Revista Brasileira de Ortopedia最新文献

Objectives  Femoral neck fractures in multiple myeloma patients are usually managed with hemiarthroplasty or total hip arthroplasty, depending on the presence of acetabular infiltration. Due to the paucity of dedicated studies, the aim of the present study is to review the clinical outcomes of hip hemiarthroplasty in patients with multiple myeloma and to review the literature regarding the outcomes and survival in these patients' subset. Methods  There were 15 patients (16 cases), with a mean age of 71.7 years, who had myeloma and received hip hemiarthroplasty for displaced femoral neck fractures had their radiographs and clinical data assessed for this study. From those, 13 cases received bipolar and 3 unipolar hemiarthroplasty. Results  After a mean follow-up of 18.2 months since the time of surgery, 3 cases suffered periprosthetic fractures (18.75%), 4 cases (25%) had heterotopic ossification, and 1 case (6.25%) had acetabular erosion. The 1- and 5-year patient mortality rates for the study cohort were 53.3 and 73.3%, respectively. Conclusion  Hip hemiarthroplasty remains a viable treatment option in myeloma patients; however, the potentially high morbidity and mortality in these patients should be sensibly understood before the surgery to achieve satisfactory expectations.

To measure the life quality, clinical-functional outcomes of a patient who had undergone acute reconstruction of radio scapho capitate (RSC), radio lunate (RLL) ligaments, using brachiorradialis tendon in treatment of radiocarpal fracture dislocation. 21-years-old, man with radiocarpal fracture dislocation in his left wrist, after motorcycle accident. Percutaneous screw fixation of the distal radius and acute reconstruction of the RSC and RLL was performed, assisted by arthroscopy. One year later, the patient experienced good evaluation. ROM was full, grip strength was 96% compared with the unaffected side were obtained. Wrist radiographic aspects showed fracture healed and radiocarpal joint congruency. Good stability and joint congruency of the radiocarpal joint were obtained and improving the life quality of that patient. Radiocarpal fracture dislocation management is difficult and complicated. There is no consensus. As there is still a lack of long-term results, the indications for surgery, and options, type of the intervention have been a matter of controversy in the literature. Would radiocarpal (RC) joint be stable when reconstruction of the radiocarpal ligaments, using brachiorradialis tendon was obtained? Is it possible to reduce and to maintain stable radiocarpal joint with this technique? The clinical relevance of this work is our suggestion of reconstruction of the RC ligament to improve this treatment. We believe that this will maintain a stable and functional wrist. We agree that the best time to perform corrections is as soon as possible and we prefer to reconstruct the RC ligament with suture or temporary or permanent radioscapholunate arthrodesis.

Common fibular nerve (CFN) palsy is the most common mononeuropathy in the lower limb, and several etiologies are described. The CFN is the minor and lateral division of the sciatic nerve; it originates in the lumbar sacral division, and many risks of compression have been described: the behavior of crossing and squatting legs, extra and intraneural compressions, local trauma, and weight loss have been increasingly reported as important and noteworthy causes. The treatment is based on the severity of the nerve condition. In cases in which neurological impairment persists, surgical decompression is indicated. In cases of atraumatic palsy, compression of the fibular neck is the most important cause. The present is the report of a case of a 39-years-old male amateur cyclist who had undergone bariatric surgery and lost more than 30% of his initial body mass. Eleven months after the surgery, he performed a strenuous cycling session and evolved with paresthesia in dorsal left foot and dorsiflexion impairment. The electromyographic examination showed CFN palsy. The patient was submitted to surgical nerve decompression, with good results in ten months of follow-up. Strenuous physical activity after bariatric surgery with substantial weight loss can evolve with CFN palsy. This etiology should be considered in the clinical reasoning in such clinical presentation.

Reduction and fixation of glenoid cavity fractures using arthroscopy cause little surgical trauma, allowing the complementary diagnosis and treatment of potentially associated injuries (either capsular, ligamentous or tendon lesions) with promising outcomes. The authors report a case of Ideberg type III glenoid fracture with a distal clavicle fracture which underwent percutaneous reduction and bone fixation (with Kirschner wires) using an arthroscopic technique. We describe the procedure and the outcomes after 18 years of follow-up. The clinical assessment included the functional University of California at Los Angeles (UCLA) score criteria and radiographic studies. The result was excellent/satisfactory, with the patient asymptomatic over time and without relevant radiographic changes. Although the management of glenoid fractures by arthroscopy remains evolving, it is a good treatment alternative to the open approach, especially in less complex fractures.

A 69-year-old female patient, who had been operated on 20 years ago (unipolar hip prosthesis), presented with a complaint of pain in the thigh and a limp with onset 1 year before. An X ray revealed stem subsidence and varus collapse. One-stage revision hip replacement was performed in view of poor cardiac status, and Brucella melitensis grew in the tissue culture. Oral doxycycline and rifampicin were administered for six weeks. The patient remained asymptomatic until the last follow up. Prosthetic joint infection by B. melitensis should be considered in a late onset, insidious presentation in an endemic country. One exchange arthroplasty with the administration of systemic antibiotics resulted in a good outcome.

Atalanto-occipital dislocations with type II fractures of the odontoid process are rare, reporting 7 cases for every 784 upper cervical spine injuries, an incidence of <0.3% and are related to a high rate of morbidity and mortality. Regarding C2 fractures, the most common are in the odontoid process, representing 7%, classified by Anderson and D'Alonso according to their level, with the highest rate of pseudarthrosis in zone II of up to 85% are caused mainly by car accidents. In the acute event, there is no consensus regarding its optimal management. We performed a complete anamnesis and a physical examination in our institution. A systematic review of case reports was carried out with the keywords "mal-union, type II odontoid process fracture, chronic atlantoaxial subluxation" in four different databases, and a comparative analysis of the cases found was performed. There were not found identical cases to the one in our report, 9 similar case reports were published with the general differences of a pseudarthrosis of the odontoid process, as well as neurological alterations in symptomatic patients and the consequent surgical treatment. Observing a patient with a type II odontoid process fracture consolidating viciously and a stable anterior atlantoaxial subluxation without neurological alterations is rare. We determined to maintain expectant management with annual follow-up.

Proximal humeral epiphysiolysis (PHE) are rare at 10.1/100,000 births and there are few cases described in the literature. We present the case of a newborn diagnosed with PHE submitted to conservative treatment. In six weeks he had complete mobility and extensive bone callus. As a very rare situation, rapid diagnosis is imperative, for which ultrasound is decisive and the attitude must be conservative and expectant, given a very rapid and expected evolution towards consolidation for normal function. This case reinforces the previous knowledge that these lesions typically evolve favorably, and post-traumatic sequelae are not expected.

The diabetic foot consumes a large number of resources and has a profound negative impact on quality of life, representing the major non-traumatic cause of lower limb amputation in adults. The present report describes a diabetic patient with a recurrent plantar ulcer in the topography of the heads of the second, third, and fourth metatarsals. The patient was treated using the distal metatarsal diaphyseal osteotomy (DMDO) technique in these bones, an Akin-type percutaneous osteotomy in the proximal phalanx of the hallux, and debridement. The 5-year postoperative follow-up revealed good outcomes regarding healing and prevention of new episodes.

Open elbow dislocation is a rare emergency in children. Its association with brachial artery injury is very rare. We report the case of a child admitted for total section of the brachial artery on open dislocation of the elbow before absence of signs of ischemia of the upper limb concerned as well as a review of the literature which is very poor.

Synovial chondromatosis is an uncommon, progressive, benign condition favoring synovial metaplasia resulting from the production of cartilaginous tissue as loose bodies within the joints. In rare cases, it can affect the interior of the shoulder joint and present with pain, edema, and impaired mobility. The diagnosis is challenging, requiring imaging techniques. Its confirmation often occurs only after surgical treatment and anatomopathological examination. The authors report two cases of patients with similar clinical presentations of pain, edema, and mobility loss in the shoulder joint. The investigation included imaging exams, such as radiographs and magnetic resonance imaging, and an anatomopathological examination confirming the diagnostic hypothesis. Arthroscopic surgical treatment with synovectomy and removal of loose bodies followed by physical therapy rehabilitation resulted in clinical improvement in both patients. This report emphasizes the importance of investigating suspected synovial chondromatosis due to its nonspecific clinical presentation. Comparing our outcomes with the literature, we concluded that surgical treatment with synovectomy, loose body removal, and physical therapy is effective, and that long-term outpatient follow-up is necessary to detect recurrence.