Saulo Gomes de Oliveira

A prospective double blinded randomized study of anterior cruciate ligament reconstruction with hamstrings tendon and spinal anesthesia with or without femoral nerve block

BACKGROUND Current literature supports the thought that anesthesia and analgesia administered perioperatively for an anterior cruciate ligament (ACL) reconstruction have a great influence on time to effective rehabilitation during the first week after hospital discharge. PURPOSE The aim of this study is to answer the research question is there a difference in clinical outcomes between the use of a femoral nerve block with spinal anesthesia versus spinal analgesia alone for people undergoing ACL reconstruction? METHODS ACL reconstruction with spinal anesthesia and patient sedation (Group one); and spinal anesthesia with patient sedation and an additional femoral nerve block (Group two). Patients were re-evaluated for pain, range of motion (ROM), active contraction of the quadriceps, and a Functional Independence Measure (FIM) scoring scale. RESULTS Spinal anesthesia with a femoral nerve block demonstrates pain relief 6h after surgery (VAS 0.37; p=0.007). From the third (VAS=4.56; p=0.028) to the seventh (VAS=2.87; p=0.05) days after surgery, this same nerve blockage delivered higher pain scores. Patients had a similar progressive improvement on knee joint range of motion with or without femoral nerve block (p<0.002). Group one and two had 23.75 and 24.29° 6h after surgery and 87.81 and 85.36° of knee flexion after 48h post op. CONCLUSION Spinal anesthesia associated with a femoral nerve block had no additional benefits on pain control after the third postoperative day. There were no differences between groups concerning ability for knee flexion and to complete daily activities during postoperative period. LEVEL OF EVIDENCE Randomized Clinical Trial Level I.

Riscos e consequências do uso da técnica transportal na reconstrução do ligamento cruzado anterior: relação entre o túnel femoral, a artéria genicular lateral superior e o epicôndilo lateral do côndilo femoral

OBJECTIVE: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. METHODS: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of the distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. RESULTS: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. CONCLUSION: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and insertion of the lateral collateral ligament, promoting post-surgical complications such as instability of the knee, osteonecrosis of the femoral condyle and ligamentizacao graft.

Atualização da anatomia do mecanismo extensor do joelho com uso de técnica de visualização tridimensional

The knee extensor mechanism is a complex structure formed by the quadriceps muscle and tendon, the patella, the patellar tendon and the ligaments that surround and help stabilize the knee. Through using a three-dimensional viewing technique on images of the knee extensor apparatus, we aimed to didactically show the structures that compose this bone-muscle-ligament complex. Anatomical dissection of the knee with emphasis on the structures of its extensor mechanism was performed, followed by taking photographs using a camera and lenses suitable for simulating human vision, through a technique for constructing three-dimensional images. Then, with the aid of appropriate software, pairs of images of the same structure from different angles simulating human vision were overlain with the addition of polarizing layer, thereby completing the construction of an anaglyphic image. The main structures of the knee extensor mechanism could be observed with a three-dimensional effect. Among the main benefits relating to this technique, we can highlight that in addition to teaching and studying musculoskeletal anatomy, it has potential use in training for surgical procedures and production of images for diagnostic tests.

Risks and consequences of using the transportal technique in reconstructing the anterior cruciate ligament: relationships between the femoral tunnel, lateral superior genicular artery and lateral epicondyle of the femoral condyle

Objective: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. Methods: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of the distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. Results: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. Conclusion: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and insertion of the lateral collateral ligament, promoting post-surgical complications such as instability of the knee, osteonecrosis of the femoral condyle and ligamentização graft.

Updating of the anatomy of the extensor mechanism of the knee using a three-dimensional viewing technique

The knee extensor mechanism is a complex structure formed by the quadriceps muscle and tendon, the patella, the patellar tendon and the ligaments that surround and help stabilize the knee. Through using a three-dimensional viewing technique on images of the knee extensor apparatus, we aimed to didactically show the structures that compose this bone-muscle-ligament complex. Anatomical dissection of the knee with emphasis on the structures of its extensor mechanism was performed, followed by taking photographs using a camera and lenses suitable for simulating human vision, through a technique for constructing three-dimensional images. Then, with the aid of appropriate software, pairs of images of the same structure from different angles simulating human vision were overlain with the addition of polarizing layer, thereby completing the construction of an anaglyphic image. The main structures of the knee extensor mechanism could be observed with a three-dimensional effect. Among the main benefits relating to this technique, we can highlight that in addition to teaching and studying musculoskeletal anatomy, it has potential use in training for surgical procedures and production of images for diagnostic tests.

Síndrome de parsonage-turner: relato de caso em paciente HIV soropositivo

The Parsonage-Turner Syndrome is a rare disease that affects the muscles of the scapular girdle, leading to muscular atrophy and a large motor deficit. The etiology is unknown, but it is believed that infectious and autoimmune factors are involved. The diagnosis is made by exclusion, and the main differential diagnoses are cervical disc hernias, rotator cuff injuries and rheumatic diseases. During diagnostic research, we conducted laboratory tests, radiographs and MRI of the shoulder and cervical spine, with particular reference to electroneuromyography to help generate a definitive diagnosis. This case report is presented because it shows a disease that is rarely associated with HIV seropositivity and the importance of early diagnosis for better treatment of these patients.

Migração intrapélvica do parafuso cefálico da haste intramedular longa para fêmur proximal: relato de caso

The use of cephalomedullary devices has gained popularity in the treatment of proximal femoral fractures. Despite their biomechanical advantages, several complications are well described in the literature. One of these complications, which is rarely reported, is the medial migration of the cephalic screw. The authors present this unusual complication in a case of a long-nail implant, which was treated with removal of the implants as a first step, and posterior osteosynthesis with a locked proximal femur plate as a second step, as well the outcome until fracture consolidation and resolution of the case.

Epidural abscess in patient with tropical pyomyositis: a case report and literature review

La piomiositis es una infeccion muscular profunda y subaguda que puede originar abscesos intramusculares unicos o multiples. Se vincula a infecciones sistemicas, diabetes mellitus, terapia inmunosupresora, SIDA [AIDS] y mieloma multiple. Describimos un caso de piomiositis tropical, con acometimiento de la columna vertebral, que evoluciono para absceso epidural, en paciente con historial anterior de espondilitis anquilosante en tratamiento con medicaciones inmunosupresoras y que presento traumatismo derecho, en el muslo derecho, previamente al inicio de los sintomas. El objetivo de este trabajo es describir el acometimiento raro de la columna vertebral en pacientes con piomiositis tropical, con solamente un caso descrito en la literatura mundial, destacando la necesidad de los metodos complementarios, en la investigacion de diagnostico, para el apropiado tratamiento y las posibles complicaciones de esa enfermedad. Los pacientes inmunosuprimidos, con dolores musculares subagudos, deben ser investigados cuanto a la piomiositis tropical y el diagnostico precoz es fundamental para el exito del tratamiento.

Absceso epidural en paciente portador de piomiositis tropical: relato de caso y revisión de la literatura

La piomiositis es una infeccion muscular profunda y subaguda que puede originar abscesos intramusculares unicos o multiples. Se vincula a infecciones sistemicas, diabetes mellitus, terapia inmunosupresora, SIDA [AIDS] y mieloma multiple. Describimos un caso de piomiositis tropical, con acometimiento de la columna vertebral, que evoluciono para absceso epidural, en paciente con historial anterior de espondilitis anquilosante en tratamiento con medicaciones inmunosupresoras y que presento traumatismo derecho, en el muslo derecho, previamente al inicio de los sintomas. El objetivo de este trabajo es describir el acometimiento raro de la columna vertebral en pacientes con piomiositis tropical, con solamente un caso descrito en la literatura mundial, destacando la necesidad de los metodos complementarios, en la investigacion de diagnostico, para el apropiado tratamiento y las posibles complicaciones de esa enfermedad. Los pacientes inmunosuprimidos, con dolores musculares subagudos, deben ser investigados cuanto a la piomiositis tropical y el diagnostico precoz es fundamental para el exito del tratamiento.

Abscesso epidural em paciente portador de piomiosite tropical: relato de caso e revisão da literatura

La piomiositis es una infeccion muscular profunda y subaguda que puede originar abscesos intramusculares unicos o multiples. Se vincula a infecciones sistemicas, diabetes mellitus, terapia inmunosupresora, SIDA [AIDS] y mieloma multiple. Describimos un caso de piomiositis tropical, con acometimiento de la columna vertebral, que evoluciono para absceso epidural, en paciente con historial anterior de espondilitis anquilosante en tratamiento con medicaciones inmunosupresoras y que presento traumatismo derecho, en el muslo derecho, previamente al inicio de los sintomas. El objetivo de este trabajo es describir el acometimiento raro de la columna vertebral en pacientes con piomiositis tropical, con solamente un caso descrito en la literatura mundial, destacando la necesidad de los metodos complementarios, en la investigacion de diagnostico, para el apropiado tratamiento y las posibles complicaciones de esa enfermedad. Los pacientes inmunosuprimidos, con dolores musculares subagudos, deben ser investigados cuanto a la piomiositis tropical y el diagnostico precoz es fundamental para el exito del tratamiento.