Marcos Emilio Kuschnaroff Contreras

Arthroscopic treatment of the snapping iliopsoas tendon through the central compartment of the hip: A PILOT STUDY

We undertook a prospective pilot study to determine whether arthroscopic surgery through the central compartment of the hip was effective in the management of a snapping iliopsoas tendon. Seven patients were assessed pre-operatively and at three, six, 12 and 24 months after operation. This included the assessment of pain on a visual analogue scale (VAS) and function using the modified Harris hip score. All the patients had resolution of snapping post-operatively and this persisted at follow-up at two years. The mean VAS score for pain fell from 7.7 (6 to 10) pre-operatively to 4.3 (0 to 10) by three months (p = 0.051), and to 3.6 (1 to 8) (p = 0.015), 2.4 (0 to 8) (p = 0.011) and 2.4 (0 to 8) (p = 0.011) by six, 12 and 24 months, respectively. The mean modified Harris hip score increased from 56.1 (13.2 to 84.7) pre-operatively to 88.4 (57.2 to 100) at one year (p = 0.018) and to 87.9 (49.5 to 100) at two years (p = 0.02). There were no complications and no weakness occurred in the musculature around the hip. Our findings suggest that this treatment is effective and would support the undertaking of a larger study comparing this procedure with other methods of treatment.

Composição corporal de pacientes acamados por fraturas do quadril

As fraturas do quadril sao a maior causa de hospitalizacao da terceira idade, e constituem um consideravel encargo economico e social. A taxa de mortalidade atual apos um ano de fratura e acima de 33%, e o risco de morte e maior do quarto ao sexto mes apos a fratura. O objetivo deste estudo foi de avaliar alteracoes na composicao corporal de pacientes idosos, durante sua hospitalizacao por fraturas femur proximal, atraves de metodos antropometricos e analise dos valores fisiologicos de gasto energetico. Foi realizado um estudo prospectivo utilizando-se 45 pacientes consecutivos com diagnostico de fratura do quadril. Em todos os casos, foram obtidas medidas diretas e avaliacoes antropometricas indiretas baseadas em estimativas, nas primeiras 24 horas e repetidas apos uma semana de admissao hospitalar. Apos uma semana de internacao houve diminuicao da media do perimetro do braco (0,73 cm, p=0.0052) e da espessura da prega tricipital (1.41 mm, p=0.0181), sem haver modificacao das outras variaveis estudadas. A avaliacao antropometrica como um meio de se fazer um mapa da composicao corporal, em conjunto com as estimativas indiretas sugeridas neste estudo, podem ajudar a determinar o estado nutricional e necessidades caloricas de pacientes idosos.

Avaliação biomecânica das fraturas intra-articulares do calcâneo e sua correlação clínica radiográfica

The present study had an objective to perfom a clinical, radiographic and biomechanical evaluation in patients with calcaneal fractures submitted to open reduction with internal fixation. The sample consisted of 22 patients - 20 male and 2 female with an average age of 40,95 (±11,63) years old. The authors have done radiographic evaluation of the pre and post operatory of Bochler and Gissane angles; furthermore, they used a CT scanning for Sanders classification of calcaneal fractures. The plantar pressure distribution was analyzed with F-scanning system. The results of the intra-articular calcaneal fractures were clinically satisfactory, showed average punctuation with 75,5 in AOFAS criterion. The surgical reduction in a better angle of Bochler and Gissane. The study showed statistical differences between the forefoot and rearfoot concerning the the contact area, average preassure and strength in the injured foot. The figures found to this parameter were bigger in the rearfoot than the forefoot. The trajectory of pressure (COP) was shorter in the fractured foot than in the normal foot. The correlation between the angle of Gissane after the reduction and the second peak of force was found, showing as better as the reduction of this angle, the better is the impulsion. It was also found the correlation between the punctuation between AOFAS and the first peak of force, showing as better is the clinical result the better is the foot supporter.

Complicações em artroscopia de quadril

OBJETIVOS: Determinar a prevalencia de complicacoes ocorridas em uma serie de casos consecutivos de artroscopia de quadril; avaliar a evolucao da casuistica atraves de uma curva de aprendizado; reconhecer as causas das complicacoes nas cirurgias do quadril por via artroscopica. METODOS: Foram avaliados 150 casos consecutivos submetidos a artroscopia de quadril no periodo de maio de 2004 a dezembro de 2008. As complicacoes encontradas foram classificadas sob tres aspectos: sistema orgânico acometido, gravidade, grupos de 50 casos de acordo com a ordem de realizacao do procedimento. Utilizaram-se para a analise dos dados obtidos a estatistica descritiva e o teste exato de Fisher. RESULTADOS: Observaram-se 15 complicacoes (10%) neste estudo. Dez foram complicacoes neurologicas, duas osteoarticulares, uma vasculo-isquemica e duas cutâneas. Na classificacao de gravidade, tres foram classificadas como maiores, 12 intermediarias e nenhuma considerada menor. A incidencia das complicacoes ao longo da curva de aprendizado nao apresentou diferenca estatistica significativa (p = 0,16). CONCLUSOES:A artroscopia de quadril e um procedimento cirurgico de baixa morbidade, que cursa, em alguns casos, com complicacoes. Essas sao, frequentemente, neurologicas e transitorias. Elas ocorrem, principalmente, devido a tracao articular. A taxa de complicacoes nao diminuiu com o evoluir da casuistica.

Osteotomia em Chevron modificada: análise preliminar do comportamento baropodométrico

OBJECTIVE: To evaluate the clinical and baropodometric characteristics of the gaits of individuals with a hallux valgus deformity after modified Chevron osteotomy, in isolation or in association with the Weil osteotomy. METHODS: Foot evaluation happened before and three months after surgery analyzing 27 mildly and moderately deformed feet. The clinical evaluation included the AOFAS score and radiographic measurements. The baropodometric evaluation was done with the Emed-at platform. Peak of Pressure, Pressure-Time Integral and Relative Load were calculated in 10 different regions of the feet: calcaneous, midfoot, first to fifth metatarsal regions, hallux, second and third to fifth toes. RESULTS: After the surgical procedure, an increase in AOFAS scores and a decrease of radiographic parameters were seen. The baropodometric evaluation, after isolated Chevron osteotomy, showed a reduction in pressure and strength under the first metatarsal and hallux, as well as an increase in the same variables on central and lateral metatarsals. After Chevron/Weil osteotomy significant alterations had only occurred in the region of the hallux and toes. CONCLUSION: In the short-term, the modified Chevron technique promoted improvements in clinical conditions and radiographic parameters. The baropodometric evaluation evidenced a load transference from medial to lateral regions of the forefoot, possibly due to the short postoperative period.

Complications in hip arthroscopy

Objectives: To determine the prevalence of complications in a series of consecutive cases of hip arthroscopy; to assess the progression of the sample through a learning curve; and to recognize the causes of complications in arthroscopic hip operations. Method: 150 consecutive cases that underwent hip arthroscopy between May 2004 and December 2008 were evaluated. The complications encountered were classified in three ways: organic system affected, severity and groups of 50 consecutive cases. The data were analyzed by means of descriptive statistics and Fishers exact test. Results: We observed 15 complications in this study (10%): ten were neurological, two were osteoarticular, one was vascular-ischemic and two were cutaneous. In the classification of severity, three were classified as major, 12 as intermediate and none as minor. The incidence of complications over the course of the learning curve did not present any statistically significant difference (p = 0.16). Conclusions: Hip arthroscopy is a surgical procedure that involves low morbidity, but which presents complications in some cases. These complications are frequently neurological and transitory, and mainly occur because of joint traction. The complication rate did not decrease with progression of our sample.

A ressonância magnética e a artrorressonância magnética na lesão labral e condral do quadril: comparação com achados na artroscopia

OBJETIVO: Estudar a sensibilidade da ressonância magnetica (RM) e da artrorressonância magnetica (artro RM) para o diagnostico das lesoes do labio acetabular e das lesoes de cartilagem do quadril. METODOS: Foram incluidos 90 pacientes (90 quadris), submetidos a videoartroscopia do quadril, no periodo entre maio de 2004 e julho de 2007, na Ultralitho Centro Medico e no Hospital Governador Celso Ramos, ambos em Florianopolis, Santa Catarina. Dos 90 pacientes, 25 (27,7%) realizaram RM, sem contraste, 54 (60%) realizaram artro RM e 11 (12,22%) realizaram os dois exames. Nos pacientes submetidos a artro RM, foi introduzido junto com o contraste um anestesico local (bupivacaina 0,5%, ou ropivacaina 1%, sem adrenalina). Em todos os casos, verificou-se a presenca de lesao do labio acetabular e de lesao condral durante a videoartroscopia. RESULTADOS: Os autores encontraram maior sensibilidade para o diagnostico de lesao do labio acetabular com a artro RM (96,9%), do que com RM (86,1%), sendo esta diferenca estatisticamente significante. Quanto ao diagnostico de lesao da cartilagem do quadril, a sensibilidade da artro RM foi de 78,4% e a da RM foi de 55,5%, encontrando-se tambem diferenca estatisticamente significante. Houve maior percentagem de falso-negativo na RM, tanto para o diagnostico de lesao labral quanto condral. Nao foi encontrado nenhum caso de falso-positivo nesta serie. A introducao de anestesico local para a realizacao de artro RM mostrou alivio da dor em 56,9%dos casos. CONCLUSAO: Os autores concluiram que a artro RM apresentou maior sensibilidade de diagnostico que a RM para lesoes do labio acetabular e da cartilagem do quadril. A indiferenca ou a piora da dor, apos a introducao de anestesico local na artro RM, nao foi considerada como fator preditivo para lesoes intra-articulares.

INTRA ARTICULAR CALCANEAL FRACTURES: A CLINICAL AND BIOMECHANICAL ANALYSIS.

Objective: Verify the variables of plantar pressure distribution of patients submitted to surgical procedure for calcaneal fracture, and correlate them with two different surgical approaches. Method: The authors studied 15 patients between 20 and 53 years of age (average 40.06 yrs.) who had intra-joint calcaneal fractures, submitted to surgical treatment by means of two different approaches: the lateral and the sinus tarsi. The authors checked the plantar pressure distribution by correlating these variables with the two different surgical approaches. The plantar pressure distribution was assessed using the Pedar System (Novel, Gmbh, Munich, Germany), by checking the maximum peak of the hindfoot and forefoot pressure on the affected and the normal sides. Results: the mean maximum pressure of the hindfoot plantigram in both approaches showed no statistical difference (t=0.11; p=0.91), as well as the mean maximum pressure of the forefoot plantigram (t=-0,48; p=0,64). Conclusion: The authors have concluded that there were no significant statistical differences between the average maximum peak of the hindfoot and forefoot pressure on the affected side as compared to the normal side, and these variables have showed no differences when compared to the surgical approach used.