Maximiliano Aguiar Porto

Epidemiologia e grau de satisfação do paciente vítima de trauma músculo-esquelético atendido em hospital de emergência da rede pública brasileira

OBJECTIVE: The purpose of this study is to describe the epidemiological profile of trauma victims assisted in a public hospital in Fortaleza - Brazil. It also intends to establish a relationship between the waiting time for primary care and the satisfaction level of those patients. Another topic assessed here is the analysis of the most frequent musculoskeletal pathologies in this population. METHODS: A cohort randomized study was conducted during 2002-2003 in a public trauma hospital in Fortaleza - Brazil, where 500 emergency patients were enrolled. RESULTS: The epidemiological profile found in this study is as follows: males (60.4%), young adults (ages ranging 15 - 30 years old) (55%), Fortaleza residents (74%), low familiar income (60%), and relatively healthy, being the fractures the most frequent lesions observed (48%). CONCLUSION: Patients assisted in trauma hospitals constitute a major social problem, and, most of the cases, they present with severe lesions, which demonstrates the need and importance of investments in emergency medical services.

What is the influence of surgical treatment of adolescent idiopathic scoliosis on postural control

PURPOSE To evaluate the effect of surgical treatment on the control of upright balance in adolescent idiopathic scoliosis (AIS). METHODS Thirty adolescents were divided into two groups: Group C (n=15) consisted of individuals without scoliosis (control), and Group S (n=15) consisted of individuals with scoliosis. The mean amplitude and velocity of the center of pressure (COP) evaluations in the anterior-posterior and medial-lateral directions were obtained before surgery and at 7, 30, 60 and 90-days after surgery, in an upright position, using a force platform. RESULTS Group S showed larger oscillation than Group C before surgery. The COP oscillation in Group S after surgery was larger than that in the pre-surgery period. The oscillation diminished over the post-surgery period, but individuals in the 90-day post-surgery period still had larger oscillation compared with the oscillation in the pre-surgery period. CONCLUSION Group S had larger AP and ML mean amplitude and mean velocity before and after surgery compared with Group C, which suggests that a sensorimotor impairment or sensory integration problem could explain the balance control alterations more than biomechanical factors in the AIS.

Utilização da tração halo-craniana pré-operatória no tratamento de deformidades vertebrais de alto valor angular

OBJETIVOS: avaliar o resultado do tratamento cirurgico das deformidades acentuadas da coluna vertebral por meio da utilizacao da tracao halo-gravitacional. METODOS: foram estudados 17 pacientes portadores de diferentes patologias (6 congenitas, 2 pos-neoplasia, 2 neurofibromatoses, 1 idiopatica, 1 raquitismo e 5 neuromusculares) submetidos a cirurgia para correcao de deformidade de alto valor angular na coluna vertebral. A idade no momento da cirurgia variou de 6 a 26 anos (media de 13,75 anos±4,5). Os parâmetros clinicos avaliados foram o sexo, a idade, o tempo e o peso da tracao. Os parâmetros radiograficos estudados foram: a medida da escoliose, da cifose e a altura da coluna vertebral. Os parâmetros radiograficos foram avaliados no periodo pre-operatorio, durante a tracao, e no pos-operatorio. RESULTADOS: o tempo de tracao variou de 14 a 106 dias (34,5±20,83) e a porcentagem de peso da tracao em relacao ao peso corporal variou de 12,5 a 50% (30%±9,36). A media inicial das escolioses foi de 98,6±25,7o(medida Cobb), reduzido para 83,5o±28,5o durante a tracao e para 77o±29,4o no pos-operatorio, com a media de correcao de 27o, sendo 63% destes ocorridos no periodo do uso do halo. A media inicial da cifose foi de 86,3±32,08o (Cobb), reduzido para 62,2o±19,9o durante a tracao e para 60o±20,9o no pos-operatorio, com a media de correcao de 26o, sendo 92% durante a tracao. CONCLUSAO: o tratamento cirurgico das deformidades acentuadas da coluna vertebral, por meio da tracao halo-gravitacional pre-operatoria, e um metodo que melhora o ângulo de Cobb reduzindo a correcao aguda intraoperatoria assim como seus riscos de lesao neurologica.Objective: evaluate the surgical treatment results of severe spine deformities using the preoperative halo gravity traction. Methods: seventeen scoliosis patients with different pathologies were evaluated (6 congenital, 2 tumor, 2 neurofibromatosis, 1 idiopathic, 1 rickets, and 5 neuromuscular). Those patients underwent a deformity correction surgery in the spine. The variety of age was 6 to 26 years-old (average of 13.75±4.5). The clinical features evaluated were age, gender, time of traction and weight used on traction. The radiographic data analyzed follows: scoliosis curve kyphosis, and spine height. Those features were evaluated in the preoperative, during traction and postoperative period. Results: the time of traction range was of 14 to 106 days (34.5±20.83) and the weight of traction percentage to the

Osteotomias segmentares múltiplas para a correção da cifose

OBJECTIVE: To evaluate the results of the surgical treatment of the spinal Kyphosis using the Pontes technique (multiple posterior osteotomies). METHODS: Ten patients (8 with Scheuermann´s kyphosis and 2 with kyphosis after laminectomy) submitted to surgical correction of kyphotic deformity greater than 70o were retrospectively assessed. The age at the surgical time ranged from 12 to 20 years old (mean age16.8 years ± 2.89). The radiographic parameters evaluated were the kyphosis, the lordosis and the scoliosis - whenever present. The presence of proximal and distal junctional kyphosis, loss of correction, and complications as implants loosening and breakage were also assessed. The radiographic parameters were evaluated at the preoperative, early postoperative and late postoperative time. RESULTS: The patients were followed through a period that ranged from 24 to 144 months (65.8 ±39.92). The mean value of the kyphosis was 78.8o ± 7.59o (Cobb) before surgery and 47.5o ± 12.54o at late follow up, with mean correction of 33.9o ± 9.53o and lost correction of 2.2o. CONCLUSION: The surgical treatment of the thoracic kyphosis using multiples posterior osteotomies presented a good correction of the deformity and minimal lost of correction during follow up.

Halo gravity preoperative traction in severe spine deformities treatment

OBJETIVOS: avaliar o resultado do tratamento cirurgico das deformidades acentuadas da coluna vertebral por meio da utilizacao da tracao halo-gravitacional. METODOS: foram estudados 17 pacientes portadores de diferentes patologias (6 congenitas, 2 pos-neoplasia, 2 neurofibromatoses, 1 idiopatica, 1 raquitismo e 5 neuromusculares) submetidos a cirurgia para correcao de deformidade de alto valor angular na coluna vertebral. A idade no momento da cirurgia variou de 6 a 26 anos (media de 13,75 anos±4,5). Os parâmetros clinicos avaliados foram o sexo, a idade, o tempo e o peso da tracao. Os parâmetros radiograficos estudados foram: a medida da escoliose, da cifose e a altura da coluna vertebral. Os parâmetros radiograficos foram avaliados no periodo pre-operatorio, durante a tracao, e no pos-operatorio. RESULTADOS: o tempo de tracao variou de 14 a 106 dias (34,5±20,83) e a porcentagem de peso da tracao em relacao ao peso corporal variou de 12,5 a 50% (30%±9,36). A media inicial das escolioses foi de 98,6±25,7o(medida Cobb), reduzido para 83,5o±28,5o durante a tracao e para 77o±29,4o no pos-operatorio, com a media de correcao de 27o, sendo 63% destes ocorridos no periodo do uso do halo. A media inicial da cifose foi de 86,3±32,08o (Cobb), reduzido para 62,2o±19,9o durante a tracao e para 60o±20,9o no pos-operatorio, com a media de correcao de 26o, sendo 92% durante a tracao. CONCLUSAO: o tratamento cirurgico das deformidades acentuadas da coluna vertebral, por meio da tracao halo-gravitacional pre-operatoria, e um metodo que melhora o ângulo de Cobb reduzindo a correcao aguda intraoperatoria assim como seus riscos de lesao neurologica.Objective: evaluate the surgical treatment results of severe spine deformities using the preoperative halo gravity traction. Methods: seventeen scoliosis patients with different pathologies were evaluated (6 congenital, 2 tumor, 2 neurofibromatosis, 1 idiopathic, 1 rickets, and 5 neuromuscular). Those patients underwent a deformity correction surgery in the spine. The variety of age was 6 to 26 years-old (average of 13.75±4.5). The clinical features evaluated were age, gender, time of traction and weight used on traction. The radiographic data analyzed follows: scoliosis curve kyphosis, and spine height. Those features were evaluated in the preoperative, during traction and postoperative period. Results: the time of traction range was of 14 to 106 days (34.5±20.83) and the weight of traction percentage to the

Influência do macheamento do orifício piloto nos parafusos cervicais anteriores

OBJECTIVE: Experimentally analyze the influence of the pilot hole tapping on the mechanical properties and the bone-implant interface of anterior cervical screw. METHODS: Eight shorn Santa Ines sheep were used in the study. In cervical segments C2-C7 of the column 2.5mm pilot holes were made on both sides of the vertebra. On the right side of the vertebra tapping was done before the insertion of the cortical screw of 3.5mm, and on the left side the implant was placed without tapping the pilot hole. Mechanical assays were performed to assess the strength of pullout as well as a histomorphometric study of bone-implant interface during the acute phase and eight weeks after implant placement. The insertion torque was measured during implant placement. RESULTS: The insertion torque and pullout strength were higher for implants placed without tapping the pilot hole. The bone-implant interface showed greater area of bone contact and greater bone area within the implant thread on the screws implanted without prior tapping. No differences were observed in the bone outside the thread pitch of the implant. CONCLUSIONS: Tapping the pilot hole reduces insertion torque and pullout strength of the implant in both acute and chronic phases, and reduces the area of bone-implant contact and the bone area within the thread pitch.ResUMO Objetivo: Analisar experimentalmente a influencia do macheamento do orificio piloto nas propriedades mecânicas e na interface osso-implante do parafuso cervical anterior. Metodos: Oito carneiros da raca Santa Ines deslanados foram utilizados no estudo. Nos segmentos vertebrais cervicais de C2-C7 foram realizados orificios piloto de 2,5mm, de ambos os lados da vertebra. No lado direto da vertebra foi realizado o macheamento previamente a insercao do parafuso cortical de 3,5mm, e no lado esquerdo o implante foi colocado sem o macheamento do orificio piloto. Foram realizados ensaios mecânicos para avaliar a forca de arrancamento dos implantes e estudo histomorfometrico da interface osso-implante na fase aguda e oito semanas apos a colocacao dos implantes. O torque de insercao foi mensurado durante a colocacao dos implantes. Resultados: O torque de insercao e a resistencia ao arrancamento dos implantes foram maiores nos implantes colocados sem o macheamento do orificio piloto. A interface osso-implante apresentou maior area de contato osseo e maior area ossea no interior da rosca do implante nos parafusos implantados sem o macheamento previo. Nao foi observado diferenca na area ossea fora do passo de rosca do implante. Conclusoes: O macheamento do orificio piloto reduz o torque de insercao e a resistencia ao arrancamento do implante na fase aguda e cronica, e reduz a area de contato osso-implante e area de osso no interior do passo de rosca. Descritores: Fixacao de fratura; Coluna vertebral; Parafusos osseos; Histologia; Macheamento.

Influencia del taladramiento del agujero piloto en tornillos cervicales anteriores

OBJECTIVE: Experimentally analyze the influence of the pilot hole tapping on the mechanical properties and the bone-implant interface of anterior cervical screw. METHODS: Eight shorn Santa Ines sheep were used in the study. In cervical segments C2-C7 of the column 2.5mm pilot holes were made on both sides of the vertebra. On the right side of the vertebra tapping was done before the insertion of the cortical screw of 3.5mm, and on the left side the implant was placed without tapping the pilot hole. Mechanical assays were performed to assess the strength of pullout as well as a histomorphometric study of bone-implant interface during the acute phase and eight weeks after implant placement. The insertion torque was measured during implant placement. RESULTS: The insertion torque and pullout strength were higher for implants placed without tapping the pilot hole. The bone-implant interface showed greater area of bone contact and greater bone area within the implant thread on the screws implanted without prior tapping. No differences were observed in the bone outside the thread pitch of the implant. CONCLUSIONS: Tapping the pilot hole reduces insertion torque and pullout strength of the implant in both acute and chronic phases, and reduces the area of bone-implant contact and the bone area within the thread pitch.ResUMO Objetivo: Analisar experimentalmente a influencia do macheamento do orificio piloto nas propriedades mecânicas e na interface osso-implante do parafuso cervical anterior. Metodos: Oito carneiros da raca Santa Ines deslanados foram utilizados no estudo. Nos segmentos vertebrais cervicais de C2-C7 foram realizados orificios piloto de 2,5mm, de ambos os lados da vertebra. No lado direto da vertebra foi realizado o macheamento previamente a insercao do parafuso cortical de 3,5mm, e no lado esquerdo o implante foi colocado sem o macheamento do orificio piloto. Foram realizados ensaios mecânicos para avaliar a forca de arrancamento dos implantes e estudo histomorfometrico da interface osso-implante na fase aguda e oito semanas apos a colocacao dos implantes. O torque de insercao foi mensurado durante a colocacao dos implantes. Resultados: O torque de insercao e a resistencia ao arrancamento dos implantes foram maiores nos implantes colocados sem o macheamento do orificio piloto. A interface osso-implante apresentou maior area de contato osseo e maior area ossea no interior da rosca do implante nos parafusos implantados sem o macheamento previo. Nao foi observado diferenca na area ossea fora do passo de rosca do implante. Conclusoes: O macheamento do orificio piloto reduz o torque de insercao e a resistencia ao arrancamento do implante na fase aguda e cronica, e reduz a area de contato osso-implante e area de osso no interior do passo de rosca. Descritores: Fixacao de fratura; Coluna vertebral; Parafusos osseos; Histologia; Macheamento.

Influence of tapping the pilot hole in anterior cervical screws

OBJECTIVE: Experimentally analyze the influence of the pilot hole tapping on the mechanical properties and the bone-implant interface of anterior cervical screw. METHODS: Eight shorn Santa Ines sheep were used in the study. In cervical segments C2-C7 of the column 2.5mm pilot holes were made on both sides of the vertebra. On the right side of the vertebra tapping was done before the insertion of the cortical screw of 3.5mm, and on the left side the implant was placed without tapping the pilot hole. Mechanical assays were performed to assess the strength of pullout as well as a histomorphometric study of bone-implant interface during the acute phase and eight weeks after implant placement. The insertion torque was measured during implant placement. RESULTS: The insertion torque and pullout strength were higher for implants placed without tapping the pilot hole. The bone-implant interface showed greater area of bone contact and greater bone area within the implant thread on the screws implanted without prior tapping. No differences were observed in the bone outside the thread pitch of the implant. CONCLUSIONS: Tapping the pilot hole reduces insertion torque and pullout strength of the implant in both acute and chronic phases, and reduces the area of bone-implant contact and the bone area within the thread pitch.ResUMO Objetivo: Analisar experimentalmente a influencia do macheamento do orificio piloto nas propriedades mecânicas e na interface osso-implante do parafuso cervical anterior. Metodos: Oito carneiros da raca Santa Ines deslanados foram utilizados no estudo. Nos segmentos vertebrais cervicais de C2-C7 foram realizados orificios piloto de 2,5mm, de ambos os lados da vertebra. No lado direto da vertebra foi realizado o macheamento previamente a insercao do parafuso cortical de 3,5mm, e no lado esquerdo o implante foi colocado sem o macheamento do orificio piloto. Foram realizados ensaios mecânicos para avaliar a forca de arrancamento dos implantes e estudo histomorfometrico da interface osso-implante na fase aguda e oito semanas apos a colocacao dos implantes. O torque de insercao foi mensurado durante a colocacao dos implantes. Resultados: O torque de insercao e a resistencia ao arrancamento dos implantes foram maiores nos implantes colocados sem o macheamento do orificio piloto. A interface osso-implante apresentou maior area de contato osseo e maior area ossea no interior da rosca do implante nos parafusos implantados sem o macheamento previo. Nao foi observado diferenca na area ossea fora do passo de rosca do implante. Conclusoes: O macheamento do orificio piloto reduz o torque de insercao e a resistencia ao arrancamento do implante na fase aguda e cronica, e reduz a area de contato osso-implante e area de osso no interior do passo de rosca. Descritores: Fixacao de fratura; Coluna vertebral; Parafusos osseos; Histologia; Macheamento.

occulT ManubriosTernal joinT injury associaTed WiTh fracTure of The Thoracic spine

The authors report the occurrence of an occult manubriosternal joint injury in the initial evaluation on a patient with a thoracic spine fracture (T9). This T9 fracture was diagnosed in a 37-year-old man and was associated with a partial neurological deficit. At the initial evaluation, the radiographs produced did not show the manubriosternal joint injury. During rehabilitation, after surgical stabilization of the thoracic spine fracture, the patient suddenly felt an intense pain accompanied by deformation at the sternal level. From imaging examinations, manubriosternal luxation was diagnosed. Because of recurrence of the luxation and the incapacitating pain, open reduction and fixation of the manubriosternal joint had to be performed. At the 12-month follow-up, the patient presented complete recovery of the neurological lesion, consolidation of the arthrodesis on the T7-T11 vertebral segment and maintenance of the reduction of the manubriosternal joint, which was asymptomatic during daily activities.

Lesão oculta da articulação manúbrio-esternal associada à fratura da coluna torácica

The authors report the occurrence of an occult manubriosternal joint injury in the initial evaluation on a patient with a thoracic spine fracture (T9). This T9 fracture was diagnosed in a 37-year-old man and was associated with a partial neurological deficit. At the initial evaluation, the radiographs produced did not show the manubriosternal joint injury. During rehabilitation, after surgical stabilization of the thoracic spine fracture, the patient suddenly felt an intense pain accompanied by deformation at the sternal level. From imaging examinations, manubriosternal dislocation was diagnosed. Because of recurrence of the dislocation and the incapacitating pain, open reduction and fixation of the manubriosternal joint had to be performed. At the 12-month follow-up, the patient presented complete recovery of the neurological lesion, consolidation of the arthrodesis on the T7-T11 vertebral segment and maintenance of the reduction of the manubriosternal joint, which was asymptomatic during daily activities.