Clasificación fracturas tobillo: en algunas publicaciones se conoce como En su libro sobre las pseudoartrosis (), conjunto con O. Cech, de Praga, utiliza. Pseudoartrosis (3). 1. PPSSEEUUDDOOAARRTTRROOSSIISS DDRR.. EEDDGGAARR VVAALLEENNZZUUEELLAA. pseudoartrosis Necrosis avascular del escafoides Clasificación Las fracturas de escafoides se clasifican.
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Post surgical orthognathic of upper maxilla pseudoarthrosis. Hospital Universitario 12 de Octubre. The development of rigid internal fixation in the management of facial fractures over the last 25 years increased not only the number of available treatments but also, when incorrectly applied, the types of complications arising.
We present a pseudoargrosis case report of upper jaw pseudoarthrosis after a convencional treatment of orthognatic surgery osteotomy type LeFort I.
Pseudarthrosis-nonunion can result after incorrect treatment of facial fractures with clasificacikn miniplatesscrews. When we review the publishing literature, we find that the correct treatment of this potential pitfalls has not changed significantly during last years. The aim is the mechanical immobility of the created fracture.
Sometimes we must harvest cancellous bone graft to complete the treatment. We discuss the different terms related to anomalies in the ossification. Inadequate stabilization of fractures by either conservative or operative methods often leads to infection, pseudoarthrosis or both. Clasiificacion promote healing of both infections and pseudarthrosis, absolutely stable fixation of the fragments is necessary.
Depending on the defect zones that may develop, the osteosynthesis or reosteosynthesis that is usually necessary must be accompanied by a graft of autogenous cancellous bone.
Pseudarthrosis; Delayed union; Orthognatic surgery. The development of rigid internal fixation in the Management of facial fractures over the last 25 years increased not only the number of available treatments but also, when correctly applied, the types of complications that arise.
However, when we review the published literature, we find that the correct treatment of these potential pitfalls have not significantly changed over the past few years. The aim is the mechanical immobility of the center of the created fracture.
pseudoartrosis maxilar superior: Topics by
Sometimes, depending n the type of obtained consolidation, we resort to obtaining bone grafts. The majority of the clinical cases described in relation to abnormal ossification of the created fracture occur after inappropriate facial fracture treatment. Below we discuss the case of pseudarthrosis of the superior maxilla after a conventional orthognathic surgical procedure Superior maxilla osteotomy type Le Fort I. Woman 39 years old, admitted for surgical treatment of a dental facial deformity.
Her medical history showed that she was anemic and had no known allergies to medication. Upon physical examination the prognosis is class 3 molar and pseudo hipoplasia of the superior maxilla.
A cranial orthopantography and teleradiography were carried out at the start of the corresponding cephalometric study. After orthodontic treatment and extraction of the 4 wisdom teeth the patient underwent orthognathic conventional surgery. The bones were fixed with 2 premade titanium plates in both nasal maxilla outriggers 7mm of adavance3mm of anterior impaction and 5mm of posterior impaction, 1mm left rotation, partial inferior nasal septum resection, alar cinching and labial closure in V-Y fashion Fig.
The patient was released and had follow up external consults that showed episodes of repeating bilateral cellulitis. It started months after the initial intervention. It was decided that the patient have the osteosythesis material removed one year after the initial intervention. This is done by reopening of the previous bilateral superior sub labial approach. Between operations we attempt not to move the third half of the face even with the Le Fort I osteotomy.
This surgery is categorized as intolerance to osteosynthetic material. One year after having periodic revisions in our external consults as well as with the orthodontist the patient reported exerting less force when chewing which allowed her to have solids in her diet. Clinical exploration showed light movement of the superior maxilla even with the Le Fort I, the patient maintains correct occlusion of class I.
In the computed tomography of the facial middle third we observe an absence of superior maxilla consolidation with continued bone remedy of the Le Fort osteotomy Fig. Given the evolution time since the first intervention, a diagnostic hypothesis of superior maxilla pseudoarthrosis of this osteotomy is established. A decision is made to operate on the patient again in order to have definitive management of this complication.
After blocking the elastic inter maxilla in class I and reopening the new superior sub labial approach Fig. The superior osteotomy maxilla is attached using two preformed titanium plates in which the pseudoartrpsis is already established Fig.
The grafts are then placed in the bone gap of the Le Fort I osteotomy, closing the defected area Fig. The anatomic pathological study of the localized fracture tissue shows a presence of cartilaginous cells with predominant fibroblast proliferation on the inside of the tissue. After said intervention our consults show consolidation at osteotomy level, without its movement, with stable occlusion and an aesthetically pleasing aspect.
In like manner complications after taking the graft from the tibia were not valued, being that the Rx control was favorable Fig. The clinical classification of unusual bone consolidation defects is regularly arbitrary.
There is wide spectrum of definitions that describe concurrent simultaneous conditions and functional implications that are determined by anatomic position. The time varies according to the diverse reviewed series. Although the common time used as a reference is 6 months.
Pseudoartrosis maxilar superior post-cirugía ortognática: A propósito de un caso clínico
This time is derived from the observations and histological study done on skeletal bone. Investigations into the maxilla bone consolidation of sheep show that the healing process is identical to that of the rest of the skeleton. Eventually there is an pseudoartroxis consolidated bone structure. Unlike the absence of union, there is potential for bone consolidation after additional immobilization and adequate reduction.
Fractures that do not have ossification after 6 months of post operative treatment are defined as pseudoarthrosis some authors increase the limit to 8 months. The articulated joints where the chipped tissue discovered is fibrocartilage are false joints. While the bone formation continues in delayed union, this process ends in the cases that have a lack clasificacio union.
There is a permanent clasificaciom of identifiable bone tissue in the center of the fracture. Experimental studies on animals Schenk and Willenegger 2 have shown that the chip of fibro cartilage is live tissue but it is not vascularized.
The continual mobilization between the fracture fragments allows for fibro cartilage mineralization. It’s important to distinguish between hypertrophic pseudoarthrosis, where there is objectivable pseudoartrosix in bone callus formation, and atrophic pseudoarthrosis non union without bone callus formationrelated to the insufficient vascular contribution.
Both types of pseudoarthrosis can be radio logically distinguished. In hypertrophic pseudoarthrosis the ends of the fragments are typically swollen called elephant feet while in atrophic pseudoarthrosis the ends simulate osteosclerosis. Depending on if the associated infected processes are intermittent or chronic, we see pseudoarthrosis either with contact or with a bone interfragment gap.
Osteomyelitis in the bone gap can occur after conservative or surgical treatment. Inadequate treatment of the fracture with internal fixation can result in inflammation. In any fracture where internal fixation was used, the definitive result can vary from bone union to a failed clasidicacion. If the failure happened before the end of the bone consolidation phase a radio logically visible callus will form with posterior repair of the bone gap after reabsorbtion of the ends of the fracture.
Since the purpose of using plates and screws is to stabilize the broken bone fragments it should completely guarantee stabilization. Movement when foreign bodies are present generally implies not only pseudoarthrosis but also infection of the area.
The absence of union implies an alteration to the normal bone healing process. While the conservative healing of treated fractures occurs mainly via callus formation from the periosteum, the objective of stable fixation of the fractures should be direct bone healing from the cortical and osteons directly bridging the bone gap.
Comminution at the center of the fracture involves added difficulty during fixation and because of this a higher incidence of pseudoarthrosis. Alteration of bone microcirculation and the simultaneous micro movements caused by insufficient stability are the main factors that lead to non union. It pseudoatrrosis yet to be established which of the components of internal fixation techniques microcirculation or micro pseudoartrosiz are more important.
At the moment there is no doubt that applying osteosynthetic materials modifies microcirculation. Experiments performed on dogs and sheep showed that vascularization is reduced when using plates fixed with bi cortical screws static compression.
When reduction is inadequate and osteosynthesis is not carried out properly, the endostic vascularization is also altered because of the micro-macro movement of the bone fragments. Normal consolidation of the fracture gap can not take place through secondary treatment. Furthermore, there can be many pseudoartrosks involved in the genesis of a lack of consolidation at the center of the fracture. These factors include failed antibiotic treatment, delayed treatment, the presence of many fractures, foreign bodies at the center of the fracture, patient age, metabolic alterations, and drug and alcohol abuse.
These factors are usually associated with malnutrition and have adverse affects on bone treatment. Topazian and Goldberg 6 show a high complication rate among indigenous populations that had complex postoperative clinical follow-up. The lack of cooperation and the hygiene deficit also make the prognosis worse.
It is crucial to analyze the factors that cause failed consolidation and prevent adequate ossification of the fracture. Osteomyelitis is another factor that should be independently considered as being involved in the lack of union.
Lack of ossification and infection has been described as highly associated. Infection affects the bone treatment, reducing oxygenation, increasing fibroblast proliferation and delaying osteoblastic and osteoclastic activity. Formation of fibrous tissue prevails over bone deposit which creates pseudoartdosis lack of consolidation.
Anderson and Alpert 7 consider that infection can be avoided by establishing early surgical treatment.
Like many things, the best treatment is to prevent the problem before it starts. That number is similar to the revisions performed 20 years ago. Lack of fracture fixation or incorrect fracture fixation causes the local inflammatory process that takes place at the center of the fracture to endostically spread out.
This happens as a result of limited perfusion of the sides of the bone fracture. As a result, osteomyelitis of the bone gap can be associated. Regardless of whether there is osteomyelitis often associated with lack of consolidation around the center of the fracture or a over infected pseudoarthrosis the main goal should be the complete stabilization of the fracture.
Review of clinical studies shows that the titanium plates can be used even in the center of an inflamed fracture if a proper technique is used. Use of autologous bone grafts taken from in the center of the fracture.
It is true that using an inter maxilla block as the only method of stabilization causes inflammation, but usually causes extensive reabsorbtion of the distal fragments of the fracture, which generally results in pseudoarthrosis.
Internal fixation is important for complete treatment, assuring correct and stable occlusion. Pseudoarthrosis treatment, especially when there is a bone defect, involves not only internal rigid fixation, but also autologous bone grafts that reconstruct the created bone gap.
Any sequestrum o tissue fragment should be removed and the distal fragments of the fracture should be split Instability combined with weak osteosynthetic material or continual bone gap contamination in the presence of soft tissue defects regularly leads to chronic infected pseudoarthrosis.