TRATAMENTO CIRÚRGICO DE FRATURA COMINUTIVA DE MANDÍBULA: RELATO DE CASO

ResumoUm dos maiores desafios no tratamento de fraturas cominutivas da mandíbula é restaurar o contorno anatômico das áreas fraturadas, pois, a maioria dos casos apresenta deslocamento ósseo severo e perda óssea que diminuem a previsibilidade da redução dos fragmentos. Nesse contexto o tratamento deste tipo de fraturas mandibulares ainda permanece um desafio para a cirurgia maxilofacial no que se refere à técnica de redução. Nesse sentido, a redução aberta com fixação interna rígida se apresenta como uma boa opção de tratamento, por encurtar o tempo de reabilitação orofuncional e diminuir as chances de infecção. O presente trabalho tem como objetivo apresentar o caso clínico de um paciente do sexo masculino vítima de acidente com animal cursando com múltiplas fraturas de face. A abordagem cirúrgica eleita para o tratamento da fratura mandibular cominutiva foi a redução aberta e instalação de placa de reconstrução e parafusos de titânio. A abordagem aberta evitou o bloqueio maxilo-mandibular pós-operatório em um paciente jovem. Esta técnica permitiu a redução precisa dos fragmentos devolvendo a função mastigatória de maneira precoce.Palavras-chave: Fraturas maxilomandibulares, traumatismos mandibulares, redução aberta, fixação de fratura.AbstractOne of the biggest challenges in treating comminuted jaw fractures is restoring the anatomical contour of the fractured areas. Most cases have severe bone dislocation and bone loss that decreases reduction predictability. In this context, the treatment of this type of mandibular fractures still remains a challenge for maxillofacial surgery regarding the reduction technique. In this sense, open reduction with rigid internal fixation is a good treatment option because it decreases orofunctional rehabilitation time and reduces the chances of infection. The present work aims to present the clinical case of a male patient victim of animal accident with multiple facial fractures. The chosen surgical approach for the treatment of comminuted mandibular fracture was open reduction and installation of reconstruction plate and titanium screws. The open approach favored not performing postoperative maxillomandibular block in a young patient. This technique allowed the precise reduction of fragments and the early masticatory function.Key-words: Jaw fractures, mandibular injuries, open fracture reduction, fracture fixation.

Use of Nonvascularized Autologous Fibular Strut Graft in the Treatment of Major Bone Defect after Periprosthetic Knee Fracture

We present the case of a patient who suffered a comminuted supracondylar periprosthetic femur fracture. The patient was an 86-year-old lady who suffered a minor fall at home and presented at our hospital with a right comminuted distal femur fracture around a total knee arthroplasty. The patient was submitted to a cruciate-sacrificing total knee replacement 6 years before at the same institution. Despite severe metaphyseal fragmentation and short distal fragment, the prosthesis was stable; thus, open fracture reduction and stabilization with internal fixation were performed. The surgical technique included the use of a nonvascularized autologous fibular strut graft as an augmentation technique in conjunction with double plating fixation. Clinically, patient presented a painless aligned knee 12 months after femur fixation, although she was not able to return to an independent level of activity. No pain involving the donor graft site was reported at the time of the most recent follow-up examination. This case study demonstrates the use of free nonvascularized autogenous fibular strut bone graft as an option to bridge major bone defects. This proved to be a relatively simple, not expensive procedure that can be done percutaneously and does not need high-quality training.