Osvandré Lech

Tratamento conservador das lesões parciais e completas do manguito rotador

SUMMARY The lesion of rotator cuff is the most frequent lesion of theshoulder. Circa 180 patients were conservatively treated in bothClinics during the years of 1976 and 1997. This group of patientsreceived a wide range of treatments (only medication, homeexercises, infiltration, physiotherapy, etc). This study evaluated theresults of the conservative treatment in 26 patients with partial andtotal rupture of the rotator cuff. The protocol consisted of a programwith duration of 6 months including specific miofascial therapy,assisted active exercises and of strengthening of the muscles ofthe rotator cuff and axioscapular musculature. The inclusion criteriaof the study were: 1) to carry the program with just one reabilitator;2) no previous infiltration; 3) no previous surgery; 4) absence ofdiagnosed rheumatopathy. Six months after the end of treatment,eighteen patients (69,22%) presented with satisfactory results,while the other 8 cases (30,78%) were considered not satisfactoryand were referred to surgery.Resumen pt: A lesao do manguito rotador e a mais frequente patologia do ombro. Cerca de 180 pacientes foram tratados conservadoramente nos dois Servicos nos anos d...

Regenerative potential of the cartilaginous tissue in mesenchymal stem cells: update, limitations, and challenges

Advances in the studies with adult mesenchymal stem cells (MSCs) have turned tissue regenerative therapy into a promising tool in many areas of medicine. In orthopedics, one of the main challenges has been the regeneration of cartilage tissue, mainly in diarthroses. In the induction of the MSCs, in addition to cytodifferentiation, the microenvironmental context of the tissue to be regenerated and an appropriate spatial arrangement are extremely important factors. Furthermore, it is known that MSC differentiation is fundamentally determined by mechanisms such as cell proliferation (mitosis), biochemical-molecular interactions, movement, cell adhesion, and apoptosis. Although the use of MSCs for cartilage regeneration remains at a research level, there are important questions to be resolved in order to make this therapy efficient and safe. It is known, for instance, that the expansion of chondrocytes in cultivation, needed to increase the number of cells, could end up producing fibrocartilage instead of hyaline cartilage. However, the latest results are promising. In 2014, the first stage I/II clinical trial to evaluate the efficacy and safety of the intra-articular injection of MSCs in femorotibial cartilage regeneration was published, indicating a decrease in injured areas. One issue to be explored is how many modifications in the articulate inflammatory environment could induce differentiation of MSCs already allocated in that region. Such issue arose from studies that suggested that the suppression of the inflammation may increase the efficiency of tissue regeneration. Considering the complexity of the events related to the chondrogenesis and cartilage repair, it can be concluded that the road ahead is still long, and that further studies are needed.

Trauma ortopédico multitasking

O Comite de Trauma Ortopedico da SBOT entrega uma obra marcante - um conjunto de artigos cientificos de excelente qualidade. O objetivo e mais do que meritorio, pois possibilita que este material, que teve apresentacao oral no XVll Congresso Brasileiro de Trauma Ortopedico, em maio de 2011 em Salvador, Bahia, tenha tambem apresentacao escrita, possibilitando aos autores a incorporacao nos seus curriculos.O Comite de Trauma Ortopedico faz muito mais em prol da ortopedia brasileira e internacional – educa, atualiza, publica, faz pesquisa de opiniao, possui interface governamental, relaciona-se com entidades internacionais de fomento cientifico, aprimora seu quadro de associados, dentre outros. Por isso, pode ser identificada como sociedade

BIOMECHANICS AND HISTOLOGICAL ANALYSIS IN RABBIT FLEXOR TENDONS REPAIRED USING THREE SUTURE TECHNIQUES (FOUR AND SIX STRANDS) WITH EARLY ACTIVE MOBILIZATION

Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant (p=0.095). Conclusion: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques applied.

Síndrome de Gorham-Stout: "doença do osso fantasma"

A sindrome de Gorham-Stout e uma doenca que apresenta osteolise idiopatica de um osso ou area contigua proxima. A etiologia e desconhecida, sendo uma condicao rara, de dificil diagnostico e tratamento controverso. Acomete pessoas sem distincao quanto a idade e ao sexo. Neste trabalho realizamos uma revisao bibliografica da doenca, dando enfoque especifico no diagnostico diferencial, e demonstramos o acompanhamento de um paciente com esta sindrome, desde o seu diagnostico, tratamento e estado atual de evolucao.

Integridade do músculo subescapular após a cirurgia aberta para tratamento da luxação recidivante glenoumeral: avaliação clínica e radiológica

OBJECTIVE: To evaluate the integrity of the subscapularis tendon by strength, function and magnetic resonance imaging after deltopectoralis access for anterior shoulder instability. METHODS: 20 patients with anterior shoulder instability have been evaluated. Minimum follow-up was 12 months, with a mean of 40 months. Only male patients were included, with a mean of age of 29 years (20 - 42 years). The patients have been submitted to physical examinations of mobility, muscular strength, Belly Test and Gerber Test. The isokinetic strength in internal and external rotation, in angular speeds of 60o/s and 180o/s, for both shoulders was measured using a dynamometer. In 15 patients magnetic resonance imaging (MRI) was carried out on both shoulders for evaluating the thickness, cross-sectional area and atrophy of the subscapularis muscle. RESULTS: A significant difference was found between torque peaks at the speed of 60o/s for internal (p=0.036) and external (p=0.008) rotation. However, at 180o/s the opposite happens (internal rotation: p=0.133; external rotation: p=0.393). Subscapularis muscle thickness and area are significantly smaller than the normal side, with a deficit of 19% and 23%, respectively. According to Rowe and UCLA scores, we find excellent and good results for the majority of patients, with a mean of 88 and 31.6 points, respectively. CONCLUSION: Despite of the good functional results, open surgery can limit strength and reduce the thickness and the cross-sectional area of subscapularis muscle. However, the best results were found in the patients who had the dominant side operated.

Trans-scaphoid perilunate fracture dislocation beyond Mayfield stage IV: a case report on a new classification proposal

This report and review of the literature aims to recognize the complete enucleation beyond stage IV of the classification proposed by Mayfield. The addition of a fifth category is proposed, added for complete ligament injuries that lead to nonexistent circulation for the radiolunate ligament, preventing surgical reconstruction, thus influencing surgical treatment.

Pseudoartrose do escafoide em esqueleto imaturo

This paper presents a review of the literature on pseudarthrosis of the scaphoid in skeletally immature individuals, taking into consideration its epidemiology, diagnosis and treatment, as well as its controversies. Knowledge of this subject makes it possible for patients to be given appropriate treatment immediately. Pseudarthrosis of the scaphoid in skeletally immature patients is a rare condition that results from error or lack of diagnosis of a fracture. Thus, careful clinical and radiographic examination should be performed in order to confirm or rule out this diagnosis. Several treatment methods have been reported and have shown good results. These include conservative plaster cast treatment, bone graft without osteosynthesis, bone graft with Kirschner wires, percutaneous screws and bone graft with compression screws. The treatment performed depends on the characteristics of the pseudarthrosis and the surgeons experience.

Pseudarthrosis of the scaphoid in immature skeletons

This paper presents a review of the literature on pseudarthrosis of the scaphoid in skeletally immature individuals, taking into consideration its epidemiology, diagnosis and treatment, as well as its controversies. Knowledge of this subject makes it possible for patients to be given appropriate treatment immediately. Pseudarthrosis of the scaphoid in skeletally immature patients is a rare condition that results from error or lack of diagnosis of a fracture. Thus, careful clinical and radiographic examination should be performed in order to confirm or rule out this diagnosis. Several treatment methods have been reported and have shown good results. These include conservative plaster cast treatment, bone graft without osteosynthesis, bone graft with Kirschner wires, percutaneous screws and bone graft with compression screws. The treatment performed depends on the characteristics of the pseudarthrosis and the surgeons experience.

OSTEOID OSTEOMA IN SCAPHOID: CASE REPORT.

Osteoid osteoma is a benign osteoblastic tumor that is unusual in the hand. A location in the carpal bones is infrequent, which leads to errors in diagnosing it because of polymorphism of the clinical symptoms. Reviewing the literature shows that nine cases of osteoid osteoma in the scaphoid have been reported. Here, one case of osteoid osteoma in the scaphoid that was initially treated as De Quervains stenosing tenosynovitis is reported, with a definitive diagnosis that was delayed for five years.