-223
Archivo PDF: 470.79 Kb.

RESUMEN

Objetivo. Evaluar el clavo intramedular sin rimar (UTN) en el tratamiento de la pseudoartrosis traumática de la tibia. Material y métodos. Se trató a un total de 33 pacientes adultos, 29 hombres y 4 mujeres, con edad promedio de 35.6 años, de agosto de 1997 a agosto de 2001, mediante limpieza del foco de pseudoartrosis, injerto óseo, diafisectomía del peroné y enclavamiento de la tibia sin rimar. Resultados. Se obtuvo la consolidación tibial en 32 de los 33 enfermos, en un promedio de 7 meses. El individuo restante se trató con una segunda aplicación de injerto óseo. Hubo necesidad de rotar un colgajo cutáneo en 4 casos, por fallas de cicatrización local. Conclusión. Se ha mostrado la utilidad del clavo UTN en la estabilización de la tibia como parte del tratamiento para la pseudoartrosis, en el 96 % de nuestros casos.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Abbas E, et al. Infected tibial nonunion, good results after open cancellous bone grafting in 37 cases. Acta Orthop Scand 1995; 66(5): 447-451.

2. Bhan S, et al. Percutaneous bone grafting for nonunion and delayed union of fractures of the tibial shaft. International Orthopaedics (SICOT), 1993; 17: 310-312.

3. Bizot P, et al. Secondary nailing of the tibia in nonunions with septic risk. Indications and results. Rev Chir Orthop Reparatrice Appar Mot 1991; 77(4): 241-8.

4. Boidar S, et al. Percutaneous autologous bone marrow grafting on the site of tibial delayed union. Croatian Medical Journal 1999; 40(3).

5. Brighton CT, et al. Tibial nonunion treated with direct current, capacitive coupling or bone graft. Clinical Orthopaedics and Related Research 1995; (321): 223-234.

6. Brumback RJ, et al. Intramedullary nailing of the femur: reamed versus nonreamed. J Am Acad Orthop Surg 2000; 8: 83-90.

7. Cierny G. Infected tibial nonunions (1981-1995), the evolution of change. Clinical Orthopaedics and Related Research 1999; 360: 97-102.

8. Connolly JF. Letters to the Editor. Journal of Orthopaedic Trauma 1994; 8(4): 359-360.

9. Court-Brown CM. Letters to the Editor. Journal of Orthopaedic Trauma 13(4): 274.

10. Cuypers L, et al. Locking graft in the treatment of tibial pseudarthrosis. Acta Orthopaedica Belgica 1992; 58(Suppl. 1).

11. Choon-Lai T, et al. The infected nonunion of the tibia. Clinical Orthopaedics and Related Research 1995; 315: 176-191.

12. de Meulemeester C, et al. The fibula pro tibia procedure in the treatment of nonunion of the tibia. Acta Orthopaedica Belgica 1992; 58(Suppl. 1).

13. Dickson K, et al. Delayed unions and nonunions of open tibial fractures, correlation with arteriography results. Clinical Orthopaedics and Related Research 302: 189-193.

14. Ebraheim NA, et al. The treatment of tibial nonunion with angular deformity using an Ilizarov device. The Journal of Trauma 1995; 38(1): 111-117.

15. Evrard J. Place de la greffe inter-tibio-péroniére dans le traitement des fractures et pseudarthroses infectées de jambe. Revue de Chihrugie Orthopedique 1992; 78(6).

16. Gunzburg R, et al. Biomechanical behavior of the tibiofibular frame in nonunion. Acta Orthopaedica Belgica 1991; 57: 3.

17. Hein D, et al. La presión intramedular en el enclavado del fémur y tibia, con y sin fresado, estudio in vitro en huesos humanos intactos. Injury 24(Suppl. 3): 56-63.

18. Johnson EE, et al. Delayed intramedullary nailing after failed external fixation of the tibia. Clin Orthop 1990; (253): 251-7.

19. Johnson EE, et al. Distal metaphyseal tibial nonunion. Clinical Orthopaedics and Related Research 1990; 250: 234-240.

20. Klemm K, Schnettler R. The use of gentamicin-PMMA chains in the treatment of infected tibial nonunion. Acta Orthopaedica Belgica 1992; 58(Suppl. 1).

21. Levin PE. Letters to the Editor. Clinical Orthopaedics and Related Research 1996; 332: 304.

22. Mast JW, et al. Preoperative planning for the treatment of nonunions and the correction of malunions of the long bones. Orthopedic Clinics of North America 1990; 21(4): 693-714.

23. Mayo AK, et al. Treatment of tibial malunions and nonunions with reamed intramedullary nails. Orthopaedic Clinics of North America 1990; 21(4): 715-724.

24. McLaren AC, et al. Locked intramedullary fixation for metaphyseal malunion and nonunion. Clinical Orthopaedics and Related Research 1991; (265): 253-260.

25. Müller Chr, et al. Presión intramedular, tensión diafisaria y aumento de la temperatura cortical al realizar el fresado de la cavidad medular del fémur-estudio comparativo entre fresas romas y afiladas. Injury 24(Suppl. 3): 22-30.

26. Ochsner PE, et al. Heatg-induced segmental necrosis after reaming of one humeral and two tibial fractures with a marrow medullary canal. Injury 29(Suppl. 2).

27. Patzakis MJ, et al. Results of bone grafting for infected tibial nonunion. Clinical Orthopaedics and Related Research 1995; 315: 192-198.

28. Reimer BL, et al. Comparison of reamed and nonreamed solid core nailing of tibial diaphysis after external fixation: a preliminary report. Journal of Orthopaedic Trauma 1993; 7(3): 279-285.

29. Rijnberg WJ, et al. Central grafting for persistent nonunion of the tibia. Journal of Bone and Joint Surgery 1993; 75-B: 926-31.

30. Rodríguez ME. Injertos óseos intramedulares a distancia en pseudoartrosis. Revista Cubana de Ortopedia y Traumatología 1997; (1-2): 56.

31. Rosson JW, et al. Locked nailing for nonunion of the tibia. The Journal of Bone and Joint Surgery 1992; 74-B(3): 358-361.

32. Saleh M, et al. Management of nonunion of fractures by distraction with correction of angulation and shortening. Journal of Bone and Joint Surgery 1996; 78-B(1).

33. Schwartsman V, et al. Tibial nonunions, treatment tactics with the Ilizarov method. Orthopedic Clinics of North America 1990; 21(4): 639-653.

34. Simon JP, et al. Posterolateral bone grafting for nonunion of the tibia. Acta Orthopaedica Belgica 1992; 58: 3.

35. Stuyck J, et al. Corrective osteotomy for mal- and nonunion of the tibia using the posterolateral approach. Acta Orthopaedica Belgica 1992; 58(Suppl. 1).

36. Tempelman D, et al. Exchange reamed intramedullary nailing for delayed union and nounion of the tibia. Clinical Orthopaedics and Related Research 1995; 315: 169-175.

37. Tiedeman JJ, et al. Treatment of nonunion by percutaneous injection of bone marrow and demineralized bone matrix. Clinical Orthopaedics and Related Research 1991; 268: 294-302.

38. Tracy WJ, et al. Management strategies for bone loss in tibial shaft fractures. Clinical Orthopaedics and Related Research 1995; 315: 138-152.

39. Warren SB, Brooker AF. Intramedullary nailing of tibial nonunions. Clinical Orthopaedics and Related Research 1992; 285: 236-243.

40. Weise K, et al. Role of intramedullary nailing in pseudarthrosis and malalignment. Orthopade 1996; 25 (3): 247-58.

41. Weller S. Fijación interna de las fracturas por el método de enclavado intramedular. Injury 24(Suppl. 3): 1-6.

42. Wenda K, et al. Patogenia e importancia clínica del embolismo de médula ósea en el enclavado medular demostrado mediante ecocardiografía intraoperatoria. Injury 24(Suppl. 3): 73-81.

43. Wiss DA, et al. Nonunion of the tibia treated with a reamed intramedullary nail. Journal of Orthopaedic Trauma 1994; 8(3): 189-194.

44. Wolfe MW, et al. Bone morphogenetic proteins in the treatment of nonunions and bone defects: historical perspective and current knowledge; University of Pennsylvania Orthopaedic Journal, 1999, http://health.upenn.edu/ortho/oj/1999/html/oj12sp99p1.html.

45. Wu CC, et al. High succes rate with exchange nailing to treat a tibial shaft aseptic nonunion. Journal of Orthopaedic Trauma 1999; 13(1): 33-38.

46. Yajima H, et al. Vascularized fibular grafts in the treatment of osteomyelitis and infected nonunion. Clinical Orthopaedics and Related Research 1993; 293: 256-264.