Celso Hermínio Ferraz Picado

Damage to the superior gluteal nerve after direct lateral approach to the hip.

The superior gluteal nerve may be damaged during total hip arthroplasty. We prospectively studied 40 patients who had total hip arthroplasties using the Hardinge direct lateral approach to the hip to determine any correlation between superior gluteal nerve damage and abductor function. We used the Trendelenburg test to clinically evaluate abductor function preoperatively and 1 year postoperatively. We evaluated superior gluteal nerve function by electromyography preoperatively and at 4, 8, and 12 weeks until its normalization over a maximum of 24 weeks postoperatively. The Tren-delenburg test was positive in 20 patients (50%) preoperatively and in 10 patients (25%) 1 year postoperatively. Seventeen patients (42.5%) had damage to the superior gluteal nerve visible on the first electromyographic evaluation performed 4 weeks postoperatively; three (7.5%) of these patients showed changes when reevaluated 6 months postoperatively; only one of the three patients had a positive Trendelenburg test 1 year postoperatively. Nine of the 37 patients with normal electromyography results had positive Trendelenburg tests. Our results suggest there are frequent electromyographic signs of damage to the superior gluteal nerve using the direct lateral approach to the hip. However, the damage tends to improve spontaneously and does not seem to cause clinically apparent abductor insufficiency.

Sonographic Evaluation of the Abductor Mechanism After Total Hip Arthroplasty

Objective. The purpose of this series was to determine the frequency of abductor mechanism avulsion by sonography after total hip arthroplasty with the Hardinge approach (J Bone Joint Surg Br 1982; 64:17–19) and its relationship to the presence of insufficiency of this musculature in the postoperative period. Methods. Thirty‐four consecutive patients were prospectively accessed in the postoperative period of hip arthroplasty by the Trendelenburg test, hip sonography, and abductor muscle electromyography. In patients who were found to have clinical insufficiency of the abductor musculature, we also measured the femoral offset in the preoperative and postoperative radiographs. Hip sonography was performed by an experienced musculoskeletal radiologist blinded to the other tests, and the tendons of the gluteus medius and gluteus minimus were visualized on longitudinal and transverse sections with a 7‐ to 10‐MHz linear transducer. Results. Eight patients presented clinical insufficiency of the abductor musculature as detected by the Trendelenburg test. Four of these 8 patients with abductor insufficiency presented tendinous avulsion detected by sonography. One of the 4 patients with abductor insufficiency and normal sonographic findings had a decrease in the femoral offset caused by the arthroplasty itself. Two patients presented electromyographic changes of the abductor musculature, with no tendinous avulsion detected by sonography and no abductor insufficiency. Conclusions. We concluded that in patients undergoing total hip arthroplasty by the Hardinge approach in whom insufficiency of the abductor musculature develops, sonography is an interesting method of investigation because it identified the cause of this problem in most of our patients.

Estimulação elétrica neuromuscular e o alongamento passivo manual na recuperação das propriedades mecânicas do músculo gastrocnêmio imobilizado

We evaluated the influence of immobilization, free remobilization, remobilization with manual passive stretching, remobilization with neuromuscular electric stimulation (NMES) and remobilization with electric stimulation and associated passive stretching on some mechanical properties of the gastrocnemius muscle of female rats. Sixty female rats were assessed, being distributed into 6 experimental groups. One of these groups served as control. The animals of the five remaining groups had their right posterior limb immobilized for 14 consecutive days. From the five groups, one was sacrificed right after the immobilization period, a second group was released from immobilization, a third was submitted to the manual passive stretching technique for 10 consecutive days, a fourth was submitted to NMES for 10 consecutive days and the last one was submitted to NMES and manual passive stretching for 10 consecutive days. We found that the immobilization caused a significant reduction of the mechanical properties values evaluated on the muscle. The free remobilization could not reestablish any of the properties. The remobilization by manual passive stretching restored the mechanical properties of stretching at the proportionality limit, stiffness and resilience. The remobilization stimulated by NMES reestablished all of studied properties. The remobilization by electric stimulation and passive stretching reestablished the mechanical properties of stretching at the maximum limit, proportionality limit, and stiffness.

Resultado tardio da infecção isolada no quadril por Paracoccidioides brasiliensis

SUMMARY Infections caused by Paracoccidioides brasiliensis are always a diagnostic challenge, even in endemic areas due to its multiple clinical presentations and involved organs. This paper describes the evolution of the only case found in literature in which the disease affected just one hip.

Recuperação mecânica muscular com laser

OBJECTIVE: We evaluated the influence of low-power laser irradiation, either associated or not with immobilization, on the mechanical properties of the gastrocnemius muscle submitted to experimental injury with an impact mechanism. METHODS: Seventy female Wistar rats were divided into 7 experimental groups: group 1 - control; group 2 - injury; group 3 - injury-laser irradiation; group 4 - injury-immobilization for 24-hour laser irradiation; group 5 - injury-immobilization for 72-hour laser irradiation; group 6 - injury-immobilization for 24 hours; group 7 - injury-immobilization for 72 hours. The IBRAMED® Laserpulse equipment (670 nm) was used for biostimulation. The muscles were submitted to mechanical assays in an EMIC® universal testing machine and load x stretching graphs were used to calculate the mechanical properties, i.e., at the proportionality limit and maximum limit. RESULTS: The injury provoked a reduction of load at the proportionality limit and at the maximum limit compared to group 1 (p< 0.05). Groups 2, 4, 5 and 7 differed significantly from group 1. The property of stretching at the proportionality limit differed significantly between group 1 and groups 4, 5, 6 and 7 and between groups 2 and 4. The property of stretching at the maximum limit differed between groups 1 and 5 and between groups 3 and 5. CONCLUSION: The association of immobilization for 24 and 72 hours with laser therapy did not improve the mechanical properties of the muscle, whereas the separate use of each treatment modality was more effective.

Correção da falha óssea femoral e tibial pelo método do transporte ósseo de Ilizarov

Analisamos retrospectivamente 11 pacientes submetidos a tecnica do transporte osseo de Ilizarov, todos portadores de falha ossea diafisaria secundaria a resseccao de segmentos osseos infectados, 5 localizadas no femur e 6 na tibia. No grupo de pacientes com lesao femoral a falha ossea variou de 7cm a 12 cm, em dois destes pacientes havia encurtamento do membro de 2 cm. No grupo com lesao tibial a falha ossea variou de 2,5cm a 10cm, com encurtamento do membro em dois pacientes de 1,5cm e 2 cm respectivamente. O tempo medio de seguimento desde o final do tratamento ate essa avaliacao foi de 49 meses para os pacientes portadores de lesao femoral e de 28,3 meses para os pacientes portadores de lesao tibial. O transporte femoral foi do tipo bifocal, o transporte tibial foi bifocal em 4 pacientes e trifocal em 2 pacientes. Em todos nossos pacientes ocorreu formacao do regenerado. A consolidacao do foco alvo foi naturalmente obtida em 7 pacientes, um paciente necessitou enxertia ossea para obtencao da consolidacao deste foco. Em 3 pacientes a nao uniao do foco alvo fez com que fosse modificado o metodo de tratamento, com a retirada do fixador circular externo. Em todos os pacientes ocorreu infeccao no trajeto dos fios. Houve quebra dos fios de toda montagem feita na coxa. Todos fios perderam a tensao que inicialmente lhes foram imposta. Dois pacientes submetidos ao transporte femoral evoluiram com artrite septica do joelho. A mobilidade do joelho foi severamente comprometida nos pacientes que realizaram o transporte femoral, o mesmo ocorrendo em relacao ao tornozelo dos pacientes submetidos ao transporte tibial. Todos os pacientes com lesao na tibia terminaram o tratamento com encurtamento do membro, o mesmo ocorrendo em 2 pacientes tratados devido a lesao femoral. Durante o tratamento nenhum paciente sentiu-se confortavel e todos necessitaram de suporte para conseguir apoio parcial do membro. Todos pacientes ficaram satisfeitos com o resultado do tratamento. Concluimos que a resposta biologica ao transporte osseo e formidavel, com a formacao do regenerado reparando grandes falhas osseas. Entretanto, consideramos que o aparelho circular externo preconizado por Ilizarov traz consigo diversas complicacoes principalmente relacionadas a presenca dos fios transfixantes, causando sofrimento para os pacientes, principalmente quando instalados no femur.

Bilateral spontaneous fracturing of the femoral neck in a patient with renal osteodystrophy.

We report a case of bilateral fracturing of the femoral neck in a patient with renal osteodystrophy who was treated by means of osteosynthesis. In this type of patient, there is a need to remain watchful for the possibility of occurrences of spontaneous fracturing of the femoral neck, even if the initial radiographic examination is normal.

Distúrbios de coagulação em pacientes com osteonecrose da cabeça femoral

Objective: To compare the occurrence of thrombophilic disorders in patients with idiopathic osteonecrosis of the femoral head and patients with secondary osteonecrosis of the femoral head. Methods: Twenty-four consecutive patients were enrolled, with eight of them presenting idiopathic osteonecrosis and 16 presenting secondary osteonecrosis. The tests for detection of thrombophilic disorders were measurements of protein C, protein S and antithrombin levels and detection of prothrombin and factor V gene mutations. We compared the results using the odds ratio statistics for the thrombophilic disorders between the two groups. Results: The odds ratio for the protein S deficiency and protein C deficiency between the idiopathic and secondary groups were 5 and 2.14, respectively. Thus, an individual with idiopathic osteonecrosis has 5 times more chance of presenting protein S deficiency and 2.14 times more chance of presenting protein C deficiency than an individual with secondary osteonecrosis. Conclusion: Patients with idiopathic osteonecrosis have more chances of presenting thrombophilias than those with secondary osteonecrosis, suggesting these coagulation disorders can play an important role in the pathogenesis of the osteonecrosis in cases where there was no initial risk factorOBJECTIVE: To compare the occurrence of thrombophilic disorders in patients with idiopathic osteonecrosis of the femoral head and patients with secondary osteonecrosis of the femoral head. METHODS: Twenty-four consecutive patients were enrolled, with eight of them presenting idiopathic osteonecrosis and 16 presenting secondary osteonecrosis. The tests for detection of thrombophilic disorders were measurements of protein C, protein S and antithrombin levels and detection of prothrombin and factor V gene mutations. We compared the results using the odds ratio statistics for the thrombophilic disorders between the two groups. RESULTS: The odds ratio for the protein S deficiency and protein C deficiency between the idiopathic and secondary groups were 5 and 2.14, respectively. Thus, an individual with idiopathic osteonecrosis has 5 times more chance of presenting protein S deficiency and 2.14 times more chance of presenting protein C deficiency than an individual with secondary osteonecrosis. CONCLUSION: Patients with idiopathic osteonecrosis have more chances of presenting thrombophilias than those with secondary osteonecrosis, suggesting these coagulation disorders can play an important role in the pathogenesis of the osteonecrosis in cases where there was no initial risk factor recognized. Level of Evidence III, Case-Control Study.

Aseptic Loosening Rate of the Mayo Femoral Stem With Medium-Term Follow Up

The aseptic loosening rate of the Mayo hip prosthesis femoral stem was determined in a 44 patient (52 hips) series, by comparing preoperative and postoperative clinical and radiographic parameters, over a minimal 5-year postoperative period. Loosening was obvious before five years in four hips (7.6%), while the stem was considered stable in the remaining 48 hips over a mean 6.1 year period, therefore accounting for a 92.3% Kaplan-Meier survival rate. We conclude that the aseptic loosening rate is too high for the Mayo hip prosthesis femoral stem, as compared to literature data concerning the non-conservative stems.

Ultra-som terapêutico e imobilização na reparação do trauma muscular

INTRODUCTION: We assessed the effects of therapeutic ultrasound (TUS), either added to cast immobilization (CI) as a treatment alternative to muscular injuries caused by impact by assessing the mechanical properties of stretching and load at proportionality and maximum limit, stiffness (S) and gastrocnemius muscle resiliency. METHODS: 70 female rats were employed in the study, and the animals were divided into 7 groups: Group 1-Control; Group 2-Untreated; Group 3-CI for 24 hours; Group 4-CI for 72 hours; Group 5-TUS without CI; Group 6-CI for 24 hours combined with TUS; Group 7-CI for 72 hours combined with TUS. RESULTS: Loads at proportionality limit and maximum limit showed that the group receiving TUS behaved similarly to control group. The property of stretching at proportionality limit was not different from one group to another; the maximum stretching of the group receiving TUS and of the groups immobilized for 72 hours was comparable to controlgroup. CONCLUSION: The group receiving TUS showed similar stiffness levels compared to control group and superior resiliency compared to all remaining groups. The standalone use of TUS provided similar results to those regarded as normal, but these were not noticed when TUS was combined to CI.