[Tratamento de não união séptica femoral em cão com estabilização com haste intramedular bloqueada associada a autoenxerto de osso corticoesponjoso e retalho do omento maior: relato de caso]

Não uniões ósseas associadas à osteomielite crônica necessitam de um planejamento terapêutico muito bem realizado, demandando tratamento multimodal para conseguir atingir a consolidação óssea e eliminar a infecção. Relatou-se um caso de sucesso do uso da associação de retalho do omento maior com estabilização cirúrgica com haste intramedular bloqueada para tratamento de uma não união séptica de fêmur em cão. O paciente apresentou retorno funcional parcial do membro com 30 dias após a cirurgia, cultura bacteriana estéril com sinais radiográficos de consolidação óssea e retorno funcional total do membro aos 90 dias de pós-operatório.

Palavras-chave:
complicação; ortopedia; osteomielite; planejamento

Autoria

M.P. Menezes

Universidade Estadual Paulista “Júlio de Mesquita Filho” ˗ Jaboticabal, SPUniversidade Estadual PaulistaBrazilJaboticabal, SP, BrazilUniversidade Estadual Paulista “Júlio de Mesquita Filho” ˗ Jaboticabal, SP

https://orcid.org/0000-0002-0294-5126

R.C. Costa

https://orcid.org/0000-0001-6404-2603

M.E.B.A.M. Conceição

https://orcid.org/0000-0002-6939-2183

B.W. Minto

https://orcid.org/0000-0002-8808-4127

L.G.G.G. Dias ^**Autor para correspondência (corresponding author) E-mail: gustavogosuen@gmail.com

https://orcid.org/0000-0003-3993-1649

*Autor para correspondência (corresponding author) E-mail: gustavogosuen@gmail.com

SCIMAGO INSTITUTIONS RANKINGS

Figuras

Figuras (3)

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Figure 1
Photographic images of dog’s right femur nonunion osteosynthesis. The yellow asterisk illustrates the cranial direction of the limb and the black asterisks indicate the proximal direction. (A) Fistula (black arrow) in the caudo-lateral aspect of the right limb; (B) fistulous path in the medial face of the right limb; (C) evidence of devitalized bone fragments (yellow arrow) and large amount of fibrous tissue (white arrow); (D) Bone defect (blue arrow) after surgical debridement; (E) the greater omentum (purple arrow), collected after caudal laparotomy, at the 13th right rib, passed through the subcutaneous space (grey arrow) to the fracture site; (F) Placement of the Corticospongious bone autograft at the fracture site (light green arrow). Green arrow indicates the locking screw used on the interlocking nail; (G) femoral diaphysis overlapped with the omentum flap. (H) The patient, after thirty days, exhibiting adaptive support by hyperextension of the tibiotarsal joint (red arrow) and stifle joint.

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Figure 2
Preoperative radiographic images in the (A) mediolateral and (B) craniocaudal projections, illustrating a complete comminuted fracture of the middle third of a canine right femur, with irregular and sharp fragment edges, and edema of the adjacent soft tissue. The radiographic signs are compatible with a septic nonunion.

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Figure 3
(A, B) Postoperative radiographic images of canine right femur, immediately after osteosynthesis as treatment of a bone septic nonunion, in medio-lateral (A) and cranio-caudal (B) projections, focusing on the implant used, an interlocking nail (black arrow) with 4 locking screws and on the presence of a radiolucent line indicating the fracture site (red arrow). (C, D) Radiographic images of the same patient, at 30 days after surgery, showing the onset of bone consolidation, in the medio-lateral (C), and cranio-caudal (D) projections. (E, F) Radiographic images in the medio-lateral (E) and cranio-caudal (F) projections, at 100 days after osteosynthesis, note the implant dynamization by the removal of the locking screws, closer to the focus of the fracture (blue arrows), showing bone consolidation (yellow arrows). (G, H) Radiographic images at 170 days after the first surgery, immediately after the second dynamization, in which the two remaining screws were removed, in medio-lateral (G) and cranio-caudal (H) projections.

Figure 1 Photographic images of dog’s right femur nonunion osteosynthesis. The yellow asterisk illustrates the cranial direction of the limb and the black asterisks indicate the proximal direction. (A) Fistula (black arrow) in the caudo-lateral aspect of the right limb; (B) fistulous path in the medial face of the right limb; (C) evidence of devitalized bone fragments (yellow arrow) and large amount of fibrous tissue (white arrow); (D) Bone defect (blue arrow) after surgical debridement; (E) the greater omentum (purple arrow), collected after caudal laparotomy, at the 13th right rib, passed through the subcutaneous space (grey arrow) to the fracture site; (F) Placement of the Corticospongious bone autograft at the fracture site (light green arrow). Green arrow indicates the locking screw used on the interlocking nail; (G) femoral diaphysis overlapped with the omentum flap. (H) The patient, after thirty days, exhibiting adaptive support by hyperextension of the tibiotarsal joint (red arrow) and stifle joint.

Figure 2 Preoperative radiographic images in the (A) mediolateral and (B) craniocaudal projections, illustrating a complete comminuted fracture of the middle third of a canine right femur, with irregular and sharp fragment edges, and edema of the adjacent soft tissue. The radiographic signs are compatible with a septic nonunion.

Figure 3 (A, B) Postoperative radiographic images of canine right femur, immediately after osteosynthesis as treatment of a bone septic nonunion, in medio-lateral (A) and cranio-caudal (B) projections, focusing on the implant used, an interlocking nail (black arrow) with 4 locking screws and on the presence of a radiolucent line indicating the fracture site (red arrow). (C, D) Radiographic images of the same patient, at 30 days after surgery, showing the onset of bone consolidation, in the medio-lateral (C), and cranio-caudal (D) projections. (E, F) Radiographic images in the medio-lateral (E) and cranio-caudal (F) projections, at 100 days after osteosynthesis, note the implant dynamization by the removal of the locking screws, closer to the focus of the fracture (blue arrows), showing bone consolidation (yellow arrows). (G, H) Radiographic images at 170 days after the first surgery, immediately after the second dynamization, in which the two remaining screws were removed, in medio-lateral (G) and cranio-caudal (H) projections.

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Universidade Federal de Minas Gerais, Escola de Veterinária Caixa Postal 567, 30123-970 Belo Horizonte MG - Brazil, Tel.: (55 31) 3409-2041, Tel.: (55 31) 3409-2042 - Belo Horizonte - MG - Brazil
E-mail: abmvz.artigo@gmail.com

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[Tratamento de não união séptica femoral em cão com estabilização com haste intramedular bloqueada associada a autoenxerto de osso corticoesponjoso e retalho do omento maior: relato de caso]

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[1] *Autor para correspondência (corresponding author) E-mail: gustavogosuen@gmail.com