Damian Bustos

Osteointegración del aloinjerto crioconservado asociado a plasma enriquecido en plaquetas, en defectos óseos infectados. Estudio experimental. [Osseointegration of cryopreserved allograft associated with platelet-rich plasma, in infected bone defects. Experimental study.

espanolIntroduccionEl objetivo de este trabajo experimental es determinar si el agregado de plasma rico en plaquetas influye en la osteointegracion del aloinjerto crioconservado con antibioticos, en fracturas infectadas, con perdida osea, en huesos largos de conejos.Material y metodosSe evaluaron cuatro grupos de 7 conejos cada uno, a los cuales se les genero una fractura infectada del femur derecho. En los cuatro grupos, se coloco aloinjerto molido con antibiotico local, en el grupo II y en el grupo IV, se agrego tambien plasma rico en plaquetas. Se sacrifico a los grupos I y II, a los 30 dias, y a los grupos III y IV, a los 90 dias. Se realizo una evaluacion histologica y tomografica.ResultadosNueve conejos murieron en el periodo de estudio. No hubo diferencias estadisticamente significativas entre los grupos evaluados. En el grupo IV, con plasma rico en plaquetas, se observo neoformacion osea en tres de las cuatro muestras; se advirtieron sectores de acoplamiento entre el tejido receptor y el injertado, con consolidacion en las imagenes tomograficas.ConclusionesEn este trabajo, hubo correlacion entre los resultados histologicos y tomograficos. Pese a que no se hallaron diferencias estadisticamente significativas, el agregado de plasma rico en plaquetas, ademas de estimular la generacion de nuevos tejidos, disminuyo la reabsorcion del tejido injertado al analisis anatomopatologico, y mostro mayor neoformacion osea y consolidacion en el grupo IV (75%) tratado con plasma rico en plaque- tas que en el grupo III (25%) al que no se asocio plasma rico en plaquetas al aloinjerto oseo. EnglishBackgroundThe objective of this experimental work was to determine whether the addition of platelet-rich plasma influences the osseointegraton of cryopreserved allograft with antibiotics in infected fractures with bone loss, in long bones of rabbits.MethodsFour groups of 7 rabbits with generated infected fracture of the right femur. Milled allograft with local antibiotic was placed in the four groups; groups II and IV also received platelet-rich plasma. Rabbits in groups I and II were sacrificed at 30 days, and those of groups III and IV at 90 days. Histological and CT evaluation was performed.ResultsNine rabbits died during the study period. There were no statistically significant differences between groups. In group IV with platelet-rich plasma, bone formation was observed in three of the four samples, with noticeable areas of coupling between the receiver and the grafted tissue with consolidation in CT.ConclusionsIn our study, there was no correlation between the histological and tomographic findings. Although we found no statistically significant differences, the addition of platelet-rich plasma stimulated the generation of new tissue, and also decreased reabsorption of the grafted tissue according to the pathologic analysis. Besides increased bone formation and consolidation was detected in group IV (75%) treated with platelet-rich plasma, compared to group III (25%) without platelet-rich plasma bone allograft.

Two-team simultaneous open surgical treatment in bilateral shoulder fracture dislocation.

UNLABELLED Different surgical options have been described for the treatment of bilateral shoulder fracture dislocations. We report 2 cases of bilateral shoulder fracture dislocation treated simultaneously by 2 surgical teams. One case had bilateral hemiarthroplasty performed, and the second case had 1 hemiarthroplasty and McLaughlin procedure on the other shoulder. A device to allow holding the patient in a bend chair position, with both shoulders hanging outside the operative table, allowing their free movement, was designed. At 1-year follow-up, neither of the patients had complications and both are pleased with their early result. Simultaneous treatment of both the shoulders by 2 different surgical teams in bilateral shoulder fracture dislocations that need surgical treatment has the advantages of reduced overall hospitalization time, reduced anesthetic risk, faster return to work, and reduced overall cost of care. The decision for simultaneous bilateral shoulder surgery must be made in concert with the patient, medical consultant, and anesthesiologist. LEVEL OF EVIDENCE Level IV-case series.