Marcos Giordano

O efeito do laser de baixa energia no crescimento bacteriano "in vitro"

OBJECTIVE: To perform an in vitro bacteriologic study to evaluate the effect of two types of low level laser (LLL) on different bacterial populations usually present in post-traumatic wounds. METHODS: Swabs were prepared directly at the infection site of patients hospitalized with chronic post-traumatic osteomyelitis. Isolated bacteria were Acinetobacter baumanii complex, Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonela sp, Serratia sp, and Staphylococcus aureus. The material collected was seeded in agar-blood medium with a sterile loop, using 30 Petri dishes for each germ. Two LLL devices were used: Ibramed Laser Pulse #01189, with 15W/904nm for 200 seconds, and Phisiolux dual Bioset #9909001, with 20W/904nm for 230 seconds. In groups I (n = 10) and II (n = 10), bacteria were irradiated with laser. Group III (n = 10) was the control group and was not irradiated. Bacteria in groups I and II were submitted to radiation in a laminar flow chamber that was previously sterilized with UV rays, and the laser was directly, centrally, and perpendicularly applied to the bacteria cultivation surface, from a standard distance of one centimeter, through an orifice made in the lid of the dishes. Bacterial growth was analyzed 12 and 24 hours after the irradiation. Results were statistically processed using the non-parametric test of Kruskall-Wallis, with a significance level p < 5%. RESULTS: A similar behavior was seen in the bacterial population of the three groups studied after 12 and 24 hours of irradiation with the two types of LLL, and there was no statistically significant difference in the bacterial growth between groups I and II and between these two groups and group III (control). CONCLUSION: In the conditions of this study, the effect of LLL showed to be innocuous for the increase in the number of units forming bacterial colonies, in the doses used in this study, as an adjuvant for the wound healing process, even under contamination by the bacteria being evaluated.

SYNOVIAL OSTEOCHONDROMATOSIS OF THE RETROCALCANEAL BURSA : A CASE STUDY

A 42-year-old man presented with synovial osteochondromatosis (SO) of the retrocalcaneal bursa with intraosseous lesions in the calcaneum, leading to significant pain and consequent disability. Simple x-rays, computed tomography, and magnetic resonance imaging were performed preoperatively. The patient has remained asymptomatic, clinically and radiographically, without recurrent lesions for 18 months postoperatively.

Comparative radiographic analysis on the anatomical axis in knee osteoarthritis cases: inter and intraobserver evaluation.

Objective To make a comparative inter and intraobserver analysis on measurements of the anatomical axis between panoramic radiographs of the lower limbs in anteroposterior (AP) view with bipedal weight-bearing, on short film. Methods An accuracy study comparing radiographic measurements on 47 knees of patients attending the knee surgery outpatient clinic due to osteoarthritis. The radiographic evaluation used was as standardized for the total knee arthroplasty program, including panoramic AP views of the lower limbs and short radiographs of the knees in AP and lateral views, all with bipedal weight-bearing. Following this, the anatomical axis of the lower limbs or the femorotibial angle was measured by five independent examiners on the panoramic and short AP radiographs; three of the examiners were considered to be more experienced and two, less experienced. All the measurements were made again by the same examiners after an interval of not less than 15 days. The statistical analysis was performed using the intraclass correlation coefficient, in order to evaluate the inter and intraobserver concordance of the anatomical axis measurements. Results From the statistical analysis, it was observed that there was strongly significant concordance between the anatomical axis measurements on the panoramic and short radiographs, for all the five examiners and for both measurements. Conclusions Under the conditions studied, short radiographs were equivalent to panoramic radiographs for evaluating the anatomical axis of the lower limbs in patients with advanced osteoarthritis. The measurements used also showed high rates of inter and intraobserver concordance and reproducibility.

Ensaio mecânico da resistência ao impacto do cimento ósseo puro e associado a duas drogas anestésicas locais

OBJETIVO: Investigar o comportamento mecânico da combinacao de anestesico local e cimento osseo in vitro. METODOS: Foram comparados dois cimentos ortopedicos (Simplex® e Biomecânica®) e duas drogas anestesicas locais de largo uso na clinica anestesiologica (lidocaina e bupivacaina). Os anestesicos utilizados estavam em po. Elaboraram-se seis grupos de investigacao, baseados na combinacao ou nao das drogas. Nos grupos em que o polimero foi combinado a medicacao, a mistura consistiu de 40g de polimetilmetacrilato com 2g de anestesico local. Foram confeccionados 60 corpos de prova prismaticos, medindo 5 x 120 x 30mm (n = 30) e 5 x 60 x 30mm (n = 30). Os corpos de prova foram testados mecanicamente em maquina universal. Foram realizados ensaios mecânicos de resistencia ao impacto direto. Foi realizada analise estatistica para verificar o efeito do cimento (Simplex® e Biomecânica®) e da medicacao (lidocaina e bupivacaina) na resistencia do corpo de prova, com a = 5%. RESULTADOS: Observou-se que existe influencia significativa da medicacao na resistencia do corpo de prova (p = 0,0001). Pelo teste de comparacoes multiplas de Tukey, identificou-se, ao nivel de 5%, que a mistura com bupivacaina apresentou resistencia significativamente maior do que com a lidocaina e com o polimero puro. Nao existe diferenca significativa na resistencia entre a lidocaina e o polimero puro. Existe influencia significativa do cimento na resistencia do corpo de prova (p = 0,015). Mostrou-se que o cimento Simplex® apresentou resistencia significativamente maior do que o Biomecânica®. Existe influencia significativa da interacao cimento-medicacao na resistencia do corpo de prova (p = 0,035). A analise dos contrastes mostrou que o cimento Simplex® apresentou resistencia significativamente maior do que o Biomecânica® apenas quando sem adicao da medicacao (p = 0,002). Nao existe diferenca significativa na resistencia entre os cimentos Simplex® e Biomecânica® para as medicacoes lidocaina (p = 0,13) e bupivacaina (p = 0,63). No cimento Simplex®, a associacao com a bupivacaina apresentou resistencia significativamente maior do que com a lidocaina e o polimero puro (p = 0,001 e p = 0,012, respectivamente). Nao existe diferenca significativa na resistencia entre a lidocaina e o polimero puro para o cimento Simplex® (p = 0,39). No cimento Biomecânica®, a associacao com a bupivacaina apresentou resistencia significativamente maior do que com a lidocaina e o polimero puro (p = 0,0001 e p = 0,0001, respectivamente). Nao existe diferenca significativa na resistencia entre a lidocaina e o polimero puro para o cimento Biomecânica® (p = 0,37). CONCLUSAO: Nas condicoes estudadas, nao ha reducao significativa da resistencia ao impacto na combinacao de cimento ortopedico com anestesicos locais.

A Survey of Current Practices and Preferences for Internal Fixation of Trochanteric Fractures of the Femur in Brazil

Objective The primary aim of this study was to survey current practices and preferences behind internal fixation of trochanteric femoral fractures among Brazilian orthopedic surgeons. The secondary aim was to identify the main reason for these preferences. Methods A survey containing 20 images of trochanteric fractures of the femur was presented to a group of 62 orthopedists, all members of the Brazilian Society of Orthopedics and Traumatology (SBOT). The first part of the questionnaire was created to identify the surgeons’ degree of professional experience, type of practice, and areas of greatest interest and performance within the specialty. The second part of the questionnaire contained options for fixating different trochanteric fracture patterns in the femur for participants to choose, along with the main reason for their decision. Statistical analysis was descriptive and profiled the surgeons’ major area of interest, treatment option, and the main reason for their therapeutic decision. Results Of the 62 orthopedists who participated in the study, 10 (16.0%) stated that their area of greatest interest was orthopedic trauma and 52 (83.9%) reported greater interest in another area of the specialty; these two groups were classified as the Trauma Group and Orthopedics Group, respectively. To treat AO 31A1 type fractures, the trauma group selected the sliding hip screw (SHS) in 66.7% of cases, while the orthopedics group chose the SHS in 65.8% of cases. For 31A2 type fractures, the trauma group chose the intramedullary (IM) nail in 64.0% of the cases, while the orthopedics group chose the IM nail in 76.7% of the cases. For 31A3 type fractures, the trauma group opted for the IM nail in 70.0% of the cases, while the orthopedics group selected the IM nail in 88.0% of the cases. The two most important factors in implant selection for the three types of fracture were fracture pattern and implant availability. Conclusion The sliding hip screw is preferred by most Brazilian orthopedic surgeons for fixation of 31A1 type trochanteric femoral fractures. For 31A2 and 31A3 type fractures, the IM nail is preferred.

General principles for treatment of femoral head fractures

Femoral head fractures occur almost exclusively as a result of a traumatic hip dislocation. Treatment is typically an emergency and includes the reduction of the dislocated hip under anesthesia. As a rule, the earlier the reduction, the better the outcome. Open reduction and internal fixation of the fracture of the femoral head is the treatment of choice for most young patients. In some selected cases when there is a very small fragment located in the region below the fovea, removal should be indicated. In elderly patients and those who experience severe femoral head impaction, it is preferable to perform a total hip replacement. Despite optimal management, the rate of complications after femoral head fractures may reach as high as 50%. In the present study, the authors review the general principles of management of patients with femoral head fractures.

Positioning of the acetabular component in cemented prostheses - radiographic calculation

Objective to assess the reliability of the inclination angle and anteversion of acetabular cup component in patients with idiopatic osteoarthritis of the hip, aseptic necrosis and hip neck fracture using trigonometric formula and plain radiographs. Methods 66 patients underwent cemented total arthroplasty of 72 hips. The inclination of acetabular component was measured using plain radiograph. The acetabular component anteversion was measured using trigonometric formula. Results it was observed that, in the osteoarthritic hips, hip neck fracture and aseptic necrosis, the degree of agreement was highly significant (p < 0.0001), in the measurements of anteversion and inclination angles, among the three assessments, from intra as well as inter-observers. All the agreement pairs were of excellent degree (ICC > 0.80). Conclusion using plain radiographs and trigonometric formula, the method resulted to be highly accurate and reliable. Besides being easy to be calculated. No significant variation was found in the anteversion and inclination angles when compared with osteoarthritis of the hip, aseptic necrosis and hip neck fracture.