Leandro Alves de Oliveira

Giant cell tumor of the femoral neck: case report ☆

The authors present the case of a patient with a giant cell tumor of the left femoral neck, with adjacent progressive invasion of bone tissue. Initial treatment was done with local curettage and autologous bone graft from fibula, electrocauterization and filling with methyl methacrylate. A local tumoral relapse was present after one year; therefore a new surgical procedure was necessary, with proximal femoral wide resection and unconventional endoprosthesis fixation. The article discusses the clinical aspects and surgical treatment. This report aimed to demonstrate the necessity to perform wide resection for giant cell tumor of the femoral neck, prioritizing total resection of the tumor and its local extension, preserving limb integrity and demonstrating the complete failure of preserving surgery in cases of femoral neck involvement.

Proximal femural valgus subtrochanteric osteotomy for non union of trochanteric fractures

Objectives: To evaluate valgus subtrochanteric osteotomy for the treatment of trochanteric non-union. Methods: A retrospective study of cases series. From 1998 September to 2009 January, seventeen (17) cases with a diagnosis of non-union of trochanteric fracture were re-operated by the hip group of the Ortophaedic And Traumatology service of the Hospital Geral de Goiania (HGG). The patients presented pain at the fracture site, a femoral varus angle of less than 120°, and non-union of the fracture in the 3rd months after the initial surgery. Results: Patients with ages ranging from 30 to 73 years, with a maximum follow-up of 09 years and minimum of 09 years. The mean time from first surgery to osteotomy was six months. Bone union was observed in 16 patients, with a mean union time of 12 weeks after surgery. The mean hip varus angle was 1050 (1200 to 900). After surgery, the mean hip valgus angle was 1440 (1550 to 1350). We had one unsuccessful case; a 78-year old patient who had osteogtomy, fixed with DHS of 1500, with valgization to 1540. After six months of follow-up without union of the fracture, it was decided to perform total cemented hip artroplasthy, without complications. Conclusion: Valgus subtrochanteric osteotomies can be indicated for the treatment of trochanteric treatment of pseudoarthroses, with good final results for bone union, avoiding the need for total hip artroplasthy and maintaining biological fixation, as well as reestablishing the mechanical and anatomical axis of the affected limb.

Contribution to the anatomical study of the corticoperiosteal flap of the medial femoral condyle

Objective: to perform the anatomical study, in cadavers, of the corticoperiosteal flap of the medial femoral condyle, based on the medial genicular artery, evaluating challenges in dissection and the topographic patterns. Materials and methods: fifteen limbs from eight cadavers were studied, ages ranging from 19 to 74 years old. They were placed at supine position, and a longitudinal incision on the medial face of the lower part of the thigh was performed, exposing medial vastus and sartorius muscles, with descendent genicular vessels being also exposed. The distance between the descendent genicular artery and the medial articular line of the knee, the diameter of the vessel, the length of the pedicle, and the presence of the fasciocutaneous branch and its location were analyzed. Results: the distance between the origin of the descendent genicular artery and the medial articular line of the knee ranged from 11.2cm to 14.5cm, with an average of 12.63cm. The mean artery diameter was 2.5mm (from 2.25mm to 2.75mm). The distance between the descendent genicular artery and the fasciocutaneous branch ranged from 1.0 to 1.5cm. The mean length of the vascular pedicle was 7.01cm, ranging from 5.6cm to 8.6cm. Conclusion: the corticoperiosteal flap of the medial femoral condyle of the knee is easy to dissect, presents a constant vascular pedicle, with average length of 7.0cm and diameter of 2.5mm, enabling it to be indicated for microsurgical transplants.

Contribuição ao estudo anatômico do retalho vascularizado corticoperiosteal do côndilo medial do fêmur

OBJECTIVE: to perform the anatomical study, in cadavers, of the corticoperiosteal flap of the medial femoral condyle, based on the medial genicular artery, evaluating challenges in dissection and the topographic patterns. MATERIALS AND METHODS: fifteen limbs from eight cadavers were studied, ages ranging from 19 to 74 years old. They were placed at supine position, and a longitudinal incision on the medial face of the lower part of the thigh was performed, exposing medial vastus and sartorius muscles, with descendent genicular vessels being also exposed. The distance between the descendent genicular artery and the medial articular line of the knee, the diameter of the vessel, the length of the pedicle, and the presence of the fasciocutaneous branch and its location were analyzed. RESULTS: the distance between the origin of the descendent genicular artery and the medial articular line of the knee ranged from 11.2cm to 14.5cm, with an average of 12.63cm. The mean artery diameter was 2.5mm (from 2.25mm to 2.75mm). The distance between the descendent genicular artery and the fasciocutaneous branch ranged from 1.0 to 1.5cm. The mean length of the vascular pedicle was 7.01cm, ranging from 5.6cm to 8.6cm. CONCLUSION: the corticoperiosteal flap of the medial femoral condyle of the knee is easy to dissect, presents a constant vascular pedicle, with average length of 7.0cm and diameter of 2.5mm, enabling it to be indicated for microsurgical transplants.

Total arthroplasty in displaced dysplastic hips with acetabular reconstruction and femoral shortening – technical note

To describe a new procedure of total hip replacement in patient with severe developmental dysplasia of the left hip, using technique of acetabular reconstruction with autogenous bone grafts and subtrochanteric shortening femoral osteotomy. Total hip replacement done in January of 2003. The Eftekhars classification was used and included type D, neglected dislocations. Bone graft incorporated in acetabular shelf and femoral osteotomy. Our contribution is the use of an Allis plate to better fix acetabular grafts, avoiding loosening, and cerclage around bone graft in femoral osteotomy site, which diminish pseudoarthrosis risk. This technique shows efficiency, allowing immediately resolution for this case with pain and range of motion of hip improvement. It also allows the acetabular dysplasia reconstruction, equalization of the limb length (without elevated risk of neurovascular lesion) and repairs the normal hip biomechanics due to the correction of the hips center of rotation.

Osteotomia valgizante subtrocantérica do fêmur proximal para o tratamento da não consolidação das fraturas transtrocanterianas

OBJETIVOS: Avaliar a consolidacao de pseudoartrose transtrocanteriana tratada com osteotomia de valgizacao subtrocanterica. METODOS: Estudo retrospectivo de serie de casos. No periodo de setembro de 1998 a janeiro de 2009 foram reoperados no Servico de Ortopedia e Traumatologia do Hospital Geral de Goiânia (HGG), pelo grupo de quadril, 17 pacientes com diagnostico de nao consolidacao de fratura transtrocanteriana. Apresentavam dor no local da fratura, ângulo de varismo do femur menor ou igual a 120° e nao consolidacao da fratura no terceiro mes do primeiro pos-operatorio. RESULTADOS: Pacientes com idade variando entre 30 e 73 anos, com seguimento maximo de nove anos e minimo de um ano. O tempo medio entre a primeira cirurgia e a osteotomia de correcao foi de seis meses. A consolidacao foi evidenciada em 16 pacientes. A media de consolidacao foi de 12 semanas de pos-operatorio. O ângulo de varizacao pre-operatorio do quadril foi calculado e sua media foi de 105 o de varo, sendo o maior 120 o e o menor 90 o. O ângulo da valgizacao pos-operatorio foi calculado e sua media foi de 144 o de valgo, sendo o maior de 155 o e o menor de 135 o. Tivemos um caso de insucesso: paciente de 78 anos, que realizou a osteotomia, fixada com DHS de 150 o, com valgizacao para 154 o, apos seis meses de acompanhamento sem consolidacao da fratura, foi optado por uma artroplastia total de quadril cimentada, sem intercorrencias. CONCLUSAO: As osteotomias valgizantes subtrocantericas podem ser indicadas para o tratamento das pseudoartroses em fraturas transtrocantericas, com bons resultados finais de consolidacao, evitando a substituicao protetica e mantendo uma fixacao biologica, alem de restabelecer o eixo mecânico e anatomico do membro acometido.