Carlos Augusto de Mattos

Comparative study on three surgical techniques for intra-articular calcaneal fractures: open reduction with internal fixation using a plate, external fixation and minimally invasive surgery

Objective To evaluate, compare and identify the surgical technique with best results for treating intra-articular calcaneal fractures, taking into account postoperative outcomes, complications and scoring in the Aofas questionnaire. Methods This was a retrospective study on 54 patients with fractures of the calcaneus who underwent surgery between 2002 and 2012 by means of the following techniques: (1) open reduction with extended L-shaped lateral incision and fixation with double-H plate of 3.5 mm; (2) open reduction with minimal incision lateral approach and percutaneous fixation with wires and screws; and (3) open reduction with minimal incision lateral approach and fixation with adjustable monoplanar external fixator. Results Patients treated using a lateral approach, with fixation using a plate had a mean Aofas score of 76 points; those treated through a minimal incision lateral approach with screw and wire fixation had a mean score of 71 points; and those treated through a minimal incision lateral approach with an external fixator had a mean score of 75 points. The three surgical techniques were shown to be effective for treating intra-articular calcaneal fractures, without any evidence that any of the techniques being superior. Conclusion Intra-articular calcaneal fractures are complex and their treatment should be individualized based on patient characteristics, type of fracture and the surgeons experience with the surgical technique chosen.

Surgical treatment of intra-articular calcaneal fractures: description of a technique using an adjustable uniplanar external fixator

Several surgical techniques are available for the treatment of intra-articular calcaneal fractures. The use of a uniplanar external fixator is an option for the treatment of fractures classified as Sanders types 2 and 3. Satisfactory reduction and stabilisation of the fracture are achieved by means of mini-incisions and fixator adjustment. The advantages of this technique include less soft-tissue damage, avoidance of internal implants and early weight-bearing with the potential to improve postoperative recovery.

Iphone app use to Cobb angle in adolescent idiopathic scoliosis: Does this apply?

OBJETIVO: Validar un nuevo metodo de medicion del angulo de Cobb para la escoliosis a partir de la aplicacion movil CobbMeter, para facilitar la evaluacion y la medicion en la practica clinica.METODOS: Cinco observadores con experiencia minima de dos anos en el area llevaron a cabo mediciones radiograficas del angulo en 24 radiografias de pacientes con escoliosis idiopatica juvenil mediante la aplicacion movil CobbMeter. Los observadores realizaron mediciones seriadas en las imagenes con la aplicacion, que se repitieron despues de un mes. El observador mas experimentado del grupo, despues de las mediciones realizadas con la aplicacion, determino en cada radiografia el angulo de Cobb de la manera tradicional.RESULTADOS: La desviacion estandar de la media en la comparacion de los angulos medidos por el metodo electronico y manual no fue clinicamente significativa. Aunque el 40% de las mediciones electronicas estan fuera del intervalo de confianza en comparacion con las mediciones manuales, esta diferencia fue insignificante en la practica clinica.CONCLUSIONES: La aplicacion CobbMeter es otra alternativa para medir el angulo de Cobb en la escoliosis.

Use of superficial peroneal nerve graft for treating peripheral nerve injuries

Objective To evaluate the clinical results from treating chronic peripheral nerve injuries using the superficial peroneal nerve as a graft donor source. Methods This was a study on eleven patients with peripheral nerve injuries in the upper limbs that were treated with grafts from the sensitive branch of the superficial peroneal nerve. The mean time interval between the dates of the injury and surgery was 93 days. The ulnar nerve was injured in eight cases and the median nerve in six. There were three cases of injury to both nerves. In the surgery, a longitudinal incision was made on the anterolateral face of the ankle, thus viewing the superficial peroneal nerve, which was located anteriorly to the extensor digitorum longus muscle. Proximally, the deep fascia between the extensor digitorum longus and the peroneal longus muscles was dissected. Next, the motor branch of the short peroneal muscle (one of the branches of the superficial peroneal nerve) was identified. The proximal limit of the sensitive branch was found at this point. Results The average space between the nerve stumps was 3.8 cm. The average length of the grafts was 16.44 cm. The number of segments used was two to four cables. In evaluating the recovery of sensitivity, 27.2% evolved to S2+, 54.5% to S3 and 18.1% to S3+. Regarding motor recovery, 72.7% presented grade 4 and 27.2% grade 3. There was no motor deficit in the donor area. A sensitive deficit in the lateral dorsal region of the ankle and the dorsal region of the foot was observed. None of the patients presented complaints in relation to walking. Conclusions Use of the superficial peroneal nerve as a graft source for treating peripheral nerve injuries is safe and provides good clinical results similar to those from other nerve graft sources.

Arthroscopic treatment of post-traumatic elbow stiffness

To evaluate patients undergoing arthroscopic release of a stiff elbow, with discussion of the technique, possible difficulties and risks. Methods: Twenty-four elbow arthroscopy procedures were performed. All the patients were evaluated using goniometry before the operation and six months afterwards and were rated using the Mayo elbow performance score (MEPS). Results: Fifteen men and nine women underwent surgery (14 right elbows and ten left elbows). Their mean age was 34.58 years and length of follow-up, 38.41 months. Their mean gain of range of motion was 43.3° and of MEPS, 85.4. Conclusion: Arthroscopic release might enable better intra-articular viewing and enhance the options for changing strategy during surgery, reducing surgical trauma and enabling early rehabilitation. This technique can reach similar or better results than open surgery. The disadvantages of arthroscopy are the long learning curve and higher cost of the procedure. Neurovascular complications are reported with both techniques. To avoid such problems, the protocol for portal construction must be rigorously followed. Arthroscopic release was shown to be a safe and effective option for achieving range-of-motion gains in cases of post-traumatic stiff elbow.

Tratamento artroscópico da rigidez pós-traumática do cotovelo

To evaluate patients undergoing arthroscopic release of a stiff elbow, with discussion of the technique, possible difficulties and risks. METHODS: Twenty-four elbow arthroscopy procedures were performed. All the patients were evaluated using goniometry before the operation and six months after wards and were rated using the Mayo elbow performance score (MEPS). RESULTS: Fifteen men and nine women underwent surgery (14 right elbows and ten left elbows). Their mean age was 34.58 years and length of follow-up, 38.41 months. Their mean gain of range of motion was 43.3o and of MEPS, 85.4. CONCLUSION: Arthroscopic liberation might enable better intrarticular visualization and enhance options to change strategy during surgery, reduction of surgical trauma and possibility of early rehabilitation, and this technique can reach similar or better results than open surgery. Disadvantages of arthroscopy are lack of ability of surgeons and higher cost of procedure. Both techniques report neurovascular complications, to avoid such problems the arthroscopic portals protocols must be rigorously followed. Arthroscopic release of the stiff elbow can enable range of motion gain, and also promotes high level of satisfaction by the decrease of pain and good cosmetic appearance. Some cases might demand adjuvant treatments. When correctly indicated, arthroscopy may be a safe surgical option with satisfactory outcomes.

Eficácia do antibiótico profilático intraósseo versus endovenoso em cirurgias do joelho em porcos: estudo experimental

Objective  To demonstrate that the intraosseous (IO) access is more effective compared with the intravenous (IV) access for prophylactic antibiotic administration in knee joint surgeries, using 36 pigs as live models. Materials and Methods  Skin, subcutaneous tissue, cartilage, and bone samples were collected, analyzed and compared after the administration of IV or IO antibiotic in different groups. Results  When comparing the IO and IV groups, the IO group showed a higher concentration of prophylactic antibiotic in the skin ( p  = 0.049), cartilage ( p  = 0.018), and bone ( p  = 0.002), in the analysis of the first 24 hours after 30 minutes of infusion. Conclusion  Since complications regarding this practice are rare, the use of this pathway may be an alternative to reduce the risk of surgical site infection in orthopedic surgeries, leading to a decrease in morbidity and mortality and hospital expenses with readmission or prolonged hospitalization time. However, further research and further experimental studies in humans are required, as the effectiveness of the method in pigs has been proved.Resumo Objetivo Demonstrar em 36 porcos como modelos vivos que o acesso intraosseo e mais efetivo em comparacao com o endovenoso na administracao de antibiotico profilatico em cirurgias na articulacao do joelho. Metodo Foram coletadas e analisadas amostras de pele, tecido subcutâneo, cartilagem e osso, apos administracao de antibiotico EV e IO (grupos diferentes), e comparadas entre si. Resultado A comparacao entre os grupos IO e EV indicou que o grupo IO mostrou maior concentracao de antibiotico profilatico na pele (p = 0,049), cartilagem (p = 0,018) e osso (p = 0,002) na analise das primeiras 24 horas apos 30 minutos de infusao. Conclusao Visto que as complicacoes dessa pratica sao raras, o uso dessa via pode ser uma opcao para a diminuicao do risco de infeccao do sitio cirurgico nas cirurgias ortopedicas, leva a diminuicao da morbimortalidade e dos gastos hospitalares com reabordagens ou tempo prolongado de internacao. Contudo, sao necessarios maior pesquisa e novos estudos experimentais em seres humanos, dado que esta comprovada a eficacia do metodo em porcos.

Functional assessment of endoprosthesis in the treatment of bone tumors

Objectives Evaluate the functional grade of these patients and to identify the types of complications found that influenced the average life span of endoprostheses the functions of the operated limb. Methods We analyzed 14 post-operative cases of endoprosthesis, patients with malignant bone tumors and aggressive benign bone tumors submitted to surgery between 2004 and 2014. The evaluation system used was proposed by Enneking, recommended by the Musculoskeletal Tumor Society (MSTS), in addition to the radiologic evaluation. Results Endoprosthesis are excellent choices for the treatment of bone tumors with limb preservation in relation to pain, strength, and patients emotional acceptance. Another factor for good results is the immediate weight-bearing capacity, generating a greater independence. Conclusion The authors conclude that all patients classified the therapy as excellent/good, regardless of the type of prosthesis used, extent of injury, and/or type of tumor resection performed.

Injuries among amateur runners

Objectives To determine the frequency and severity of injuries that affect amateur runners. Methods This study was conducted by means of a questionnaire applied to 204 amateur runners. Individuals who were under the age of 18 years and those who were unpracticed runners were excluded. The data gathered comprised the number, type, site and degree of severity of the injuries and the individuals’ age and sex. Results It was observed that male athletes predominated. The mean age was 32.6 ± 9.3 years with a range from 18 to 68 years, and the injuries were classified as mild, keeping the athlete away from practicing running for fewer than eight days. Sprains, blisters and abrasions were the most frequent injuries, located most often on the lower limbs and predominantly on the feet. Conclusion In practicing running, sprains, blisters and abrasions occur frequently, but are mild injuries. They mostly affect the lower limbs.

Reproducibility of the Tronzo and AO classifications for transtrochanteric fractures

Objective To analyze the reproducibility of the Tronzo and AO classifications for transtrochanteric fractures. Method This was a cross-sectional study in which the intraobserver and interobserver concordance between two readings made by 11 observers was analyzed. The analysis of the variations used the kappa statistical method. Results Moderate concordance was found in relation to the AO classification, while slight concordance was found for the Tronzo classification. Conclusion This study found that the AO/Asif classification for transtrochanteric presented greater intra and interobserver reproducibility and that greater concordance was correlated with greater experience of the observers. Without division into subgroups, the AO/Asif classification was shown, as described in the literature, to be acceptable for clinical use in relation to transtrochanteric fractures of the femur, although it did not show absolute concordance, given that its concordance level was only moderate. Nonetheless, its concordance was better than that of the Tronzo classification.