Rogério Andrade do Amaral

Giant cell tumor of the femoral neck: case report ☆

The authors present the case of a patient with a giant cell tumor of the left femoral neck, with adjacent progressive invasion of bone tissue. Initial treatment was done with local curettage and autologous bone graft from fibula, electrocauterization and filling with methyl methacrylate. A local tumoral relapse was present after one year; therefore a new surgical procedure was necessary, with proximal femoral wide resection and unconventional endoprosthesis fixation. The article discusses the clinical aspects and surgical treatment. This report aimed to demonstrate the necessity to perform wide resection for giant cell tumor of the femoral neck, prioritizing total resection of the tumor and its local extension, preserving limb integrity and demonstrating the complete failure of preserving surgery in cases of femoral neck involvement.

Solitary ischial osteochondroma: an unusual cause of sciatic pain: case report,

The aim was to report on a rare case of osteochondroma of the left ischium, which evolved with compression of the sciatic nerve, thus causing sciatic pain in the homolateral lower limb. The patient was female and presented sciatic pain that was treated clinically for one year. However, the pain evolved with increasing intensity and worsened with hip movement. This was associated with diminished motor force and paresthesia of the homolateral lower limb. Radiological investigation of the region showed a bone lesion in the external portion of the left ischium, in the path of the sciatic nerve. Tomographic reconstruction showed cortical continuity with the bone of origin, i.e., a pattern characteristic of osteochondroma. En-bloc resection of the lesion was performed using the Kocher-Langerbeck route, and the anatomopathological analysis proved that it was an osteochondroma. The patients neurological symptoms improved and, after two months of follow-up, she remained asymptomatic and without any signs of recurrence. Since osteochondroma is the commonest benign bone tumor, it should be taken into consideration in the diagnostic investigation of compressive tumor lesions that could affect the sciatic nerve.

Proximal femural valgus subtrochanteric osteotomy for non union of trochanteric fractures

Objectives: To evaluate valgus subtrochanteric osteotomy for the treatment of trochanteric non-union. Methods: A retrospective study of cases series. From 1998 September to 2009 January, seventeen (17) cases with a diagnosis of non-union of trochanteric fracture were re-operated by the hip group of the Ortophaedic And Traumatology service of the Hospital Geral de Goiania (HGG). The patients presented pain at the fracture site, a femoral varus angle of less than 120°, and non-union of the fracture in the 3rd months after the initial surgery. Results: Patients with ages ranging from 30 to 73 years, with a maximum follow-up of 09 years and minimum of 09 years. The mean time from first surgery to osteotomy was six months. Bone union was observed in 16 patients, with a mean union time of 12 weeks after surgery. The mean hip varus angle was 1050 (1200 to 900). After surgery, the mean hip valgus angle was 1440 (1550 to 1350). We had one unsuccessful case; a 78-year old patient who had osteogtomy, fixed with DHS of 1500, with valgization to 1540. After six months of follow-up without union of the fracture, it was decided to perform total cemented hip artroplasthy, without complications. Conclusion: Valgus subtrochanteric osteotomies can be indicated for the treatment of trochanteric treatment of pseudoarthroses, with good final results for bone union, avoiding the need for total hip artroplasthy and maintaining biological fixation, as well as reestablishing the mechanical and anatomical axis of the affected limb.

Intraosseous lipoma of the iliac: case report

Lipomas are benign tumors that attack fat cells and most often affecting soft tissues in adulthood. On rare occasions, they may affect bones, preferentially the metaphyses of the long bone. They are generally asymptomatic and radiography shows radiolucent lesions with a thin sclerotic rim or radiodense lesions with a thick sclerotic rim. Malignant transformation of these tumors is rare, as is their recurrence, and there is no need for surgery in most cases. In this report, we present a rare case of intraosseous lipoma in the iliac bone.

Total arthroplasty in displaced dysplastic hips with acetabular reconstruction and femoral shortening – technical note

To describe a new procedure of total hip replacement in patient with severe developmental dysplasia of the left hip, using technique of acetabular reconstruction with autogenous bone grafts and subtrochanteric shortening femoral osteotomy. Total hip replacement done in January of 2003. The Eftekhars classification was used and included type D, neglected dislocations. Bone graft incorporated in acetabular shelf and femoral osteotomy. Our contribution is the use of an Allis plate to better fix acetabular grafts, avoiding loosening, and cerclage around bone graft in femoral osteotomy site, which diminish pseudoarthrosis risk. This technique shows efficiency, allowing immediately resolution for this case with pain and range of motion of hip improvement. It also allows the acetabular dysplasia reconstruction, equalization of the limb length (without elevated risk of neurovascular lesion) and repairs the normal hip biomechanics due to the correction of the hips center of rotation.

Osteotomia valgizante subtrocantérica do fêmur proximal para o tratamento da não consolidação das fraturas transtrocanterianas

OBJETIVOS: Avaliar a consolidacao de pseudoartrose transtrocanteriana tratada com osteotomia de valgizacao subtrocanterica. METODOS: Estudo retrospectivo de serie de casos. No periodo de setembro de 1998 a janeiro de 2009 foram reoperados no Servico de Ortopedia e Traumatologia do Hospital Geral de Goiânia (HGG), pelo grupo de quadril, 17 pacientes com diagnostico de nao consolidacao de fratura transtrocanteriana. Apresentavam dor no local da fratura, ângulo de varismo do femur menor ou igual a 120° e nao consolidacao da fratura no terceiro mes do primeiro pos-operatorio. RESULTADOS: Pacientes com idade variando entre 30 e 73 anos, com seguimento maximo de nove anos e minimo de um ano. O tempo medio entre a primeira cirurgia e a osteotomia de correcao foi de seis meses. A consolidacao foi evidenciada em 16 pacientes. A media de consolidacao foi de 12 semanas de pos-operatorio. O ângulo de varizacao pre-operatorio do quadril foi calculado e sua media foi de 105 o de varo, sendo o maior 120 o e o menor 90 o. O ângulo da valgizacao pos-operatorio foi calculado e sua media foi de 144 o de valgo, sendo o maior de 155 o e o menor de 135 o. Tivemos um caso de insucesso: paciente de 78 anos, que realizou a osteotomia, fixada com DHS de 150 o, com valgizacao para 154 o, apos seis meses de acompanhamento sem consolidacao da fratura, foi optado por uma artroplastia total de quadril cimentada, sem intercorrencias. CONCLUSAO: As osteotomias valgizantes subtrocantericas podem ser indicadas para o tratamento das pseudoartroses em fraturas transtrocantericas, com bons resultados finais de consolidacao, evitando a substituicao protetica e mantendo uma fixacao biologica, alem de restabelecer o eixo mecânico e anatomico do membro acometido.