Arnaldo Valdir Zumiotti

Comparison between proximal row carpectomy and four-corner fusion for treating osteoarthrosis following carpal trauma: a prospective randomized study

OBJECTIVE: To compare the functional results of carpectomy and four‐corner fusion surgical procedures for treating osteoarthrosis following carpal trauma. METHODS: In this prospective randomized study, 20 patients underwent proximal row carpectomy or four‐corner fusion to treat wrist arthritis and their functional results were compared. The midcarpal joint was free of lesions in all patients. RESULTS: Both proximal row carpectomy and four‐corner fusion reduced the pain. All patients had a decreased range of motion after surgery. The differences between groups were not statistically significant. CONCLUSIONS: Functional results of the two procedures were similar as both reduced pain in patients with scapholunate advanced collapse/scaphoid non‐union advanced collapse (SLAC/SNAC) wrist without degenerative changes in the midcarpal joint.

The impact of ertapenem use on the susceptibility of Pseudomonas aeruginosa to imipenem: a hospital case study.

We sought to evaluate the indirect impact of ertapenem use for the treatment of extended-spectrum beta-lactamase-producing Enterobacteriaceae infections in our hospital on the susceptibility of Pseudomonas aeruginosa to imipenem. The use of ertapenem was mandated for treatment of extended-spectrum beta-lactamase-producing Enterobacteriaceae infections in the absence of nonfermenting gram-negative bacilli for 1 year. The use of imipenem was restricted. Imipenem consumption decreased 64.5%. Ertapenem consumption was 42.57 defined daily doses per 1,000 patient-days. None of the 18 P. aeruginosa isolates recovered after ertapenem introduction were imipenem-resistant, compared with 4 of the 20 P. aeruginosa isolates recovered in the previous year.

Skin Coverage of the Middle-distal Segment of the Leg With a Pedicled Perforator Flap

Objective: This is a clinical study of our experience using pedicle perforator flaps to cover skin defects in the middle and distal segment of the leg. Design: Prospective study. Setting: University hospital. Patients/Intervention: Twenty-four patients underwent treatment of a skin defect in the middle or distal segment of the leg by means of pedicled flaps based on perforating arteries. The perforating arteries were located before the operation by means of echo-Doppler examination. The flaps were planned in propeller fashion (21 cases) and as advancement (three cases). Main Outcome Measurements: The results were evaluated according the origin of perforator flap, size of the flap, and donor area and viability of the flap. The success rate of the echo-Doppler to identify the location of perforator vessel was also evaluated. Results: In nine cases, the perforating vessels originated from the fibular artery, in 10 the posterior tibial artery, and in five the anterior tibial artery. The mean size of the flaps was 5 cm in width by 12 cm in length. The success rate using an echo-Doppler was 87%. The flaps were fully viable in 20 cases and partially viable in four cases. Conclusion: On the basis of these results, it is concluded that perforating flaps are a good choice of treatment for skin losses, especially in the distal segment of the leg, and could be an alternative option for the use of free microsurgical flaps.

Osteoarticular complications related to HIV infection and highly active antiretroviral therapy

With the significant increase in life expectancy for HIV-infected patients in the era of high potency antiretroviral therapy, major metabolic changes have been observed due to the prolonged period of the viral infection and the treatment itself. Osteoarticular changes resulting from these processes are mainly reported in long term HIV-infected patients receiving high potency antiretroviral therapy and include osteopenia/osteoporosis, osteonecrosis, carpal tunnel syndrome and adhesive capsulitis of the shoulder.

Influence of ertapenem administration on the incidence of carbapenem-resistant Pseudomonas aeruginosa

IOT – Institute of Orthopedics and Traumatology(Instituto de Ortopedia e Traumatologia), Clinical Hospital,School of Medicine, Sao Paulo University, started theadministration of ertapenem in March 2006. The ClinicalHospital is a tertiary and quaternary healthcare center andthe Institute of Orthopedics and Traumatology isexclusively designed to treat highly complex cases,counting on 200 beds. That antibiotic (ertapenem) wasincluded in the standardization of the use of antimicrobialagents intended to treat hospital-acquired infectionsassociated to enterobacteriaceae producing ESBL (extendedspectrum beta-lactamase), including cases of post-surg icalor post-traumatic bone and soft tissues infections. At IOT,the Gram-negative bacillus most frequently found in thatgroup of infections is

Comparative multicenter study of treatment of multi-fragmented tibial diaphyseal fractures with nonreamed interlocking nails and with bridging plates

OBJECTIVE A prospective, randomized study to compare patients with closed, multi-fragmented tibial diaphyseal fractures treated using one of two fixation methods undertaken during minimally invasive surgery: nonreamed interlocking intramedullary nails or bridging plates. MATERIALS AND METHODS Forty-five patients were studied; 22 patients were treated with bridging plates, 23 with interlocking nails without reaming. All fractures were Type B and C (according to the AO classification). RESULTS Clinical and radiographic healing occurred in all cases. No cases of infection occurred. The healing time for patients who received nails was longer (4.32 weeks on average) than the healing time for those who received plates (P = 0.026). No significant differences were observed between the two methods regarding ankle mobility for patients in the two groups. CONCLUSIONS The healing time was shorter with the bridging plate technique, although no significant functional differences were found.

Fatores preditivos de infecção em pacientes com fraturas expostas nos membros inferiores

134 pacientes com fraturas expostas dos membros inferiores dos tipos II, IIIA, IIIB e IIIC foram estudados prospectivamente entre fevereiro de 1998 e maio de 2000 no Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de Sao Paulo para determinar os fatores de risco de infeccao previsiveis Todos os pacientes foram registrados em um protocolo no qual eles tiveram amostras de fragmentos osseos iniciais coletadas para cultura bacteriana, avaliacao de condicoes clinica e administracao precoce de antibiotico. Durante a abordagem inicial, as causas das fraturas, o tempo de exposicao da fratura e o local onde os primeiros socorros foram recebidos foram observados. Durante o debridamento inicial, o volume de transfusao sanguinea, a classificacao clinica ASA, o tempo cirurgico, o ferimento cirurgico e o tipo de estabilizacao esqueletica foram observados. Uma analise univariavel foi realizada para identificar os riscos pervisiveis estatisticamente significantes para o desenvolvimento de infeccoes, com os seguintes resultados: tempo de exposicao da fratura (p=0.0201), local dos primeiros socorros (p=0.400), tipo de fratura (p=0.0130), classificacao ASA (p=0.0005), volume de transfusao de sangue (p=0.0002) tipo de osso fraturado (p=0.0052), tipo de acidente (p=0.0450), ferimento cirurgico (p=0.0024), estabilizacao esqueletica (p=0.0446), cultura bacteriana positiva na admissao (p=0.5290) e cirurgias concomitantes (p=0.1867). As variaveis com associacao significante com a infeccao foram introduzidas em uma equacao de regresao multivariada (modelo logistico) para identificar as com efeitos independentes dos outros fatores. O modelo logistico final foi obtido e demonstrou as probabilidades de infeccao nas fratruras expostas estudadas. Os riscos relativos revelados no modelo logistico final foram : volume de transfusao sanguinea (mais do que 1 unidade) - 6.4;classificacao ASA nivel III - 5.2; fixacao interna do osso (imediata) - 3.9; osso fraturado (femur) - 3.5 and ferimento aberto - 3.0

Comparative study of the locked intramedullary nail and Ender pins in the treatment of tibial diaphyseal fractures

OBJECTIVE To compare the locked, unreamed intramedullary nail with Ender pins in the treatment of open Gustilo grade I or II or closed tibial diaphyseal fractures of type A, B, or C2 of the AO classification. MATERIALS AND METHODS Forty-four patients with unilateral tibial diaphyseal fractures were treated with intramedullary nails or Ender pins. Twenty patients were treated with an unreamed intramedullary nail with access via the patellar tendon with static locking. Twenty-four patients were treated with Ender pins introduced medially and laterally with respect to the tuberosity of the tibia. The main parameters analyzed were type of reduction, complications, union rate, deformities, joint mobility, pain, gait, effort capacity, presence of neurovascular disorders, and complaints related to the synthesis material. RESULTS During 1 year of follow-up, the fractures of 90.0% of the patients with intramedullary nails and 95.7% of patients with Ender pins healed within an average of 21.5 weeks and 20.9 weeks, respectively. The significant findings were as follows: patients treated with Ender pins had less mobility of the subtalar joint; patients treated with intramedullary nails were more likely to have pain in the knee; both groups showed shortening of the tibia at the end of 1 year of treatment. CONCLUSIONS The two methods are similar in the treatment of type A, B, and C2 tibial diaphyseal fractures.

Cobertura do terço distal da perna com retalhos de perfurantes pediculados

SUMMARY Perforating vessels patches represent an advancement in terms of skin failures treatment. On the distal third of the leg, the alterna- tives for skin covering are scarce, often requiring microsurgery. In this study, we aimed to make a prospective assessment of 20 patients submitted to treatment of bloody areas of legs distal third by means of pedicled patches in perforating arteries. The location of the perforating arteries was preoperatively found using the eco- doppler test. The patches were planned to allow up to 180-degree rotation in the bloody area. In 6 cases, perforating vessels had the fibular artery as source; in 10, the posterior tibial artery, and; in 4, the anterior tibial artery. The accuracy rate of the ecodoppler was 88.2%. For young patients presenting injuries caused by trauma, procedure failures were found in 15.4%, and for those with associ- ated comorbidities, 33.3%. Based on our studies, we conclude that perforating vessels patches are a good alternative for skin failures on the distal segment of the leg.

Fatores preditivos para marcha na fratura transtrocanteriana do fêmur

OBJECTIVE: The objective of this study was to identify variables that could predict the quality of gait in patients with transtrochanteric femoral fractures after treatment. MATERIALS AND METHODS: Hospitalized patients diagnosed with transtrochanteric femoral fractures were selected between September/2005 and August/2006 and followed-up for 6 months after the trauma date. An observational prospective study was conducted to assess the quality of gait 3 and 6 months after fracture in 31 patients (13 males and 18 females). The mean age was 76±2,7. RESULTS: Seven patients (22,6%) passed away during the follow-up period. The patients with associated fractures or with four or more co-morbidities showed a worse quality of gait after 6 months. Patients without orthopaedic complications or who got partial weight load prior to 30 days showed a better performance. CONCLUSION: The quantification of predictive gait indexes allows us to propose new treatment approaches consistently to the different realities showed by each group of patients.