• Rua General Jardim, 846 cj 41 Higienópolis, São Paulo - SP

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It includes academic lectures, presentations from national and international congresses, published papers, case discussions, performed surgical procedures, and proprietary techniques developed.

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Biological Bone Reconstructions part IIII

Biological Bone Reconstructions part IIII

Figure 1: In 1997, the world literature indicated amputation as the approach to treating tumors in the lower limb in children under 10 years of age, due to the future discrepancy of the limb. Note that the physis of the fibula is at the level of the ankle joint, while the physis of the tibia is at a higher level. We therefore plan to transfer the distal fibula to the tibia after resection of the tumor. In addition, the nutral artery of the fibula and its growth plate enter the proximal third of the fibula. Thus, the fibular osteotomy must be performed above this entrance, and a lateral window must be created to enable proximal splinting, followed by the preparation of a cavity in the talus to accommodate the fibular epiphysis with its growth plate
Figure 2: In this image we can identify: The surface of the talus, the proximal segment of the tibia, the interosseous membrane, the entry point of the nutricial artery and the fibular epiphysis. In addition, we can determine the level of the proximal fibular osteotomy.
Figure 3: We are going to perform an arthrodesis between the talus and the remaining tibia, using the fibular epiphysis, whose epiphyseal cartilage has already been removed, and transferring it through the interosseous membrane. In this way, we transfer the growth cartilage from the fibula to the tibia, performing an auto-transplant of the growth plate through the interosseous membrane.
Figure 4: To finalize the arthrodesis, we made an oval cavity in the talus to accommodate the fibular epiphysis, ensuring an adequate fit in the joint structure
Figure 5: We finalized this reconstruction with fixation using a Steinmann pin through the calcaneus, ensuring stability and support for the structure.
Figure 6: We accommodate the operated limb in the orthosis modeled for this patient, ensuring the transfer of the growth plate from the fibula to the tibia and finalizing the procedure.
Figure 7: At five months, we can see bone neoformation and the transfer of the fibular plate to the tibia. In addition, the mapping shows that this segment is vascularized, demonstrating the success of the autotransplant.
Figure 8: At one year and five months, we observed good bone integration and significant thickening of the new tibia, with the fibular plate translated and fully viable
Figure 9: After two years, the patient shows good support and functionality, both in knee flexion and in monopodal loading.

Autor do Caso

Autor : Prof. Dr. Pedro Péricles Ribeiro Baptista

 Oncocirurgia Ortopédica do Instituto do Câncer Dr. Arnaldo Vieira de Carvalho

Consultório: Rua General Jardim, 846 – Cj 41  –  Cep: 01223-010   Higienópolis  São Paulo – S.P.

Fone:+55 11 3231-4638  Cel:+55 11 99863-5577  Email: drpprb@gmail.com

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