Revista Brasileira de Ortopedia最新文献

Objective  Surgical procedures of curettage and surgical resection are used to treat giant cell tumor (GCT) of the distal radius, but it is still controversial whether one provides better functional outcomes than the other. The present study aims to determine and compare both procedures regarding complications, local recurrence, and mobility. Methods  A complete search of the applicable literature was done and independently assessed by three authors. Included studies reported on patients who were surgically treated for GCT of the distal radius with either curettage or surgical resection. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was used to obtain research regarding outcomes of surgical resection and curettage for GCT of the distal radius. A meta-analysis was performed using this data. Quality assessment was performed. Results  Seven studies, comprising 114 patients with resection and 108 with curettage, totaling 222 subjects with 117 males and 105 females, were included in the present review. Overall, patients in the curettage group had a higher recurrence rate (0.205; 95% confidence interval [95%CI] = 0.057-0.735; p  = 0.015). Incidences in complications remains the same in both groups (2.845; 95%CI = 0.644-12.57; p  = 0.168). Incidences in functional outcomes were the same in both groups as well (-0.948; 95%CI = -2.074-0.178; p  = 0.099). Conclusion  The authors prefer resection and reconstruction for GCT of distal radius as optimum treatment method due to the similar functional outcomes and lower chances of recurrence. Curettage might be a treatment option in low-grade GCT coupled with adjuvant, neoadjuvant or ablation to reduce the risk of recurrence.

Objective  The management of slipped capital femoral epiphysis (SCFE) has been completely transformed by modified Dunn osteotomy, a subcapital realignment osteotomy achieved through a safe surgical dislocation technique originally described by Ganz. The purpose of this study was to evaluate the clinical and radiological outcomes of patients with moderate to severe SCFE after modified Dunn osteotomy. Methods  A total of 15 patients (16 hips, with one bilateral case; 12 males, 3 females) aged from 10.2 to 17-years-old (mean: 14.3) with stable, moderate to severe, chronic SCFE (moderate: = 6; severe = 10) underwent modified Dunn osteotomy as treatment. The hip joint range of motion (ROM), Harris (HHS), and Merle d'Aubigné (MdA) hip scores were used for clinical assessments. They were assessed radiographically using the Southwick and Alpha angles. Results  At the most recent follow-up (mean 8.6 years; 3.1-14), the mean hip joint ROM, the mean HHS (preoperative: 69.20 ± 5.94; postoperative: 86 ± 7.37; p  < 0.00001), and the mean MdA score (preoperative: 12.47 ± 1.13; postoperative: 14.27 ± 1.83; p  < 0.00001) all showed statistically significant clinical improvements The radiological results demonstrated improvements in the mean Southwick angle (preoperative: 56.60 ± 12.89°; postoperative: 16.40 ± 4.69°; p  < 0.00001) and Alpha angle (preoperative: 101.87 ± 12.88°; postoperative: 29.33 ± 7.29°; p  < 0.00001). There were two significant postoperative complications identified: femoral head avascular necrosis (AVN) and deep infection. Conclusion  According to the study's findings, the modified Dunn osteotomy is a safe, efficient treatment option for stable moderate-to-severe chronic SCFE with a manageable risk of complications.

Congenital clubfoot is a complex, frequent deformity that can be challenging even in experienced hands. The Ponseti method remains universally accepted as the gold standard for treatment, and excellent outcomes are within expectations in most cases with appropriate technical management. Recurrences continue to be a problem and are mainly associated with non-compliance with orthosis use. However, other factors may influence the risk of recurrence and contribute to an unsatisfactory outcome. Tibialis anterior transfer balances deforming forces and helps correction as long as the foot is flexible. A recurred deformity is not corrected spontaneously, it requires treatment. Adjuvant surgical procedures should be part of the orthopedist's therapeutic arsenal.

Objective  To assess the efficacy of distal radius volar plates in cases involving dorsal fragments at the Ulnar Corner (UC) and Lister Tubercle (LT). Methods  A retrospective study that included patients with distal radius fractures (DRFs) featuring UC and LT dorsal fragments treated with volar plates. The exclusion criteria comprised lunate facet fractures, UC fragment ratio below 25%, and patients treated with dorsal plates. Radiographic and tomographic measurements included radial length (RL), radial inclination (RI), ulnar variance (UV), palmar tilt (PT), fragment areas, UC fragment ratio, and displacement. The scores on the Gartland Werley (GW) classification and on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, as well as grip strength, and range of motion (ROM), were assessed. Results  The study involved 17 male and 5 female subjects (mean age: 39.7 ± 10.7 years). The UC and LT fragments displayed mean areas of 1.6 ± 0.7cm ² and UC fragment ratio of 0.4 ± 0.1. The fixation rates for UC and LT fragments were of 18.2% and 31.8% respectively. Improved RI, UV, and PT were noted postoperatively. The mean GW and DASH scores were of 2.1 ± 2.0 and 4.3 ± 3.2 respectively. Grip strength on the operated side was of 89.5 ± 9.8% of the healthy side, and at least 90.9% of the patients achieved adequate ROM. Conclusion  While volar plates are the standard treatment for intra-articular DRFs, displaced dorsal fragments can impact the outcomes. Mini dorsal incisions may aid in the fixation of UC fragments that are challenging to secure with volar plates, preserving joint health.

Posterior meniscal root repair is an expensive procedure because its performance often requires the use of specific devices. This issue is a limiting factor, especially in the public health system. Given this context, the development of alternative methods to treat these injuries became necessary. Among the available options, the technique combining the use of anterior portals and a tibial bone tunnel with an epidural needle has been proven to be effective and relevant due to its low cost. The present study aimed to provide technical guidance and suggestions to increase the success rate of this procedure, to enable its performance by knee surgeons in low-resource settings.

The original LaPrade technique for anatomic reconstruction of the posterolateral corner of the knee uses two separate allografts. More recently, a modification of this technique, using an adjustable-length suspension device with a cortical button for tibial fixation, allows anatomic reconstruction with a single semitendinosus autograft. This modification is of utmost relevance when sources of allograft are not available for multiligament knee reconstruction. In both techniques interference screws are used for femoral fixation of the fibular collateral ligament and popliteus tendon. The minimum length recommended for the anatomic reconstruction with single semitendinosus is 25 cm, but anatomic variations in the population exist, and a longer semitendinosus may be necessary. Indeed, some patients may only reach the necessary length considering the thinnest limb of the semitendinosus. In these patients, femoral fixation of the thinnest limb with a knotless suture anchor, as we describe, for the popliteus tendon limb, allows expansion of this technique to borderline semitendinosus autografts while reducing the risk of tunnel coalition. We also describe a different sequence of steps: fixation of the fibular collateral ligament in the femoral tunnel followed by its tensioning and fixation in the fibular head tunnel, fixation of the popliteus tendon in its femoral footprint with a knotless suture anchor and, finally, tensioning of the popliteofibular ligament and popliteus tendon. This different sequence also helps avoiding tendon waste, which may be left over, allowing more graft incorporation into the tibial tunnel.

The clinical disorder traditionally known as pes planovalgus due to posterior tibial tendon insufficiency or adult-acquired pes planovalgus has been the subject of several publications over the past two decades. Now, it is understood that the problem does not lie in the posterior tibial tendon per se and may even occur without tendon injury. Studies have brought new concepts and understanding that question the views on this subject, culminating in the replacement of existing classifications with one that is more assertive and discriminative of the potential presentation patterns of the deformity. In addition, a change in the name of the disorder to progressive collapsing foot deformity (PCFD) has been proposed. Regarding surgical treatment, the concept of an à la carte approach persists, emphasizing axis realignment through osteotomies, arthrodeses, and soft tissue balancing, which consists of tendon transpositions/repairs and reconstruction of ligament structures, especially the deltoid ligament complex and the spring ligament.

Objective  To compare the fixation methods for tibial pilon fractures among patients treated in a hospital. Methods  We analyzed the medical records of 28 patients who underwent a surgical procedure for tibial pilon fracture, among whom 15 subjects received a circular external fixator, and 13 underwent internal fixation using a plate and screws. We assessed age, sex, aggravating factors, trauma energy (high or low), presence of soft tissue injuries, associated fractures, and clinical outcomes. Results  Most patients were male, aging between 40 and 60 years. The most common trauma mechanism was car accident, and the associated injury was a fracture of the distal third of the fibula. The fracture patterns in patients treated with a circular external fixator were AO 43C3 and 43C2. As for the prevalent fracture patterns in the internal fixation group, we identified AO 43C1, 43C2, and 43C3. Conclusion  An individualized therapeutic choice is critical for a better functional outcome. Additionally, it is essential to highlight that the profile of fractures and patients in the circular external fixator and internal fixation groups tends to be quite heterogeneous, because the treatment of fractures with the worst classification and most frequently associated with soft tissue injuries often uses circular external fixation; meanwhile, those with less severe fractures and a lower incidence of soft tissue injuries are usually managed with open reduction and internal fixation. We noted that the clinical and radiographic outcomes tended to be similar between both groups despite the particularities of each method.

Objective  To identify the causes of revision of total knee arthroplasty in a referral center in Brazil. Methods  This is a case series, with 80 patients undergoing revision surgery for total knee arthroplasty (RTKA) at a referral center for knee surgery, between August 2019 and November 2021, with a mean age of 69.6 years. Of these patients, 60.23% were female and 39.77% were male. The average body mass index (BMI) was 30.23 kg/m ² . The causes of TKA failure were defined as: periprosthetic infection according to the 2018 International Consensus Meeting criteria, ligament instability, range of motion limitation, periprosthetic fracture, malalignment, aseptic loosening, pain due to non-replacement of the patellar cartilage, polyethylene wear, fracture of implants, insufficiency of the extensor mechanism. Results  Periprosthetic joint infection (PJI) was the main cause of revision total knee arthroplasty (TKA), corresponding to 47.73% of cases. Aseptic loosening of one or more components represented the second most frequent reason for TKA failure, accounting for 35.23% of revisions. Range of motion limitation represented the third most frequent cause, accounting for 5.68% of surgeries. Instability was the fourth most frequent reason for RTKA, occurring in 4.55% of patients. The other causes of revision were: periprosthetic fracture (3.41%), failure due to rupture of the extensor mechanism (2.27%), and pain attributed to non-replacement of the patellar cartilage (1.14%). Conclusions  Periprosthetic joint infection was the most frequent cause of TKA revision in our series. Other reasons for TKA failures were, in descending order: aseptic loosening, limited range of motion, and instability.

Objective  To biomechanically evaluate different fixation devices for the proximal biceps in the humerus of sheep, comparing their fixation strength to failure, tendon displacement, and failure site in each technique. Methods  A total of 27 humerus tests were performed on sheep, separating them into 3 groups: group A with tenodesis with metallic anchors ( n  = 11), group B with biocomposite knotless devices ( n  = 8) and group C with metallic interference screws ( n  = 8), performing tenodesis with the sheep's own biceps, maintaining its native distal insertion. The three methods were submitted to a universal tensile testing machine. Results  There was no statistically significant difference in the strength of fixation until failure and displacement between the tendons fixed by the different techniques. Regarding the pattern of ruptures, it was observed that most ruptures of the metallic anchors occurred at the level of the myotendinous junction, most of the bioabsorbable knotless anchors failed due to slippage of the wire-screw interface, and all interference screws failed via tendon slip. Conclusion  The three techniques with metal anchor, onlay bioabsorbable knotless anchors, and interference screws are largely resistant to tensile loads for long head of the biceps tenodesis in sheep. There was no statistical difference between the three groups. Cyclic load resistance studies can provide more valuable data for comparing groups.