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1er. PRECICE  NAIL IN COLOMBIA

1er. PRECICE NAIL IN COLOMBIA

CORA Group, As Pioneers and Center of Excellence in Orthopedic Reconstructive Extremity Surgery we performed the first surgery of this modern device in Colombia. The first two Intramedullary Femoral Elongation (PRECICE Nail) devices were successfully applied, fulfilling all the requirements for a safe, uncomplicated application at The Rosario Clinic, El Tesoro, in Medellín.

FAQ
Has Osteomyelitis Cure?

YES.  It has healing

There are different treatments and alternative to antibiotics? YES !! know them

There are specialized treatment centers? YES! Consult a www.doctorleonmora.com , www.coragroup.com.co

Will Osteomyelitis Repeat once treatment is over? Not! The cause of recurrence or relapse is incomplete or inadequate treatment

If I have a limb shortening by bone infection, this can be lengthening? Yes, it is part of treatment (Limb Lengthening)

 

Osteomyelitis is an acute or chronic infection of the bone or bone marrow, usually caused by bacteria or mycobacteria and pyogenic fungi. Risk factors are recent trauma infected open fractures or bruises, immunosuppressed patients with diabetes, hemodialysis and intravenous drug abuse. It can also occur in childhood through blood (Hematogenous) causing damage to the bones and growth plate

 

Etiology

 

Staphylococcus aureus is the most commonly isolated from all forms of osteomyelitis body. Osteomyelitis initiated hematogenously is seen frequently in children, and nearly 90% of cases is caused by Staphylococcus aureus. It is an inflammation or swelling of bone tissue that is usually the result of an infection.

Acute osteomyelitis almost always occurs in children. When it appears in adults, often due to a commitment in the resistance of the subject due to weakness, substance abuse, infections of the root canal of a tooth or the use of immunosuppressive drugs.

 

Osteomyelitis is a secondary complication in trauma accident. In such cases, the bacteria usually spread by the bloodstream, infecting locally before reaching the underlying bone.

In most cases you are posttraumatic complications associated with osteosynthesis (Application of plates or intramedullary nails) for the treatment of fractures.

The biggest problem is generated by the abandonment of these cases by allowing the advance specialists and chronicity of infection, without making effective procedures for bone healing. Many patients consult years after its appearance because they have been told that there is no cure and this is not true, now with proper treatment can be cured permanently.

 

Pathogeny

 

Generally, microorganisms have spread to the bone through the blood, for example through the bloodstream. contagiously also they spread to the bone from local areas of infection and cellulite or by a penetrating trauma, including iatrogenic causes such as joint replacements or internal fixation of fractures or pipes (Endodontics, Root Canals) root of the teeth. Once the bone is infected, leukocytes enter the infected area, and its attempt to eliminate infectious organisms, release enzymes that eat away at the bone. Pus by blood vessels bone extends forming abscesses which deprives the bone blood flow, and are formed in the region of the areas of infected bone devitalized, known as sequestered bone infection, which forms the basis of a chronic infection. Often the body will try to create new bone around the area of ??necrosis. The resulting new bone so called involucrum. On histologic examination, these areas of necrosis of the bones are the basis for distinguishing between acute osteomyelitis and chronic osteomyelitis. Osteomyelitis is an infectious process that encompasses all the bones and its components, including bone marrow and periosteum. When is chronic can lead to bone sclerosis and deformity.

In children, usually, the long bones are usually affected, while in adults, the vertebrae and the pelvis are most commonly affected.

 

It is classified according to the site of bone involvement and the general condition of the patient, this allows you to plan the type of treatment, if required segmental resection of bone, make bony enlargements (Limb Lengthening) or requires bone transport, this is defined according to state of soft tissues (skin and muscle) at the site of infection.

 

Clinical Picture

Osteomyelitis occurs frequently during childhood, with an average age of 6 years. It is exceptional in the neonatal period. It is preferably in the most fertile metaphysis: near the knee, below the elbow. In 30 to 40% of cases, the appearance of a minor lesion in the days before the onset of infection. In the typical case, it is a male (preferably 3/1) complaining of pain at the end of a long bone. The pain has a sudden onset, occasionally accompanied by fracture and functional impairment of the affected limb. The gentle mobilization of the adjacent joint is possible. The infectious syndrome is marked with an over 38 ° fever, malaise, chills and sweating. In the initial phase, local signs are nonspecific. Later in the course of infection, there is an increased volume and localized inflammation. Usually, no lymphadenopathy (lymph nodes) are palpated. Other events that can be found in osteomyelitis particularly in a febrile context include:

• a state of agitation or prostration;

• pseudo paralysis a member of a baby or newborn;

• seizures;

• lameness.

 

In the case of Chronic Osteomyelitis active or bone infection post-traumatic occurs with the appearance of redness in the surgical area, out of purulent material, exposing the material osteosynthesis or bone appearance local pain and functional limitation, lack of consolidation of fractures, this infection causes irreparable damage to the bone compromising circulation and integrity and requires specialized treatment.

 

Treatment

Osteomyelitis requires a prolonged antibiotic therapy, taking weeks to months. For this purpose often a central intravenous line is placed. Osteomyelitis may also require surgical debridement (removal of infected bone segment). Severe cases can lead to loss of a limb if appropriate measures are not taken or treated in non-specialized in the management of infections, bone lengthening (Limb Lengthening), care of skin coverage, management of nonunion centers fractures. The first-line antibiotics of choice are usually glycopeptides such as vancomycin, as determined by the patient's history and culture of the bacterium causing bone infection, with regard to infectious organisms. They can also use different schemes according to antibiotic resistance of the bacteria or antibiotic tolerance by the patient, the most important is the culture and sensitivity.

Acute and chronic osteomyelitis have Healing, i.e. can be eradicated definitively the disease if treated comprehensively and effectively, so it is not only the management with antibiotics required, in many cases it is necessary to remove bone segments, remove the dead bone or bone exposed secuestrum desiccated, is the only way to eradicate osteomyelitis.

Is a false statement to say that bone - Osteomyelitis Infection Not have a cure, this will apply many specialists who do not have the experience or enough knowledge to completely eradicate the disease, because they have the means and knowledge of holistic treatment that is not only the use of antibiotics should be surgical means to eliminate segments of infected bone and reconstructive techniques like a distraction osteogenesis or bone lengthening (limb lengthening) is applied for a time ranging from 2 to 6 months with external fixators circular or monolateral. This coupled with new and revolutionary techniques (Distraction Osteogenesis, deformity correction and Limb Lengthening), Technical of bone stabilization and reconstruction of soft tissues allow full recovery of limb function, elimination of chronic wounds and malodorous, the chronic pain, allowing the patient to return to their work and move without problems.

Keywords (osteomyelitis, Osteomyelitis, Limb Lengthening, Bone Infection, bone infection, bone lengthening and bone transport)

 

- There are specialized treatment centers?

YES! Of Corse You will  Consult a www.doctorleonmora.com , www.coragroup.com.co

I have low height, I'm healthy, I will to do a limb lengthening?

Patients who have functional stature, no disease or pathology that indicates.  May perform a bone lengthening of the limbs, this is also called a cosmetic Elongation. This decision extended to gain a few inches in height (between 4 to 15cm) must be agreed with the specialist which evaluates some anatomical and physical parameters to define how to do it, where do the osteotomies and what types of tools used for this purpose, external fixators progressive distraction or nails. You should also advise the patient of possible complications and problems that can occur. Note that there is NO other method or medications known to allow osteotomies gain height without surgery in patients who have completed his  physiological growth and have closed the nuclei of growth, there are no drugs, infusions or drugs, or orthotics, or any device that lengthens definitely not be confused or accept treatments that may cause harm or injury to your body. Consult qualified specialists.


This cosmetic Elongation treatment take approximately 4 to 6 months period and must perform two bone elongation steps, the first step is generally performed to a lengthening of both tibia and fibula, simultaneous initial surgery is performed with low energy osteotomy  in the Tibia and Fibula, placing an external fixator or intramedullary nail extension at this stage is able to extend the limbs 5-8 inches is expected to mature new bone, to harden and consolidate in order to remove external tutor during treatment requires an intensive program of physical therapy at home (mainly) as directed, to avoid complications as contractures, joint stiffness, loss of articular cartilage and muscle atrophy, in this lengthening phase should use crutches or walker to get around, the lengthening is performed at home, ambulance, should not be in bed, you can perform normal activities of daily living. Then wait an average of 6-12 months for gait rehabilitation and full joint mobility arches, later to start the second stage of bone lengthening but this time both Femur, simultaneously applying a monolateral external fixator MLRS or an intramedullary nail extensible. It also requires intensive physiotherapy program,


The treatment leaves some scars on the limbs by the application  nail, osteotomies and / or the application of external fixator pins, usually performed minor surgery after the treatment is to reduce the size of scars or if they have a local depression or fibrosis.

Am I a Candidate for Limb Lengthening or correction of deformity?

Here are a number of common conditions likely field-work reconstructive surgery, each case must be analyzed individually, but in general any musculoskeletal problem is susceptible of improvement according to the present situation. There is no age limit for treatment

 

  • Adults and Children from 1-100 years
  • Length discrepancy or differences in Arms or Legs
  • Bone or joint deformities,
  • Congenital Deformities (Birth)
  • Congenital short femur - Congenital Short Femur
  • Fibular hemimelia - Deformities or absence of the fibula
  • Hemiatrofias or hypoplasia postaxials
  • Varo Equine Foot (Foot Chapin), Pie cavo, PEVA sequels
  • Traumatic injuries, sequelae of fractures
  • Lesions of the growth plate (Fisis)
  • Malunion - bone Malunion
  • No delay or consolidation Union
  • Shortening and angular deformities of the bones
  • Segmental Bone Defects
  • Ulcers bone infection, skin coverage defects
  • Joint contracture of the elbow, wrist, hip, knee or ankle (joint Rigid)
  • Musculoskeletal Infections - OSTEOMYELITIS CHRONIC
  • Bone or tissue infection, bone fistulas
  • Chronic osteomyelitis (any duration)
  • Sequelae of Poliomyelitis, septic arthritis, sepsis
  • Aftermath of Infection hip or knee prosthesis (prosthesis Failed)
  • Joint ankylosis, failed arthrodesis infected
  • Tumor benign or malignant lesions
  • Segmental bone defects, joint losses
  • Short Stature (Height Low)
  • Acondroplasis and hipoacondroplasis (dwarfism), Turner, Ollier's Disease
  • Constitutional stature -
  • Hypophosphatemic rickets, epiphyseal dysplasias
External fixator and Pins care?

Keep the pin sites (Pines), free of infection is probably the most important thing you need during your recovery. If you do a good job keeping yourself free from infection (and if his body cooperates with you), you will have a treatment time easier and less painful. Hence the importance of daily care and grooming pin external fixator permanent.


The first situation to consider is that each nail is its own open wound and should never be shared with another nail germs. This means that you never use an applicator (Q-tip, swab), paper towel, gauze or any other cleaning tool a pin to the next. You must use a swab for each pin.
This is what should be done and it has worked pretty well so far in most patients:

1) shower (bathroom body)
Take a daily shower and make sure you have a hose to wash. Washing the tutor and the pins should be done every 3 or 4 days, for daily moisture may favor colonization site interface between the pins and the skin. So you should have a bag system to isolate the tutor and the pins on the daily bath bathe ideally be sitting on a plastic chair (Rimax) to prevent falls in the bathroom. It uses a 80-inch hose, flexible, chain purchased in stores with household items (Home center) attached to a shower head. Buy an "investor" who, with the flick of a switch, water is directed either in the shower with the new 80 "through the hose or sprinkler shirt. Using your favorite soap on the rest of your body, but only use PH neutral liquid soap on the tip with the tutor (Dove or Johnson for children.) Use a soft sponge to clean the skin and tutor Point the shower hose directly over the pin sites (front and back the frame). not touch the pin site with the hose or pump bottle,. only soap and water to clean water hose that will get rid of most of the dead skin and thoroughly clean areas nail Ensure all soap residue is removed with the shower hose ... Cleaning the pin sites should be the last thing you do in the shower, so any other residue from the rest of the shower I could have fallen into the pin sites were cleaned. I can use a clean cloth or small towel to dry only the area around the pin sites and frame, but never touch the same pin sites. Allow them to dry air or with a hair dryer cold. Avoid during shower get water that has touched the genitals to the area of the pin, the may be contaminated with body secretions and infected.

2) Cleaning
Do this on a bed or in a place where you can sit comfortably with your leg up for a half hour. Having all the materials and implements care in a bowl pin with you. Use the aqueduct water suitable for human consumption or sterile saline 100 ml in a glass of clean paper (use a paper cup different every day). Use sterile swabs 6 "cotton tipped applicators (Q-tips). Probably use about 15 cleaning swabs each. Take three or four packets, strip them of the paper wrapper and dip them in the mixture. Take an applicator and use it to clean a pin site. Wipe entire site pin and pull the applicator away. You will probably need two or three applicators for each nail to do a good job. Do not forget to clean the entire length own plug. Any excess dead skin and other debris should be removed. NEVER use applicator SAME IN MORE THAN ONE OR PIN you will spread potential infection. Repeat this process for each of the pin sites. Note: I used brushes sterilized teeth (different brush for each nail) to pin sites particularly hard to clean or infected; sure to buy only soft toothbrush and gently brush the pin site but firmly enough to clean thoroughly .. Do not forget to sterilize every toothbrush before cleaning in boiling water and alcohol. Submerge toothbrush every sterilized in sterile water mixture only once. When finished cleaning each of the pins, turn left on Mix and pour directly into the pin sites Dry each nail with a sterile applicator -. never use the same applicator for drying more than one site pin Use a hair dryer with a low temperature to further dry areas nail Make sure the hair dryer does .. Do not touch the pin sites. Wipe the front and back pin sites.

3) Anti-biotic ointment (Local Antibiotic Use)
Only recommend in cases of very dry skin around the pins
Use triple antibiotic pain relief ointment (Neosporin, or better yet, a generic copy each pharmacy chain has) to keep the sites free of bacteria nails still wet. The dry cracked skin around the nails sites can be very painful. Apply about 1/4 inch of ointment with a sterile applicator to each nail. Again, use only an applicator at the site of a pin. Make sure the entire site is covered by the ointment.

4) Xeroform Vaseline (adaptic)
This is another product that can help keep the pin sites clean and moist. The gauze dressing comes in a long rectangle and folded. Purchase scissors specifically for cutting gauze that you can buy at a pharmacy specializing in surgical supplies for about $ 7 (regular scissors will not work). Also buying two clamps. Scissors and pincers sterilized each day in boiling water for 10 minutes and then cleaned with alcohol. Cut about an inch gauze square rectangle. Fasten with sterilized tweezers, not your fingers. Make diagonal cut 2/3s of the way the gauze. Using the two tongs, place the gauze in place pin with diagonal cut around the pin. Do not touch the plug with pliers site directly.

5) External Bandages or guardian bag (This only applies to all frames monolateral and circular)
Finally, you are ready to finish the job. Use a clean bag or dressing for each day. Make sure the bandage is clean gauze covering adaptic. This dressing is extra protection to keep the pin sites clean, avoid contact with animals or environmental pollution
Note to Swimmers: If you can swim in chlorinated water, you can use the shower in the locker room (plus neutral pH soap) for daily cleaning and then continue with the rest of the pin care. If you can not make full pin care as described above, pour some hydrogen peroxide and sterile water mixture in the areas of the nails and cover with a bandage fresh Kerlix do the rest of the attention of the pin in house.


Building your immune system
While attention pin is the most important factor in preventing infection, how your body responds to infection is important too. I take a lot of vitamins (a multi-vitamin, an additional 1500 mg of calcium) to boost my immune system. I also drink a cup of freshly squeezed orange juice every day. Do not forget to take at least 1500 mg of calcium daily to help support bone growth. I also take the combination of arginine and ornithine and Symphytum officinale to promote bone growth.

Antibiotics: Cephradine 500mg PO QID x 10 days w / 5 refills. First part for 10 days and then stop. Start another segment of 10 days if the infection is suspected again (increased pain, swelling, drainage, new, redness).

Pain medicine: You should take as formulated by the specialist ONLY, NOT self medicate, can take up to 1 gram oral acetaminophen every 6 hours, NO can take anti-inflammatory drugs NSAIDs such as diclofenac, ibuprofen, naproxen, nimesulide, celecoxib, meloxicam, etc. NOT be used daily because they inhibit bone growth and the newly formed bone atrophy, slowing the consolidation process. The opioid derived pain well controlled but can cause dependence or side effects such as drowsiness, dizziness and vomiting, verify individual tolerance.
There are other medications for pain control should be handled by your specialist and other aids for management of anxiety, insomnia and stress

If you have a cast: keep it dry. Do not attempt to remove. Do not place objects on it.
 

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