Jamil Faissal Soni

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.

Unstable femoral fractures treated with titanium elastic intramedullary nails, in children

Objective: To evaluate the indications, epidemiology, associated lesions, complications and prognosis among children with unstable femoral diaphysis fractures who were treated with titanium elastic intramedullary nails. Method: This was a retrospective analysis on 24 patients aged 5-12 years with unstable femoral diaphysis fractures who underwent surgical treatment with elastic titanium intramedullary nails at the Cajuru University Hospital, Curitiba-PR, between April 2002 and March 2008, with a minimum follow-up of 36 months. The epidemiological data, angular deviations, leg shortening and bone consolidation were evaluated. Results: The medical files of 113 cases operated between April 2002 and March 2008 were reassessed. From these, 24 cases of unstable femoral diaphysis fractures treated with elastic titanium intramedullary nails with retrograde insertion were included in the study. There were two bilateral fractures and two exposed fractures. Seven patients were female and 17 were male, and the mean age was 8.3 years. The following were presented at the end of the study: shortening, varus or valgus displacement, final retrocurvatum or antecurvatum of zero, and absence of delayed consolidation or pseudarthrosis. Conclusions: The elastic titanium intramedullary nails were easily placed and removed. We believe that using elastic titanium intramedullary nails is a good option for fixation of unstable femoral fractures in children.

Fraturas instáveis do fêmur em crianças tratadas com hastes intramedulares elásticas de titânio

OBJETIVO: Avaliar as indicacoes, epidemiologia, lesoes associadas, complicacoes e prognostico das fraturas diafisarias instaveis do femur na crianca tratadas com hastes intramedulares elasticas de titânio. METODO: Estudo retrospectivo composto por 24 pacientes com fraturas diafisarias instaveis do femur com idade entre cinco e 12 anos, submetidos a tratamento cirurgico com hastes intramedulares elasticas de titânio no Hospital Universitario Cajuru - Curitiba, PR. Pacientes atendidos no periodo de abril de 2002 a marco de 2008, com seguimento minimo de 36 meses, submetidos a avaliacao de dados epidemiologicos, desvios angulares, encurtamento e consolidacao ossea. RESULTADOS: Foram reavaliados os prontuarios de 113 casos operados de abril de 2002 a marco de 2008, destes, incluidos no estudo 24 casos com fraturas de femur diafisarias instaveis tratadas com hastes intramedulares elasticas de titânio com insercao retrograda. Apresentando duas fraturas bilaterais, duas fraturas expostas, sete pacientes do sexo feminino e 17 masculinos, com idade media de 8,3 anos. Apresentaram, ao final do estudo: encurtamento, desvios em varo ou valgo, retrocurvato ou antecurvato final igual a zero, nao havendo ainda presenca de retardo de consolidacao ou pseudartrose. CONCLUSOES: As hastes intramedulares elasticas de titânio sao de facil colocacao e remocao. Consideramos a utilizacao das hastes intramedulares elasticas de titânio uma boa opcao para a fixacao de fraturas instaveis do femur em criancas.

Cotovelo flutuante em crianças

Objetivo: Analisar, retrospectivamente, o manejo do cotovelo flutuante em criancas, atendidas no Hospital do Trabalhador - UFPR, com enfoque na ocorrencia de lesoes associadas, tratamento realizado e resultados obtidos. Metodos: Entre abril de 2002 e abril de 2007, foram atendidos 15 pacientes com cotovelo flutuante, idade entre tres e 14 anos, 12 pacientes do sexo masculino e tres do feminino, oito fraturas no membro superior direito e sete no esquerdo, com seguimento minimo de tres anos e oito meses. Avaliamos, ainda, o mecanismo do trauma, lesoes associadas, exposicao da fratura, classificacao, tratamento e os resultados. Resultados: Sete pacientes sofreram queda da mesma altura; tres, queda de nivel; um, do cavalo; um, de motocicleta; uma crianca atropelada; e duas prenderam o braco na centrifuga. No umero tivemos quatro fraturas diafisarias e 11 fraturas supracondilianas. No antebraco, 13 fraturas do 1/3 distal e duas diafisarias. Tivemos tres fraturas expostas, dois pacientes com lesao nervosa, um com sindrome compartimental e nenhum apresentou lesao vascular. Um paciente foi tratado com tala gessada, sendo que os outros 14 pacientes tiveram suas fraturas fixadas tanto no umero quanto no antebraco. Tivemos um paciente que evoluiu com varo de cinco graus e nao tivemos alteracoes funcionais na nossa serie. Conclusao: O cotovelo flutuante e uma lesao infrequente, com potencial risco de complicacoes, entre elas: lesoes nervosas, exposicao ossea e sindrome compartimental. Recomendamos para seu tratamento, reducao e fixacao de ambas as fraturas, o que permite melhor cuidado das partes moles, bem como avaliacao da perfusao do membro, com bons resultados funcionais.