Bruno Pereira

Percutaneous Osteotomies in Hallux Valgus: A Systematic Review

ABSTRACT Percutaneous and minimally invasive surgery is one of the greatest advances in the operating field of orthopedic since the late 1990s. The potential advantages include a shorter operative time, quicker recovery, and reduced hospital stay compared with traditional open surgery. However, scientific validation of the safety and efficacy of hallux valgus (HV) percutaneous surgery remains inconclusive. The objective of the present study was to systematically review the published data and clinical evidence for percutaneous HV surgery, evaluate the scientific method of the reports, and clarify the indications, safety, efficacy, and potential risks of these surgical techniques. Two reviewers independently identified the studies using a PubMed search, with the keywords “hallux valgus,” “osteotomy,” “minimally invasive,” and “percutaneous.” Quality assessment was performed using the Coleman methodology scale, and each study was assigned a level of evidence and grade of recommendation. Eighteen studies were included and reported a total of 1534 procedures for percutaneous HV surgery on 1397 patients. Of the 18 studies, 14 (77.8%) were level IV, 2 (11.1%) were level III, and 2 (11.1%) were level II. Overall, the average angle correction of the HV deformity improved postoperatively. Regarding the complications, although some investigators revealed no major complications, others described deformity recurrence in 7.8%, stiffness of the first metatarsophalangeal joint in 9.8%, malunion in 4% to 8.7%, and infection rates ranging from 1.9% to 14.3%. The main indication for percutaneous HV surgery is the correction of mild deformities. The complication rate was elevated even in experienced surgeons. In conclusion, future research in percutaneous techniques should include adequately sized randomized control trials, standardization of treatment protocols, and the use of validated tools for the measurement of clinical outcomes. Level of Clinical Evidence: 3

Long-term Follow-up of Dorsal Wedge Osteotomy for Pediatric Freiberg Disease

Background: Treatment for Freiberg disease has been largely conservative despite availability of various operative options for severe or refractory cases. The aim of this study was to evaluate the long-term results of pediatric patients with symptomatic Freiberg disease treated with intra-articular dorsal wedge osteotomy. Methods: Pediatric patients treated for Freiberg disease with surgery between January 1982 and 1999 were identified and selected for long-term clinical evaluation. Patients were evaluated regarding operative satisfaction and clinical outcome, performed according to the American Orthopaedic Foot & Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal scale and range of motion (ROM) of metatarsophalangeal (MTP) joint. Patients had radiographic assessment of degenerative joint status with anteroposterior and oblique foot x-ray. Twenty patients (18 female, 2 male; mean age 15.2 years; range 12-17 years) were identified. The mean follow-up period was 23.4 (range 15-32) years. Results: The clinical outcomes of our patients were classified as excellent in 16 (80%) and good in 4 (20%). The AOFAS mean score was 96.8 (range 91-100) points at the last clinical appointment. A negative correlation between AOFAS score and time of follow-up (r’s = −0.61, P < .001) was found. Also, a strong negative correlation was found between Smillie classification and AOFAS final score (r’s = −0.88, P < .001). Conclusion: The patients were very satisfied with pain and quality of life at a mean follow-up time of 23.4 years. To our knowledge, this is the first long-term follow-up report supporting the procedure described by Gauthier and Elbaz as a good option for operative treatment of Freiberg disease. Level of Evidence: Level IV, retrospective case series.

Biomechanics of Lower Limb Injuries

Biomechanics is a discipline among the sciences derived from the natural sciences, which deals with physical analysis of biological systems, therefore, the physical analysis of the human body movements. When dimensioned biomechanics in the context of related sciences, whose aim’s to study the movement, we must remember that this scientific context rests on two fundamental facts: (a) the biomechanics has clearly defined its subject matter, thus defining its basic structure of knowledge, and (b) the results of investigations are obtained through the use of scientific methods.

Ankle Osteochondroma: A Case Report

She was submitted to lesion excision and osteosynthesis with syndesmosis tibio-peroneal and fibula stabilization with plate and 2 trans-syndesmotic screws (Figure 4). Histopathological examination confirmed the diagnosis of osteochondroma. At 2 months after surgery it was performed the extraction of two transsyndesmotic screws (Figure 5), and after 18 months it was removed all material of osteosynthesis (Figure 6). Volume 9 Issue 2 2017

Modified Elmslie-Trillat Procedure for Distal Realignment of Patella Tendon

Patellofemoral dysfunction, due to either a patellofemoral malalignment or patellar instability, is a complex and debilitating condition that significantly decreases the knee function. Conservative management may yield significant clinical outcomes; however, when morphologic anomalies are identified, the surgical approach should be employed. Hence, several surgical procedures have been described in the scientific literature aiming the correction of underlying extensor mechanism malalignments. Still, the rate of complications is higher than desirable. The described technique is based on the principles of transferring the tibial tubercle medially as described in the Elmslie-Trillat technique. However, a curvilinear horizontal cut is made prior to the vertical cut, which raises a thick osseous fragment and allows the formation of a gutter when the osseous fragment is moved medially. Whereas the horizontal gutter provides stability to the bone fragment, the thicker dimension of the osseous fragment and retention of the distal attachment significantly enhances the osteotomy union. Hence, adequate pain relief and stability with very low postoperative morbidity could be achieved. The purpose of this surgical note is to describe a modification to the Elmslie-Trillat technique to treat patellofemoral dysfunctions, achieving a higher osseous stability and decreased postoperative morbidity.

Fixação pedicular percutânea de fraturas vertebrais toracolombares sem compromisso neurológico

Objective: To evaluate the efficacy and safety of percutaneous pedicle fixation in thoracolumbar fractures without neurologic compromise. Methods: The study included patients aged between 18 and 70 with AO thoracolumbar fracture type (A.3) and kyphosis >30° or reduction of vertebral body height >50% or >50% of spinal canal compromise, who underwent surgery with percutaneous pedicle fixation in the first ten days after fracture. Radiological parameters were evaluated: Cobb angle, vertebral collapse, anterior wedging and spinal canal compromise preoperatively, postoperatively and at the end of follow-up. The clinical and functional outcome was assessed by the Oswestry Disability Index (ODI). Results: Mean operative time was 81 minutes (Min 69, Max 95 min). The mean volume of intraoperative blood loss was 85ml (75 Min and Max 155 ml). The mean follow-up was seven months (3 months Min, Max, 14 months) with an average ODI of 18% (excellent). Conclusions: The clinical results suggest that the pedicle fixation percutaneous technique may be an alternative to surgical treatment of thoracolumbar fractures type (A.3), without neurological deficits. This technique has proved to be safe and effective, with the advantages of a minimally invasive approach.OBJETIVO: Evaluar la eficacia y la seguridad de la fijacion percutanea pedicular de fracturas toracolumbares sin comprometimiento neurologico. METODOS: Se incluyeron en el estudio los pacientes de edades comprendidas entre 18 y 70 anos, con fractura toracolumbar tipo AO (A.3), cifosis >30° o reduccion de la altura del cuerpo vertebral >50% o compresion del canal vertebral >50%, quienes fueron sometidos a tratamiento quirurgico mediante fijacion percutanea pedicular. Se evaluaron los parametros radiologicos: el angulo de Cobb, el colapso vertebral, el acunamiento anterior y la compresion del canal vertebral antes de la operacion, despues de la operacion y al final del seguimiento. La evolucion clinica y funcional fue evaluada por el Oswestry Disability Index (ODI). RESULTADOS: El tiempo quirurgico promedio fue 81 minutos (minimo 69, maximo 95 min.) El volumen promedio de la perdida de sangre intraoperatoria fue 85 ml (minimo 75 y maximo 155 ml). El promedio de seguimiento fue siete meses (minimo 3 meses, maximo 14 meses). Se presento un ODI promedio final de 18% (excelente). CONCLUSIONES: Los resultados clinicos sugieren que la fijacion percutanea pedicular puede ser una tecnica quirurgica alternativa para el tratamiento de las fracturas toracolumbares tipo AO (A.3), sin deficits neurologicos. Esta tecnica ha demostrado ser eficaz y segura, y presenta las ventajas de un enfoque minimamente invasivo.

Percutaneous pedicle fixation of thoracolumbar vertebral fractures without neurological deficits

Objective: To evaluate the efficacy and safety of percutaneous pedicle fixation in thoracolumbar fractures without neurologic compromise. Methods: The study included patients aged between 18 and 70 with AO thoracolumbar fracture type (A.3) and kyphosis >30° or reduction of vertebral body height >50% or >50% of spinal canal compromise, who underwent surgery with percutaneous pedicle fixation in the first ten days after fracture. Radiological parameters were evaluated: Cobb angle, vertebral collapse, anterior wedging and spinal canal compromise preoperatively, postoperatively and at the end of follow-up. The clinical and functional outcome was assessed by the Oswestry Disability Index (ODI). Results: Mean operative time was 81 minutes (Min 69, Max 95 min). The mean volume of intraoperative blood loss was 85ml (75 Min and Max 155 ml). The mean follow-up was seven months (3 months Min, Max, 14 months) with an average ODI of 18% (excellent). Conclusions: The clinical results suggest that the pedicle fixation percutaneous technique may be an alternative to surgical treatment of thoracolumbar fractures type (A.3), without neurological deficits. This technique has proved to be safe and effective, with the advantages of a minimally invasive approach.OBJETIVO: Evaluar la eficacia y la seguridad de la fijacion percutanea pedicular de fracturas toracolumbares sin comprometimiento neurologico. METODOS: Se incluyeron en el estudio los pacientes de edades comprendidas entre 18 y 70 anos, con fractura toracolumbar tipo AO (A.3), cifosis >30° o reduccion de la altura del cuerpo vertebral >50% o compresion del canal vertebral >50%, quienes fueron sometidos a tratamiento quirurgico mediante fijacion percutanea pedicular. Se evaluaron los parametros radiologicos: el angulo de Cobb, el colapso vertebral, el acunamiento anterior y la compresion del canal vertebral antes de la operacion, despues de la operacion y al final del seguimiento. La evolucion clinica y funcional fue evaluada por el Oswestry Disability Index (ODI). RESULTADOS: El tiempo quirurgico promedio fue 81 minutos (minimo 69, maximo 95 min.) El volumen promedio de la perdida de sangre intraoperatoria fue 85 ml (minimo 75 y maximo 155 ml). El promedio de seguimiento fue siete meses (minimo 3 meses, maximo 14 meses). Se presento un ODI promedio final de 18% (excelente). CONCLUSIONES: Los resultados clinicos sugieren que la fijacion percutanea pedicular puede ser una tecnica quirurgica alternativa para el tratamiento de las fracturas toracolumbares tipo AO (A.3), sin deficits neurologicos. Esta tecnica ha demostrado ser eficaz y segura, y presenta las ventajas de un enfoque minimamente invasivo.

Fijación pedicular percutánea de las fracturas vertebrales toracolumbares sin comprometimiento neurológico

Objective: To evaluate the efficacy and safety of percutaneous pedicle fixation in thoracolumbar fractures without neurologic compromise. Methods: The study included patients aged between 18 and 70 with AO thoracolumbar fracture type (A.3) and kyphosis >30° or reduction of vertebral body height >50% or >50% of spinal canal compromise, who underwent surgery with percutaneous pedicle fixation in the first ten days after fracture. Radiological parameters were evaluated: Cobb angle, vertebral collapse, anterior wedging and spinal canal compromise preoperatively, postoperatively and at the end of follow-up. The clinical and functional outcome was assessed by the Oswestry Disability Index (ODI). Results: Mean operative time was 81 minutes (Min 69, Max 95 min). The mean volume of intraoperative blood loss was 85ml (75 Min and Max 155 ml). The mean follow-up was seven months (3 months Min, Max, 14 months) with an average ODI of 18% (excellent). Conclusions: The clinical results suggest that the pedicle fixation percutaneous technique may be an alternative to surgical treatment of thoracolumbar fractures type (A.3), without neurological deficits. This technique has proved to be safe and effective, with the advantages of a minimally invasive approach.OBJETIVO: Evaluar la eficacia y la seguridad de la fijacion percutanea pedicular de fracturas toracolumbares sin comprometimiento neurologico. METODOS: Se incluyeron en el estudio los pacientes de edades comprendidas entre 18 y 70 anos, con fractura toracolumbar tipo AO (A.3), cifosis >30° o reduccion de la altura del cuerpo vertebral >50% o compresion del canal vertebral >50%, quienes fueron sometidos a tratamiento quirurgico mediante fijacion percutanea pedicular. Se evaluaron los parametros radiologicos: el angulo de Cobb, el colapso vertebral, el acunamiento anterior y la compresion del canal vertebral antes de la operacion, despues de la operacion y al final del seguimiento. La evolucion clinica y funcional fue evaluada por el Oswestry Disability Index (ODI). RESULTADOS: El tiempo quirurgico promedio fue 81 minutos (minimo 69, maximo 95 min.) El volumen promedio de la perdida de sangre intraoperatoria fue 85 ml (minimo 75 y maximo 155 ml). El promedio de seguimiento fue siete meses (minimo 3 meses, maximo 14 meses). Se presento un ODI promedio final de 18% (excelente). CONCLUSIONES: Los resultados clinicos sugieren que la fijacion percutanea pedicular puede ser una tecnica quirurgica alternativa para el tratamiento de las fracturas toracolumbares tipo AO (A.3), sin deficits neurologicos. Esta tecnica ha demostrado ser eficaz y segura, y presenta las ventajas de un enfoque minimamente invasivo.