Revista Brasileira de Ortopedia (English Edition)最新文献

{"title":"Anterior fixation of odontoid fractures: results","authors":"João Pedro Ferraz Montenegro Lobo,&nbsp;Vitorino Veludo Moutinho,&nbsp;António Francisco Martingo Serdoura,&nbsp;Carolina Fernandes Oliveira,&nbsp;André Rodrigues Pinho","doi":"10.1016/j.rboe.2017.07.010","DOIUrl":"10.1016/j.rboe.2017.07.010","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the clinical and radiological outcomes of the surgical treatment in patients diagnosed with odontoid fracture who underwent open reduction and internal fixation (ORIF) with screws.</p></div><div><h3>Methods</h3><p>This was a retrospective study with nine patients. Pain (visual analog scale [VAS]) and neurological status (Frankel scale) were assessed. The neck disability index (NDI) and the post-operative cervical range of motion were calculated. The cervical spine was radiologically evaluated (X-ray and CT) pre- and postoperatively.</p></div><div><h3>Results</h3><p>The mean age of patients was 70 years. All patients presented type IIb (Grauer classification) fractures, with a mean deviation of 2.95<!--> <!-->mm. Two patients had subaxial lesions. The mean follow-up was 30 months. The mean time from trauma to surgery was seven days. The pre-operative Frankel score was E in all except one patient (B), in whom a post-operative improvement from B to D was observed. Post-operative pain was 2/10 (VAS). A total of 77% of patients presented a mild or moderate disability (NDI). Six patients regained full range of cervical movement, and bone union required approximately 14 weeks. Pseudarthrosis complications were observed in two patients (77% union rate), one patient presented screw repositioning and one case, dysphonia.</p></div><div><h3>Conclusion</h3><p>Delayed diagnosis is still an issue in the treatment of odontoid fractures, especially in elderly patients. Concomitant lesions, especially in younger patients, are not uncommon. The literature presents high fusion rates with ORIF (≥80%), which was also observed in the present study. However, surgical success depends on proper patient selection and strict knowledge of the technique. This pathology presents a reserved functional prognosis in the medium-term, especially in the elderly.</p></div>","PeriodicalId":101095,"journal":{"name":"Revista Brasileira de Ortopedia (English Edition)","volume":"53 5","pages":"Pages 532-536"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rboe.2017.07.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36517638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the role of core decompression in the early stages of osteonecrosis of the femoral head? Evaluation of the surgical result by functional score and radiological follow-up","authors":"Helder de Souza Miyahara,&nbsp;Bruno Berbert Rosa,&nbsp;Fabio Yuiti Hirata,&nbsp;Henrique de Melo Campos Gurgel,&nbsp;Leandro Ejnisman,&nbsp;José Ricardo Negreiros Vicente","doi":"10.1016/j.rboe.2018.07.013","DOIUrl":"10.1016/j.rboe.2018.07.013","url":null,"abstract":"<div><h3>Objectives</h3><p>This study is aimed at evaluating whether core decompression of the femoral head in the early stages of femoral head osteonecrosis improves patients’ subjective perception of pain and avoids the progression of the disease to a femoral head collapse and a final indication of total hip arthroplasty.</p></div><div><h3>Methods</h3><p>Eighteen patients (30 hips) in the early stages of the disease (Ficat and Arlet 1 and 2A) were evaluated through clinical, radiological, risk factor maintenance, and by the functional Merle D’Aubigné, and Postel score before and after core decompression of the femoral head.</p></div><div><h3>Results</h3><p>There was an improvement of symptoms up to the sixth month in 83.3% of the hips evaluated through the Merle D’Aubigné and Postel score. However, 73.3% of the cases evolved with femoral head collapse, and in 50%, total hip arthroplasty was indicated regardless of whether or not the risk factors were maintained.</p></div><div><h3>Conclusions</h3><p>Core decompression of the femoral head improves patients’ pain early in the initial stages of the pathology. However, it does not alter the prognosis and the ultimate indication of total hip arthroplasty in the final stages of the disease.</p></div>","PeriodicalId":101095,"journal":{"name":"Revista Brasileira de Ortopedia (English Edition)","volume":"53 5","pages":"Pages 537-542"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rboe.2018.07.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36517552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbidities, clinical intercurrences, and factors associated with mortality in elderly patients admitted for a hip fracture","authors":"Stephanie Victoria Camargo Leão Edelmuth,&nbsp;Gabriella Nisimoto Sorio,&nbsp;Fabio Antonio Anversa Sprovieri,&nbsp;Julio Cesar Gali,&nbsp;Sonia Ferrari Peron","doi":"10.1016/j.rboe.2018.07.014","DOIUrl":"10.1016/j.rboe.2018.07.014","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze comorbidities and clinical complications, and to determine the factors associated with mortality rates of elderly patients admitted with a hip fracture in a tertiary public hospital.</p></div><div><h3>Methods</h3><p>Sixty-seven medical records were reviewed in a retrospective cohort study, including patients equal to or older than 65 years admitted to this institution for hip fracture between January 2014 and December 2014. The evaluated items constituted were the following: interval of time between fracture and hospital admission, time between admission and surgical procedure, comorbidities, clinical complications, type of orthopedic procedure, surgical risk, cardiac risk, and patient outcome.</p></div><div><h3>Results</h3><p>The average patients’ age in the sample was 77.6 years, with a predominance of the female gender. Most patients (50.7%) had two or more comorbidities. The main clinical complications during hospitalization included cognitive behavioral disorders, respiratory infection and of the urinary tract. The times between fracture and admission and between admission and surgery were more than seven days in most of cases. The mortality rate during hospitalization was 11.9%, and was directly connected to the presence of infections during hospital stay (<em>p</em> <!-->=<!--> <!-->0.006), to time between admission and surgery longer than seven days (<em>p</em> <!-->=<!--> <!-->0.005), to the Goldman Cardiac Risk Index class <span>III</span> (<em>p</em> <!-->=<!--> <!-->0.008), and to age equal to or greater than 85 years (<em>p</em> <!-->=<!--> <!-->0.031).</p></div><div><h3>Conclusion</h3><p>Patients with hip fractures generally present comorbidities, are susceptible to clinical complications, and have an 11.9% mortality rate.</p></div>","PeriodicalId":101095,"journal":{"name":"Revista Brasileira de Ortopedia (English Edition)","volume":"53 5","pages":"Pages 543-551"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rboe.2018.07.014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36517553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior interosseous nerve: anatomical study and clinical implications","authors":"Edie Benedito Caetano ,&nbsp;Luiz Angelo Vieira ,&nbsp;João José Sabongi Neto ,&nbsp;Maurício Benedito Ferreira Caetano ,&nbsp;Rodrigo Guerra Sabongi","doi":"10.1016/j.rboe.2018.07.010","DOIUrl":"10.1016/j.rboe.2018.07.010","url":null,"abstract":"<div><h3>Objective</h3><p>The goal of this study was to describe anatomical variations and clinical implications of anterior interosseous nerve. In complete anterior interosseous nerve palsy, the patient is unable to flex the distal phalanx of the thumb and index finger; in incomplete anterior interosseous nerve palsy, there is less axonal damage, and either the thumb or the index finger are affected.</p></div><div><h3>Methods</h3><p>This study was based on the dissection of 50 limbs of 25 cadavers, 22 were male and three, female. Age ranged from 28 to 77 years, 14 were white and 11 were non-white; 18 were prepared by intra-arterial injection of a solution of 10% glycerol and formaldehyde, and seven were freshly dissected cadavers.</p></div><div><h3>Results</h3><p>The anterior interosseous nerve arose from the median nerve, an average of 5.2<!--> <!-->cm distal to the intercondylar line. In 29 limbs, it originated from the nerve fascicles of the posterior region of the median nerve and in 21 limbs, of the posterolateral fascicles. In 41 limbs, the anterior interosseous nerve positioned between the humeral and ulnar head of the pronator teres muscle. In two limbs, anterior interosseous nerve duplication was observed. In all members, it was observed that the anterior interosseous nerve arose from the median nerve proximal to the arch of the flexor digitorum superficialis muscle. In 24 limbs, the branches of the anterior interosseous nerve occurred proximal to the arch and in 26, distal to it.</p></div><div><h3>Conclusion</h3><p>The fibrous arches formed by the humeral and ulnar heads of the pronator teres muscle, the fibrous arch of the flexor digitorum superficialis muscle, and the Gantzer muscle (when hypertrophied and positioned anterior to the anterior interosseous nerve), can compress the nerve against deep structures, altering its normal course, by narrowing its space, causing alterations longus and flexor digitorum profundus muscles.</p></div>","PeriodicalId":101095,"journal":{"name":"Revista Brasileira de Ortopedia (English Edition)","volume":"53 5","pages":"Pages 575-581"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rboe.2018.07.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36517557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New quantitative method to measure the Hill-Sachs lesion: validation of Hardy's radiographic method for MRI/AMRI","authors":"Flávio de Oliveira França ,&nbsp;André Godinho ,&nbsp;Elisio Ribeiro ,&nbsp;Abel Ranzzi ,&nbsp;Brício Lima Lobão Bittencourt ,&nbsp;Bruno Brum Barreto","doi":"10.1016/j.rboe.2018.07.012","DOIUrl":"10.1016/j.rboe.2018.07.012","url":null,"abstract":"<div><h3>Objective</h3><p>To validate Hardy's radiographic method for magnetic resonance imaging/magnetic resonance arthrography (MRI/MRA) in the assessment of Hill-Sachs lesion (HSL) involvement in patients with a history of anterior shoulder instability.</p></div><div><h3>Methods</h3><p>This study retrospectively evaluated 53 shoulder radiographs and MRI/MRA to compare the measurements of HSL through Hardy's radiographic method. Imaging exams used in the study were conducted between the March 2013 AND September 2015. The data obtained from these exams were carried out during 2015. Inclusion criteria were previous history of anterior instability of the shoulder, presence of LHS, and radiographs at 70° medial rotation.</p></div><div><h3>Results</h3><p>MRI/MRA had a sensitivity of 100% and specificity of 100% when using the Hardy's radiographic method 20% cutoff point to measure the HSL.</p></div><div><h3>Conclusion</h3><p>MRI/MRA can be used to assess the degree of HSL involvement with the same reliability as Hardy's radiographic method.</p></div>","PeriodicalId":101095,"journal":{"name":"Revista Brasileira de Ortopedia (English Edition)","volume":"53 5","pages":"Pages 589-594"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rboe.2018.07.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36525463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of three-dimensional prototyping in planning the treatment of proximal humerus bone deformities","authors":"Fernando Carlos Mothes ,&nbsp;Almiro Britto ,&nbsp;Fábio Matsumoto ,&nbsp;Marco Tonding ,&nbsp;Rafael Ruaro","doi":"10.1016/j.rboe.2018.07.016","DOIUrl":"10.1016/j.rboe.2018.07.016","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the use of three-dimensional prototyping or rapid prototyping in acrylic resin to create synthetic three-dimensional models in order to promote the understanding of bone deformities of the shoulder.</p></div><div><h3>Methods</h3><p>Five patients were analyzed between ages of 11 and 73 years old, treated between 2008 and 2013 with glenohumeral deformities that required a more thorough review of the anatomical alterations, for whom three-dimensional prototyping was performed.</p></div><div><h3>Results</h3><p>Patient 1 was treated conservatively and is awaiting humeral head arthroplasty if symptoms get worse. Patient 2 underwent a valgus proximal humerus osteotomy secured with pediatric locked hip plate according to a prior assessment with prototyping. Patient 3 underwent a disinsertion of the rotator cuff, tubercleplasty and posterior reinsertion of the rotator cuff. Patient 4 underwent an arthroscopic step-off resection, 360-degree capsulotomy, and tenolysis of the subscapularis. Patient 5 underwent a reverse shoulder arthroplasty with an L-shaped bone graft on the posterior glenoid.</p></div><div><h3>Conclusions</h3><p>Rapid prototyping in acrylic resin allows a better preoperative planning in treatment of bone deformities in the shoulder, minimizing the risk of intraoperative complications in an attempt to improve the results.</p></div>","PeriodicalId":101095,"journal":{"name":"Revista Brasileira de Ortopedia (English Edition)","volume":"53 5","pages":"Pages 595-601"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rboe.2018.07.016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36528841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral condyle osteochondral fracture treated with bone suture after acute patellar dislocation: a case report","authors":"Camila Maftoum Cavalheiro ,&nbsp;Riccardo Gomes Gobbi ,&nbsp;Betina Bremer Hinckel ,&nbsp;Marco Kawamura Demange ,&nbsp;José Ricardo Pécora ,&nbsp;Gilberto Luis Camanho","doi":"10.1016/j.rboe.2017.04.008","DOIUrl":"10.1016/j.rboe.2017.04.008","url":null,"abstract":"<div><p>Osteochondral fracture after acute patellar dislocation in teenagers is relatively common (up to 60% of cases of patellar dislocation), but poorly diagnosed. There are several treatments proposed for this type of injury, but none well defined in the literature.</p><p>A male patient, 13 years old, with a diagnosis of osteochondral fracture of the lateral femoral condyle after acute dislocation of the right patella. He underwent surgical treatment of the chondral injury, which consisted of suturing of the chondral fragment to the cartilage defect and, in a second approach, reconstruction of the medial patellotibial ligament and medial patellofemoral ligament with autologous flexor graft. Currently, the patient has been followed up for 16 months postoperatively for the suture of the chondral fragment and for 8 months for the ligament reconstruction. He has been evaluated through functional scores and T2 weighted magnetic resonance imaging. Acute fixation through direct bone suturing of a purely chondral fragment can be considered in special situations.</p></div>","PeriodicalId":101095,"journal":{"name":"Revista Brasileira de Ortopedia (English Edition)","volume":"53 5","pages":"Pages 636-642"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rboe.2017.04.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36528842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trans-scaphoid perilunate fracture dislocation beyond Mayfield stage IV: a case report on a new classification proposal","authors":"Antonio Lourenço Severo,&nbsp;Marcelo Barreto Lemos,&nbsp;Tomas Araújo Prado Pereira,&nbsp;Rulby Deisy Puentes Fajardo,&nbsp;Philipe Eduardo Carvalho Maia,&nbsp;Osvandré Lech","doi":"10.1016/j.rboe.2017.05.008","DOIUrl":"10.1016/j.rboe.2017.05.008","url":null,"abstract":"<div><p>This report and review of the literature aims to recognize the complete enucleation beyond stage IV of the classification proposed by Mayfield. The addition of a fifth category is proposed, added for complete ligament injuries that lead to nonexistent circulation for the radiolunate ligament, preventing surgical reconstruction, thus influencing surgical treatment.</p></div>","PeriodicalId":101095,"journal":{"name":"Revista Brasileira de Ortopedia (English Edition)","volume":"53 5","pages":"Pages 643-646"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rboe.2017.05.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36528845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total hip revision arthroplasty of high-risk pelvic vascular injury associated with an endovascular approach: a case report","authors":"Rafael Leite de Pinho Tavares,&nbsp;Elias Arcenio Neto,&nbsp;Walter Taki","doi":"10.1016/j.rboe.2018.07.002","DOIUrl":"10.1016/j.rboe.2018.07.002","url":null,"abstract":"<div><p>Vascular injury during a revision total hip revision arthroplasty surgery is an uncommon event; nonetheless, it is recognized as an intraoperative complication. Preoperative planning becomes imperative in such cases, especially when there is a conflict between the implanted material and the iliac vessels. Usually an ilioinguinal approach is used to identify the vascular structures at risk and isolate them from the prosthetic components, which increases the duration and morbidity of the procedure for the patient. The article describes a less invasive alternative approach to prevent intraoperative arterial injury. The patient was informed that the data related to her case would be submitted for publication and signed an informed consent form.</p></div>","PeriodicalId":101095,"journal":{"name":"Revista Brasileira de Ortopedia (English Edition)","volume":"53 5","pages":"Pages 626-631"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rboe.2018.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36528839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asian ethnicity: a risk factor for adhesive capsulitis?","authors":"Eduardo Angeli Malavolta,&nbsp;Mauro Emilio Conforto Gracitelli,&nbsp;Gustavo de Mello Ribeiro Pinto,&nbsp;Arthur Zorzi Freire da Silveira,&nbsp;Jorge Henrique Assunção,&nbsp;Arnaldo Amado Ferreira Neto","doi":"10.1016/j.rboe.2018.02.004","DOIUrl":"10.1016/j.rboe.2018.02.004","url":null,"abstract":"<div><h3>Objective</h3><p>The aim of this study was to evaluate whether Asian ethnicity is a risk factor for the development of adhesive capsulitis. The secondary aim was to describe the distribution of cases of capsulitis by age group.</p></div><div><h3>Methods</h3><p>A cross-sectional study comparing the rate of adhesive capsulitis in individuals of Asian ethnicity with that of other ethnicities. We excluded patients with fractures and those with symptoms not involving the shoulder. The odds ratio was adjusted for confounding factors by binary logistic regression.</p></div><div><h3>Results</h3><p>A total of 1331 patient records were evaluated and after applying the selection criteria, 814 patients remained. We found 134 cases of adhesive capsulitis (15.6%). The peak of incidence was at 60–64 years in the patients of Asian ethnicity and at 55–59 years in the other patients. The unadjusted odds ratio was 4.2 (CI 95%, 2.4–7.4), while the odds ratio adjusted for sex and diabetes mellitus was 3.6 (CI 95%, 2.0–6.5).</p></div><div><h3>Conclusion</h3><p>Patients of Asian ethnicity showed an independent risk factor for the development of adhesive capsulitis, with an adjusted odds ratio of 3.6. Adhesive capsulitis was more common between 55 and 64 years.</p></div>","PeriodicalId":101095,"journal":{"name":"Revista Brasileira de Ortopedia (English Edition)","volume":"53 5","pages":"Pages 602-606"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rboe.2018.02.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36528843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}