Edison Noboru Fujiki

Avaliação da qualidade de vida dos pacientes idosos com fratura do colo do fêmur tratados cirurgicamente pela artroplastia parcial do quadril

Thirty patients with ages ranging from 70 to 95 years, 24 (80%) females and six (20%) males with femoral neck bone fracture were assessed. They were submitted to partial hip arthroplasty between 2001 and 2003, in the following hospitals: Hospital Ipiranga SUS-SP and Mario Covas State Hospital- Santo Andre-SP. Partial arthroplasty was performed in unstable Garden III and Garden IV fractures, using the partial cemented Thompsons prosthesis. The SF-36 questionnaire on health-related quality of life was applied. Patients were interviewed at the eleventh month after surgery, aiming to evaluate quality of life in elderly patients who had femoral neck fractures and surgically treated with partial hip prosthesis. Regarding their physical health, patients presented low scores related to functional capacity and high scores regarding physical aspects, pain and overall health status. Mental health was shown to be moderate regarding vitality and high in terms of social and emotional aspects, as well as mental health itself. We may conclude that Thompsons partial arthroplasty, after femoral neck fracture in patients over the age of 80 years, followed-up for 11 months after surgery, enables a good quality of life.

Evaluation of movements of lower limbs in non-professional ballet dancers: hip abduction and flexion

BackgroundThe literature indicated that the majority of professional ballet dancers present static and active dynamic range of motion difference between left and right lower limbs, however, no previous study focused this difference in non-professional ballet dancers. In this study we aimed to evaluate active movements of the hip in non-professional classical dancers.MethodsWe evaluated 10 non professional ballet dancers (16-23 years old). We measured the active range of motion and flexibility through Well Banks. We compared active range of motion between left and right sides (hip flexion and abduction) and performed correlation between active movements and flexibility.ResultsThere was a small difference between the right and left sides of the hip in relation to the movements of flexion and abduction, which suggest the dominant side of the subjects, however, there was no statistical significance. Bank of Wells test revealed statistical difference only between the 1st and the 3rd measurement. There was no correlation between the movements of the hip (abduction and flexion, right and left sides) with the three test measurements of the bank of Wells.ConclusionThere is no imbalance between the sides of the hip with respect to active abduction and flexion movements in non-professional ballet dancers.

SACRAL STRESS FRACTURE IN A RUNNER: A CASE REPORT

INTRODUCTION Stress fractures result from cyclic overload and usually affect the bones of the lower extremities. These stress fractures occur most often in athletes and in members of the military. These fractures, which are also known as fatigue fractures, are susceptible to repeated trauma and typically involve the metatarsal bones, femur, tibia, fibula, pelvis or spine. The few cases of sacral stress fractures that have been described in the literature involve young, physically active patients, usually females. Sacral stress fractures [...]

Ultrasonographic study of the femoropatellar joint and its attachments in normal infants from birth to 24 months of age: part I.

Eighty knees of 40 musculoskeletally normal infants whose age ranged from 0 to 24 months (average 9.65 months) were ultrasonographically analyzed. The lengths of the patella, patellar ligament – and the Insall–Salvati index, knee being flexed at 30°, were assessed. The angles of the femoral cartilaginous sulcus knee flexed at 0, 30, 60, and 90° were also defined. Patellar length varied from 1.84 to 2.02 cm (mean, 93.3 cm; standard deviation, 0.35); patellar ligament length varied from 1.67 to 1.86 (mean, 1.76 cm; standard deviation, 0.25); the Insall–Salvati index varied from 1.04 to 1.13, (mean, 1.09; standard deviation, 0.14); and femoral cartilaginous sulcus angle ranged from 148.7 to 149.3° (average, 148.9° and standard deviation, 6.20). Statistical tests showed no significant difference in the proposed measures according to sex and side (right/left). Moreover, we did not observe significant difference in the femoral cartilaginous sulcus angle with respect to the various degrees of knee flexion. Thus, we conclude that ultrasonography is useful for determining the normal values of the Insall–Salvati index and femoral cartilaginous sulcus angle in infants from 0 to 24 months. Then, we suggest standardization of this imaging procedure for the early diagnosis of deformities, which might impair the knee in infants within this range of age.

Ultrasonographic study of the femoro-patellar joint and its attachments in infants from birth to 24 months of age. Part II: children with Down syndrome.

An ultrasonographic study was carried out in 25 infants (50 knees) with Down syndrome, whose age ranged from zero to 24 months, average being 13.2 months; 13 were males and 12 were females. The ultrasonographic investigation was performed with the knee being in full extension for the transversal view and in 30° flexion for the sagittal view. The Insall–Salvati index and femoral cartilaginous sulcus angle were measured. Insall–Salvati index values ranged from 1.06 to 1.15 (average 1.10), with standard deviation of 0.16. No significant differences were observed with regard to Insall–Salvati index values in normal children. The femoral cartilaginous sulcus angle in infants with Down syndrome ranged from 152.7 to 155.8° (average 154.3) with standard deviation of 7.959. In Down syndrome we noticed significant difference as compared to the normal values. The authors suggest that ultrasonography is useful in Down syndrome for an early diagnosis of instability of the patella.

Randomized clinical trial between proximal row carpectomy and the four-corner fusion for patients with stage II SNAC.

Objective To compare the outcomes of patients with stage II SNAC submitted to surgical treatment by proximal row carpectomy (PRC) or four-corner fusion (FCF). Method Twenty-seven patients aged 18–59 years (mean 37.52 years) were included. Thirteen patients underwent PRC in Group A, and 14 underwent FCF of the wrist in Group B. Evaluations were made before and after surgery with follow-up between 45 and 73 months. Range of motion (ROM); pain assessment with a visual analog scale (VAS); grip strength; disability of the arm, shoulder, and hand (DASH); and return to work were evaluated. Results Group A patients had 68.5% and Group B patients, 58.01% of the ROM of the contralateral side. The VAS score was 2.3 in Group A and 2.9 in Group B. Grip strength was 78.67% and 65.42%, respectively, relative to the side not affected. The DASH score was 11 for PRC and 13 for FCF. In Group A, 9/13 (69.23%) and in Group B, 8/14 (57.14%) patients are currently working. Complications were symptomatic osteoarthritis in the mid-carpal joint in Group A and loosening of a screw in Group B. Conclusion The clinical and functional results do not present statistically significant differences for both analyzed methods.

Randomized clinical trial on percutaneous minimally invasive osteosynthesis of fractures of the distal extremity of the radius

Objectives the purpose of this study was to compare the postoperative radiological and clinical outcomes with minimally invasive percutaneous osteosynthesis using three implants: volar locking plate, intramedullary nail system and nonbridging external fixator for distal radius fractures. Methods forty-eight patients (A group, 16; B group 16; C group 16) underwent minimally invasive percutaneous osteosynthesis of reductible and unstable displaced (Type IIB by Rayhack Classification) distal radius fractures. In B group intramedullary nail system was used, in A group the patients were treated with volar locking plate and in C group the patients were treated by nonbridging external fixator from January 2011 to December 2012. The mean follow-up period was 12 months. Radiologic parameters, range of motion, grip strength, and disability of the arm, shoulder, and hand score were evaluated at each examination (3rd and 6th week, and 12th months). The visual analog scale of wrist pain and complications were assessed at the final follow-up. Results the groups did not differ significantly in radiological outcomes after 12 months, but the clinical results, VAS scale and dash score in group A (volar locking plate) and B (nail intramedullary) were statistically significantly better than that of C group (nonbridging external fixator). One patient underwent an osteosynthesis with nail intramedullary and another with external fixator (C group) developed persistent pain near the site of the superficial radial nerve because of the distals screw and pins, respectively. Conclusion in clinical parameters, significant differences in outcomes were found between groups A and B after six weeks versus C group.

Preoperative planning of primary total hip arthroplasty using conventional radiographs

Objective the objective of this study was to present an analog method for preoperative planning of primary total hip arthroplasty procedures based on measuring the components by overlaying the transparencies of the prosthesis on the preoperative radiographs and checking the accuracy, both for predicting the size of the acetabular and femoral components used and for restoring the offset and correcting the dysmetria. Methods between March 2005 and July 2009, 56 primary total hip arthroplasty procedures performed on 56 patients at the Mario Covas State Hospital in Santo André were analyzed. The measurements on the femoral and acetabular components obtained through planning were compared with those that were used in the surgery. The offsets measured through the preoperative planning were compared with those measured on the postoperative radiographs. Dysmetria was evaluated before and after the operation. Results accuracy of 78.6% (p < 0.001) in predicting the size of the acetabular component and 82.2% (p < 0.001) in predicting the femoral nail was observed. The offsets measured through preoperative planning were statistically similar to the offsets measured on the postoperative radiographs. After the operation, we observed absolute equalization in 48.2% of the cases. In 87.5%, the dysmetria was less than or equal to 1 cm and in 69.6%, it was less than or equal to 0.5 cm. Conclusions the accuracy was 78.6% and 82.2%, respectively, for the acetabular and femoral components. The offsets that were planned preoperatively were statistically similar to those measured on postoperative radiographs. We found absolute equalization in 48.2% of the cases.

Delayed traumatic spinal epidural hematoma with neurological deficits

UNLABELLED To describe the mechanism that causes spinal epidural hematoma with neurologic deficit and review the literature. We report a case of a 62-year-old man with post-traumatic epidural hematoma in the cervicothoracic spine, who developed progressive neurological deficit which eventually resulted in complete paralysis below T1. During surgical evacuation significant spine compression due to an organizing hematoma was observed. After surgery, the patients motor function improved and there was a complete recovery of the neurologic deficit after a rehabilitation program. CONCLUSION Epidural hematoma can happen after delayed traumatic event leading to a variable degree of neurologic damage.

Estudo das fraturas peritrocanterianas instáveis do fêmur tratadas com haste céfalo-diafisária bloqueada: técnica minimamente invasiva

Sessenta e cinco pacientes com fraturas peritrocanterianas instaveis foram tratados cirurgicamente com fixacao intramedular cefalo-diafisaria bloqueada (sistema minimamente invasivo). Realizou-se reducao fechada em mesa de tracao com utilizacao da radioscopia. Carga parcial assistida foi encorajada a partir do segundo dia pos-operatorio. Em todos os pacientes estudados, foi obtida consolidacao entre 12 e 18 semanas (media de 14.5 semanas), sendo observados seis casos (9,2%) de consolidacao viciosa, quatro (6,1%) de encurtamento do membro (<1cm), tres (4,6%) de migracao do parafuso de compressao para o acetabulo e um caso (1,5%) de fratura intra-operatoria da cortical lateral do femur. Cinco pacientes (7.6%) apresentaram trombose venosa profunda (TVP) distal sem repercussoes clinicas. Nao foi constatada infeccao superficial ou profunda ate a data da ultima revisao. Nos tres casos de migracao proximal do parafuso de compressao, o sistema foi retirado sem intercorrencias. Concluimos ser a metodologia utilizada eficaz, segura, de baixa morbidade, tecnica rapida, com poucas complicacoes e que propicia a reabilitacao precoce do paciente.