Márcio Aurélio Aita

Alternative to the Distal Interphalangeal Joint Arthrodesis: Lateral Approach and Plate Fixation

PURPOSE Several fixation techniques for distal interphalangeal (DIP) joint arthrodesis have been described, with good clinical results and complication rates between 10% and 20%. We propose an alternative technique and fixation method using a lateral approach and 1.3-mm plate and screws fixation. METHODS Between March and September 2005, 11 patients, totaling 15 fingers, had DIP joint arthrodesis by the described technique. The indications were posttraumatic arthritis in 8 fingers, degenerative or rheumatoid arthritis in 5 fingers, and isolated flexor digitorum profundus tendon lesions in 2 fingers. Patients were analyzed for osseus union, pain relief, and functional mobility of the finger. RESULTS Arthrodesis relieved pain and restored stability at the 12th week, on average, with osseous union in all patients. All patients maintained full proximal interphalangeal joint motion with pulp-to-palm distance of zero at 6 months of follow-up evaluation. There were no rotational or angular deformities, nail bed lesions, or skin complications. CONCLUSIONS The lateral approach with plate and screws fixation is an option for DIP joint arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Four corner arthrodesis limited to the centre using a scaphoid one piece graft and a dorsal circular plate

We present 20 patients, who had a four corner arthrodesis, from July 2006 to March 2008, using a dorsal circular plate, to treat scaphoid nonunion and scapholunate dissociation with advanced collapse (SNAC, SLAC). The surgical technique was a fusion restricted to the central area filled with one piece of cancellous bone graft taken from the excised scaphoid. Wrist motion, grip strength, and Disabilities of Arm Shoulder and Hand (DASH) score improved after surgery at a mean follow-up of 20.2 months. Fusion occurred in 19/20 patients. Two patients (10%) had persistent pain. The rest had a good clinical result. We found that four-corner fusion using a dorsal circular plate using the specific technical modifications was successful.

Anomalous presentation of flexor carpi radialis brevis: a report of six cases

An anomalous presentation of flexor carpi radialis brevis (FCRB) is reported in six patients. These findings occurred in a consecutive series of 172 distal radius fracture fixations using a volar approach between 2002 and 2007. This is the first report of this anomalous muscle from a clinical series.

Randomized clinical trial between proximal row carpectomy and the four-corner fusion for patients with stage II SNAC.

Objective To compare the outcomes of patients with stage II SNAC submitted to surgical treatment by proximal row carpectomy (PRC) or four-corner fusion (FCF). Method Twenty-seven patients aged 18–59 years (mean 37.52 years) were included. Thirteen patients underwent PRC in Group A, and 14 underwent FCF of the wrist in Group B. Evaluations were made before and after surgery with follow-up between 45 and 73 months. Range of motion (ROM); pain assessment with a visual analog scale (VAS); grip strength; disability of the arm, shoulder, and hand (DASH); and return to work were evaluated. Results Group A patients had 68.5% and Group B patients, 58.01% of the ROM of the contralateral side. The VAS score was 2.3 in Group A and 2.9 in Group B. Grip strength was 78.67% and 65.42%, respectively, relative to the side not affected. The DASH score was 11 for PRC and 13 for FCF. In Group A, 9/13 (69.23%) and in Group B, 8/14 (57.14%) patients are currently working. Complications were symptomatic osteoarthritis in the mid-carpal joint in Group A and loosening of a screw in Group B. Conclusion The clinical and functional results do not present statistically significant differences for both analyzed methods.

The Proximally Designed Sural Flap Based on the Accompanying Artery of the Lesser Saphenous Vein

Most of the literature about the sural flap deals with soft tissue defects at the lower leg and foot based on the classical description of Masquelet et al. Nevertheless, some authors have shown that the lesser saphenous vein and its accompanying artery play an important role in the vascularization of the posterior skin of the leg. This finding allowed a more proximal design of the flap, increasing its arc of rotation. Thirteen cases of distally based sural flaps were performed and divided in two groups according to the level where the flaps were harvested. In group A, the entire flap was outlined distal to the midpoint of the leg, and in group B, the flap was outlined proximal to the midpoint of the leg. In group A, all the soft tissue defects were located at the lower leg and the foot, and in group B, they involved the anterior the tibia. In group A, the complication rate was 33.33% and the flap survival rate was 83.33%. In group B, the complication rate was 42.85% and survival rate was 100%. The proximally designed sural flap can safely reach the anterior aspect of the tibia in its middle and distal thirds.

Measurement of quality of life among patient undergoing arthroplasty of the thumb to treat CMC arthritis

Objective To present the clinical and functional results, including measurement of quality of life, of patients undergoing trapeziometacarpal arthroplasty. Method This was a prospective evaluation on 45 patients (53 thumbs) with a diagnosis of idiopathic rhizarthrosis who underwent resection arthroplasty and interposition of an uncemented Ascension® implant, made of pyrocarbon. The clinical and functional results were analyzed through radiography, range of motion (ROM) in degrees (°), visual analog scale (VAS) for pain and the disability of arm, shoulder and hand (DASH) questionnaire for quality of life. In the group analyzed, 38 were women and seven were men, and their mean age was 63.17 years (range: 50–78). Eight patients were treated bilaterally. Results After 42.08 months of follow-up (range: 8–73), the subjective pain evaluation (VAS) score was 1.37 (range: 1–4). The complete ROM of the thumb increased to 95.75% (range: 75–100%) in relation to the contralateral side. The mean DASH questionnaire score was 9.98 (range: 1–18). The complication rate (negative events) was 11.32%. Five patients presented dislocation of the thumb prosthesis. All of them were reoperated by means of dorsal capsuloplasty using a portion of the retinaculum of the extensors as a graft, and good clinical evolution was achieved in these cases. One patient presented fracturing of the metacarpal and was treated by means of osteosynthesis using Kirschner wires. Conclusion This method is effective for treating rhizarthrosis, according to the measurements made on the clinical and functional results, even after taking the complication rate into consideration. Moreover, it provides an improvement of quality of life for these patients.

Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the distal radioulnar joint

Objectives To measure the quality of life and clinical outcomes of patients treated with interosseous membrane (IOM) ligament reconstruction of the forearm, using the brachioradialis (BR), and describe a new surgical technique for the treatment of joint instability of the distal radioulnar joint (DRUJ). Methods From January 2013 to September 2016, 24 patients with longitudinal injury of the distal radioulnar joint DRUJ were submitted to surgical treatment with a reconstruction procedure of the distal portion of the interosseous membrane or distal oblique band (DOB). The clinical-functional and radiographic parameters were analyzed and complications and time of return to work were described. Results The follow-up time was 20 months (6–36). The ROM averaged 167.92° (93.29% of the normal side). VAS was 2/10 (1–6). DASH was 5.63/100 (1–18). The time to return to work was 7.37 months (3–12). As to complications, one patient had an unstable DRUJ, and was submitted to a new reconstruction by the Brian-Adams technique months. Currently, he has evolved with improved function, and has returned to his professional activities. Three other patients developed problems around the transverse K-wire and were treated with its removal, all of whom are doing well. Conclusion The new approach presented in this study is safe and effective in the treatment of longitudinal instability of the DRUJ, since it has low rate of complications, as well as satisfactory radiographic, clinical, and functional results. It allows return to social and professional activities, and increases the quality of life of these patients.

Dorsal capsulodesis associated with arthoscopy-assisted scapholunate ligament reconstruction using a palmaris longus tendon graft ☆

Objectives To measure the quality of life, the time to work return, and clinical, functional, and radiographic parameters of patients treated with dorsal capsulodesis associated with scapholunate (SL) reconstruction, assisted by arthroscopy. Methods From January 2015 to September 2016, 14 adult patients with SL dissociation underwent surgical treatment with the SL reconstruction procedure assisted by arthroscopy, using the new technique proposed in this study. All patients were assessed by the occupational therapy department at regular intervals after surgery and performed the same sequence of rehabilitation. The parameters analyzed were: range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH), visual analog scale (VAS), and radiographic analysis to visualize the pre- and postoperative SL gap and the pre- and postoperative dorsal intercalated segment instability (DISI) deformity the. The complications and the time to return to work activities were described. Results The follow-up time was 12 months (3–17). The ROM averaged 321° (96.9% of the normal side). VAS was 1.79/10 (1–6). DASH was 6.50/100 (1–30). The time to work return work was 4.42 months (2–17). As for complications, one patient developed SLAC, and underwent four-corner fusion one year after ligament reconstruction. Currently, he has experienced pain relief, with a functional range of motion of the wrist, and has not yet returned to professional activities. The preoperative SL gap was 4.29 mm (2–7); in the postoperative period, it was 1.79 mm (1–4). The DISI deformity was present in ten patients with SL angle > 70° (preoperative) and it was corrected after surgery, in all patients. SLAC stage I was identified in a patient. Arthroscopy was performed in all cases. The SL instability was classified as Geissler grade III in four cases and as grade IV in ten cases. Conclusion The new approach (dorsal capsulodesis associated with SL reconstruction, assisted by arthroscopy) presented in this study is safe and effective in the treatment of SL dissociation, since it offers satisfactory clinical, radiographic and functional results, showing low rates of complications. For patients, it allows the return to their social and professional activities, and increases their life quality.

Síndrome do túnel carpal: resultados do tratamento cirúrgico com a técnica de mini-incisão

Introducao: A sindrome do tunel carpal e constituida por um conjunto de sinais e sintomas caracteristicos como parestesia, formigamento, dor e perda da forca nas maos. Inicialmente os sintomas sao brandos, progredindo ao longo do tempo. Objetivo: Apresentar os resultados do tratamento cirurgico com mini-incisao, bem como discutir a relacao entre os resultados e a tecnica cirurgica utilizada. Metodo: Esta pesquisa foi realizada na Faculdade de Medicina do ABC, onde foram avaliados 79 punhos de 71 pacientes, todos submetidos ao tratamento cirurgico da sindrome do tunel carpal por “mini-incisao”, entre janeiro de 1996 e maio de 2007. A media de idade entre os pacientes foi de 52,4 anos, sendo a idade minima 27 e a maxima 80 anos. Sessenta e cinco pacientes eram do sexo feminino e seis do masculino. Quanto ao lado acometido, foram obtidos 36 punhos do lado direito e 27 do lado esquerdo, sendo 8 bilaterais. Resultados: Os resultados clinicos mostraram que 60 pacientes ficaram satisfeitos com os sintomas, com os resultados esteticos e funcionais e com a melhora da forca muscular para apreensao. Dois pacientes apresentaram complicacoes cutaneas com infeccao superficial e necessitaram de antibioticoterapia oral. Conclusoes: Concluimos que o tratamento cirurgico por “mini-incisao” e uma tecnica segura, com poucas complicacoes e resultados clinicos e esteticos satisfatorios para o tratamento da sindrome do tunel do carpo.