Tiango Aguiar Ribeiro

Coxa profunda in the diagnosis of pincer-type femoroacetabular impingement and its prevalence in asymptomatic subjects.

In many papers, the diagnosis of pincer-type femoroacetabular impingement (FAI) is attributed to the presence of coxa profunda. However, little is known about the prevalence of coxa profunda in the general population and its clinical relevance. In order to ascertain its prevalence in asymptomatic subjects and whether it is a reliable indicator of pincer-type FAI, we undertook a cross-sectional study between July and December 2013. A total of 226 subjects (452 hips) were initially screened. According to strict inclusion criteria, 129 asymptomatic patients (257 hips) were included in the study. The coxa profunda sign, the crossover sign, the acetabular index (AI) and lateral centre-edge (LCE) angle were measured on the radiographs. The median age of the patients was 36.5 years (28 to 50) and 138 (53.7%) were women. Coxa profunda was present in 199 hips (77.4%). There was a significantly increased prevalence of coxa profunda in women (p < 0.05) and a significant association between coxa profunda and female gender (p < 0.001) (92% vs 60.5%). The crossover sign was seen in 36 hips (14%), an LCE > 40° in 28 hips (10.9%) and an AI < 0º in 79 hips (30.7%). A total of 221 normal hips (79.2%) (normal considering the crossover) had coxa profunda, a total of 229 normal hips (75.5%) (normal considering the LCE) had coxa profunda and a total of 178 normal hips (75.3%) (normal considering AI) had coxa profunda. When the presence of all radiological signs in the same subject was considered, pincer-type FAI was found in only two hips (one subject). We therefore consider that the coxa profunda sign should not be used as a radiological indicator of pincer-type FAI. We consider profunda to be a benign alteration in the morphology of the hip with low prevalence and a lack of association with other radiological markers of FAI. We suggest that the diagnosis of pincer-type FAI should be based on objective measures, in association with clinical findings.

Predictors of hip fracture mortality at a general hospital in South Brazil: an unacceptable surgical delay

OBJECTIVE: Hip fractures have been associated with increased mortality in the elderly. Several risk factors such as the time between the insult and the surgical repair have been associated with hip fracture mortality. Nevertheless, the risk of delayed surgical repair remains controversial. Few studies have examined this issue in Brazil. The aim of this study was to study the risk factors for death one year after hip fracture and in-hospital stay at a tertiary hospital in South Brazil. METHODS: A prospective cohort study was carried out from April 2005 to April 2011 at a tertiary university hospital at Santa Maria, Brazil. Subjects admitted for hip fracture who were 65 years of age or older were followed for one year. Information about fracture type, age, gender, clinical comorbidities, time to surgery, discharge, and American Society of Anesthesiologists score were recorded. Death was evaluated during the hospital stay and at one year. RESULTS: Four hundred and eighteen subjects were included in the final analysis. Of these, 4.3% died in-hospital and 15.3% were dead at one year. Time to surgery, American Society of Anesthesiologists score, Ischemic Heart Disease, and in-hospital stay were associated with death at one year in the univariate analysis. The American Society of Anesthesiologists score and time to surgery were one-year mortality predictors in the final regression model. In-hospital death was associated with American Society of Anesthesiologists score and age. CONCLUSION: Time to surgery is worryingly high at the South Brazil tertiary public health center studied here. Surgical delay is a risk factor that has the potential to be modified to improve mortality.

Vertical Open Patella Fracture, Treatment, Rehabilitation and the Moment to Fixation

Patella fracture is relatively uncommon and the vertical trace fracture represents almost 12-17%. The open patella fracture expresses 6-30%. The association of these two uncommon conditions was the aim of this case report even as the treatment and the moment of fixation (definitive surgical treatment). A 27-year-old man after a motorcycle accident showed an open patella fracture classified as a Gustilo and Anderson type IIIA lesion. The patient was immediately treated with precocious surgery fixation with a modified tension band which consists of two parallel K-wires positioned orthogonal to the fracture line and a cerclage wire shaped anteriorly at patella as an eight. The premature fixation benefited the infection prevention and provided earlier joint motion, which increased the nutrition of articular cartilage. Six months postoperatively, the patient had a satisfactory joint motion with full extension and 116° of joint flexion and returned to his daily life activities without restriction. Twelve months postoperatively, the patient had full extension and 120° of knee flexion without pain, joint effusion and instability. Muscle strength force was considered normal at grade V. In conclusion, early chirurgic treatment and precocious articular mobilization improve prognosis, suggesting that the employment of these practices should be adopted whenever possible in most of the open fractures.

An Atypical Calcaneal Fracture in a Child: A Literature Review Concerning the Treatment

Calcaneal fractures are considered uncommon accounting for 0.005-0.41% of all children fractures. Few reports concerning treatment are available. Most of these fractures are non-displaced/minimally displaced and are associated with a fall of less than 1 m. The aim of this case report was to discuss the diagnosis and treatment of a child calcaneal fracture, an atypical presentation despite the high energy mechanism of trauma. A 7-year-old child fell from a 5-m ladder with all his weight on his right heel. Significantly hind-foot reduced range of motion associated with a lateral/plantar calcaneal swelling and pain was found. Neurovascular examination and other parts of the body were normal. Radiograph showed an undisplaced calcaneal body fracture and computed tomography confirmed no subtalar joint involvement. A splint followed by plaster was applied. Weight bearing and deambulation were not allowed. After 4 weeks, no pain and limping was reported by the child’s parents. Plaster was removed and radiograph showed fracture consolidation. Patient had no complaints of pain, no restrictions in range of motion and normal walking. Limping in children is a difficult complaint to assess. Differential diagnoses of a calcaneal fractures should be performed, even without a history of trauma or a history of trivial trauma.

Traumatic Hemipelvectomy: A Rare and Catastrophic Injury

Traumatic hemipelvectomy or complete dislocation of the hemipelvis1-4 is a very rare3,5-9 and catastrophic injury4 that usually results in death4,10. Its true incidence is thought to be underestimated3, but traumatic hemipelvectomy may account for approximately 0.6% of all pelvic trauma11. In recent years, improvements in trauma care have increased the survival rates in these rare cases4,5,7,12. Complete traumatic hemipelvectomy is defined as an injury resulting from a high-energy trauma that presents with a total disruption of the hemipelvis, from the pubic symphysis to the sacroiliac joint4. A hemipelvectomy is considered to be partial when the lower extremity remains attached by skin to the victim3. We describe a traumatic hemipelvectomy in a young patient with a rare and catastrophic injury that presented in an unusual form.nnThe patient was informed that data concerning the case would be submitted for publication, and he provided consent.nnA previously healthy thirty-three-year old man arrived at our hospital after his motorcycle collided with a car. The patient was promptly assessed according to the standard Advanced Trauma Life Support (ATLS) protocol13. He presented with a patent airway and no signs of chest trauma. Examination revealed a blood pressure reading of 40/0 mm Hg, an oxygen saturation level of 63%, and a Glasgow Coma Scale score of 13; urine obtained with a Foley catheter was clear, showing no bladder lesion. The right lower limb, which was cold, cyanotic, and did not have a pulse, was covered with a compressive dressing. There was also a provisional splint on the left upper limb. No radiographs were obtained upon presentation because of the hemodynamic instability.nnThe patient was taken …

Acetabular revision in total hip arthroplasty with tantalum augmentation and lyophilized bovine xenograft

Objective To evaluate a mixed technique of acetabular reconstruction, which uses trabecular metal in the form of tantalum augments associated with lyophilized bovine xenograft. Methods Fifteen patients were evaluated prospectively, who underwent acetabular reconstruction with impacted lyophilized bovine xenograft associated with the use of tantalum augments. The main outcome was the failure of the tantalum–bone interface. Results The population had a mean age of 58.33 years ± 14.27; the majority was female, 80%. Of the total subjects, 66.7% were operated for failure in primary arthroplasty. The mean follow-up time was 45.2 months ± 11.39. The failure rate of the method in the period and population studied was 6.7%. Conclusion An extremely high index (93.3%) of success was observed in an average time of 45.2 months of follow-up. Data were comparable to current literature, demonstrating that the technique employed and proposed is adequate for hip reconstruction in young patients.

Total hip arthroplasty: a still evolving technique

It has been advocated that total hip arthroplasty (THA) is probably the most successful surgical intervention performed in Medicine. In the 1960s, Sir John Charnley not only introduced, but also modified and improved the technique of cemented arthroplasties. The concepts on biological fixation established by Pillar and Galante served as the foundation for the development of uncemented implants that are now used worldwide. Currently, THA is a worldwide widespread surgery performed on millions of people. However, keeping abreast of the large number of information available on these procedures, especially on implant fixation, designs, different tribological pairings, and the long-term results can be challenging at times. This article is a brief update on the main aspects of THA.

An Atypical Type-II Monteggia Fracture Equivalent Lesion

Forearm fractures are common childhood injuries, accounting for about 45% of all fractures and 62% of upper-limb fractures1-3. Approximately 75% to 84% of fractures occur in the distal third of the forearm, 15% to 18% occur in the middle third, and 1% to 7% occur in the proximal third4. Monteggia lesions account for 5% of all forearm fractures5,6.nnThe Monteggia lesion is a radial head fracture or dislocation in association with a concomitant fracture of the metaphysis or diaphysis of the ulna2,6-11. It was first described in 1814 by Giovanni Battista Monteggia12. In 1967, Bado5 introduced a classification system for Monteggia lesions that is well established in clinical orthopaedic practice13.nnBado’s classification subdivided Monteggia fracture-dislocations into four types of true Monteggia lesions; he also introduced equivalent lesions of this fracture pattern (Table I). The equivalent lesions are rare and usually occur in children14-19. Equivalent lesions are fractures that have the same mechanism of injury, with a similar radiographic pattern and method of treatment20. In 1991, Jupiter et al. provided the subclassification of a posterior Monteggia lesion based on anatomic location of the ulnar fracture and the pattern of radial head injury9.nnView this table:nnTABLE I nBado Classification for Monteggia Lesions5nnnnThe type-II Monteggia fracture is well described and has an incidence of 15% to 70%21,22. In his original classification, Bado stated that there were no equivalents to type-II Monteggia lesions other than epiphyseal fracture of the radial head or fracture of the radial neck5,20. In the orthopaedic literature, there are reports of type-II Monteggia fractures and equivalent type-II lesions (which occur mostly in adults)9, …