Rui dos Santos Barroco

Biplanar chevron osteotomy.

Results of biplanar chevron osteotomy performed on patients with mild-to-moderate hallux valgus deformity with an increased distal metatarsal articular angle (DMAA) are shown. The study included clinical data of 32 patients (54 feet) who had completed a 2-year follow-up, and radiological data of these 32 and other 29 patients (50 feet) for a total of 61 patients (104 feet, 53 right and 51 left). There were 59 females and two males with ages varying from 11 to 66 years. According to the AOFAS Hallux Rating, the preoperative average score (50) improved to 90 (average score after the surgery). The hallux valgus angle was improved from an average of 25° to 14°, the first intermetatarsal angle from 12° to 8° and the DMAA from 15° to 5°. At the end of treatment, 94% of patients were classified as having grade 0 or I sesamoid lateral sub-luxation. Given improvement in angles and 90% of patients satisfied with an average AOFAS postoperative score of 90, the technique seems indicated for treatment of symptomatic hallux valgus deformity with increased DMAA.

Avaliação da relação dos metatarsais na biomecânica de 332 pés normais pelo método de mensuração dos seus comprimentos relativos

OBJECTIVE: To identify the mean normal length of the metatarsals and the most common metatarsal formulas through a simple measurement method, thereby providing surgeons with data for planning treatment on symptomatic individuals with biometric abnormalities of the foot. METHODS: We evaluated and measured dorsoplantar weight-bearing radiographs of normal adult feet (83 males and 83 females). RESULTS: We found relative mean lengths for metatarsus I of 125.4 mm for males and 115.1 mm for females; for metatarsus II, 127.8 mm for males and 117.3 mm for females; for metatarsus III, 123.4 mm for males and 113.5 mm for females; for metatarsus IV, 114.2 mm for males and 105.3 mm for females; for metatarsus V, 99.5 mm for males and 91.7 mm for females. The mean forefoot width was 87.1 mm for males and 80.8 mm for females. CONCLUSION: Feet with index minus occurred most frequently in both sexes, although all three metatarsal formulas can be considered to be normal patterns. The mean normal pattern for males and females respectively was the following: metatarsus I 2.4 mm and 2.2 mm shorter than metatarsus II; metatarsus III 4.4 mm and 3.8 mm shorter than metatarsus II; metatarsus IV 9.2 mm and 8.2 mm shorter than metatarsus III; metatarsus V 14.7 mm and 13.6 mm shorter than metatarsus IV.

EVALUATION OF METATARSAL RELATIONSHIPS IN THE BIOMECHANICS OF 332 NORMAL FEET USING THE METHOD OF MEASURING RELATIVE LENGTHS

To identify the mean normal length of the metatarsals and the most common metatarsal formulas through a simple measurement method, thereby providing surgeons with data for planning treatment on symptomatic individuals with biometric abnormalities of the foot. Methods: We evaluated and measured dorsoplantar weight-bearing radiographs of normal adult feet (83 males and 83 females). Results: We found relative mean lengths for metatarsus I of 125.4 mm for males and 115.1 mm for females; for metatarsus II, 127.8 mm for males and 117.3 mm for females; for metatarsus III, 123.4 mm for males and 113.5 mm for females; for metatarsus IV, 114.2 mm for males and 105.3 mm for females; for metatarsus V, 99.5 mm for males and 91.7 mm for females. The mean forefoot width was 87.1 mm for males and 80.8 mm for females. Conclusion: Feet with index minus occurred most frequently in both sexes, although all three metatarsal formulas can be considered to be normal patterns. The mean normal pattern for males and females respectively was the following: metatarsus I 2.4 mm and 2.2 mm shorter than metatarsus II; metatarsus III 4.4 mm and 3.8 mm shorter than metatarsus II; metatarsus IV 9.2 mm and 8.2 mm shorter than metatarsus III; metatarsus V 14.7 mm and 13.6 mm shorter than metatarsus IV.

Avaliação da qualidade de vida em pacientes com fratura da tíbia

OBJECTIVE: To evaluate the impact of tibial fractures on patients quality of life. METHOD: All patients were evaluated by means of a protocol of clinical and epidemiological data. The Johner and Wruhs method was employed to evaluate tibial fractures and the results were compared to those of the SF-36 Health Survey, which was applied by the authors from the sixth month postoperatively. Those methods were applied considering the return of the patients or not to all the activities they used to perform before the accident. RESULTS: We found a statistical significance (p<0.05) showed by Mann- Whitneys U-test between the component of SF-36, and return or not to previous activities. Regarding the results of SF36 and clinical evaluation (Johner and Wruhs), on the Kruskal-Wallis test, we also found significant correlation. CONCLUSION: According to the established criteria and based on the results, tibial fractures, even with favorable clinical outcomes, result in a diminished quality of life.

Tratamento do neuroma de Morton via plantar: avaliação retrospectiva dos resultados cirúrgicos

Com a finalidade de avaliar a eficacia da tecnica cirurgica, envolvendo a neurectomia por via plantar, transversa, fora da zona de carga, em portadores de neuroma de Morton, 217 pacientes foram submetidos a este tratamento.Um total de 264 pes foram observados, sendo 32,2% no pe direito, 46,1% no pe esquerdo e 21,7% bilateralmente.Quanto ao sexo, foram observadas ocorrencias de 86,6% no sexo feminino e 13,4% masculino.Quanto a localizacao, 83,5% (220 neuromas) estavam presentes no terceiro espaco interdigital, 7,5% no segundo espaco, com presenca de bilateralidade em 47 pacientes.O tempo medio de acompanhamento foi de 7,5 anos, variando de 4 a 216 meses, com resultado satisfatorio e regulares em 95,8% dos pacientes no total, com apenas 11 pacientes (4,2%) insatisfeitos com o tratamento de forma global.Os autores concluem, por tanto, que a neurectomia por via plantar transversa e uma opcao satisfatoria, com boa visibilizacao anatomica do neuroma, evoluindo com boa cicatrizacao, retorno precoce as atividades e satisfacao do paciente com o resultado alcancado.

Fratura-luxação bilateral de calcâneo

The calcaneus is the most commonly fractured tarsal bone. However, locked fracture-dislocation of the calcaneus is a rare condition because ofxa0the bone and ligament stability between the calcaneus, talus, and cuboid. We report the unique features of a case of bilateral fracture-dislocation of the calcaneus, including open fractures, bilateral fibular dislocation, and bilateral interposition of the flexor hallucis longus tendon at the fracture site. A literature review identified only 19 cases of locked fracture-dislocation, but none of these cases involved the combination of injuries observed in this case. Fracture of the calcaneus may be associated with a variety of injuries requiring proper diagnosis and treatment. nLevel of evidence V; Therapeutic Studies; Expert Opinion.

Association between vascular injury identified via echo-Doppler examination and talus fracture-dislocation

Objective: To investigate the association between talus fracture-dislocation and the occurrence of pre-operative vascular injuries identified via echo-colour Doppler examination of the lower limbs and to assess whether these injuries directly affect talar necrosis. Methods: Retrospective study with data collection on 26 patients with a diagnosis of talus fracture-dislocation who were evaluated by pre-operative arterial and venous echo-colour Doppler from 2004 to 2015. Results: The sample included 26 patients (26 feet), ranging in age from 16 to 62 years, with a mean follow-up time of 2 years and 9 months. A total of six (23.07%) changes were diagnosed via echo-colour Doppler, of which five (83.33%) were due to arterial injury of the ‘segmental occlusion of the posterior tibial artery’ type and one (16.67%) was due to venous injury of the ‘recent deep venous thrombosis of the popliteal-distal segment’ type, with no arterial injury. No significant association was found between the vascular injuries diagnosed by Doppler and progression to necrosis. Conclusion: A significant portion of the patients with talus fracture-dislocation presented with vascular injury diagnosed by echo-colour Doppler, although no association was found between vascular injury and outcomes of osteonecrosis. Level of Evidence IV; Diagnostic studies.