Revista Brasileira de Ortopedia (English Edition)最新文献

Primary osseous angiosarcoma is a rare entity with variable biological behavior and poor prognosis. Little is known about the oncologic treatment and its etiology is still unknown. This study presents a case of lytic lesion in the right femur with dissemination to other bones, such as the vertebral column and skull, and to the lungs and central nervous system. Orthopedic surgery was performed in order to improve quality of life. Surgical specimen confirmed the diagnosis of high-grade malignant osseous angiosarcoma. Despite oncologic and orthopedic treatment, the patient had rapid and aggressive progression with a poor outcome.

To describe the arthroscopic surgical technique for subspine impingement (SSI) of the anterior inferior iliac spine (AIIS) associated with mixed type femoroacetabular impingement (FAI), through two standard arthroscopic portals (anterolateral and distal mid-anterior) in two patients with trifocal impingement. The authors report the cases of two young male patients, aged 32 and 36 years old, with trifocal femoropelvic impingement (TFPI). The technique consists of segmental capsulectomy, arthroscopic dissection of the AIIS, partial release of the direct head of the rectus femoris, resection of the AIIS projection with a burr and with fluoroscopic aid, correction of the pincer deformity, repair of the labrum with bioabsorbable anchors, and femoral osteoplasty. Details of the diagnostic workup and of the surgical technique are provided and discussed. In these cases, full range of motion was regained after surgery, as well as complete relief of pain, which was sustained in the last follow-up, one year post-operatively. Radiographs show adequate correction of the deformities in all three impingement sites. Simultaneous correction of the three sites (cam, pincer, and subspinal) provided full relief of symptoms and allowed return to work and sports. The authors propose that when approaching the symptomatic SSI, the possibility of concomitant FAI should always be considered and, in those cases, the approach must be comprehensive.

Objective

Analyze the percutaneous fixation technique for scaphoid fractures in the waist of the scaphoid and the proximal pole, and demonstrate its result.

Methods

A retrospective cross-cohort study conducted from January 2005 to April 2015, aiming at the consolidation time, epidemiological profile, level of function, return to work, and complications.

Results

Twenty-eight patients were selected, with a mean of eight weeks of follow-up. They presented a mean age of 30.5 years, male prevalence (25 patients; 89.2%), and no differences between dominant and non-dominant sides. The mean time from diagnosis was 4.16 weeks, but in three cases of fibrous union, the pre-operative period was over one year. The most frequent mechanism of injury was a fall on the outstretched hand, in 22 cases (78.5%). Of all fractures, 24 cases were in the waist (85.8%) and four were of the proximal pole (14.2%); seven patients had displacement (25%). There was consolidation in 26 cases (92.8%) with a mean of 7.5 weeks after surgery. In cases of non-union, radiological follow-up was up to 24 weeks, requiring a new surgical intervention.

Conclusions

Percutaneous fixation is an excellent, reproducible technique that allows early active mobility of the wrist with a low complication rate, although it requires a learning curve.

Objective

The use of open reduction and internal fixation (ORIF) for unstable pelvic injuries is associated with extensive blood loss, iatrogenic neurovascular injury, and infection. Moreover, the placement of sacroiliac (SI) screws is a blinded procedure, guided primarily by palpation and two-dimensional radiological screening, which demands expertise. The complex three-dimensional anatomy of SI joint and its proximity to neurovascular structure require a safe and precise technique. Computed tomography (CT)-guided SI joint stabilization allows an accurate intra-operative assessment of screw placement. This study demonstrated a technique of CT-guided closed reduction and screw fixation of the SI joint in unstable pelvic fractures.

Methods

This was a retrospective non-randomized cohort study conducted at a tertiary care hospital. Six patients with unstable pelvic fractures were operated; the anterior rim was stabilized first by ORIF with plate on the superior and anterior aspects of the pubic symphysis. Subsequently, the posterior stabilization was made percutaneously under CT guidance with a 7-mm cannulated cancellous screw.

Results

The mean operative time was 48 min (35–90 min), the mean effective radiation dose was 9.32 (4.97–13.27), and the mean follow-up was 26 months (6–72 months). All patients had satisfactory healing, with near-anatomic reduction and no complications, except in one case where the plate broke at 61 months post surgery, but no intervention was required. The mean VAS score at the final follow-up was 1.8, and all patients returned to their original occupation without any limitations.

Conclusion

CT-guided SI joint stabilization offers many advantages, including safe and accurate screw placement, reduced operating time, decreased blood loss, early definitive fixation, immediate mobilization, and fewer infections and wound complications.

Objective

To evaluate the reproducibility and repeatability of Hill–Sachs lesion measurement from computed tomography images, with computer software and tridimensional prototype.

Methods

Three-dimensional models were made from computed tomography images from 14 patients with anterior shoulder instability, using InVesalius 3.0® software. Hill–Sachs lesions were measured with Rhinocerus 5.0® software with pre-determined position. Mid-lateral distance, perpendicular to humeral shaft, cranial-caudal distance, parallel to humeral shaft, and the longitudinal distance of the lesion were measured. Using the Printer-ZP 310 three-dimensional printer, plaster models were made. To measure the Hill–Sachs lesion, a calibrated universal digital caliper was used in the same way as the software.

Results

There was intra-observer and inter-observer variability for measurement of the same model. Observers did not perform the measurements in a similar way, showing difficulty to use the method (p < 0.05). Using the software to measure the mid-lateral distance, as well as in the measurement with the caliper, the model type influenced the measurements for each of the observers, rendering the method invalid (p < 0.05).

Conclusion

There was no reproducibility and repeatability for Hill–Sachs lesion measurement between plaster models and software models.

Objective

To report a series of cases of patients treated by fracture of the femoral head through the Ganz pathway with controlled dislocation of the hip.

Method

All patients who were surgically treated with a Ganz access route for femoral head fractures were identified in a tertiary referral service for trauma. A review of medical records with X-rays and CT scans was carried out. The radiographic evaluation was classified according to Pipkin and the functional evaluation was performed through the application of the modified Harris Hip Score. Data regarding the quality of reduction, type of fixation, and postoperative complications were collected.

Results

The sample consisted of three men and one woman, with a mean age of 30 years (20–51). Regarding Pipkin's classification, two cases were type I, one type II, and one type IV. Regarding the Harris Hip Score, an average of 65.75 points was obtained (range: 20–86). All cases had anatomical reduction in the intraoperative period. One case presented post-traumatic sciatic nerve praxis and evolved with infection at the surgical site.

Conclusion

Surgical treatment of femoral head fractures through controlled hip dislocation is a viable option and can be considered an alternative to classical approaches.

Objective

To determine the quality of life related to health and its related factors in patients diagnosed with rotator cuff lesions in the Municipality of Pereira, Colombia, 2013.

Methods

Cross-sectional study. Simple random sampling of 239 patients over 18 years of age attended at five health care institutions in the urban area of Pereira. Socio-demographic, biological, clinical and self-perception aspects of the disability were collected regarding the quality of life related to health. Use of measures of frequency, Chi-square and logistic regression for analysis.

Results

72% (173) reported poor quality of life related to health in the physical health status component and 60% (144) in the mental health status component. Factors associated with poor quality of life related to health according to physical health status were: schooling, having caregiver, and shoulder disability in manual activities, daily activities and pain and physical limitation. While the factors associated with poor quality of life related to health in mental health status components were: schooling, having caregiver and shoulder disability due to pain and physical limitation. The greater the perception of shoulder disability, the worse the perception of health status.

Conclusion

The introduction of psychometric measures for the evaluation of the health status of patients with shoulder injuries contributes to a treatment adjusted to individual requirements and daily activities of the patient.

Objective

The aim of the present study was to evaluate the influence of simvastatin on mechanical properties of muscle and bone in hypercholesterolemic rats submitted to physical exercise.

Methods

Ten male Wistar rats were submitted to a high-fat diet rich in cholesterol for 90 days. The animals were then divided into two groups: animals treated with physical exercise (EG) and animals treated with physical exercise and simvastatin (ESG). Protocols for physical exercise in water and simvastatin administration were performed for eight weeks. After this period, the animals were euthanized; the left tibia and right gastrocnemius muscle were dissected for mechanical analysis, and the right tibia for densitometry. The data were analyzed using Student's t-test, considering a level of significance of 5%.

Results

The comparison of maximum load and stiffness revealed no significant differences between the groups for both the tibia (p = 0.851 and p = 0.259) and the gastrocnemius (p = 0.911 and p = 0.083). The tibia BMD also showed no significant difference between the groups (p = 0.803).

Conclusion

Simvastatin had no negative effects on mechanical properties in tibia and gastrocnemius of hypercholesterolemic rats submitted to physical exercise.

Objective

This study presents the results of 25 consecutive patients and evaluates the success of reverse sural fasciocuteneous flap (RSFF) on coverage of the foot and ankle region.

Methods

A total of 25 patients with soft tissue defects in the lower leg, foot, or ankle were treated with RSFF, from January 2010 to January 2017. In the evaluation of patients, the form prepared by the clinic was used and the following data were collected: age, follow-up, gender, etiology, defect size, complications, and patient satisfaction rates.

Results

Mean follow up time was 18 months. In all patients, the defects were fully covered. Three patients developed partial necrosis due to venous congestion. There was no complete flap loss in any of the patients. Patient satisfaction was excellent in all cases.

Conclusion

RSFF is quick, versatile, and easy to apply; it also provides safe soft tissue coverage, requires no microvascular repair, and provides an alternative to microsurgical reconstruction.

Objective

To analyze the sequelae of Neer type 2 distal end clavicle fractures treated with superior anterior locking plate.

Methods

From June 2012 to February 2015 a study was conducted with 14 male patients; 12 with unilateral and two with bilateral distal clavicle fractures treated with superior anterior plate. They were evaluated at intervals, with mean follow up of 16 months (14–18 months). All patients were evaluated clinically by both the Oxford Shoulder Score and the QuickDASH score.

Results

Union was seen in all fractures within 7–9 weeks (mean time: 8.2 weeks). All patients had good shoulder range-of-motion. The average Oxford Shoulder Score and QuickDASH score were 45.6 and 7.1, respectively. All patients returned to work within 3–4 months of the postoperative period.

Conclusion

Displaced distal clavicle fractures treated with superior anterior plates accomplished superlative results in terms of bony union, with rarely any complications.