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Efeito do adesivo butil-2-cianoacrilato em osteotomias e enxerto ósseo em coelhos: aspecto macroscópico e radiográfico The effect of 2-butyl-cyanoacrylate adhesive in osteotomies and bone grafts in rabbits: macroscopic and radiographic characteristics  [cached]
Mário Sérgio Viana Xavier,Vilnei Mattioli Leite
Revista Brasileira de Ortopedia , 2012, DOI: 10.1590/s0102-36162012000500016
Abstract: OBJETIVO: Avaliar o efeito do adesivo tecidual butil-2-cianoacrilato em osteotomias e enxerto ósseo (EO), sob o aspecto macroscópico e radiográfico. MéTODOS: Foram utilizados 48 coelhos, divididos aleatoriamente em quatro grupos de 12 animais, com períodos de observa o de duas, quatro, oito e 16 semanas. Foram operados os dois membros torácicos de cada animal e realizadas duas osteotomias em cada um dos rádios, com a retirada de um fragmento ósseo (EO) de 1cm de comprimento. De um lado foi recolocado o EO no local e aplicada uma gota do adesivo em cada uma das osteotomias. No outro lado, foi realizado o mesmo procedimento sem a aplica o do adesivo. Fixou-se em 0,05 ou 5% o nível de rejei o da hipótese de nulidade. RESULTADOS: Presen a de marcas azuis em todas as pe as cirúrgicas em que foi utilizado o adesivo. A partir da quarta semana, ausência de movimento dos EO com adesivo e controle. No grupo A, nas osteotomias proximais com adesivo, ocorreu menos desvio do EO (p = 0,02). No grupo C, a uni o (p = 0,03) e a integra o do EO (p = 0,02) foram melhores nas osteotomias proximais com adesivo. CONCLUS ES: O adesivo n o foi totalmente metabolizado com 16 semanas. Há consolida o clínica das osteotomias em quatro semanas. O adesivo estabilizou o EO nas primeiras semanas e n o interferiu na consolida o das osteotomias, assim como na integra o dos EO a observa o radiográfica. OBJECTIVE: To evaluate the effect of butyl-2-cyanoacrylate tissue adhesive in osteotomies and bone grafts, with regard to macroscopic and radiographic characteristics. METHODS: Forty-eight rabbits were used, randomly divided into four groups of 12 animals, with observation periods of two, four, eight and 16 weeks. Both thoracic limbs were operated in each animal and two osteotomies were performed in each of the radii, withdrawing a bone fragment (bone graft) of 1 cm in length. On one side, the bone graft was then replaced and a drop of adhesive was applied to each of the osteotomies. On the other side, the same procedure was performed without applying the adhesive. The rejection level for the nullity hypothesis was set at 0.05% or 5%. RESULTS: Blue marks were present in all the surgical specimens in which adhesive was applied. From the fourth week onwards, there was absence of movement of the bone grafts with adhesive and control. In group A, in the proximal osteotomies with adhesive, there was less deviation of the bone graft (p = 0.02). In group C, the union (p = 0.03) and the integration of the bone graft (p = 0.02) were better in the proximal osteotomies with adhesive. CONCLUSI
Estudo anat?mico do trajeto do nervo musculocutaneo em rela??o ao processo coracoide
Rebou?as, Fabiano;Brasil Filho, Romulo;Filardis, Cantidio;Pereira, Renato Rodrigues;Cardoso, Alessandro Alvarenga;
Revista Brasileira de Ortopedia , 2010, DOI: 10.1590/S0102-36162010000400010
Abstract: objetive: the authors performed an anatomic study of the trajectory of the muscle cutaneous nerve, dissecting 20 shoulders in 10 fresh adult corpses. method: the distance was measured from the inferior edge of the coracoid process to the point of penetration of the nearest branch of the cutaneous nerve muscle of the coracobrachialis muscle, called base. starting at the inferior-medial edge of the coracoid process, a second measurement was made to the point at which the lateral fascicle of the brachial plexus crosses the subclavius muscle, denominated height. the third measurement was of the triangular area formed by the two first measurements, denominated area. results: the average base length was 3.42 cm, varying from 2.38 cm to 4.40 cm. the height measurement was 2.74 cm, on average, varying between 1.03 cm and 3.80 cm. and the average area was 4.92 cm2, varying between 1.22 cm2 and 7.99 cm2. conclusion: these measurements are very important due to the risk of injury in the cutaneous nerve muscle in surgeries performed on the shoulder.
Rela??o anat?mica do nervo supraescapular com o processo coracoide, articula??o acromioclavicular e acr?mio
Terra, Bernardo Barcellos;Gaspar, Eric Figueiredo;Siqueira, Karina Levy;Cardozo Filho, Nivaldo Souza;Monteiro, Gustavo Cará;Andreoli, Carlos Vicente;Ejnisman, Benno;
Revista Brasileira de Ortopedia , 2010, DOI: 10.1590/S0102-36162010000300008
Abstract: objective: to establish the anatomic relationship of the suprascapular nerve (ssn) located in the suprascapular notch to the medial border of the base of the coracoid process, the medial acromial surface of the acromioclavicular joint and the anterolateral edge of the acromion. methods: we dissected 16 shoulders of 16 cadavers, 9 males and 7 females. the distance from the suprascapular nerve (in its course beneath the transverse ligament) to certain fixed points in the medial base of the coracoid process was measured with the aid of a caliper, as well as to the articular surface of the acromion and the acromioclavicular joint on the anterolateral edge of the acromion. these measures were correlated with age and sex. the specimens with signs of previous surgery were excluded. results: measuring the suprascapular nerve in its notch to the medial border of the coracoid process, the base of the coracoid process averaged 3.9 cm (ranging from 3.1 cm to 5.2 cm), the acromioclavicular joint averaged 4.7 cm (ranging from 3.9 cm to 5.2 cm,) and the anterolateral border of the acromion averaged 6.1 cm (ranging from 5.7 cm to 6.8 cm). conclusion: accurate knowledge of the anatomy of nerves of the scapulohumeral region is essential in order to avoid iatrogenic injuries and to achieve satisfactory results in surgical treatment (open or arthroscopic) of shoulder pathologies.
Isolated Fracture of the Coracoid Process  [PDF]
Ali Güle?,Harun Kütahya,Recep Gani G?ncü,Serdar Toker
Case Reports in Orthopedics , 2014, DOI: 10.1155/2014/482130
Abstract: Coracoid fractures are rarely seen fractures. In the shoulder girdle, coracoid process fractures generally accompany dislocation of the acromioclavicular joint or glenohumeral joint, scapula corpus, clavicula, humerus fracture, or rotator cuff tear. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. In this paper, a 34-year-old male manual labourer presented to the emergency department with complaints of pain and restricted movement in the left shoulder following a traffic accident. On direct radiographs and computerised tomography images a fragmented fracture was observed on the base of the coracoid process. In addition to the coracoid fracture, a mandibular fracture was determined. The patient was admitted for surgery on both fractures. After open reduction, fixation was made with a 3.5?mm cannulated screw and washer. At the postoperative 6th week, bone union was determined. The patient returned to his previous occupation pain-free and with a full range of joint movement. In conclusion, in the current case of isolated fragmented coracoid process fracture showing minimal displacement in a patient engaged in heavy manual work, surgery was preferred as it was thought that nonunion might be encountered particularly because of the effect of forces around the coracoid. 1. Introduction Coracoid fractures are rarely seen fractures [1]. In the shoulder girdle, coracoid process fractures generally accompany dislocation of the acromioclavicular (AC) joint or glenohumeral joint, scapula corpus fracture, clavicular fracture, humerus proximal end fracture, or rotator cuff tear [2]. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. The case presented here is of an isolated coracoid process fracture treated surgically. 2. Case Report A 34-year-old male manual labourer presented at the Emergency Department with complaints of pain and restricted movement in the left shoulder following a traffic accident. In the physical examination, ecchymosis and sensitivity in the left shoulder, restricted shoulder movements, and sensitivity in the jaw were determined. The results of the neurovascular examination were normal. On direct radiographs and computerised tomography (CT) images a fragmented fracture was observed on the base of the coracoid process (Figures 1 and 2). In addition to the coracoid fracture, a mandibular fracture was determined. The patient was admitted for surgery on both fractures. After making the incision along the Langer’s line on the coracoid
Morphometry of coracoid process  [cached]
Vedat Sabanc?o?ullar?,Mehmet ?lkay Ko?ar,Fatma Hayat Erdil,Mehmet ?imen
Erciyes Medical Journal , 2007,
Abstract: Purpose: In this study, because of the relationship with the subcoracoid impingement syndrome, various morphometric measurements of the coracoid process were calculated.Material and Methods: A total of 80 dry scapulae with unknown sex and age were obtained from the Department of Anatomy. Scapulae were classified into 3 groups according to shape of the region between the coracoid process and glenoidal cavity.Various measurements were calculated.Results: It was observed that, the percentapes of Type I spherical in shape was 37.5%, Type II square in shape was 32.5% and Type III was hooked in shape was 30%. Statistical analysis evaluations showed correlations between the length and thickness of the coracoid process (r =0.432, p< 0.05). In comparison of the right and left scapulae, the length of the coracoid process was observed to be longer on the right scapula than the left, and this difference was statistically significant (t =2.111, p< 0.05).Conclusion: In present study, it was observed that the morphometry of the coracoid process of the scapulae might show prominent differences. In patients presenting with complaints of shoulder pain, anatomical variations of the coracoid process , should be considered important in planning surgical interventions to the relavant area.
Traumatic Isolated Coracoid Fractures in the Adolescent  [PDF]
Amol R. Chitre,Hiren M. Divecha,Mounir Hakimi,Hans A. J. Marynissen
Case Reports in Orthopedics , 2012, DOI: 10.1155/2012/371627
Abstract: Coracoid fractures are rare injuries in themselves. Even rarer are isolated fractures of the coracoid in the skeletally immature patient. Due to the low numbers of these fractures, there is no true consensus on how to treat them. We report two cases of an isolated fracture of the coracoid. Case A is a 13-year-old boy who sustained the coracoid fracture following a skiing injury; case B is a 15-year-old boy who fell onto the right shoulder during a wheelbarrow race at school. Initial radiographs in case A suggested a displaced fracture; however, a CT scan taken after a short period of conservative treatment showed minimal displacement. In case B both the radiographs and CT scan showed no displacement. Both injuries were treated conservatively and united uneventfully with a full return to function. We advocate conservative management for these injuries in the skeletally immature patient. 1. Introduction Coracoid fractures are uncommon in general orthopaedic practice accounting for less than 13% of all scapular fractures, which in themselves constitute between 5% and 10% of all fractures around the shoulder girdle [1]. The first reports of isolated coracoid fractures date as far back to 1907 [2]. Certainly, radiological advances since then have made identification of these injuries easier, but reports in the current literature remain sparse. 2. Case Reports Case Report A A 13-year-old boy presented to the local trauma services with shoulder pain and reduced movement after suffering a skiing injury, a fall directly onto his right dominant shoulder. Following radiographs, he was placed into a broad arm sling and advised to attend his local orthopaedic service in the UK on his return for consideration of operative intervention. At 11 days postinjury, his pain was resolving, though he did have isolated tenderness over the coracoid. There was no neurovascular deficit. The initial plain radiographs were provided and confirmed a coracoid base fracture with some displacement (Figure 1). He remained in a broad arm sling and had a CT scan performed. Figure 1: Case A: initial axillary radiograph. The CT scan with 3D reconstruction (19 days postinjury) confirmed a virtually undisplaced fracture of the coracoid (Figure 2), therefore conservative management continued with active assisted physiotherapy. Figure 2: Case A: axial CT scan and CT 3D reconstruction. At 9 weeks postinjury, he had full, pain-free range of motion. Repeated radiographs confirmed an anatomical position of the fracture with good callus formation (Figure 3). Figure 3: Case A: axillary radiograph at 9
Development of Skills and Abilities to the Management of Maxillary Osteotomies in Simulators  [PDF]
Ouvi?a, Jorge Manuel,Pigni, Fernando Luis,Ferraris, Luis,Santa María, Juan
Revista Argentina de Anatomia Online , 2011,
Abstract: The practices in simulators from the simplest to live models, are an interesting and useful materials. The laboratory training and proprioceptive and associative abilities in relation to surgical skills are the basis of complex practices to be applied to future patients. In the period from 1 July 2006 to June 31, 2008, were performed 120 osteotomies in the context of the “hands on” course of plastic surgery, performed at the Center of Research and Development in Experimental Models of the HDU Adrogué, School of Medicine, University of Buenos Aires. We used 40kg of live pigs under general anesthesia and mechanical ventilation. Each student made 6 osteotomies being the number of vacancies in two students for the course was repeated five times a year, each of the three years (6 x 2 x 5 x 2 = 120). Were performed sagittal osteotomies branch and other osteotomies as Lefort I and II. These were made by residents with their respective trainers. As a final assessment, the students had to submit a report that deals about the osteotomy technique or variants used in performing them.The surgery on simulators enables the prior development of skills and abilities required to perform a safer surgery, helping to reduce the major risks caused by beginners in their first surgical practices.
Metastatic breast carcinoma of the coracoid process: two case reports
Eric C Benson, Darren S Drosdowech
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-22
Abstract: In this case report, we present two cases with metastatic breast carcinoma of the coracoid process, one of which presented with a pathologic fracture of the coracoid.An orthopaedic surgeon must be aware of the potential for metastatic disease to the coracoid as they may be the first medical provider to encounter evidence of malignant disease.The coracoid process of the scapula is a rare site of involvement for metastatic disease or for primary tumors. Bone metastases are common in patients with breast carcinoma, with an incidence as high as 73% (range 47-85%) [1]. The exact mechanism of metastases to bone remains unknown.We are unaware of any reports in the literature of pathologic coracoid process fractures, and only one report of metastatic disease to the coracoid [2]. We present the cases of two patients with metastatic breast carcinoma of the coracoid process, one of which presented with a pathologic fracture of the coracoid. We informed the patients or their families that the data concerning their cases would be submitted for publication, and they consented.A 40-year-old, right-hand dominant female who had a known history of right breast carcinoma presented to our clinic for evaluation for open biopsy of a lesion at the base of the coracoid. Four months prior to clinic presentation, she underwent right breast lumpectomy and lymph node dissection. Surgical pathology revealed invasive mammary carcinoma, SBR grade 2 with no involvement of the lymph nodes. Resection margins were negative. She was Her-2-neu negative, estrogen receptor negative, and progesterone receptor positive. A bone scan revealed increased uptake at the eighth thoracic vertebra and in the region of the coracoid in the right shoulder. Further CT imaging of both regions indicated a fracture through the transverse process of T8, though the patient was asymptomatic at this level and had a prior history of a fall from a horse that correlated with this finding. There was no history of any shoulder pai
Coracoid Abnormalities and Their Relationship with Glenohumeral Deformities in Children with Obstetric Brachial Plexus Injury
Rahul K Nath, Faiz Mahmooduddin, Xiaomei Liu, Melissa J Wentz, Andrea D Humphries
BMC Musculoskeletal Disorders , 2010, DOI: 10.1186/1471-2474-11-237
Abstract: 39 patients (age range: 2-13 years, average: 4.7 years), with deformities secondary to OBPI were included in this study. Parameters for quantifying coracoid abnormalities (coracoscapular angle, coracoid overlap, coracohumeral distance, and coracoscapular distance) and shoulder deformities (posterior subluxation and glenoid retroversion) were measured on CT images from these patients before any surgical intervention. Paired Student t-tests and Pearson correlations were used to analyze different parameters.Significant differences between affected and contralateral shoulders were found for all coracoid and shoulder deformity parameters. Percent of humeral head anterior to scapular line (PHHA), glenoid version, coracoscapular angles, and coracoscapular and coracohumeral distances were significantly lower for affected shoulders compared to contralateral ones. Coracoid overlap was significantly higher for affected sides compared to contralateral sides. Significant and positive correlations were found between coracoscapular distances and glenohumeral parameters (PHHA and version), as well as between coracoscapular angles and glenohumeral parameters, for affected shoulders. Moderate and positive correlations existed between coracoid overlap and glenohumeral parameters for affected shoulders. On the contrary, all correlations between the coracoid and glenohumeral parameters for contralateral shoulders were only moderate or relatively low.These results indicate that the spatial orientation of the coracoid process differs significantly between affected and contralateral shoulders, and it is highly correlated with the glenohumeral deformity. With the progression of glenohumeral deformity, the coracoid process protrudes more caudally and follows the subluxation of the humeral head which may interfere with the success of repositioning the posteriorly subluxed humeral head anteriorly to articulate with the glenoid properly.Obstetric brachial plexus injury commonly involves injury
Base of coracoid process fracture with acromioclavicular dislocation in a child
Prithee Jettoo, Gavin de Kiewiet, Simon England
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-77
Abstract: Coracoid fracture is an uncommon injury, accounting for only 2% to 13% of all scapular fractures and approximately 1% of all fractures [1-3]. Acromioclavicular joint dislocation is a very rare injury in a child below the age of thirteen [4]. We report an interesting case of fracture of the coracoid process associated with acromioclavicular joint dislocation in a child. He underwent open reduction internal fixation of the acromioclavicular joint and coracoid process. He subsequently made a good progress with pain free full range of shoulder movement.A twelve year old boy came off a rope swing from four metres, landed on his right shoulder and sustained an isolated injury to his right shoulder girdle. He complained of pain and swelling. Clinically, he had a prominent lateral clavicle associated with swelling, marked bruising and tenderness over his right shoulder and scapular area. His range of motion was restricted. He had no evidence of a brachial plexus injury, and had no vascular compromise.His initial radiographs showed a widely displaced acromioclavicular joint with possible coracoid process fracture (Figure 1). He had a computed tomography (CT) scan, which confirmed the associated fracture at the base of his coracoid process (Figures 2, 3). A three dimensional CT scan reconstruction showed a spatial view of the coracoid process fragment (Figures 4, 5)He underwent surgical intervention with reduction and fixation of the acromioclavicular joint with two threaded half pins and screw fixation of the base of coracoid fracture (Figure 6). Intraoperatively, his coracoclavicular and coracoacromial ligaments were intact and attached to the fracture fragment; but he had a disrupted acromioclavicular capsule. Post-operatively, a shoulder immobiliser was applied; and he started intermittent graded right shoulder movement. The threaded pins were removed four weeks later (Figure 7). At 3 months follow-up, the patient had a good range of movement of his right shoulder, with o
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