Leandro Cardoso Gomide

Tríade terrível do cotovelo: avaliação do tratamento cirúrgico

OBJETIVOS: Avaliar a epidemiologia e os resultados cirurgicos do tratamento das fraturas-luxacoes de cotovelo, incluindo apenas os casos que associam a luxacao com a fratura do processo coronoide e da cabeca do radio (triade terrivel). METODO: Foram avaliados 19 pacientes, sendo 12 do genero masculino e sete do genero feminino. Foi feita uma analise dos prontuarios para coleta de dados a respeito do mecanismo do trauma, padrao das fraturas, tempo para a cirurgia e tipo de procedimento realizado. Foi realizada a avaliacao clinica para mensuracao dos arcos de movimento do cotovelo e aplicacao do questionario MEPS. RESULTADOS: O mecanismo de trauma mais comum em nossa casuistica foi a queda de altura (12 pacientes). Todos os pacientes foram submetidos a tratamento cirurgico sendo que o tempo medio entre a data do trauma e a cirurgia foi de 16,1 dias. O seguimento medio foi de 50,3 meses. Foram obtidos arcos de flexo-extensao media de 112° e pronossupinacao de 127,9°. A media do questionario MEPS foi de 86 pontos, sendo encontrados resultados excelentes e bons em 15 dos pacientes (79%). O tempo para a cirurgia, arco de flexoextensao final maior que 100° e a contratura em flexao menor que 30° se mostraram estatisticamente significantes para o bom resultado clinico final. Cinco pacientes tiveram complicacoes, sendo tres em relacao a nervos perifericos, uma pseudoartrose e uma instabilidade recorrente. CONCLUSAO: Apesar da gravidade da lesao encontrada na triade terrivel do cotovelo, a maioria dos pacientes avaliados obteve um cotovelo estavel com bons resultados clinicos. Os fatores que levam a melhores resultados clinicos sao: cirurgia antes de 14 dias de lesao, arco de flexo-extensao maior que 100° e contratura em flexao menor que 30°.

TERRIBLE TRIAD OF THE ELBOW: EVALUATION OF SURGICAL TREATMENT

Objectives: To evaluate the epidemiology of and surgical results from treating elbow fracture-dislocations, including only the cases in which dislocation is associated with fracture of the coronoid process and the radial head (terrible triad). Methods: Nineteen patients were evaluated: 12 males and 7 females. The medical records were analyzed to gather data about the mechanism of injury, fracture pattern, time elapsed until surgery and type of procedure applied. A clinical assessment was made to measure elbow range of motion, and the MEPS questionnaire was applied. Results: The most common mechanism of injury in our sample was a fall from a height (12 patients). All the patients underwent surgical treatment and the mean time elapsed between the date of the injury and the surgery was 16.1 days. The mean follow-up was 50.3 months. The mean range of flexion-extension obtained was 112° and the mean range of pronation-supination obtained was 127.9°. The mean score from the MEPS questionnaire was 86 points, and excellent and good results were obtained for 15 patients (79%). The time elapsed until surgery, final flexion-extension range greater than 100° and flexion contracture of less than 30° were shown to have a statistically significant relationship with a good final clinical result. Five patients had complications, of which three cases related to peripheral nerves, one case to pseudarthrosis and one case to recurrent instability. Conclusions: Despite the severity of the injuries found in the terrible triad of the elbow, most of the patients evaluated here achieved elbow stability with good clinical results. The factors that led to better clinical results were surgery not more than 14 days after the injury, flexion-extension range greater than 100° and flexion contracture less than 30°.

Queimadura de terceiro grau na região da placa eletrocirúrgica durante artroscopia de ombro: relato de caso

O numero de artroscopias de ombro esta aumentando e, por causa disso, a frequencia de complicacoes relacionadas tambem aumenta. O presente caso relata uma queimadura de terceiro grau na regiao da placa eletrocirurgica durante esta cirurgia e alerta sobre possiveis causas e como tentar prevenir esta rara, mas possivel complicacao.

Relationship between the critical shoulder angle and the development of rotator cuff lesions: a retrospective epidemiological study

Objective To perform a retrospective epidemiological study of radiographs in order to evaluate the relationship between the anatomy of the scapula and the development of rotator cuff injuries (RCIs). Methods This study retrospectively evaluated the relation of the critical shoulder angle (CSA) and RCIs from January 2011 to November 2013; patients were examined in the Orthopedics and Traumatology Department of a university hospital. The CSA was measured by radiographic standardization of two groups: a control group of 34 asymptomatic shoulders and a study group of 44 shoulders with complete RCIs. Results The mean age in the control group was 59.97 years (45–84) and the mean age in the group with RCIs was 59.75 years (45–84). Regarding the CSA, the control group had a mean angle of 33.59° (±3.37) and the group with RCIs had a mean angle of 39.75° (±5.35; p < 0.007). Conclusion There is an association between CSA and RCIs.

Estudo mecânico das propriedades dos fios de sutura usados em cirurgias ortopédicas

Objective  To evaluate the mechanical properties of sutures commonly used in orthopedic surgeries, characterizing their behavior through tensile tests and determining which one has greater mechanical strength. Method  Tensile tests of different sutures were performed in a mechanical testing machine BME 10 kN, using a 50 kgf maximum capacity loading cell. Seven samples from each suture material were tested. Both ends of the sample material were fixed in the proper metal claw, maintaining an initial length of 5 cm. Tests were performed at a speed of 20 mm/minute and at room temperature, recording data for maximum displacement and maximum force at the rupture point. Results  FiberWire® #2 (Artrhex, Naples, FL, USA) presented the highest mean strength of rupture (240.17 N), followed by HiFi® #2 (Conmed, Utica, NY, USA) (213.39N) and Ethibond® #5 (Ethicon Inc., Somerville, NJ, USA) (207.38 N). Ethibond® #2 (Ethicon Inc., Somerville, NJ, USA) had the lowest mean strength of rupture (97.8 N). Conclusion  Non-absorbable braided polyblend sutures, more recently introduced, are superior to conventional, braided polyester sutures, and FiberWire® #2 is the most resistant suture evaluated in the present study.

Prospective study of ultrasound-guided peri-plexus interscalene block with continuous infusion catheter for arthroscopic rotator cuff repair and postoperative pain control

Objective This trial investigated postoperative analgesia in arthroscopic rotator cuff repair surgery patients under general anesthesia, associated with ultrasound-guided peri-plexus interscalene brachial plexus block (US-IBPB), and compared single injection to elastomeric pump continuous infusion of local anesthetics. Complications associated to both techniques are described. Methods In this prospective, quasi-randomized controlled clinical trial, 68 adults scheduled for elective arthroscopic rotator cuff repair were assigned to receive Group 1 (G1 = 41) US-IBPB with a 20 mL injection of 0.5% peri-plexus ropivacaine, introduction of catheter, injection of 20 mL of 0.5% ropivacaine through continuous catheter infusion of local anesthetic by elastomeric pump (ropivacaine 0.2%, infusion of 5 mL/h). In Group 2 (G2 = 27), US-IBPB, with a single peri-plexus injection of 40 mL ropivacaine 0.5%. In both groups oral analgesics were prescribed, paracetamol 500 mg associated to codeine 30 mg for patients with VAS between 3 and 5, and also oxycodone 20 mg for VAS ≥ 6. The anesthesiology team was available through contact telephones and the patients received a table to complete in order to report pain intensity according to VAS, use of oral medication, and complications related to the catheter and pump, until the third postoperative day. Results The intensity of pain was higher on second day after surgery than on days 1 and 3, in both groups confirmed by the ANOVA test (p = 0.00006) Among the groups, G1 patients had lower pain intensity than G2, (p = 0.000197). G2 patients presented greater pain intensity during all periods studied (days 1, 2, and 3) than G1 patients. Postoperatively, G2 patients had higher consumption of rescue analgesics, nausea, and vomiting (40.74%) vs. G1 (5%) and dizziness (25.92%). No patient with catheter and elastomeric pump (G1) had complications regarding its insertion and maintenance during postoperative period. Conclusion The quality of analgesia for arthroscopic rotator cuff repair with peri-plexus US-IBPB and continuous infusion with elastomeric pump presented superior postoperative analgesia quality to single puncture IBPB on postoperative days 2 and 3, with lower consumption of rescue opioids in this period.

THIRD-DEGREE BURN IN THE REGION OF THE ELECTROSURGICAL PAD DURING SHOULDER ARTHROSCOPY: A CASE REPORT

The number of shoulder arthroscopy procedures is increasing and, because of this, the frequency of related complications is also increasing. This report presents a case of third-degree burn from an electrosurgical pad during this procedure and serves as an alert regarding the possible causes and how to try to prevent this rare, but possible complication.

Extravasamento de líquido no mediastino e derrame pleural durante artroscopia de ombro: relato de caso

This study is intended to present a rare but possible respiratory complication during a shoulder arthroscopy performed in the beach chair position. Fluid leaked into the mediastinum during the procedure when the infusion pump was being used, which caused respiratory difficulty. Treatment was conservative, with extubation delay, stay at the Intensive Care Unit, diuretic drugs, and support action. In the fourth postoperative day, the patient was asymptomatic regarding such complication.