Helencar Ignácio

Surgical treatment of the congenital dislocation of the hip after walking age: open reduction and Salter's osteotomy

A luxacao congenita do quadril (LCQ), apos a marcha, requer o tratamento cirurgico, sendo uma das opcoes a reducao aberta associada a osteotomia do osso inominado (tipo Salter). Neste estudo foram avaliados 18 pacientes, 22 quadris, que apresentavam LCQ tratados cirurgicamente, entre 1989 e 1995, utilizando a osteotomia do osso inominado, pela tecnica de Salter, pos reducao aberta. A idade dos pacientes, na epoca da cirurgia, variou de 12 a 30 meses, com media de 19 meses, sendo 15 do sexo feminino e 3 do masculino, 4 pacientes tinham acometimento bilateral, sendo que nos demais, 8 tinham o quadril esquerdo acometido e 6 o lado direito. Os resultados foram avaliados segundo criterios clinicos de Dutoit et al.(3) e radiograficos de Severin(12), apos um seguimento medio de 48 meses. Clinicamente foram obtidos 18% de resultados excelentes (4); 54% resultados bons (12); 14% regulares (3); e 14% ruins (3). Quanto aos criterios radiograficos, encontramos 36% dos quadris classificados como excelentes (8); 45% bons (10); 5% regulares (1); e 14% ruins(3). Como complicacoes foram constatados 3 casos de reluxacao, tratados com outra tecnica cirurgica. Nao foi observado nenhum caso de infeccao, fratura do enxerto e lesao vascular ou nervosa.

Sesamoid complex angle correction after arthrodesis of the first cuneometatarsal joint in the treatment of hallux valgus

Objective: To evaluate the degree of sesamoid complex correction in patients with moderate and severe hallux valgus undergoing cuneometatarsal arthrodesis by comparing general preand postoperative values and also post-reduction outcomes between moderate and severe cases. Methods: The radiographs of 24 patients (83.3% females and 16.7% males) who underwent arthrodesis of the first cuneometatarsal joint were retrospectively analysed. The patients’ mean age was 52.58 years. The metatarsophalangeal, intermetatarsal and sesamoid dislocation angles were measured on the preoperative and immediate postoperative radiographs, with the former measured in the standing position and the latter measured intraoperatively, all in the anteroposterior incidence. The first metatarsal lateralization necessary to centralize the sesamoids was measured in degrees. We refer to this angle as the “angle to be corrected”. Results: We achieved sesamoid dislocation correction, reducing the indicated angles in relation to their preoperative values. Both moderate and severe cases showed statistically significant differences in angular correction after surgery, with p=0.018 and p<0.001, respectively. Comparing the moderate and severe cases, a statistically significant difference was observed preoperatively, with p=0.007; however, the results were not statistically significant postoperatively (p=0.227). Conclusion: We achieved effective correction of the ABC in terms of both the total patient sample and the isolated analysis of the moderate and severe groups. Preoperatively, the moderate cases had smaller angles than the severe cases, but both groups exhibited reductions in these angles in the postoperative period and had similar outcomes. Level of Evidence IV; Prognostic Studies; Case Series.