Anderson Freitas

Lesões abdominais por uso do fio guia em ensaios cirúrgicos do quadril: estudo em cadáver

OBJECTIVES: Evaluate the relationship between abdominal injuries and the introduction of guide wire in experimental hip surgery, to propose a scoring system and a medical management based on the distance traveled by the guide wire from the quadrilateral plate until the damaged anatomical structure. MATERIAL AND METHODS: 18 cadaveric hips, a Steimann pin of 3.2 x 300mm, an electric drill and a caliper were used. The wire was inserted in the center of the femoral neck through a lateral approach in the hip under direct visualization. Via median abdominal extended approach to the pelvic region, the quadrilateral plate was observed until the wire crossed it. From this point the wire was further inserted 140 mm in order to observe its abdominal path and describe the lesions presented based on the distance traveled. RESULTS: There were five lesions (27%) in the sigmoid colon, and one transfixing injury (5%) of the obturator nerve. The common iliac arteries and veins from the contralateral hip were not injured. CONCLUSION: The guide wire must not exceed the quadrilateral plate. Preventive measures are important in the pre- and intra-operatory stages and the score and medical management proposed in this study should be carefully observed in cases of injury.

Ensaio de aplicabilidade in vitro do sistema dinâmico do quadril AF(DHS- AF)

Objective: This report considers the results of the applicability test of a modified dynamic hip system developed by the authors, which allows either the manipulation or the exchange of the sliding screw, without the need to remove the plate and take all the system apart in order to change its size or position. Methods: Five modified plates – DHS-AF – manufactured with austenitic stainless steel ASTM F 138, with 4 holes and a 135o angle were inserted in five segments of synthetic bone of proximal femur (Synbone). All implants were fixed to the femur following the surgical techniques described by AO foundation (Arbeitsgemeinschaft fur Osteosynthesefragen). Results: The modified dynamic hip system (DHS-AF) allowed ease in handling and exchange of sliding screw without the need for plate removal. Conclusion: In vitro test of the applicability of DHS-AF afforded promising results and led us to believe that after biomechanical evaluation to confirm its safety it may be reproduced in vivo.

Analysis of mechanical strength to fixing the femoral neck fracture in synthetic bone type Asnis

OBJECTIVE: To analyze the results of biomechanical assays of fixation of Pauwels type III femoral neck fracture in synthetic bone, using 7.5mm cannulated screws in inverted triangle formation, in relation to the control group. METHODS: Ten synthetic bones were used, from a domestic brand, divided into two groups: test and control. In the test group, a 70° tilt osteotomy of the femoral neck was fixated using three cannulated screws in inverted triangle formation. The resistance of this fixation and its rotational deviation were analyzed at 5mm displacement (phase 1) and 10mm displacement (phase 2). The control group was tested in its integrity until the fracture of the femoral neck occurred. The Mann-Whitney test was used for group analysis and comparison. RESULTS: The values in the test group in phase 1, in samples 1-5, showed a mean of 579N and SD =77N. Rotational deviations showed a mean of 3.33°, SD = 2.63°. In phase 2, the mean was 696N and SD =106N. The values of the maximum load in the control group had a mean of 1329N and SD=177N. CONCLUSION: The analysis of mechanical strength between the groups determined a statistically significant lower value in the test group. Level of Evidence III, Control Case.

Analysis on the mechanical resistance of fixation of femoral neck fractures in synthetic bone, using the dynamic hip system and an anti-rotation screw,

Objective To statistically analyze the results obtained from biomechanical tests on fixation of femoral neck fractures of Pauwels III type, in synthetic bone, using the dynamic hip system with an anti-rotation screw, versus a control group. Methods Ten synthetic bones from a Brazilian manufacturer (model C1010) were used and divided into two groups: test and control. In the test group, fixation of an osteotomy was performed with 70° of inclination at the level of the femoral neck, using DHS with an anti-rotation screw. The resistance of this fixation was evaluated, along with its rotational deviation at 5 mm of displacement (phase 1) and at 10 mm of displacement (phase 2), which was considered to be failure of synthesis. In the control group, the models were tested in their entirety until femoral neck fracturing occurred. Results The test values in the test group (samples 1–5) in phase 1 were: 1512 N, 1439 N, 1205 N, 1251 N and 1273 N, respectively (mean = 1336 N; standard deviation [SD] = 132 N). The rotational deviations were: 4.90°, 3.27°, 2.62°, 0.66° and 0.66°, respectively (mean = 2.42°; SD = 1.81°). In phase 2, we obtained: 2064 N, 1895 N, 1682 N, 1713 N and 1354 N, respectively (mean = 1742 N; SD = 265 N). The failure loading values in the control group were: 1544 N, 1110 N, 1359 N, 1194 N and 1437 N, respectively (mean = 1329 N; SD = 177 N). The statistical analysis using the Mann–Whitney test showed that the test group presented maximum loading at a displacement of 10 mm, i.e. significantly greater than the failure loading of the control group (p = 0.047). Conclusion The mechanical resistance of the test group was significantly greater than that of the control group.

APOPHYSEAL FRACTURE OR AVULSION OF THE GREATER TROCHANTER

ABSTRACTS The apophyseal fracture or avulsion of the greater trochanter occurs in skeletally immature patients. It has at etiological factors indirect mechanisms (avulsion) and direct mechanisms (trauma on the trochanter), the latter being the most common. The clinical presentation is easily identified and a simple X- ray can confirm the diagnosis. Regardless of the treatment chosen, this pathology has a high correlation with osteonecrosis of the femoral head, even as a rare fact, however with innocent appearance, on this pathology.

Simultaneous bilateral fractures of the femoral neck

A mong the traumatologic pathologies that affect elderly people, fracture of the femoral neck can be considered an injury that most frequently affects morbidity and mortality. In elderly people, these fractures often are associated with metabolic disorders such as osteoporosis, chronic renal failure, celiac disease, hyperparathyroidism, and other pathologies affecting bone metabolism. Simultaneous bilateral fractures of the femoral neck were first reported in psychiatric patients having drug-induced or electroshock-induced seizures. The incidence of simultaneous fractures has decreased considerably since the introduction of muscle relaxants as adjuvant therapy in 1957; however, recent reports of fractures caused by seizure or accidental electric shock are still available. In the past 40 yr, only 25 simultaneous bilateral fractures of the femoral neck have been reported in the literature, and most have occurred in association with tonic-clonic seizures. Considering the limited number of patients and the controversy over treatment for this pathology, here, we report an elderly patient with simultaneous bilateral femoral neck fractures. The patient signed informed consent.

ENSAIO ESTÁTICO DE FLEXÃO NO PARAFUSO DESLIZANTE DO QUADRIL AF (DHS- AF®)

OBJECTIVE: To analyze the in vitro mechanical strength of the DHS-AF®. METHODS: We evaluated the in vitro resistance of a sliding bolt modified by the addition of a connector system, DHS-AF®. RESULTS: The changes performed by the authors allow the exchange by the surgeon of the sliding bolt without the need to remove the plate and disassemble the entire device to reposition it properly. We conducted a static bending test to evaluate maximum strength, stiffness and ductility of the system. DHS-AF® showed satisfactory mechanical properties when compared to other conventional devices which use the same principle. CONCLUSION: Based on these results, the authors propose the use of this new implant in further in vivo studies. Level of Evidence III, Analytical Study.

Descrição anatômica do terço proximal da artéria circunflexa femoral medial: estudo em cadáver

Objective To describe, in a cadaver study, the anatomical arrangement of the proximal third medial femoral circumflex artery (MFCA). Methods We evaluated the anatomic arrangement of the proximal third of the MFCA through dissection in 12 cadaver hips. After measuring their height in meters (M), several parameters were determined: angle of lateralization of MFCA (Â), Depth MFCA in relation to the superomedial origin of the quadratus femoris muscle (P), and distance of MFCA from the superolateral insertion of the muscle quadratus femoris (D). Results In the comparison of mean parameters between the sexes, it was noted that: Male  = 43.6 degrees, female  = 38.3 degrees. Male D = 6mm, female D = 9.5mm. Male P = 20.8 mm, female P = 18.3mm. The average for parameters A and P were lower in females, but parameter D was higher in females. Conclusion We should use, as the secure surface parameter for the proximal third of the MFCA, the superolateral insertion point of the quadratus femoris. The fact that the parameter D of MFCA is greater in females than in males. Disconnecting the quadratus femoris at its point of origin in the isquio may offer greater security to MFCA than doing it at the point of femoral insertion. Level of Evidence.

Tenotomia do glúteo máximo em artroplastia total do quadril como prevenção de lesão do nervo ciático

The authors report a single case of complex primary hip total arthroplasty in a 34-year-old female patient with a 5.5 cm lower limb dysmetria, in whom a maximum gluteus tenotomy was performed in order to prevent sciatic nerve injury. The surgery was performed under electroneurophysiological monitoring of the fibular and tibial branches of the sciatic nerve, collecting pretenotomy, posttenotomy, and postarthroplasty reduction data. The findings demonstrate that the maximum gluteus tenotomy improved the motor response of the fibular component of the sciatic nerve.

Traumatic Open Anterior Hip Dislocation in an Adult Male: A Case Report

This case report describes the surgical treatment and one-year follow-up of an adult male patient, who was treated for a severe anterior open hip dislocation fracture with no sign of femoral head necrosis and maintaining a Harris Hip Score (HHS) of 93.