José Antonio Pinto

Evolução etária do ângulo de carregamento do cotovelo: estudo clínico-radiográfico

Objective: This paper has the purpose of evaluate the elbow carrying angle by clinic and radiographic examination in normal children and determine the range of normality according to age from childhood to skeletal maturity and also check if there is a statistically significant difference between the clinical and radiographic measurements. Methods: We evaluated 510 persons with ages varying from 1 to 18 years distributed in groups with 30 subjects according to the age group with 1-year interval. We performed radiographic examination of the elbow and measured the angle formed by the long axis of the humerus and ulna. The data were statistically analyzed using the student t-test. Results: We determined a normal curve of the study population where there was an increase of this parameter with the progression of age. No statistically significant difference between the clinical and radiographic measures. Conclusion: The average of the elbow carrying angle was 12,78 ± 5,35 degrees for females and 11,20 ± 4,45 degrees for males. This values increase progressively from childhood until 16 years when we notice stabilization. There was no statistical difference between the clinical and radiographic measurements.

Artroscopia do quadril na epifisiólise grave

We present a case report of a 12-year-old boy diagnosed with slipped capital femoral epiphysis grade III, with an acuteon-chronic presentation, associated with severe functional impairment and significant reduction in hip range of motion. The patient underwent a Dunn-type trapezoidal wedge femoral neck subtraction osteotomy by hip arthroscopy, followed by closed reduction and fixation with a 6.5mm percutaneous screw. There was significant improvement of the clinical picture on the first postoperative day, allowing for early rehabilitation. After a brief review of the literature, the authors propose this novel surgical technique as a viable method to treat severe slipped capital femoral epiphysis, encouraging the development of new studies on the subject.

Avaliação da anatomia arterial no pé torto congênito através da ultrassonografia com doppler colorido

SUMMARY Objective: This investigation intended to evaluate anterior and posterior tibial arteries at the ankle joint level in congenital clubfoot, by using color Doppler ultrasound (CDU). Material and Method: Twenty patients with idiopathic clubfoot were selected, from which 18 had unilateral involvement and two had bilateral involvement. Of the 18 patients with unilateral clubfoot, 16 went through surgical treatment and the other two were submitted to conservative treatment with serial casting. Of the bilateral cases, one patient was treated surgically and the other was treated with serial casting. All patients were clinically and radiographi-cally assessed. We used the functional rating as described by Lehman. Then, CDU was applied bilaterally at the ankle joint level, trying to identify both posterior and anterior tibial arteries. Results: In our present series of 20 cases with idiopathic clubfoot, in just one patient we could not identify the anterior tibial artery at the ankle joint level. In 12 patients who have had their arterial flow speeds and diameters measured by UDC, a positive correlation was found between functional level and anterior tibial artery diameter. No statistically significant differences were found between both flow speed and diameter of anterior tibial artery of the normal side, when compared to the affected side (in patients with unilateral disease). Conclusion: In our sample, we could not find any significant differences in arterial morphology and flow speed between the normal and the affected side. Furthermore, we noticed that the better the clinical result of clubfoot correction, the larger the diameter of anterior tibial artery in affected feet.

Estudo da impressão plantar obtida durante o teste de Jack em crianças

Objective: To assess the plantar impressions obtained in children during the Jack test, with the aim of quantifying and analyzing their variability in the critical period for plantar foot arch formation. Method: A hundred and twenty feet from 60 healthy White children, recruited in an outpatient pediatric clinic, were examined. Our sample included 35 boys and 25 girls, ranging from 2 to 5 years. The Jack test was simulated using a 45o wedge-shaped orthosis applied to the hallux. Bilateral plantar impressions were acquired in the alternate single-foot standing position using a pedigraph. Two plantar impressions were obtained for each foot, with and without the orthosis. The exams were analyzed using the Valenti and Volpon methods. Statistical tests were applied. Results: In all cases, both the Valenti and Volpon indexes decreased as the orthosis was applied. Furthermore, the difference between both indexes with and without the orthosis decreased with age. Conclusions: It is possible to quantify the Jack test using plantar impressions with the Volpon and Valenti methods. The variability observed in plantar shape tended to decrease after 4 years of age. Finally, the Jack test gradually lost its capability to change plantar impression with age, which reduces its accuracy as a parameter for a good prognosis in longitudinal medial arch formation. Level of Evidence: Level IV, observational descriptive study.

RADIOGRAPHIC ABNORMALITIES OF THE TALUS IN PATIENTS WITH CLUBFOOT AFTER SURGICAL RELEASE USING THE MCKAY TECHNIQUE.

Objective: To analyze morphological abnormalities of the talus in patients with clubfoot after surgical treatment using the McKay technique. Method: Lateral standing-position radiographs of the feet of 14 patients with unilateral clubfoot who underwent treatment by means of the doubleincision McKay technique were retrospectively analyzed. All the patients were operated by the same surgeon, with an average of 6.53 years between surgery and the radiograph. We compared the radiographic characteristics of the talus between the operated and the contralateral foot. We assessed the presence of deformity of the talar dome and head (sphericity evaluation); the talar length and height; the percentage and degree of navicular subluxation; abnormalities of the Gissane angle; and the trabecular bone pattern. Results: Abnormalities of the talar head occurred in 92.8% of the patients; of the talar dome in 92.8%; and of the trabecular pattern in 100%. The talar length ratio between the operated and the contralateral foot ranged from 0.61 to 0.88 (mean 0.79; SD = 0.09), while the height ratio ranged from 0.57 to 0.98 (mean 0.82; SD = 0.12). The Gissane angle was greater in all of the operated feet, and all of them also showed navicular subluxation, at a rate ranging from 6.43 to 59.75% (mean 26.34%; SD = 16.66%). Conclusion: Talar abnormalities occurred in 100% of the feet treated using the McKay technique. It was shown that establishing radiographic parameters to describe and quantify these deformities was feasible, through simple and easy-to-perform techniques.

Frouxidão ligamentar e pé plano em crianças normais

Objective: To study the correlation between flatfoot and joint laxity in healthy children. Methods: We evaluated 328 children with ages between 3 to 15 years, with no previous musculoskeletal complaints. We classified them by the presence of joint laxity according to the Beighton and Horan criteria, and by the presence of flatfoot according to the Valenti classification. The data obtained werecorrelated with gender, age, ethnic group, and dominant side. Fishers exact test and chi-square test were applied to analyze theresults. Results: A percentage of 83.9% ofindividuals with joint laxity was observed in children younger than 7 years of age (p < 0.001*). There is a significant association between joint laxity and gender (p = 0.025*), as girlsexhibited a greater percentage of laxity (51.02%). We observed a significant association between joint laxity and type of foot (p =0.003*), since the flatfooted group presented a higher percentage of laxity (54.96%). Flatfoot was also associated to joint laxity when we considered only the males (p = 0.001*), which was not observed in the females group. Conclusion: In the population studied, joint laxity was more frequently observed in children younger than 7 years of age, in females, and in individuals with flatfoot. There was no association between joint laxity and ethnic group or dominant side.

Correlação entre os índices de necrose e a estabilização precoce nas fraturas da extremidade proximal do fêmur na infância

OBJETIVO: Desenvolvemos este trabalho, com o intuito de avaliar o resultado do tratamento de pacientes portadores de fraturas do femur proximal, em uma serie de casos. Procuramos observar a influencia das complicacoes mais prevalentes nos resultados finais apos o minimo de dois anos de seguimento. Correlacionamos especialmente a instalacao da necrose avascular e o tempo entre o acidente e a instituicao da terapeutica. METODOS: Estudamos, retrospectivamente, 29 pacientes com fraturas da extremidade proximal do femur, com idade inferior a 14 anos entre 1988 e 2007. Analisamos as seguintes variaveis: sexo, idade, mecanismo de trauma, classificacao da fratura (Delbet), tratamento realizado, complicacoes (pseudartrose, deformidade em varo, anisomelia e necrose avascular), tempo para cirurgia e resultado (Ratliff). Obtivemos uma analise descritiva individual de cada variavel. Os testes foram utilizados de acordo com a adequacao das premissas de normalidade e para avaliacao utilizamos o teste exato de Fisher. RESULTADOS: Obtivemos cinco (17,2%) pacientes com necrose avascular sendo tres (60,0%) com idade superior a 10 anos; 73,3% dos pacientes tratados nas primeiras 24 horas apresentaram bons resultados; a causa mais comum de fratura foi acidente automobilistico (44,8%); os melhores resultados foram observados nos pacientes tratados cirurgicamente; 41,4% evoluiram com algum tipo de complicacao. CONCLUSOES: Entre os 29 pacientes tratados, segundo os criterios de Ratliff, obtivemos 58,6% de bons, 27,6% de regulares e 13,8% de maus resultados. Quando aplicado o tratamento incruento, obtivemos apenas 17,0% de bons resultados, enquanto que apos o tratamento cirurgico obtivemos 69,3%. Da mesma forma, observamos que houve 73,3% de bons resultados quando a cirurgia foi realizada nas primeiras 24 horas e apenas 42,8% nos pacientes submetidos a intervencao terapeutica apos este periodo. Pacientes submetidos a cirurgia nas primeiras 24 horas evoluiram com necrose da cabeca do femur em 13,3%, enquanto os que foram operados apos este periodo tiveram esta complicacao em 21,4% dos casos.

Fixação intramedular das fraturas do fêmur na infância e na adolescência com hastes flexíveis

Objetivos: Avaliar o resultado do tratamento cirurgico da fratura diafisaria isolada do femur pela fixacao intramedular retrograda com hastes de Ender. Metodos: Os autores realizam um estudo retrospectivo de 31 pacientes (32 femures), sendo 22 (71%) do sexo masculino e nove (29%), do feminino. As idades variaram entre oito e 16 anos com media de 11,3 anos. Quanto ao mecanismo de trauma, observamos: 13 (42%) foram vitimas de acidente automobilistico; cinco (16%), de acidente motociclistico; quatro (13%), de atropelamento; seis (19%), de queda de altura; e tres (10%), de queda de bicicleta. Quanto ao lado acometido, ocorreram 14 (44%) fraturas femorais direitas e 18 (56%) esquerdas com um paciente fraturado bilateralmente. O tempo de seguimento variou de 1,6 anos a 6,3 anos com media de 2,7 anos. O periodo de internacao foi, em media, de 6,81 dias, variando entre tres e 19 dias. Apos um ano, realizaram avaliacao funcional (dor, movimento, claudicacao) e escanometria para avaliar possiveis discrepâncias. Resultados: 28 (90,3%) pacientes com resultado satisfatorio e tres (9,6%), insatisfatorio. Como complicacoes, observamos anisomelia em oito (25,8%), dor em dois (6,4%) e limitacao do arco de movimento de flexao joelho em um (3,2,%) paciente. Conclusoes: Os autores ainda consideram a populacao estudada pequena, mas os resultados demonstram ser promissores. O tratamento com haste intramedular de Ender foi efetivo, seguro e economico, podendo ser indicado para as fraturas femorais isoladas estaveis.

Estudo clínico do quadril não tratado na tetraparesia espástica

Objective: To evaluate CP patients considering the hip joint and analyzing the relation between severity, age and scoliosis. Methods: A transversal descriptive study was performed in 40 patients (1 to 17 y.o.), 21 (52,5%) female and 19 (47,5%) male from Cruz Verde Association; 19 (47,5%) had history of prematurity; 26 (65,0%) with anoxia; meningitis in 4 (10%), hydrocephalus in 10(25,0%); microcephalus in 15 (37,5%). From the total 38 (95,0%) presented spasticity, 1 (2,5%) athetoid and 1 (2,5%) mixed. According to topographic classification 28 (70,0%) presented tetraparesis and 12 (30,0%) double hemiparesis. All of them are non-ambulators and 38 (95,0%) were classified as GFMCS V and 2 (5,0%) were level IV. The patients were divided in two groups (with or without indications for hip surgical treatment). The hips were analysed by Thomas, abduction, and Nelaton-Galeazzi tests. The scoliosis was clinically analysed considering trunk symmetry and dorsal hump. Results: We observed positive correlation between the patients’ scoliosis and hip flexion contracture. There was no difference between the patients’ age and and hip flexion contracture. There was no difference between topographic types and hip contractures. Conclusions: We did not find positive correlation between patients’ age and hip contractures; patients with scoliosis present worse hip abduction compromise.

Correlation between avascular necrosis and early stabilization of proximal femoral fractures in childhood

Objective: We developed this study with the aim of evaluating the results from treating patients with proximal femoral fractures, in a series of cases. We sought to observe the influence of the most prevalent complications on the final results after a minimum follow-up of two years. We especially considered the relationship between establishment of avascular necrosis and the time between the accident and the therapeutic intervention. Method: We retrospectively studied proximal extremity fractures of the femur in 29 patients under 14 years of age between 1988 and 2007. We analyzed the following variables: sex, age, mechanism of injury, fracture classification (Delbet), treatment administered, complications (pseudarthrosis, varus deformity, leg length discrepancy and avascular necrosis), duration of surgery and results (Ratliff). We carried out individual descriptive analysis on each variable. The tests were used in accordance with the premise that normality applied. For the evaluation, we used Fishers exact test. Results: Five patients (17.2%) had avascular necrosis, and three of them (60.0%) were over 10 years of age. 73.3% of the patients treated within the first 24 hours showed good results. The most common cause of fractures was traffic accidents (44.8%). The best results were observed among patients who were treated surgically. 41.4% developed some type of complication. Conclusions: Among the 29 patients treated, 58.6% had good, 27.6% had regular and 13.8% had poor results, according to the Ratliff criteria. When conservative treatment was applied, only 17.0% had good results, while 69.3% had good results from surgical intervention. Likewise, 73.3% of the results were good results when surgery was performed within the first 24 hours and only 42.8% of the results were good among patients who underwent surgery after this period. Patients operated within the first 24 hours developed necrosis of the femoral head in 13.3% of cases, while 21.4% of those operated after this period developed this complication.