Showing papers in "Revista Brasileira De Ortopedia in 2013"

Anatomical study on the anterolateral ligament of the knee

Abstract: OBJECTIVE: Describe the knee anterolateral ligament (ALL) and establish its anatomical marks of origin and insertion. METHODS: Dissection of the anterolateral aspect of the knee was performed in six cadavers. After isolation of the ALL, its lenght, width and thickness were measured as its places of origin and insertion. The ALL origin was documented in relation to the lateral collateral ligament (LCL) origin and the insertion was documented in relation to the Gerdy tubercle, fibullar head and lateral meniscus. After the first two dissections, the ligament was removed and sent to histologycal analysis. RESULTS: The ALL was clearly identified in all knees. Its origin in the lateral epycondile was on average 0.5 mm distal and 2.5 mm anterior to the LCL. In the tibia, two insertions were observed, one in the lateral meniscus and another in the proximal tibia, about 4.5 mm distal to the articular cartilage, between the Gerdy tubercle and the fibullar head. The average measures obtained were: 35.1 mm lenght, 6.8 mm width and 2.6 mm thickness. In the ligament histological analysis, dense connective tissue was observed. CONCLUSION: The ALL is a constant structure in the knee anterolateral region. Its origin is anterior and distal to the LCL origin. In the tibia, it has two insertions, one in the lateral meniscus and another in the proximal tibia between the Gerdy tubercle and the fibullar head.

Estudo anatômico do ligamento anterolateral do joelho

Abstract: Resumo Objetivo : Descrever o ligamento anterolateral (LAL) do joelho e estabelecer seus pontos anatomicos de origem e insercao e suas medidas Metodos : Foram feitas disseccoes da regiao anterolateral do joelho em seis cadaveres Apos isolamento do LAL, medidas de comprimento, espessura e largura foram feitas, assim como seus locais de origem e insercao A origem do LAL foi documentada com base na sua distância ântero-posterior e proximal- distal em relacao a origem do ligamento colateral lateral A insercao foi documentada com base no tuberculo de Gerdy, a cartilagem do planalto tibial lateral e o menisco lateral Nas duas primeiras disseccoes, o ligamento foi removido e enviado para analise histologica Resultados : O LAL foi observado com clareza nas disseccoes de todos os seis joelhos Sua origem no epicondilo lateral apresentou uma media 0,5 mm distal e 2,5 mm anterior a origem do LCL Na tibia foram observadas duas insercoes, uma mais proximal no menisco lateral e outra mais distal entre o tuberculo de Gerdy e a cabeca da fibula, cerca de 4,5 mm distal a cartilagem articular da tibia As medidas encontradas do ligamento foram: comprimento medio de 35,1 mm, largura media de 6,8 mm e espessura media de 2,6 mm Na analise histologica dos ligamentos foi observada presenca de tecido conectivo denso Conclusao : O LAL do joelho e uma estrutura constante na regiao anterolateral Sua origem no femur e anterior e distal a origem do LCL Na tibia, apresenta duas insercoes, no menisco lateral e entre o tuberculo de Gerdy e a cabeca da fibula

Estudo epidemiológico das lesões no futebol profissional durante a copa américa de 2011 - argentina

Abstract: Resumo Objetivo Desenvolver estudo epidemiologico sobre as lesoes ocorridas entre os jogadores profissionais de futebol masculino durante a Copa America de 2011, na Argentina. Metodos Fez-se estudo retrospectivo das lesoes ocorridas durante a 43a edicao da Copa America de Futebol na Argentina, em 2011. As lesoes foram avaliadas pelo departamento medico das selecoes e reportadas a Conmebol. Os dados foram compilados e descritos de acordo com as normas estabelecidas pelo Centro de Pesquisas e Avaliacoes Medicas (F-Marc) da Federation Internationale de Football Association (Fifa) em 2005. Resultados Ocorreu maior prevalencia de lesoes nos membros inferiores, sendo coxas e joelhos os segmentos mais acometidos. Os diagnosticos mais frequentes foram lesoes musculares. As lesoes apresentaram em sua maior parte grau leve de severidade e ocorreu pequena diferenca na prevalencia de lesoes de acordo com as etapas da partida, havendo discreto predominio nos 15 minutos finais. A incidencia de lesoes por 1.000 horas de jogo foi similar a media encontrada na literatura. Conclusoes A analise dos resultados obtidos permitiu tracar um perfil da prevalencia, distribuicao por segmento corporal, minuto em que ocorreram e severidade das lesoes dos jogadores de futebol profissional das selecoes participantes da Copa America de 2011 na Argentina. O maior rigor dos arbitros pode ser em parte atribuido a grande competitividade de torneios internacionais. Entretanto, esses resultados nao podem ser considerados definitivos em virtude da necessidade de ser comparados a outros estudos epidemiologicos de mesmo espectro que usem conceitos e criterios semelhantes.

Protocolo de Cirurgia Segura da OMS: O grau de conhecimento dos ortopedistas brasileiros

Abstract: Resumo Objetivo A pesquisa analisou o grau de conhecimento do Protocolo de Cirurgia Segura da OMS pelos ortopedistas brasileiros Metodos Foi feita uma pesquisa voluntaria entre os 3231 ortopedistas participantes do 44° Congresso Brasileiro de Ortopedia e Traumatologia (CBOT), em novembro de 2012, por meio de um questionario sobre o uso do Protocolo de Cirurgia Segura da OMS Apos o recebimento de 502 questionarios respondidos, foi feita a analise estatistica dos resultados Resultados Dentre os 502 ortopedistas respondentes, 40,8% relataram ter vivenciado a experiencia de cirurgia em paciente ou em local errado e 25,6% deles apontaram “falhas de comunicacao” como responsaveis pelo erro Do total de respondentes, 36,5% relataram nao marcar o local da cirurgia antes de encaminhar o paciente ao centro cirurgico e 65,3%, desconhecer total ou parcialmente o Protocolo de Cirurgia Segura da OMS Desses ortopedistas, 72,1% nunca foram treinados para o uso do protocolo Discussao Erros medicos ocorrem, principalmente em ambiente cirurgico, e representam um alto risco para a seguranca dos pacientes Considerando que a cirurgia ortopedica e uma especialidade de grande volume e frequentemente de alta complexidade, envolve uma probabilidade grande de ocorrencia de erros, a maioria evitavel por meio do uso do Protocolo de Cirurgia Segura da OMS Na amostra pesquisada, restou evidenciado que 65,3% dos ortopedistas brasileiros desconhecem tal protocolo, apesar dos esforcos da OMS para a sua divulgacao

Infection after total knee replacement: diagnosis and treatment

Abstract: Infection after total knee replacement (IATJ) is a rare complication. It is associated with increased morbidity and mortality increasing the final costs. Gram positive coccus and Staphylococcus coagulase-negative and Staphylococcus aureus are the most common isolated germs (>50% of the cases). Conditions related to the patient, to the surgical procedure and even to the post op have been identified as risk factors to IATJ. Many complementary methods together with clinical symptoms are useful to a proper diagnosis. Treatment for IATJ must be individualized but generally is a combination of systemic antibiotic therapy and surgical treatment. Prosthesis exchange in one or two stages is the first choice procedure. Debridement with prosthesis retention is an option in acute cases with stable implants and antibiotic sensible germs.

Vitamin D and its relation to bone mineral density in postmenopause women

Abstract: OBJECTIVE: Compare the level of vitamin D with the bone mineral density (BMD) in postmenopausal women, with or without fractures. METHODS: 250 women with mean age of 71.1 were evaluated. The serum levels of vitamin D considered sufficient were ≥ 30 ng/mL, insufficient between 20 and 30 ng/mL and deficient < 20 ng/mL. The bone mineral density was measured and considered osteopenia when T value total of lumbar spine or hip was between -1 and -2.5 and osteoporosis < 2.5. The patients with fractures accounted for 25.2%. RESULTS: There was no significant difference in the vitamin D (ng/mL) levels among the age groups (p = 0.25), the levels of fractures (p = 0.79) and the levels of BMD (p = 0.76). CONCLUSION: 82% of the patients presented deficient and insufficient blood levels of vitamin D. Ours results showed any significant correlation between vitamin D levels and bone mineral density after adjusting for age.

Is osteoarthritis a mechanical or inflammatory disease

Abstract: Traditionally considered "wear and tear" disease, the pathogenic mechanisms of osteoarthritis have not yet been elucidated. The increasing number of articles demonstrating the influence of inflammatory factors in the onset and progression of the disease currently raises great debate in the literature about the importance of each of the factors involved in the disease. Even the choice between the terms "Osteoarthritis" and "Osteoarthrosis" generates controversy, since the first term implies the presence of inflammation as the key generator of the disease, and the latter denotes a degenerative/mechanical causal factor. The aim of this revision article is to promote a debate on the influence of inflammatory factors and mechanical factors in the pathogenesis of OA.

Profile of motorcycle victims from the emergency service of a university hospital

Abstract: OBJECTIVE: Epidemiological survey of motorcycle accidents occurring in a city with over one million inhabitants and treated at university hospital of reference between the months of July and November 2010. METHODS: Cross sectional study using structured interview (standardized form) to document the data collection: age, gender, income, using time and capacity of the motorcycle. RESULTS: From 114 cases, it was observed that the profile of the victim of motorcycle accident treated at this hospital is a young person, male, possessing a driver's license for less than five years, with a monthly income average around one thousand reais (local currency), owner of a motorcycle with low capacity (less than 150 cc) and low educational attainment. The accidents occurred predominantly in the urban area, in the afternoons and one third of them were considered work-related accidents, death generated in 3 per cent of cases and open fractures in 11 per cent of them. CONCLUSION: The incidence of motorcycle accidents involved mainly young men with little experience in traffic and low level of education.

Anatomical variation of piriformis muscle as a cause of deep gluteal pain: diagnosis using MR neurography and treatment

Abstract: Female patient, 42 years old with a history of low back pain on the left for seventeen years in which the definitive diagnosis of the etiology of pain was evident after the completion of neurography magnetic resonance imaging of the sciatic nerve. In this test it was identified the presence of an anatomical variation in the relationship between the piriformis muscle and sciatic nerve. We discuss details of this imaging technique and its importance in the frames of refractory low back pain. We also describe the treatment given to the case.

Treatment of idiopathic congenital clubfoot using the Ponseti method: ten years of experience

Abstract: OBJECTIVE: To evaluate outcomes of 229 idiopathic clubfeet (ICF) treated using the Ponseti method, from 2001 to 2011, comparing two groups with different follow-ups. METHOD: 155 patients (229 ICF) were treated separated in two groups: Group I: 72 patients (109 ICF - 47.6%) with a follow up of 62 to 128 months (mean of 85). Group II: 83 patients (120 ICF - 52.4%) with a follow up of 4 to 57 months (mean of 33.5). We have considered satisfactory outcomes for cases which correction of all deformed components, without surgery. RESULTS: Mean age for the initial assessment was 5.4 months in Group I and 3.2 in Group II. Satisfactory outcomes were obtained in 85.4% in Group I and 97.5% in Group II. Mean cast placements were 9.5 in Group I and 7 in Group II. 67% were submitted to percutaneous Achilles tenotomy in Group I and 65% in Group II. Deformity relapses, when using abducted braces, occurred in 41 (37.6%) feet from Group I; 11 were treated surgically. In Group II, 17 feet relapsed (14.1%); three of them were submitted to surgery. CONCLUSION: The method was successful in both groups, in low number of complications. The results were statistically superior in Group II when deformity correction, cast placements, relapses and surgery indication.

Estudo epidemiologico das lesoes no futebol profissional durante a Copa America de 2011, Argentina

Abstract: Resumo Objetivo Desenvolver estudo epidemiologico sobre as lesoes ocorridas entre os jogadores profissionais de futebol masculino durante a Copa America de 2011, na Argentina. Metodos Fez-se estudo retrospectivo das lesoes ocorridas durante a 43a edicao da Copa America de Futebol na Argentina, em 2011. As lesoes foram avaliadas pelo departamento medico das selecoes e reportadas a Conmebol. Os dados foram compilados e descritos de acordo com as normas estabelecidas pelo Centro de Pesquisas e Avaliacoes Medicas (F-Marc) da Federation Internationale de Football Association (Fifa) em 2005. Resultados Ocorreu maior prevalencia de lesoes nos membros inferiores, sendo coxas e joelhos os segmentos mais acometidos. Os diagnosticos mais frequentes foram lesoes musculares. As lesoes apresentaram em sua maior parte grau leve de severidade e ocorreu pequena diferenca na prevalencia de lesoes de acordo com as etapas da partida, havendo discreto predominio nos 15 minutos finais. A incidencia de lesoes por 1.000 horas de jogo foi similar a media encontrada na literatura. Conclusoes A analise dos resultados obtidos permitiu tracar um perfil da prevalencia, distribuicao por segmento corporal, minuto em que ocorreram e severidade das lesoes dos jogadores de futebol profissional das selecoes participantes da Copa America de 2011 na Argentina. O maior rigor dos arbitros pode ser em parte atribuido a grande competitividade de torneios internacionais. Entretanto, esses resultados nao podem ser considerados definitivos em virtude da necessidade de ser comparados a outros estudos epidemiologicos de mesmo espectro que usem conceitos e criterios semelhantes.

Footprint do tendão do peitoral maior: estudo anatômico

Abstract: Resumo Objetivo Estudar a insercao do tendao do peitoral maior no umero, por meio do conhecimento de suas dimensoes nos planos coronal e sagital. Metodos Foram dissecados 20 ombros de dez cadaveres frescos (cinco homens e cinco mulheres). Todos os cadaveres encontravam-se em bom estado, sem cicatrizes ou sinais de trauma previos. Fez-se o estudo por meio da via deltopeitoral estendida e foi identificada e isolada a insercao do tendao do peitoral maior no umero. Mensuraram-se as dimensoes do footprint por meio das afericoes com um paquimetro milimetrado, de seus limites de proximal para distal e medial para lateral. Foi aferida a distância da borda superior do tendao do peitoral maior ao apice da cabeca umeral. Resultados Em todos os cadaveres o peitoral maior apresentou uma insercao unica. O comprimento medio de proximal para distal foi de 80,8 mm (70-90) e de lateral para medial de 6,1 mm (5-7). Ja a distância media do apice do tendao do peitoral maior ao apice da cabeca umeral foi de 59,3 mm (55-64). Conclusoes O tendao do musculo peitoral maior apresenta insercao laminar. O footprint tem a altura e a largura media de 80,8 mm e 6,1 mm, respectivamente.

Enxerto ideal para ligamento cruzado anterior: correlação em ressonância magnética entre LCA, isquiotibiais, tendão patelar e tendão quadríceps

Abstract: Resumo Objetivos Mensurar em exames de ressonância magnetica (RM) o tamanho da origem, a insercao e o comprimento do ligamento cruzado anterior (LCA) e seus possiveis enxertos para cirurgia de reconstrucao em caso de lesao Alem desse, fez-se o cruzamento estatistico entre os dados para testar a hipotese de relacao proporcional entre essas medidas anatomicas Materiais e metodos Foram feitos 52 exames de RM entre 2008 e 2011 e avaliados de maneira aleatoria em um estudo epidemiologico longitudinal retrospectivo Para a mensuracao da largura do LCA foi usado o corte coronal obliquo, para o comprimento o corte sagital, para a insercao tibial o corte coronal e para a insercao femural o corte coronal obliquo Resultados O diâmetro medio do LCA foi de 4,80 mm (3,1-8,3 mm) e o comprimento de 3,8 cm (2,85-4,5 cm) A origem variou entre 9,7 mm e 15,4 mm A insercao media na tibia foi de 13,3 mm O diâmetro medio do semitendineo foi de 4,38 mm e o diâmetro medio do gracil de 3,42 mm O quadriceps apresentou diâmetro de 7,67 mm e comprimento de 35,34 mm e o tendao patelar 4,54 mm de diâmetro e 26,62 mm de comprimento medio Conclusao Os dados obtidos fornecem informacoes pre-operatorias importantes para o cirurgiao, facilitam o planejamento pre-operatorio, apresentam opcoes viaveis e evitam enxertos inadequados

Epidemiological study on professional football injuries during the 2011 Copa America, Argentina

Abstract: OBJECTIVE: Develop an epidemiological study of injuries occurred among male professional football players during the Copa America 2011, held in Argentina. METHODS: We conducted a retrospective study of injuries sustained during the 43rd edition of the Copa America football in Argentina, in 2011. The lesions were evaluated by the medical department of the selections and reported to the CONMEBOL. The data were compiled and reported in accordance with rules established by the FIFA Medical Assessment and Research Centre (F-MARC) in 2005. RESULTS: There was a higher prevalence of lesions in the lower limbs. Thighs and knees were the most affected segments. The most frequent diagnoses were muscle injuries. The injuries were mostly minor degrees of severity and there was little difference in the prevalence of lesions according to the stages of the match, with slight predominance in the final 15 minutes. The incidence of lesions per 1,000 game hours was similar to the average found in the literature. CONCLUSIONS: The results obtained allowed us to outline a profile of the prevalence, distribution per body segment, minute in which occurred and severity of injuries in professional football players of participating teams in the Copa America 2011 in Argentina. The extreme rigor of referees may be partly attributed to the highly competitive nature of international tournaments. However, this results cannot be considered definitive because of the need to be compared to other epidemiological studies with same design using similar concepts and criteria.

Perfil de vítima de acidente motociclístico na emergência de um hospital universitário

Abstract: Resumo Objetivo Fazer levantamento epidemiologico dos acidentes motociclisticos ocorridos em cidade com mais de um milhao de habitantes e atendidos em hospital universitario de referencia entre julho e novembro de 2010 Metodos Estudo transversal com o uso de entrevista estruturada (formulario padronizado) para documentar a coleta de dados: idade, sexo, renda mensal, tempo de uso e cilindrada da moto Resultados A partir de 114 casos, foi observado que o perfil do paciente atendido no hospital em estudo, vitima de acidente motociclistico, e de um individuo jovem, do sexo masculino, possuidor de carteira de habilitacao ha menos de cinco anos, com renda mensal media em torno de mil reais, possuidor de moto de baixa cilindrada (menos do que 150 cc) e baixa escolaridade Os acidentes atendidos ocorreram predominantemente no perimetro urbano, no periodo da tarde, e um terco deles foi considerado acidente de trabalho, que gerou obito em 3% dos casos e fraturas expostas em 11% deles Conclusao A incidencia de acidentes motociclisticos envolveu predominantemente homens jovens com pouca experiencia no trânsito e baixo nivel de instrucao

ACL ideal graft: MRI correlation between ACL and humstrings, PT and QT

Abstract: OBJECTIVE: The objective of this study was to measure in MRI scans, the size of the origin, insertion and length of the anterior cruciate ligament and possible graft for reconstruction surgery in case of injury. Besides this, there was a cross between statistical data to test the hypothesis of proportional relationship between these anatomical extent. MATERIALS AND METHODS: 52 MRI examinations performed between 2008 and 2011 were valued at random in a longitudinal retrospective epidemiological study. To measure the width of the ACL was used coronal oblique to the length of the sagittal section, for inserting the tibial coronal femoral insertion and was also used oblique coronal section. RESULTS: The average diameter of the ACL was 4.80 mm (3.1-8.3 mm), with a length of 3.8 cm (2.85-4.5 cm). The origin ranged from 9.7 mm to 15.4 mm. The average insertion on the tibia was 13.3 mm. The average diameter of the semi-tendinous was 4.38 mm and the average diameter was 3.42 mm gracilis. The quadriceps presented diameter of 7.67 mm, a length of 35.34 mm and 4.54 mm patellar tendon diameter and 26.62 mm in average length. CONCLUSION: These data provide important information for the pre-operative surgeon, facilitating preoperative planning and providing viable alternatives and avoiding inadequate grafts.

The WHO Surgical Safety Checklist: knowledge and use by Brazilian orthopedists

Abstract: Objective: The research examined Brazilian orthopedists' degree of knowledge of the World Health Organization Surgical Safety Checklist. Methods: A voluntary survey was conducted among the 3231 orthopedists taking part in the 44th Brazilian Congress of Orthopedics and Traumatology in November 2012, using a questionnaire on the use of WHO Surgical Safety Checklist. A statistical analysis was done upon receipt of 502 completed questionnaires. Results: Among the 502 orthopedists, 40.8% reported the experience of wrong site or wrong patient surgery and 25.6% of them indicated "miscommunication" as the main cause for the error. 35.5% of the respondents do not mark the surgical site before sending the patient to the operating room and 65.3% reported lack of knowledge of the World Health Organization (WHO) Surgical Safety Checklist, fully or partially. 72.1% of the orthopedists have never been trained to use this protocol. Discussion: Medical errors are more common in the surgical environment and represent a high risk to patient safety. Orthopedic surgery is a high volume specialty with major technical complexity and therefore with increased propensity for errors. Most errors are avoidable through the use of the WHO Surgical Safety Checklist. The study showed that 65.3% of Brazilian orthopedists are unaware of this protocol, despite the efforts of WHO for its disclosure.

Hamstring tendons insertion - an anatomical study

Abstract: OBJECTIVE: To study the anatomy of the hamstring tendons insertion and anatomical rela-tionships. METHODS: Ten cadaver knees with medial and anterior intact structures were selected. The dissection was performed from anteromedial access to exposure of the insertion of the flexor tendons (FT), tibial plateau (TP) and tibial tuberosity (TT). A needle of 40 × 12 and a caliper were used to measure the distance of the tibial plateau of the knee flexor tendons insertion at 15 mm from the medial border of the patellar tendon and tibial tuberosity to the insertion of the flexor tendons of the knee. The angle between tibial plateau and the insertion of the flexor tendons of the knee (A-TP-FT) was calculated using Image Pro Plus software. RESULTS: The mean distance TP-FT was 41 ± 4.6 mm. The distance between the TT-FT was 6.88 ± 1 mm. The (A-TP-FT) was 20.3 ± 4.9°. CONCLUSION: In the anterior tibial flexor tendons are about 40 mm from the plateau with an average of 20°.

The pectoralis major footprint: An anatomical study

Abstract: Objective To study the insertion of the pectoralis major tendon to the humerus, through knowledge of its dimensions in the coronal and sagittal planes. Methods Twenty shoulders from 10 cadavers were dissected and the pectoralis major tendon insertion on the humerus was identified and isolated. The dimensions of its “footprint” (proximal to distal and medial to lateral borders) and the distance from the top edge of the pectoralis major tendon to apex of the humeral head structures were measured. Results The average proximal to distal border length was 80.8 mm (range: 70–90) and the medial-to-lateral border length was 6.1 mm (5–7). The average distance (and range) from the apex of the pectoralis major tendon to the humeral head was 59.3 mm. Conclusions We demonstrate that the insertion of the pectoralis major tendon is laminar, and the pectoralis major tendon has an average footprint height and width of 80.8 mm and 6.1 mm, respectively.

Estudo anatômico da inserção dos tendões flexores do joelho

Abstract: Resumo Objetivo Determinar parâmetros anatomicos para localizar a insercao dos tendoes flexores do joelho na tibia. Metodos Foram selecionados 10 joelhos de cadaveres com estruturas mediais e anteriores integras. A disseccao foi feita por acesso ântero-medial ate a exposicao adequada da insercao dos tendoes flexores (TF), do planalto tibial (PT) e da tuberosidade anterior da tibia (TAT). Uma agulha 40×12 e um paquimetro digital foram usados para aferir a distância do planalto tibial da insercao dos tendoes flexores do joelho a 15 mm da borda medial ao tendao patelar e da tuberosidade anterior da tibia a insercao dos tendoes flexores do joelho. O ângulo formado entre o planalto tibial e a insercao dos tendoes flexores do joelho (Â PT-TF) foi calculado com o auxilio do software ImagePro Plus®. Resultados A distância PT-TF foi de 41 ± 4,6 mm em media. A distância entre a TAT-TF foi de 6,88 ± 1 mm. A angulacao (Â PT-TF) foi de 20,3 ± 4,9 graus. Conclusao Na regiao anterior da tibia os tendoes flexores estao a cerca de 40 mm do planalto com um ângulo medio de 20 graus.

Amputation after failure or complication of total knee arthroplasty: prevalence, etiology and functional outcomes

Abstract: OBJECTIVE: Identify the etiology and incidence, as well to assess functional outcomes of patients, undergoing lower limb amputation after failure or complication of total knee arthroplasty. These patients were treated at the Center for Knee Surgery at the National Institute of Traumatology and Orthopedics (INTO), during the period of January 2001 to December 2010. METHODS: The patients were interviewed and their charts were retrospectively analyzed to evaluate their functional outcome. RESULTS: The incidence of amputation due to failure or complication of total knee arthroplasty was 0.41% in 2409 cases. Recurrent deep infection was the cause of amputation in 81% of cases, being Staphylococcus aureus and Pseudomonas aeruginosa the most frequent germs. Vascular complications and periprosthetic fracture associated to metaphyseal bone loss were also causes of amputation. In our study, 44% of amputees patients were using orthesis and 62.5% have had the ability to walk. CONCLUSION: Incidence of 0.41%, being the main cause recurrent infection. The functional outcome is limited, and the fitting achieved in 44% of patients and only 62.5% are ambulatory.

Estudo anatomico da insercao dos tendoes flexores do joelho

Abstract: Resumo Objetivo Determinar parâmetros anatomicos para localizar a insercao dos tendoes flexores do joelho na tibia. Metodos Foram selecionados 10 joelhos de cadaveres com estruturas mediais e anteriores integras. A disseccao foi feita por acesso ântero-medial ate a exposicao adequada da insercao dos tendoes flexores (TF), do planalto tibial (PT) e da tuberosidade anterior da tibia (TAT). Uma agulha 40×12 e um paquimetro digital foram usados para aferir a distância do planalto tibial da insercao dos tendoes flexores do joelho a 15 mm da borda medial ao tendao patelar e da tuberosidade anterior da tibia a insercao dos tendoes flexores do joelho. O ângulo formado entre o planalto tibial e a insercao dos tendoes flexores do joelho (Â PT-TF) foi calculado com o auxilio do software ImagePro Plus®. Resultados A distância PT-TF foi de 41 ± 4,6 mm em media. A distância entre a TAT-TF foi de 6,88 ± 1 mm. A angulacao (Â PT-TF) foi de 20,3 ± 4,9 graus. Conclusao Na regiao anterior da tibia os tendoes flexores estao a cerca de 40 mm do planalto com um ângulo medio de 20 graus.

Luxacao do joelho: estudo descritivo das lesoes

Abstract: Resumo Objetivo Descrever as lesoes ligamentares e associadas ocorridas nas luxacoes traumaticas do joelho, relaciona-las aos mecanismos de trauma e identificar padroes de lesoes Metodos Foram descritas 23 luxacoes do joelho entre marco de 2010 e marco de 2011 Apos o diagnostico das lesoes, foi procedida a reducao e fixacao externa transarticular das luxacoes Num segundo tempo, os pacientes foram avaliados sob anestesia e a exploracao cirurgica das lesoes perifericas foi feita pelos membros do grupo de cirurgia do joelho da instituicao Os dados dos pacientes, junto com as descricoes das lesoes encontradas, foram registrados Resultados 65% dos pacientes eram do sexo masculino, a media de idade foi de 35 anos, o mecanismo de trauma mais comum foi o acidente com motocicleta (60%) A lesao do ligamento cruzado anterior (LCA) ocorreu em 75% dos casos, a lesao do ligamento cruzado posterior (LCP) em 95% A lesao periferica medial aconteceu em 65% das luxacoes e as lesoes laterais em 40% As luxacoes mais comuns foram as classificadas como KDI (25%) e KDIIIm (25%) A lesao arterial esteve presente em 15% dos casos e a lesao nervosa foi registrada em um paciente (5%) Na avaliacao radiografica inicial, 45% das luxacoes apresentavam-se reduzidas Conclusao As luxacoes do joelho descritas apresentaram grande variabilidade, demonstrando que e preciso a avaliacao individualizada de cada caso, sendo que o ortopedista precisa estar apto para o reconhecimento e tratamento especificos dessas diversas lesoes

Evaluation of blood loss after early or late release of ischemia in patients undergoing total knee replacement

Abstract: OBJECTIVE: compare blood loss in 40 patients underwent to unilateral total knee replacement with the release of ischemia before and after skin closure and compressive dressing. METHODS: in a prospective randomized study, in 40 patients underwent to total knee replacement, dividing then into two groups: group A in which the ischemia was released before skin closure, allowing bleeding control and group B where the ischemia was released after skin suture and pressure dressing. We compared the results of laboratory tests of serum hemoglobin before surgery and 48 hours postoperatively, the blood volume contained in vacuum suction drain and the transfusions that was necessary. RESULTS: As a result, the post operative serum hemoglobin levels had a mean decrease of 3.57 g/dL in group A and 4.24 g/dL in group B with an average of 0.67g/dL difference between them, statistically insignificant.The observed mean drainage, in the vacuum drain, were 705 mL in group A and 700 mL in group B. The 5ml difference between medians was considered statistically insignificant. The number of patients who received transfusions was four patients in both groups and all received two units of red blood cells. CONCLUSION: the post operative serum hemoglobin levels, as well as the need of blood transfusion, in the patient underwent to total knee replacement, where the ischemia was released before wound closure, has no statistical effect in comparison with patients where the sutures and bandages were done after the ischemia release. Level of Evidence IB - Individual randomized controlled trial with narrow confidence interval.

Tratamento do pé torto congênito idiopático pelo método de Ponseti: 10 anos de experiência

Abstract: Resumo Objetivo : Avaliar os resultados do tratamento de 229 pes tortos congenitos idiopaticos (PTC) pelo metodo de Ponseti, de 2001 a 2011, com a comparacao de dois grupos com diferentes tempos de seguimento Metodos : Foram tratados 155 pacientes (229 PTC) divididos em dois grupos: Grupo I: 72 pacientes (109 PTC – 47,6%) com seguimento de 62 a 128 meses (media de 85) Grupo II: 83 pacientes (120 PTC – 52,4%) com seguimento de quatro a 57 meses (media de 33,5) Consideramos resultados satisfatorios para casos que apresentaram correcao de todos os componentes da deformidade sem necessidade de cirurgias Resultados : A idade media ao inicio do tratamento foi de 5,4 meses no grupo I e 3,2 no grupo II Os resultados foram satisfatorios em 85,4% dos pes no grupo I e em 97,5% no grupo II A media do numero de gessos trocados foi de 9,5 no grupo I e de sete no grupo II Fizemos a tenotomia percutânea do calcâneo em 67% dos pes do grupo I e 65% do grupo II A recidiva das deformidades, quando do uso da ortese de abducao, ocorreu em 41 (37,6%) pes do grupo I; desses, 11 foram operados No grupo II, recidivaram 17 (14,1%) pes; desses, tres evoluiram para cirurgia Conclusao : O metodo foi eficaz em ambos os grupos, com baixo numero de complicacoes Os resultados foram estatisticamente superiores no grupo II quando analisados correcao das deformidades, numero de gessos, recidivas e indicacao cirurgica

Avaliacao da perda sanguinea apos a liberacao precoce ou tardia da isquemia em pacientes submetidos a artroplastia total do joelho

Abstract: Resumo Objetivo: Avaliar comparativamente a perda sanguinea em pacientes submetidos a artroplastia total do joelho, com liberacao da isquemia antes e apos suturas e curativo compressivo. Metodos: Fez-se um estudo prospectivo randomizado em 40 pacientes submetidos a artroplastia total do joelho divididos em dois grupos. No primeiro grupo a isquemia foi liberada antes do fechamento da ferida operatoria, o que permitiu o controle do sangramento. No segundo a isquemia foi liberada apos suturas e curativo compressivo. Foram comparados os resultados dos niveis de hemoglobina serica antes da cirurgia e em 48 horas do pos-operatorio, o volume sanguineo contido no dreno de succao a vacuo nesse periodo e a quantidade de transfusoes de sangue que foram necessarias. Resultados: Os niveis de hemoglobina pos-operatoria tiveram uma diminuicao media de 3,57g⧸dL no grupo A e de 4,24g⧸dL no grupo B, consideradas estatisticamente insignificantes (p = 0,23). Quatro pacientes nos dois grupos receberam duas unidades de concentrado de hemacias, sendo a diferenca entre as medias drenado foram considerados estatisticamente insignificantes, para os grupos estudados. Conclusao: A concentracao de hemoglobina serica pos-operatoria, bem como a necessidade de hemoderivados, nos pacientes submetidos a artroplastia total do joelho, na qual a liberacao da isquemia foi deflagrada antes do fechamento da ferida operatoria, nao tem significância estatistica quando comparada com a dos pacientes em que essa liberacao foi feita apos suturas e cultivado. Nivel de evidencia IB - Ensaio clinico controlado e rendomizado com intervalo de confianca estreito.

There have been changes in the incidence and epidemiology of pelvic ring fractures in recent decades

Abstract: The pelvic ring fractures comprise 2 -8% of all skeletal injuries. As the incidence rises to 25% in polytrauma and represents a negative prognostic factor with regard to morbidity and mortality of patients, we sought with this work to establish the profile of these, compared to an alteration in the profile of patients with pelvic ring fractures in recent decades. To this end, we evaluated the epidemiological profile, mechanism of injury and types of fractures. By reviewing the literature indexed in the databases related to the theme, 20 papers were selected that contained the requirements for the study. For the period between January 1987 and December 1999 (first decade), and another period in January 2000 and December 2010 (second decade), data were analyzed by Mann -Whitney test. The ratings Tile, Young and Burgess AO were adequate to permit their categorization. The research in each decade was homogeneous. At first the lesions were more prevalent in men with 62.5% with a tendency to reverse this pattern given the increase of women in the second decade (p = 0.286). The average age in the first decade was 39.3 years, an increase in the second (p = 0.068). The most prevalent mechanisms of trauma were related to traffic in both periods as well as fractures classified as type A (p = 0.203 and p = 0.457, respectively), having mortality rates decreased (p = 0.396). We conclude that there was a tendency to increase in the average age of patients (p = 0.068); however the increasing involvement of women (p = 0.286) and decreased mortality (p = 0.396) were not significant.

Injury of the knee ligaments associated with ipsilateral femoral shaft fractures

Abstract: OBJECTIVE: With the objective of identifying the incidence of ipsilateral knee ligament injury, thirty-six patients with femoral shaft fractures were evaluated METHODS: During the osteosynthesis procedure to repair the femur while under anesthesia, all patients underwent a physical examination and X-ray examination RESULTS: The most common mechanism of injury observed was motorcycle accidents Of the thirty-six patients that were studied, eleven patients (305%) had a knee ligament injury Of the eleven patients, 64% had a cruciate ligament injury The ligament injury was not treated at the time of the osteosynthesis procedure CONCLUSION: We highlight the difficulty of diagnosis at the time of admission and the need for systematic physical examination before and after surgical treatment of femoral fracture

Knee dislocation: descriptive study of injuries

Abstract: OBJECTIVE: Describe the ligamentous and associated injuries that occur in the traumatic knee dislocation, relating them to the mechanisms of trauma and to identify patterns of injuries. METHODS: Twenty three knee dislocations were described in the period between March 2010 and March 2011. After the diagnosis of the lesions, the reduction and transarticular external fixation of the dislocated knees were done. At the second moment, the patients were evaluated with physical examination under anesthesia and the surgical exploration of peripheral lesions was perfomed by a surgeon of the knee surgery group of this institution.The patients data with the description of the injuries were found and registered. RESULTS: 65% of patients were male, the average age was 35 years and the most common mechanism of trauma was the motorcycle accident (60%). The lesion of the anterior cruciate ligament (ACL) occurred in 75% of the cases, and the lesion of posterior cruciate ligament (PCL) in 95%. The medial peripheral injuries happened in 65% of the dislocations, and the lateral lesions in 40%. The most common dislocations were classified as KDI (25%) and as KDIIIm (25%). The arterial injury was present in 15% of the cases, and the nervous injury where registered in one patient (5%). At the initial radiographic evaluation, 45% of the dislocations presented reduced. CONCLUSION: The characteristics of the knee dislocations described showed a great range of variability demonstrating that an individualized evaluation of each case is mandatory. The surgeon should be able to recognize and choose the correct treatment to these lesions.

Uso de glucosamina e condroitina no tratamento da osteoartrose: uma revisao da literatura

Abstract: Resumo Avaliar evidencias que apoiem ou refutem o uso de glucosamina e condroitina no tratamento de pacientes com osteoartrose Foi feita uma revisao da literatura com o uso dos bancos de dados Medline, Pubmed e Cochrane Controlled Trial Register e Cochrane Databases Systematic Reviews (Cochrane Library) Foram considerados apenas estudos com elevado nivel de evidencias O estudo incluiu a analise de ensaios clinicos randomizados que incluiram pelo menos 100 pacientes em cada grupo de intervencao, metanalises e revisoes sistematicas Sete metanalises, uma revisao sistematica e cinco ensaios clinicos randomizados preencheram os criterios de inclusao desta revisao Frente as melhores evidencias existentes ate o momento, o uso da glucosamina sulfatada/hidrocloridrica e da condroitina nao produz beneficios clinicamente relevantes em pacientes com osteoartrose do joelho e do quadril (nivel de evidencia I e grau de recomendacao A) Futuros estudos com metodologia adequada sao necessarios para elucidacao dessa questao