Filipe Lima Santos

APSI scaphoid hemiarthroplasty – long-term results

Objective This study is aimed at evaluating the long-term results of proximal scaphoid hemiarthroplasty for post-traumatic avascular necrosis at this institution. Methods Twelve patients who underwent this procedure were identified, and the mean follow-up time was 6.5 years (range: 5–8 years). All patients were male, with a mean age of 39 years (range: 28–55 years). In eight patients, the non-dominant limb was affected. The procedure was carried out through a dorsal approach and all patients underwent the same rehabilitation protocol. Cases were evaluated regarding complications, pain, range of motion, functional status (Mayo Wrist Score), and disability (QuickDASH Score). Results No immediate post-operative complications, such as infection or dislocation of the implant, were observed. All patients presented with peri-implant osteolysis at follow-up, on a radiograph study. None of the patients was forced to abandon their previous professional activity, although about 50% required some type of adaptation at their workplace. The mean functional capacity was, according to the Mayo Wrist Score, of 67.5 points (range: 50–80), corresponding to a satisfactory degree of function. The QuickDASH disability score presented a mean of 25 (range: 3–47.7). Conclusion The results of this series are in line with previously published studies about this technique. Hemiarthroplasty with a pyrocarbon implant is a safe technique for the treatment of post-fracture avascular necrosis of the scaphoid proximal pole. This technique allowed for satisfactory functional results at a mean follow-up of 6.5 years.

Percutaneous Instrumentation and Reduction Technique for the Treatment of Thoracolumbar Fractures: A Case Report

Minimally invasive spine surgery suffered a sustained development in the last 15 years. One of its main goals is to achieve the same results as conventional surgery with less blood loss, muscle damage, infection rate, and hospital stay. Surgical management of thoracolumbar fractures aims to correct sagittal deformities and provide a stable and durable fixation. This article describes a new percutaneous method of thoracolumbar fracture reduction based on the 6-screw construct, which promotes an indirect reduction of the fractured vertebrae with lordotic rods connected with 4 long monoaxial percutaneous pedicle screws in the fractured and upper adjacent vertebrae. The vertebra below the fractured one is instrumented with polyaxial screws to facilitate the introduction of the lordotic rods. The postoperative radiography and computed tomography imaging results show that this technique is able to correct posttraumatic kyphosis and provide a solid and durable construct.

The use of a dorsal capsular-based flap graft for scaphoid pseudarthrosis – long-term functional results

Introduction The scaphoid has a very tenuous blood supply that limits its capacity to recover from injury. A fracture of the scaphoid therefore presents an important risk of delayed union, pseudarthrosis and avascular necrosis. The fact that this type of fracture is many times missed on the first observation further increases the risk of pseudarthrosis. The use of pedicle grafts has the ability to fill the nonunion defect with new bone, bringing new osteoblasts and blood supply to the injury site. In 2006, Sotereanos described a capsular-based vascularized distal radius graft for the treatment of scaphoid pseudarthrosis that was readily available, close to the pseudarthrosis, required minimal rotation and did not need the dissection of a pedicle. The goal of our study was to evaluate the long-term results of the treatment of pseudarthrosis of the scaphoid using a capsular-based vascularized distal radius graft (as described by Sotereanos et al., 2006). Materials and methods Ten patients who underwent this procedure were identified, and the average follow-up time was 4,5 years (range 2–6 years). All but one patient were male, with an average age of 30 years (range 18–45). In 8 patients the non-dominant limb was the one affected. A dorsal approach was used, and the technique was according to Sotereanos et al., 2006. Results There were no postoperative complications such as infection or hardware migration. Of the 10 patients, 8 evolved to union, as determined by x ray and clinical examination. None of the patients was forced to abandon their professional activity after surgery, even though 25% required some type of adaptation necessary at their workplace. The average functional capacity was, according to the Mayo Wrist Score, of 82 points (range 65–90), corresponding to a “Good” function. The average disability according to the QuickDASH was 12.6 (range 0–45.5). The two patients with persistent symptomatic nonunions declined further surgical treatment and presented with the worst outcomes. All patients had decreased ROM after surgery. Discussion The union rate after surgery in this series is in line with previously published studies about this technique. No other published studies present long-term functional studies with this technique. Conclusion This technique is safe, easy and reliable for the treatment of scaphoid nonunions. Patients presented a good functional result at a mean follow-up of 4.5 years.