Revista Brasileira de Ortopedia最新文献

The present case report is an observational study with a literature review. This case is significant because the injury is rare regarding location and clinical manifestation. A middle-aged male patient sustained a fracture at the acromial end of the clavicle with lateral fragment dislocation after falling from a bicycle. The literature reports a single similar case, but we had no access to the complete text. The patient underwent treatment with satisfactory outcomes.

Visual deficit after spinal surgery is rare but tragic. The main causes include external eye injury, cortical blindness, central retinal artery occlusion, and ischemic optic neuropathy. In scoliosis surgery, this complication potentially arises from prolonged surgical time, high blood loss, prone position, hydroelectrolytic imbalance, and cerebrospinal fluid loss. In 849 scoliosis correction surgeries, 3 patients developed postoperative visual deficits: 2 achieved complete visual acuity recovery, but 1 remained with partial sequelae. There are four causes of postoperative amaurosis: ischemic optic neuropathy, central retinal artery occlusion, external eye injury, and cortical blindness. Since the prevention of this complication cannot be assured, it is essential to explain the risk of visual deficits to patients undergoing scoliosis surgery, who must sign the informed consent form. Visual loss after spinal surgery for scoliosis correction is a rare but severe and, sometimes, irreversible complication. The surgical team must know about this possibility in order to adopt preventive measures and reduce its incidence.

Brachial neuritis, or Parsonage-Turner syndrome, is a rare disease characterized by a sudden, self-limiting pain in the upper limb followed by weakness and atrophy of the shoulder girdle muscles. Bilateral brachial plexus involvement occurs in between 10 and 30% of the patients, but symptoms are usually asymmetrical. The most common etiological factors include infection (25 to 55%) and autoimmune conditions. Up to 16% of the patients infected by the new coronavirus variant (SARS-CoV2) had neuromuscular complications. We present the case of a patient with bilateral Parsonage-Turner syndrome shortly after severe COVID-19.

Reichel syndrome or primary synovial chondromatosis (PSC) is an uncommon benign metaplastic condition that usually affects large joints. Though shoulder involvement was scarce, there are only a few cases in the pediatric population. A 14- year-old boy was admitted to the Pediatric Orthopedics department with right shoulder pain for 14 months. Imaging revealed multiple loose bodies distributed throughout the glenohumeral joint. Upon the arthroscopic approach, we remove all cartilaginous nodules within the glenohumeral space and abarticular tendon. Histopathologic examination confirmed the diagnosis of primary synovial chondromatosis. At follow-up, the patient remains free of symptoms, and shoulder radiographs showed no recurrence of calcification. The present case illustrates the clinical patterns, imaging features, histological findings, and therapeutic management of shoulder primary synovial chondromatosis in a pediatric patient.

Patients with hemophilia disease have a high risk of hemorrhage. Most hemorrhages can occur in the musculoskeletal system, presenting as hematomas, or, in rare occasions, as hemophilic pseudotumors, an uncommon pathology that are often misdiagnosed as musculoskeletal tumors because of their clinical behavior and characteristics on diagnostic imaging. Despite many treatment options, surgical excision is the treatment of choice. This article describes a case of hemophilia A in a patient who suffered from progressive swelling of the right thigh for 12 months. Diagnostic imaging suggested a hemophilia pseudotumor with vascular bundle impingement. Surgical excision was successful.

Objective  To compare the clinical outcomes of anterior cruciate ligament (ACL) reconstruction using autografts with and without internal brace augmentation. Methods  Data from patients who underwent ACL reconstruction with hamstring and quadriceps tendon autografts, with a minimum follow-up of one year, with or without internal brace augmentation were collected prospectively analyzed retrospectively. The Lysholm and Tegner functional scores were collected before and after surgery, as well as data on postoperative complications. For the comparison of means of the two groups, we used the Student t test or the Mann-Whitney non-parametric test, when the assumption of normality of the data was rejected. Results  In total, 55 patients underwent ACL reconstruction with internal brace augmentation and another 55 patients underwent ACL reconstruction without internal brace augmentation. The patients were aged between 16 and 63 years (mean of 32.7 ± 11.4 years). A total of 62 patients (56.4%) underwent ACL reconstruction with hamstring graft, and 19 patients (17.3%), with quadriceps tendon graft, with a diameter variation of 7 mm to 11 mm (mean of 8.95 ± 0.83 mm). The postoperative scores did not differ between the groups ( p  > 0.05). Regarding the group submitted to ACL reconstruction with internal brace augmentation, 4 patients had complications: @ cases of arthrofibrosis, 2 (3.7%); 1 case of rerupture (1.8%); and 1 case of thrombosis (1.8%). In the group submitted to ACL reconstruction without augmentation, 7 patients manifested complications: 2 cases of arthrofibrosis (3.9%); 4 cases of rerupture (7.3%); and 1 case of infection (2%). Conclusion  The results of the present study show that fewer cases of ACL rerupture were observed after reconstruction with internal brace augmentation when compared with ACL reconstruction without augmentation, although no differences in functional scores were found.

Objective  To analyze the reproducibility and intra- and interobserver agreement of the IDEAL classification for distal radius fractures. Methods  This qualitative, analytical study evaluated 50 pairs of radiographs in two views of patients with distal radius fractures. There were ten observers with different levels of orthopedic training who assessed the radiographs in three different evaluations. The results underwent the Cohen and Fleiss Kappa tests to determine intra- and interobserver agreement levels. Statistical calculations used Excel and SPSS, version 26.0. Results  The Cohen Kappa index values for intraobserver evaluation indicated poor to little agreement (-0.177-0.259), with statistical significance in only one instance. The Fleiss Kappa index values revealed little agreement among the resident group (0.277-0.383) with statistical significance, poor to little agreement among the general orthopedists (0.114-0.225) with statistical significance in most instances, and moderate agreement among hand surgeons (0.449-0.533) with statistical significance. Conclusion  The IDEAL classification had interobserver agreement levels ranging from poor to moderate, influenced by the physicians' training level. Other intraobserver agreement levels ranged from poor to little agreement but without statistical significance.

Objective  This study evaluated lumbar spine radiographs using the Choi and Patgaonkar classifications to verify parameters potentially influencing the L5-S1 transforaminal approach. Materials and Methods  We studied 167 lumbosacral spine radiographs from patients over 18 years old with no history of surgeries, tumors, fractures, or scoliosis to measure the iliac crest height and rim angle. We categorized the cases per pelvic morphology, mega-apophysis presence, and Choi and Patgaonkar classifications. Results  Seventy-five cases had an android pelvis and 92 had a gynecoid pelvis. The mean iliac height was 25.9 ± 7.5 cm, and the rim angle was 23.4 ± 7.5 degrees. The gynecoid pelvis showed a lower iliac height. According to Patgaonkar, 63 cases indicated a suprailiac approach, and per the Choi classification, 37 were suitable for a suprailiac approach and 106 for a suprailiac approach with foraminoplasty. Conclusion  Gynecoid pelvises had a lower iliac height. Furthermore, 37.7% of the cases were suitable for a suprailiac approach per the Patgaonkar classification. The Choi classification indicated a suprailiac approach for 22.1% of the cases and a suprailiac approach with foraminoplasty for 63.4% of the subjects.

Objective  The aim of the present study was to detect atypical Scheuermann's disease through computed tomography scans and estimate its prevalence. Methods  This cross-sectional observational study involved 1,287 computed tomography scans from patients aged 18 to 40 years of both genders. The criteria for diagnosing atypical Scheuermann's disease included wedging of 5° in 3 consecutive vertebrae, combined with a total Cobb angle of 10° or more within the thoracolumbar interval from T8 to L2. Positive cases were assessed for kyphosis severity, presence of Schmorl's nodes, and scoliosis. Prevalence estimation and correlation analysis with age and sex were performed. Results  The study identified 28 cases of atypical Scheuermann's kyphosis, indicating a prevalence of 2.8%. Conclusion  The current research, utilizing abdominal tomography, offers valuable insights into the prevalence of Scheuermann's disease in its atypical form within the sampled population.

Objective  To evaluate the clinical and functional outcomes of the pharmacological block of the genicular nerves as a modality in the therapeutic arsenal for knee osteoarthritis, since it is simple, safe, and minimally invasive. Methods  The pharmacological block of the genicular nerves was performed in 20 patients with grades 3 and 4 knee osteoarthritis per the Kellgren-Lawrence classification. We assessed their clinical and functional outcomes one, three, and six months after the procedure. Results  Of the 20 patients undergoing the procedure, 16 (80%) presented an excellent response in the first month of outpatient follow-up, since their pain level went from 8/9 to 2/3; 2 subjects presented a partial response, and 2 others did not respond to the treatment. Conclusion  The pharmacological block of the genicular nerves is efficient in reducing pain and improving the performance of daily activities by the patients, especially up to three months after the procedure.