Jefferson Soares Martins

Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing: 29 patients' clinical and functional evaluation

Objective To evaluate clinically and functionally the pos-operative results of patients submitted to tibiotalocalcaneal arthrodesis for the treatment of traumatic arthropathy and neuropathy. Methods Retrospective study of 29 patients undergoing ankle arthrodesis with intramedullary retrograde nail. All patients were evaluated for fusion time, AOFAS and VAS scores, satisfaction, and complications of surgery. The mean follow-up was 36 months (range 6–60 months). Results The union rate was 82%, and the consolidation occurred on average at 16 weeks (10–24 weeks). The pos-operative AOFAS score improved in 65.5% (average of 57.7 on neurological cases and 75.7 on cases pos-traumatic) and VAS score improved 94.1% (average of 2.3 on neurological cases and 4,2 on post-traumatic cases), and 86% of patients were satisfied with the procedure performed. Complications occurred in 11 patients (38%), including pseudoarthrosis (17.24%), infection (17.24%), material failure (13.8%) and fracture (13.8%). Conclusion Tibiotalocalcaneal arthrodesis with retrograde intramedullary nail proved to be a good option for saving the ankle joint, with improvement of clinical and functional scores (AOFAS = 65.5% and VAS = 94.1%).

Clinical evaluation of patients with osteomyelitis after open fractures treated at the Hospital de Urgências de Goiânia, Goiás

Objective To evaluate clinically patients with chronic osteomyelitis after open fractures, treated in the Hospital of urgencies in Goiania Methods A cross-sectional study, with data collection through questionnaire, from a review of medical records. We collected data on the type of trauma and the clinical characteristics of the patient. The hour of attendance and the injuries on the patients were collected, and then classified according to Gustilo and Anderson (1976). Samples of the lesion during the surgical procedure were collected for culture of pathogenic microorganisms. The analyzes were performed using STATA/SE version 8.0. Descriptive analysis was performed (absolute and relative frequencies) and to verify existence of association between variables was performed using thur-square or Fishers Exact Test. This study was approved by the Research Ethics Committee of the Hospital and Emergency in Goiania. Results There was predominance of male adult, presenting open fractures with increased involvement of the leg bones or in two or more bones (polytrauma). The majority of patients presented with a lesion type III (high-energy trauma). There was loss of excessive time since the time of the accident until the initial surgical care. We detected the presence of gram-positive cultures of material obtained after the diagnosis of osteomyelitis. Conclusions The control of factors such as antibiotics, exposure time, bacterial resistance to the antimicrobial used, extensive tissue damage and location of the fracture are extremely important to the predictive effect of infection in open fractures.

Tibiocalcaneal arthrodesis using an Ilizarov fixator

Objective To evaluate the results of arthrodesis with Ilizarov fixator with tibiocalcaneana. Methods We studied 12 patients with a mean age of 35 years, and 9 (75%) men and 3 (25%) women, underwent arthrodesis tibiocalcaneana. The diagnosis in the preoperative talus infection. We used a modified surgical technique Reckling (6 patients) and the Ilizarov technique, modified by Catagni (6 patients). Patients were evaluated by the AOFAS scale research and patient satisfaction. Results Union was achieved in 100% of cases. The mean time to healing was 6 months (range 4-12 months) and mean duration of external fixator removal was 9 months (range 4-13 months). Stretching was performed in 6 patients with an average of 4 cm. The follow-up with Vancomycin lasted around 6 months. The average AOFAS score was 72.5 points (range 57 to 89 points). All patients were satisfied with the result. Conclusion Despite the small number of cases, arthrodesis tibiocalcaneana seemed to be a good solution for cases of complex pathologies of the talus, such as infection, resulting in bone healing, pain relief and patient satisfaction.