Davi Gabriel Bellan

Artroscopia do quadril em atletas

OBJETIVO: Confirmar a importância terapeutica da artroscopia do quadril em atletas cuja dor impede a funcao desportiva da articulacao do quadril, sendo capaz de minimiza-la a ponto de ajudar o retorno a atividade esportiva em niveis satisfatorios. METODOS: Foram analisados 49 pacientes que praticam esporte (51 quadris), submetidos a artroscopia do quadril que apresentavam dor e incapacidade para a pratica esportiva. O seguimento minimo foi de 12 meses e o maximo de 74 meses (media de 39,0 meses). No periodo pre-operatorio avaliou-se a localizacao da dor, sua intensidade segundo a Escala de Expressao Facial (EEF) e o grau de incapacidade utilizando-se o criterio de Harris Hip Score modificado (HHS). Anotaram-se diferentes diagnosticos que levaram a indicacao da artroscopia, como impacto femoroacetabular, lesao do labio acetabular nao secundaria ao impacto femoroacetabular e outros. No periodo pos-operatorio, os pacientes foram avaliados pelos mesmos metodos do periodo pre-operatorio e pela analise subjetiva de retorno ao esporte. RESULTADOS: Baseando-se no HHS e EEF pre e pos-operatorios, a analise estatistica mostrou significância entre os valores. Observou-se alguma melhora em todos os casos e retorno ao esporte, de forma satisfatoria, na maioria deles. CONCLUSAO: Diante do que foi estudado, confirmamos que a artroscopia em atletas com lesoes localizadas no quadril e tecnica eficaz, capaz de promover o retorno a pratica esportiva na maioria dos casos, sem dor e com funcao articular efetiva, desde que bem indicada.

Hip arthroscopy in athletes

To confirm the therapeutic importance of hip arthroplasty in athletes whose pain precludes sportive function of the hip joint, being able to minimize it to the extent of helping on the return of sports practice at satisfactory levels. Methods: 49 athlete patients (51 hips) submitted to hip arthroscopy complaining of pain and inability to practice sports were assessed. Follow-up time ranged from 12 to 74 months (mean: 39.0 months). Preoperatively, pain site, severity according to Facial Expression Scale (FES) and the degree of disability using the modified Harris Hip Score (HHS) were assessed. Different diagnoses were provided, which led to the indication of arthroscopy, such as femoralacetabular impact, acetabular lip injury not secondary to femoral-acetabular impact, etc. Postoperatively, the patients were assessed by using the same methods as used at baseline and by the subjective analysis of return to sports activities. Results: Based on pre-and postoperative HHS and FES, the statistical analysis showed significance between values. We found some improvement in all cases and return to sports activities at a satisfactory level in most of the cases. Conclusion: As a result of our study, we confirm that arthroscopy in athletes with local hip injuries is an effective technique, able to promote the return to sports practice in most of the cases, without pain, and with an effective joint function, provided well indicated.

Sarcoma de Ewing: epidemiologia e prognóstico dos pacientes tratados no Instituto de Oncologia Pediátrica, IOP-GRAACC-UNIFESP

OBJECTIVE: To outline the epidemiological profile and prognosis for Ewings sarcoma in the Brazilian population. Material and METHODS: The medical records of 64 patients with intraosseous Ewings sarcoma who were treated at the Pediatric Oncology Institute, IOP-GRAACC-Unifesp, between 1995 and 2010, were retrospectively evaluated. RESULTS: The statistical analysis on the data obtained did not correlate factors such as sex, trauma, pathological fracture and time taken for case diagnosis with the treatment outcome. Factors such as initial metastasis, lung metastasis, tumor site, age, recurrence and type of surgery showed results corroborating what has been established in the literature. CONCLUSION: The prognosis in cases of Ewings sarcoma was mainly influenced by the presence of metastases at the time of diagnosis.

Comparative study between lateral decubitus and traction table for treatment of pertrochanteric fractures with cephalomedullary nails

Objective To perform a retrospective radiographic assessment of the reduction and implant position in the femoral head in patients with pertrochanteric fractures treated with cephalomedullary nailing in the lateral position versus traction table. Methods Radiographs of patients with pertrochanteric fracture of the femur treated with cephalomedullary nailing in the lateral position and traction table were retrospectively evaluated. For the evaluation we used the anteroposterior radiographic view of the pelvis and the lateral view of the affected side. The cervicodiaphyseal angle, the tip-apex distance (TAD), and the spatial position of the cephalic component in the head were measured. Two patient groups were created, one group operated on the traction table and another group operated in the lateral position. Results Regarding the cervicodiaphyseal angle observed in the traction table group, the results of 11 patients (61.1%) were outside the acceptable parameters proposed in the present study. Both groups were equivalent regarding TAD and the position of the cephalic component in the head. Conclusion A difference in the cervicodiaphyseal angle was observed; the group operated on the traction table had 11 patients (61.1%) whose measurements were outside the acceptable parameters.

Lateral decubitus for treating pertrochanteric fractures using cephalomedullary nails

Objective To perform a retrospective radiographic evaluation on the fracture reduction and implant position in the femoral head among patients with pertrochanteric fractures who had been treated using a cephalomedullary nail in lateral decubitus; and to assess factors that might interfere with the quality of the fracture reduction and with the implant position in using this technique. Methods Nineteen patients with a diagnosis of pertrochanteric fractures of the femur who had been treated using cephalomedullary nails in lateral decubitus were evaluated. For outpatient radiographic evaluations, we used the anteroposterior view of the pelvis and lateral view of the side affected. We measured the cervicodiaphyseal angle, tip-apex distance (TAD), spatial position of the cephalic element in relation to the head, and the bispinal diameter. To make an anthropometric assessment, we used the body mass index. Two groups of patients were created: one in which all the criteria were normal (TAD ≤25 mm, cervicodiaphyseal angle between 130° and 135° and cephalic implant position in the femoral head in the central–central quadrant); and another group presenting alterations in some of the criteria for best prognosis. Results Female patients predominated (57.9%) and the mean age was 60 years. Seven patients presented a central–central cephalic implant position. One patient present a cervicodiaphyseal angle >135° and the maximum TAD was 32 mm; consequently, 12 patients presented some altered criteria (63.2%). None of the characteristics evaluated differed between the patients with all their criteria normal and those with some altered criteria, or showed any statistically significant association among them (p > 0.05). Conclusion The technique described here enabled good reduction and good positioning of the implant, independent of the anthropometric indices and type of fracture.

Extraskeletal Osteosarcoma of the Hand in an Adolescent: A Case Report

Extraskeletal osteosarcoma (ESOS) is a well-defined and rare soft-tissue neoplasm characterized by osteoid production with no association with bone1. It represents 1% of all soft-tissue sarcomas and 4% to 5% of all osteosarcomas1-3. ESOS mainly arises in the deep soft tissue of the lower limbs and is extremely uncommon in young people. The median age of affected patients in most series has been in the fifth to seventh decades of life; the number of reported pediatric cases is low3-9. The prevalence of ESOS in the upper extremity is between 15% and 23%; 7% of these cases have occurred in the hand1,3,4,10,11. Previous series, primarily including patients treated with surgery alone, have reported five-year survival rates ranging from 24% to 50%, with high rates of distant metastasis2,4,12-14. Several reports have found no difference in overall or event-free survival between patients treated with resection and those treated with amputation5,6. Uncertainty remains as to whether ESOS should be treated with use of neo or adjuvant chemotherapy5-7,15. We report the clinical and pathological findings of an unusual case of an ESOS arising from the hypothenar muscles of the left hand in an eighteen-year-old woman. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. An eighteen-year-old woman presented with a rapidly enlarging, painless mass of the left hand. The patient had noticed the mass four months earlier. She reported no injury to the hand or prior history of radiation therapy. She denied any health problems and family history of cancer. Physical examination confirmed a firm, immobile, painless mass, …

EWINg'S SARCOmA: EPIDEmIOLOgY AND PROgNOSIS FOR PATIENTS TREATED AT THE PEDIATRIC ONCOLOgY INSTITuTE, IOP-gRAACC-uNIFESP

Objective: To outline the epidemiological profile and prognosis for Ewings sarcoma in the Brazilian population. Material and Methods: The medical records of 64 patients with intraosseous Ewings sarcoma who were treated at the Pediatric Oncology Institute, IOP-GRAACC-Unifesp, between 1995 and 2010, were retrospectively evaluated. Results: The statistical analysis on the data obtained did not correlate factors such as sex, trauma, pathological fracture and time taken for case diagnosis with the treatment outcome. Factors such as initial metastasis, lung metastasis, tumor site, age, recurrence and type of surgery showed results corroborating what has been established in the literature. Conclusion: The prognosis in cases of Ewings sarcoma was mainly influenced by the presence of metastases at the time of diagnosis.

Proximal tibial reconstruction with auto transplantation of the fibular growth plate: two case reports, describing the surgical technique

Introduction Tumors of the proximal tibia, in children, can affect the growth plate and pose a challenge to further reconstruction of the bone defects resulting from tumor resection. Reconstruction methods do not always compensate the potential for bone growth in this segment. We present a new surgical technique of bone reconstruction, based on the transposition of the ipsilateral fibula with its growth plate and the use of an internal sliding fixation device, without need for microsurgical technique.Case descriptionWe report two patients with osteosarcoma of the proximal tibia affecting the growth cartilage who were treated with the new technique.Discussion and EvaluationIn both cases, bone healing, hypertrophy and longitudinal growth of the transposed fibula were documented.ConclusionsThis new technique preserves the blood supply of the auto-transplanted bone segment, maintaining physeal growth potential, with no need for microsurgery. The implant allows longitudinal bone growth, which was radiographically confirmed.Level of evidenceCase report, Level IV.