Christiano Saliba Uliana

Transtrochanteric fractures: evaluation of data between hospital admission and discharge,

Objective to evaluate the data obtained from patients with transtrochanteric fractures who were attended at a tertiary-level trauma referral hospital, between admission and discharge, gathered prospectively by means of the SINPE© software. Methods 109 consecutive patients who were admitted between April 2011 and January 2012 were evaluated using an electronic storage and analysis database in SINPE©. The data were gathered prospectively, including evaluations on personal information about the patients, history-taking, fracture classification (Evans–Jensen, AO/OTA and Tronzo), treatment and discharge. Results the sample was composed of 43 men and 66 women. Their ages ranged from 20 to 105 years, with a mean of 69 years. Falling was the trauma mechanism for 92 patients and traffic accidents for 17. The most prevalent chronic diseases were systemic arterial hypertension and diabetes mellitus. According to the AO/OTA classification, the commonest fracture type was 31 A1. According to the Tronzo classification, type III was commonest. The fracture was fixed by means of a cephalomedullary nail in 64 cases and a sliding screw–plate in 44 cases. One fracture was fixed with a 95° screw–plate. Seven patients presented some form of clinical complication and three died during the hospital stay. All the patients who were discharged were instructed to only partially bear weight on the repair. Conclusion through SINPE©, it was possible to evaluate the personal information, history-taking, classification, treatment and discharge of patients with transtrochanteric fractures, from hospital admission to discharge.

Fraturas periprotéticas em artroplastia total de joelho

The increasing number of total knee arthroplasties, in combination with the populations longer life expectancy, has led to a greater number of long-term complications. These complications are also correlated with poor bone quality in the elderly and often result in periprosthetic fractures. This complex orthopedic problem has very diverse clinical presentation, possibly afflicting periprosthetic fracture may happen in any bone that constitutes the knee and, due to the difficulty of finding a solution, may lead to disastrous outcomes. The treatment demands broad knowledge from the orthopedic surgeon, not only regarding arthroplasty techniques, but also osteosynthesis, as well as an elaborate therapeutic including, for example, access to a bone bank.

Surgical treatment of femoroacetabular impingement using controlled hip dislocation after occurrence of slipped capital femoral epiphysis

Objective To present our experience and preliminary results from using controlled hip dislocation to treat cam-like femoroacetabular impingement, in teenagers and young adults with sequelae of slipped capital femoral epiphysis. Methods This was a retrospective analysis on 15 patients who were treated in a tertiary-level hospital between 2011 and 2013. The following data were collected for analysis from these patients’ files: demographic data, surgical procedure reports, joint mobility evaluations, patients’ perceptions regarding clinical improvement and whether they would choose to undergo the operation again, previous hip surgery and complications. The exclusion criteria were: follow-up shorter than six months, the presence of any other hip disease, osteotomy of the proximal femur performed at the same time as the osteochondroplasty and incomplete medical files with regard to the information needed for the present study. Results Fifteen patients (17 hips) who underwent osteochondroplasty to treat femoroacetabular impingement were evaluated. Nine of them were women, the mean age was 18 years old and the minimum follow-up was two years. Two patients underwent osteochondroplasty bilaterally; eight patients were operated on the left side and five on the right side. In 14 cases, the greater trochanter was lowered (relative lengthening of the neck) in association with the osteochondroplasty. For 13 patients, their previous surgery consisted of fixation of an occurrence of slipped capital femoral epiphysis; for six patients (eight hips), flexor osteotomy was performed previously; and for one patient, hip arthroscopy was performed previously. Fourteen patients presented improvement of mobility and hip pain relief, in comparison with before the operation, and they said that they would undergo the operation again. Two complications were observed: one of loosening of the fixation of the greater trochanter and one of heterotopic ossification. Conclusion The preliminary results from this study suggest that osteochondroplasty through controlled surgical hip dislocation is a good option for treating femoroacetabular impingement. Through this method, the patients reported achieving improvement of joint mobility and hip pain, with few complications.

Periprosthetic fractures in total knee arthroplasty

The increasing number of total knee arthroplasties, in combination with the populations longer life expectancy, has led to a greater number of long-term complications. These add to the poor bone quality of elderly patients and often culminate in periprosthetic fractures. This complex orthopedic problem has a great diversity of clinical presentation. It may affect any of the bones in the knee and, because of the difficulty in finding solutions, may lead to disastrous outcomes. Its treatment requires that orthopedists should have broad knowledge both of arthroplasty techniques and of osteosynthesis, as well as an elaborate therapeutic arsenal including, for example, access to a bone bank.

Surgical treatment of femoral head fractures through previously controlled hip luxation: four case series and literature review

Objective To report a series of cases of patients treated by fracture of the femoral head through the Ganz pathway with controlled dislocation of the hip. Method All patients who were surgically treated with a Ganz access route for femoral head fractures were identified in a tertiary referral service for trauma. A review of medical records with X-rays and CT scans was carried out. The radiographic evaluation was classified according to Pipkin and the functional evaluation was performed through the application of the modified Harris Hip Score. Data regarding the quality of reduction, type of fixation, and postoperative complications were collected. Results The sample consisted of three men and one woman, with a mean age of 30 years (20–51). Regarding Pipkins classification, two cases were type I, one type II, and one type IV. Regarding the Harris Hip Score, an average of 65.75 points was obtained (range: 20–86). All cases had anatomical reduction in the intraoperative period. One case presented post-traumatic sciatic nerve praxis and evolved with infection at the surgical site. Conclusion Surgical treatment of femoral head fractures through controlled hip dislocation is a viable option and can be considered an alternative to classical approaches.

Effectiveness of a step-by-step oral recount before a practical simulation of fracture fixation

OBJECTIVE To evaluate the effectiveness of a step-by-step oral recount by residents before the final execution of a practical exercise simulating a surgical fixation of a radial diaphyseal fracture. MATERIAL AND METHODS The study included 10 residents of orthopaedics and traumatology (four second- year and six first-year residents) divided into two groups with five residents each. All participants initially gathered in a room in which a video was presented demonstrating the practical exercise to be performed. One group (Group A) was referred directly to the practical exercise room. The other group (Group B) attended an extra session before the practical exercise, in which they were invited by instructors to recount all the steps that they would perform during the practical exercise. During this session, the instructors corrected the residents if any errors in the step-by-step recount were identified, and clarified questions from them. After this session, both Groups A and B gathered in a room in which they proceeded to the practical exercise, while being video recorded and evaluated using a 20-point checklist. RESULTS Group A achieved a 57% accuracy, with results in this group ranging from 7 to 15 points out of a total of a possible 20 points. Group B achieved an 89% accuracy, with results in this group ranging from 15 to 20 points out of 20. CONCLUSION An oral step-by-step recount by the residents before the final execution of a practical simulation exercise of surgical fixation of a diaphyseal radial fracture improved the technique and reduced the execution time of the exercise.

Anatomical study of the positioning of guide wires for the reconstruction of the two bands of the anterior cruciate ligament using transtibial technique

PURPOSE To determine whether it is possible and the difficulty of anatomical placement of guide wires for reconstruction of the two bands of the anterior cruciate ligament using transtibial technique and to measure the angle and positioning of the anatomic tibial guide wires for this technique. METHODS Ten cadaver knees were dissected and a guide wire was positioned in the center of origin and insertion of each band. Were collected measurements of the distance from: 1) the entry point of the guide wire on tibial tuberosity; 2) the medial end of the tibia; 3) the tibial articular surface. Were also measured the medial and caudal angles of the guide wires. RESULTS For the anteromedial band the medial angle was 19 ± 5º and the caudal was 44 ± 4º.The distances were 20 ± 2 mm from anterior tuberosity, 26 ± 5 mm from the tibial plateau and 25 ± 5 mm from the medial end of the tibia. For the posterolateral band the medial angle was 26 ± 5º and the caudal one was 36 ± 8°. The distances were 31 ± 6 mm for the anterior tuberosity, 24 ± 4 mm for the tibial plateau and 17 ± 7 mm from the end of the tibia. CONCLUSIONS It is possible to position the guide wires of the two bands to reconstruct the anterior cruciate ligament using transtibial technique. The parameters for the proper positioning of the guide wire from anteromedial band is caudal angle of 44º with entry point 20 mm from anterior tuberosity; for the posterolateral band the caudal angle is 36º; from the tibial tuberosity the distance is 31 mm. This technique is difficult to perform leaving its questionable reproducibility.