Cavus Foot Correction Using a Full Percutaneous Procedure: A Case Series.

Cavus foot is a tri-planar deformity that requires correction in several bones and soft tissue. Minimally invasive surgeries are less aggressive, faster and easier to recover from. Here, we describe the initial results of a technique for percutaneous cavus foot correction. The procedure consists of calcaneal dorsal/lateral closing wedge osteotomy (with fixation), cuboid, medial cuneiform and first metatarsal closing wedge osteotomy (without fixation), and plantar fascia and tibialis posterior tenotomy with the patient in the prone position. Immediate weight bearing is permitted. Twenty patients were selected to undergo the procedure. The mean follow-up was 4.2 months and mean age 42.3 years. Eight of the 20 patients were submitted to cuboid and first metatarsal osteotomy, and 12 (60%) only calcaneal osteotomy. The median time for complete bone healing was 2.2 months. No wound complications were observed. No cases of non-consolidation of the cuboid or first metatarsal osteotomies were detected. The most common complication was sural nerve paresthesia. This is the first description of cavus foot correction using a minimally invasive technique. Complete bone healing is obtained even with immediate weight bearing and without cuboid and first metatarsal fixation.

Comparative CT with stress manoeuvres for diagnosing distal isolated tibiofibular syndesmotic injury in acute ankle sprain: a protocol for an accuracy- test prospective study.

INTRODUCTION: Although several imaging options are available for diagnosing syndesmotic injury, a fundamental question that guides treatment remains unanswered. Syndesmotic instability is still challenging to diagnose correctly, and syndesmotic disruption and true syndesmotic instability should be differentiated. Currently, imaging tests quickly diagnose severe syndesmotic instability but have difficulty in diagnosing mild and moderate cases. This study aims to investigate which strategy among an existing CT index test and two new add-on CT index tests with stress manoeuvres more accurately diagnoses syndesmotic instability. The secondary objective is to investigate the participants' disability outcomes by applying the Foot and Ankle Ability Measure questionnaire. METHODS AND ANALYSES: This study of a diagnostic accuracy test will consecutively select individuals older than 18 years with a clinical diagnosis of a suspected acute syndesmotic injury. Three strategies of the CT index test (one in the neutral position and two with stress) will examine the accuracy using MRI as the reference standard. The external rotation and dorsiflexion of the ankle will guide the stress manoeuvres. A comparison of measurements between the injured syndesmosis and the uninjured contralateral side of the same individual will investigate the syndesmotic instability, by evaluating the rotational and translational relationships between the fibula and tibia. Sensitivity, specificity, area under the receiver operating characteristic curve and likelihood analyses will compare the diagnostic accuracies of the strategies. ETHICS AND DISSEMINATION: The Internal Review Board and the Einstein Ethics Committee approved this study (registered number 62100016.5.0000.0071). All participants will receive an oral description of the study's aim, and the choice to participate will be free and voluntary. Participants will be enrolled after they sign the written informed consent form, including the terms of confidentiality. The results will be presented at national and international conferences and published in peer-reviewed journals and social media. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT04095598; preresults).

Mind the gap between the fracture line and the length of the working area: a 2-D finite element analysis using an extramedullary fixation model / Observe a distância entre a linha de fratura e o comprimento da área de trabalho: análise bidimensional de elementos finitos em modelo de fixação extramedular

ABSTRACT Objective: To determine the ideal working area for a simple transverse fracture line treated with a bridge plate. Methods: A 2-D finite element analysis of a hypothetical femur was performed for the quantitative evaluation of a large-fragment titanium alloy locking plate based on the precept of relative stability in a case of a simple transverse diaphyseal fracture. Two simulations (one case of strain and another case of stress distribution) were analyzed in three unique situations according to the von Mises stress theory. Load distributions were observed when the bone was subjected to a single vertical load of 1000 N. Results: The longer the length of the implant flexion, which coincided with the working area of the plate, the greater the flexion of the implant. The highest concentrations of stress on the plate occurred in the region around the screws closest to the bone gap. The closer the screws to the fracture site, the greater the demands on the plate. Conclusion: When using a large-fragment titanium alloy locking plate to stabilize a simple transverse fracture based on the precept of relative stability (bridge plate), there must be considerable distance between the proximal and distal screws closest to the fracture line. The farther away this fixation is, the lower the stress on the plate and the greater the dissipation of force in the form of deflection.

RESUMO Objetivo: Determinar qual é a área de trabalho ideal em uma fratura de traço simples transverso tratada com placa em ponte. Métodos: Foi feita uma análise bidimensional de elementos finitos em um fêmur hipotético para avaliação quantitativa de uma placa bloqueada para grandes fragmentos feita de liga de titânio, usada com o princípio de estabilidade relativa em uma fratura diafisária de traço simples e transverso. Foram analisadas duas simulações, uma de deformação e outra de distribuição de tensão, de acordo com a teoria de von Mises, em três situações distintas. Foram observadas as distribuições de carga quando o osso foi submetido a uma carga monotônica vertical de 1.000 N. Resultados: Quanto maior o comprimento de flexão do implante, o que coincidiu com a área de trabalho da placa, maior a flexão dele. A maior concentração de tensão na placa foi observada na região dos parafusos mais próximos do defeito ósseo. Quanto mais próximos os parafusos do foco de fratura, maior a demanda sobre a placa. Conclusão: Ao usar uma placa bloqueada para grandes fragmentos feita de liga de titânio para estabilizar uma fratura de traço simples e transverso pelo princípio de estabilidade relativa (placa em ponte), a distância entre os parafusos mais próximos do traço de fratura proximal e distalmente deve ser longa. Quanto mais distante essa fixação, menor a concentração de tensão na placa e maior a dissipação de esforços na forma de deflexão.

Mind the gap between the fracture line and the length of the working area: a 2-D finite element analysis using an extramedullary fixation model.

OBJECTIVE: To determine the ideal working area for a simple transverse fracture line treated with a bridge plate. METHODS: A 2-D finite element analysis of a hypothetical femur was performed for the quantitative evaluation of a large-fragment titanium alloy locking plate based on the precept of relative stability in a case of a simple transverse diaphyseal fracture. Two simulations (one case of strain and another case of stress distribution) were analyzed in three unique situations according to the von Mises stress theory. Load distributions were observed when the bone was subjected to a single vertical load of 1000 N. RESULTS: The longer the length of the implant flexion, which coincided with the working area of the plate, the greater the flexion of the implant. The highest concentrations of stress on the plate occurred in the region around the screws closest to the bone gap. The closer the screws to the fracture site, the greater the demands on the plate. CONCLUSION: When using a large-fragment titanium alloy locking plate to stabilize a simple transverse fracture based on the precept of relative stability (bridge plate), there must be considerable distance between the proximal and distal screws closest to the fracture line. The farther away this fixation is, the lower the stress on the plate and the greater the dissipation of force in the form of deflection.

OBJETIVO: Determinar qual é a área de trabalho ideal em uma fratura de traço simples transverso tratada com placa em ponte. MÉTODOS: Foi feita uma análise bidimensional de elementos finitos em um fêmur hipotético para avaliação quantitativa de uma placa bloqueada para grandes fragmentos feita de liga de titânio, usada com o princípio de estabilidade relativa em uma fratura diafisária de traço simples e transverso. Foram analisadas duas simulações, uma de deformação e outra de distribuição de tensão, de acordo com a teoria de von Mises, em três situações distintas. Foram observadas as distribuições de carga quando o osso foi submetido a uma carga monotônica vertical de 1.000 N. RESULTADOS: Quanto maior o comprimento de flexão do implante, o que coincidiu com a área de trabalho da placa, maior a flexão dele. A maior concentração de tensão na placa foi observada na região dos parafusos mais próximos do defeito ósseo. Quanto mais próximos os parafusos do foco de fratura, maior a demanda sobre a placa. CONCLUSÃO: Ao usar uma placa bloqueada para grandes fragmentos feita de liga de titânio para estabilizar uma fratura de traço simples e transverso pelo princípio de estabilidade relativa (placa em ponte), a distância entre os parafusos mais próximos do traço de fratura proximal e distalmente deve ser longa. Quanto mais distante essa fixação, menor a concentração de tensão na placa e maior a dissipação de esforços na forma de deflexão.

Minimally invasive posteromedial percutaneous plate osteosynthesis for diaphyseal tibial fractures: technique description.

PURPOSE: The aim of this study was to evaluate the feasibility of performing minimally-invasive plate osteosynthesis (MIPO) in tibial fractures using two posteromedial incisions, and to measure the distance between the plate and neurovascular structures. MATERIALS AND METHODS: We performed nine dissections of specimens that were submitted to tibial MIPO with two posteromedial incisions. One locking compression plate (LCP) of 14 to 16 holes was inserted into the submuscular tunnel in a retrograde manner. Incisions were linked to evaluate the distance between neurovascular structures and the plate. RESULTS: During the proximal incision, a blunt dissection between semitendinosus and medial gastrocnemius tendons, as well as their lateral shift, helped to protect the main local neurovascular structures. In its distal portion, the submuscular plate tunnel insertion and its direction to the proximal incision prevented direct contact and possible damage to neurovascular structures. Moreover, we obtained successful results from a patient submitted to this procedure. CONCLUSION: Posteromedial MIPO represents a safe and attractive alternative for tibial fractures, particularly if there are damaged soft tissues in the anterior and medial side, or when access to intramedullary osteosynthesis is blocked.

EPIDEMIOLOGICAL STUDY ON LISFRANC INJURIES.

OBJECTIVE: To analyze the characteristics of patients with Lisfranc injuries and their associated fractures . METHODS: This is a retrospective analysis on 42 patients with Lisfranc injuries hospitalized at Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, between 2006 and 2010. Parameters on patient profile, risk factors, fracture characteristics, data on treatment and acute complications were analyzed . RESULTS: Analysis of 42 cases showed that in our sample, men were more affected than women, with a ratio of 4.25:1. The most frequent trauma mechanism was car accident, followed by motorcycle accident. The most frequent type of injury was isolated lesion type B of Quenu and Kuss classification, representing 50% of cases. The most common fracture on the sample was the second metatarsal bone, with 16 cases, followed by cuboid bone fracture. Among the 42 cases, 17% had exposed fractures and 33 patients presented other associated fractures. The mean time elapsed between the trauma and definitive treatment was 6.7 days, while the mean length of hospital stay was 13.8 days. Six patients presented acute postoperative complications . CONCLUSION: Lisfranc injuries are more common in men undergoing automobile trauma. The prevalence of associated fractures is a frequent finding and the hospital stay may be longstanding. Level of Evidence IV, Case Series.

OBJETIVO: Analisar o perfil de pacientes com lesões de Lisfranc, as características das lesões e fraturas associadas. MÉTODOS: Trata-se de uma análise retrospectiva com 42 pacientes com lesões de Lisfranc internados no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 2006 e 2010. O perfil dos pacientes, características das lesões, fraturas associadas, dados sobre o tratamento e complicações agudas foram analisados. RESULTADOS: Nesta amostra, os homens foram mais afetados do que as mulheres, com uma proporção de 4,25:1. O mecanismo de trauma mais frequente foi acidente de carro, seguido por acidente com moto. O tipo de lesão mais frequente foi a lesão isolada tipo B de Quenu e Kuss, representando 50% dos casos. A fratura mais comumente encontrada foi a do segundo metatarso, com 16 casos, seguido pela fratura do osso cubóide. Entre os 42 casos estudados, sete foram fraturas expostas e 33 pacientes apresentaram fraturas associadas. O tempo médio entre o trauma e o tratamento definitivo foi de 6,7 dias. O tempo médio de permanência hospitalar foi de 13,8. Seis pacientes apresentaram complicações pós-operatórias agudas. CONCLUSÃO: As lesões de Lisfranc são mais comuns em homens submetidos a trauma automobilístico. A prevalência de fraturas associadas é um achado frequente e o tempo de permanência hospitalar pode ser prolongado. Nível de Evidência IV, Série de Casos.

EPIDEMIOLOGICAL STUDY ON LISFRANC INJURIES / ESTUDO EPIDEMIOLÓGICO DAS LESÕES DE LISFRANC

ABSTRACT Objective: To analyze the characteristics of patients with Lisfranc injuries and their associated fractures . Methods: This is a retrospective analysis on 42 patients with Lisfranc injuries hospitalized at Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, between 2006 and 2010. Parameters on patient profile, risk factors, fracture characteristics, data on treatment and acute complications were analyzed . Results: Analysis of 42 cases showed that in our sample, men were more affected than women, with a ratio of 4.25:1. The most frequent trauma mechanism was car accident, followed by motorcycle accident. The most frequent type of injury was isolated lesion type B of Quenu and Kuss classification, representing 50% of cases. The most common fracture on the sample was the second metatarsal bone, with 16 cases, followed by cuboid bone fracture. Among the 42 cases, 17% had exposed fractures and 33 patients presented other associated fractures. The mean time elapsed between the trauma and definitive treatment was 6.7 days, while the mean length of hospital stay was 13.8 days. Six patients presented acute postoperative complications . Conclusion: Lisfranc injuries are more common in men undergoing automobile trauma. The prevalence of associated fractures is a frequent finding and the hospital stay may be longstanding. Level of Evidence IV, Case Series.

RESUMO Objetivo: Analisar o perfil de pacientes com lesões de Lisfranc, as características das lesões e fraturas associadas. Métodos: Trata-se de uma análise retrospectiva com 42 pacientes com lesões de Lisfranc internados no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 2006 e 2010. O perfil dos pacientes, características das lesões, fraturas associadas, dados sobre o tratamento e complicações agudas foram analisados. Resultados: Nesta amostra, os homens foram mais afetados do que as mulheres, com uma proporção de 4,25:1. O mecanismo de trauma mais frequente foi acidente de carro, seguido por acidente com moto. O tipo de lesão mais frequente foi a lesão isolada tipo B de Quenu e Kuss, representando 50% dos casos. A fratura mais comumente encontrada foi a do segundo metatarso, com 16 casos, seguido pela fratura do osso cubóide. Entre os 42 casos estudados, sete foram fraturas expostas e 33 pacientes apresentaram fraturas associadas. O tempo médio entre o trauma e o tratamento definitivo foi de 6,7 dias. O tempo médio de permanência hospitalar foi de 13,8. Seis pacientes apresentaram complicações pós-operatórias agudas. Conclusão: As lesões de Lisfranc são mais comuns em homens submetidos a trauma automobilístico. A prevalência de fraturas associadas é um achado frequente e o tempo de permanência hospitalar pode ser prolongado. Nível de Evidência IV, Série de Casos:

Cartilage lesions and ankle osteoarthrosis: review of the literature and treatment algorithm / Lesão de cartilagem e osteoartrose do tornozelo: revisão da literatura e algoritmo de tratamento

The main etiology of ankle osteoarthrosis is post-traumatic and its prevalence is highest amongyoung individuals. Thus, this disease has a great socioeconomic impact and gives rise to significant losses of patients' quality of life. The objective of its treatment is to eliminate pain and keep patients active. Therefore, the treatment should be staged according to the degree of degenerative evolution, etiology, joint location, systemic condition, bone quality, lower-limb alignment, ligament stability and age. The treatment algorithm is divided into non-surgical therapeutic methods and options for surgical treatment. Joint preservation, joint replacement and arthrodesis surgical procedures have precise indications. This article presents a review on this topic and a proposal for a treatment algorithm for this disease...

A principal etiologia da osteoartrose (OA) do tornozelo é pós-traumática e sua maior prevalência está entre indivíduos jovens; assim, essa doença apresenta grande impacto socioeconômico e significativo prejuízo na qualidade de vida dos pacientes. O objetivo do tratamento é eliminar a dor e manter os pacientes ativos. Dessa forma, o tratamento deve ser estagiado de acordo com o grau de evolução da degeneracão, a etiologia, a localização articular, a condição sistêmica, a qualidade óssea, o alinhamento do membro inferior, a estabilidade ligamentar e a idade. O algoritmo de tratamento é dividido nas modalidades de terapia não cirúrgicas e nas opções de tratamento cirúrgico. As cirurgias de preservação articular, as cirurgias de substituição articular e as artrodeses apresentam indicações precisas. O presente artigo apresenta uma revisão sobre o tema e uma proposta de algoritmo de tratamento para essa doença...

Charcot neuroarthropathy: realignment of diabetic foot by means of osteosynthesis using intramedullary screws – case report

Diabetes mellitus is a serious disease that affects a large portion of the population. Charcot neuroarthropathy is one of its major complications and can lead to osteoarticular deformities, functional incapacity, ulcers and ankle and foot infections. Realignment of the foot by means of arthrodesis presents a high rate of implant failure due to weight-bearing on an insensitive foot. The aim of this report was to describe successful use of intramedullary osteosynthesis with compression screws to stabilize the deformed foot, in a diabetic patient with neuroarthropathy...

O diabetes mellitus é uma doença grave que afeta uma grande parcela da população. A neu-roartropatia de Charcot é uma das grandes complicações que podem levar a deformidades osteoarticulares, incapacidade funcional, úlceras e infecção no tornozelo e no pé. O realinhamento do pé por meio de artrodeses apresenta elevado índice de falha do implante por causa da descarga de peso em um pé insensível. O objetivo deste relato de caso é descrever o uso bem-sucedido de osteossíntese intramedular com parafusos de compressão para estabilização do pé com deformidade em paciente diabético com neuroartropatia...

Epidemiological study on talus fractures

Objective: To analyze the characteristics of patients with talus fractures and the injuries that they present. Methods: Retrospective analysis on patients hospitalized in the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine of the University of São Paulo, between 2006 and 2011, with talus fractures. Patient profile parameters, risk factors, fracture characteristics, treatment data and acute complications were analyzed. Results: Analysis on 23 cases showed that men were more affected than women, with a ratio of 4.8:1. The most frequent trauma mechanism was traffic accidents, followed by falls from a height. The most frequent type of fracture was at the neck of the talus, with 17 cases. Among the 23 cases, seven had peritalar dislocation at the time of presentation, four had exposed fractures and 11 presented other associated fractures. The mean length of time between the trauma and the definitive treatment was six days, while the mean length of hospital stay was 11 days. Three patients presented acute postoperative complications. Conclusion: Talus fractures occurred most commonly in the region of the talar neck and most frequently in young males who suffered high-energy trauma. In almost half of the cases, there were other associated fractures. The length of hospital stay was 11 days...

Objetivo: Analisar as características dos indivíduos e das lesões encontradas em pacientes com fraturas de tálus. Métodos: Análise retrospectiva dos pacientes internados no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo de 2006 a 2011 com fratura de tálus. Foram estudados parâmetros associados ao perfil do paciente e fatores de risco, características da fratura, dados do tratamento e complicações agudas. Resultados: A análise dos 23 casos mostrou que os homens foram mais afetados do que as mulheres, com uma relação de 4,8:1. O mecanismo de trauma mais frequente foram os acidentes de trânsito, seguido pelas quedas de altura. O tipo de fratura mais frequente foi a do colo do tálus, com 17 casos. Dos 23 casos, sete apresentavam luxação peritalar no momento da apresentação, quatro tinham fratura exposta e 11 apresentavam outras fraturas associadas. O tempo médio entre o trauma e o tratamento definitivo foi de seis dias, enquanto o tempo médio de permanência hospitalar foi de 11 dias. Houve três pacientes que apresentaram complicações pós-operatórias agudas. Conclusão: A fratura do tálus foi mais comum na região do colo e mais frequente em jovens do gênero masculino que sofreram traumatismos de alta energia. Em quase metade dos casos houve fraturas associadas e o tempo de permanência hospitalar foi de 11 dias...

Epidemiologic study of ankle fractures in a tertiary hospital.

OBJECTIVES: To evaluate the epidemiology of ankle fractures surgically treated at the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo. METHODS: Medical records of patients admitted with foot and ankle fractures between 2006 and 2011 were revised. Seventy three ankle fractures that underwent surgical treatment were identified. The parameters analyzed included age, gender, injured side, AO and Gustilo & Anderson classification, associated injuries, exposure, need to urgent treatment, time to definitive treatment and early post-operative complications. STUDY DESIGN: retrospective epidemiological study. RESULTS: Male gender was predominant among subjects and the mean age was 27.5 years old. Thirty nine fractures resulted from traffic accidents and type B fracture according to AO classification was the most common. Twenty one were open fractures and 22 patients had associated injuries. The average time to definitive treatment was 6.5 days. Early post-operative complications were found in 21.3% of patients. CONCLUSIONS: Ankle fractures treated in a tertiary hospital of a large city in Brazil affect young people victims of high-energy accidents and present significant rates of associated injuries and post-operative complications. Level of Evidence IV, Cases Series.

Epidemiological study on talus fractures.

OBJECTIVE: to analyze the characteristics of patients with talus fractures and the injuries that they present. METHODS: retrospective analysis on patients hospitalized in the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine of the University of São Paulo, between 2006 and 2011, with talus fractures. Patient profile parameters, risk factors, fracture characteristics, treatment data and acute complications were analyzed. RESULTS: analysis on 23 cases showed that men were more affected than women, with a ratio of 4.8:1. The most frequent trauma mechanism was traffic accidents, followed by falls from a height. The most frequent type of fracture was at the neck of the talus, with 17 cases. Among the 23 cases, seven had peritalar dislocation at the time of presentation, four had exposed fractures and 11 presented other associated fractures. The mean length of time between the trauma and the definitive treatment was six days, while the mean length of hospital stay was 11 days. Three patients presented acute postoperative complications. CONCLUSION: talus fractures occurred most commonly in the region of the talar neck and most frequently in young males who suffered high-energy trauma. In almost half of the cases, there were other associated fractures. The length of hospital stay was 11 days.

OBJETIVO: Analisar as características dos indivíduos e das lesões encontradas em pacientes com fraturas de tálus. MÉTODOS: Análise retrospectiva dos pacientes internados no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo de 2006 a 2011 com fratura de tálus. Foram estudados parâmetros associados ao perfil do paciente e fatores de risco, características da fratura, dados do tratamento e complicações agudas. RESULTADOS: A análise dos 23 casos mostrou que os homens foram mais afetados do que as mulheres, com uma relação de 4.8:1. O mecanismo de trauma mais frequente foram os acidentes de trânsito, seguido pelas quedas de altura. O tipo de fratura mais frequente foi a do colo do tálus, com 17 casos. Dos 23 casos, sete apresentavam luxação peritalar no momento da apresentação, quatro tinham fratura exposta e 11 apresentavam outras fraturas associadas. O tempo médio entre o trauma e o tratamento definitivo foi de seis dias, enquanto o tempo médio de permanência hospitalar foi de 11 dias. Houve três pacientes que apresentaram complicações pós-operatórias agudas. CONCLUSÃO: A fratura do tálus foi mais comum na região do colo e mais frequente em jovens do gênero masculino que sofreram traumatismos de alta energia. Em quase metade dos casos houve fraturas associadas e o tempo de permanência hospitalar foi de 11 dias.

Charcot neuroarthropathy: realignment of diabetic foot by means of osteosynthesis using intramedullary screws - case report.

Diabetes mellitus is a serious disease that affects a large portion of the population. Charcot neuroarthropathy is one of its major complications and can lead to osteoarticular deformities, functional incapacity, ulcers and ankle and foot infections. Realignment of the foot by means of arthrodesis presents a high rate of implant failure due to weight-bearing on an insensitive foot. The aim of this report was to describe successful use of intramedullary osteosynthesis with compression screws to stabilize the deformed foot, in a diabetic patient with neuroarthropathy.

O diabetes mellitus é uma doença grave que afeta uma grande parcela da população. A neuroartropatia de Charcot é uma das grandes complicações que podem levar a deformidades osteoarticulares, incapacidade funcional, úlceras e infecção no tornozelo e no pé. O realinhamento do pé por meio de artrodeses apresenta elevado índice de falha do implante por causa da descarga de peso em um pé insensível. O objetivo deste relato de caso é descrever o uso bem-sucedido de osteossíntese intramedular com parafusos de compressão para estabilização do pé com deformidade em paciente diabético com neuroartropatia.

Cartilage lesions and ankle osteoarthrosis: review of the literature and treatment algorithm.

The main etiology of ankle osteoarthrosis is post-traumatic and its prevalence is highest among young individuals. Thus, this disease has a great socioeconomic impact and gives rise to significant losses of patients' quality of life. The objective of its treatment is to eliminate pain and keep patients active. Therefore, the treatment should be staged according to the degree of degenerative evolution, etiology, joint location, systemic condition, bone quality, lower-limb alignment, ligament stability and age. The treatment algorithm is divided into non-surgical therapeutic methods and options for surgical treatment. Joint preservation, joint replacement and arthrodesis surgical procedures have precise indications. This article presents a review on this topic and a proposal for a treatment algorithm for this disease.

A principal etiologia da osteoartrose (OA) do tornozelo é pós-traumática e sua maior prevalência está entre indivíduos jovens; assim, essa doença apresenta grande impacto socioeconômico e significativo prejuízo na qualidade de vida dos pacientes. O objetivo do tratamento é eliminar a dor e manter os pacientes ativos. Dessa forma, o tratamento deve ser estagiado de acordo com o grau de evolução da degeneração, a etiologia, a localização articular, a condição sistêmica, a qualidade óssea, o alinhamento do membro inferior, a estabilidade ligamentar e a idade. O algoritmo de tratamento é dividido nas modalidades de terapia não cirúrgicas e nas opções de tratamento cirúrgico. As cirurgias de preservação articular, as cirurgias de substituição articular e as artrodeses apresentam indicações precisas. O presente artigo apresenta uma revisão sobre o tema e uma proposta de algoritmo de tratamento para essa doença.

Epidemiologic study of ankle fractures in a tertiary hospital

OBJECTIVES: To evaluate the epidemiology of ankle fractures surgically treated at the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo. METHODS: Medical records of patients admitted with foot and ankle fractures between 2006 and 2011 were revised. Seventy three ankle fractures that underwent surgical treatment were identified. The parameters analyzed included age, gender, injured side, AO and Gustilo & Anderson classification, associated injuries, exposure, need to urgent treatment, time to definitive treatment and early post-operative complications. Study design: retrospective epidemiological study. RESULTS: Male gender was predominant among subjects and the mean age was 27.5 years old. Thirty nine fractures resulted from traffic accidents and type B fracture according to AO classification was the most common. Twenty one were open fractures and 22 patients had associated injuries. The average time to definitive treatment was 6.5 days. Early post-operative complications were found in 21.3% of patients. CONCLUSIONS: Ankle fractures treated in a tertiary hospital of a large city in Brazil affect young people victims of high-energy accidents and present significant rates of associated injuries and post-operative complications. Level of Evidence IV, Cases Series. .

Hállux Rígidus: estudo prospectivo da substituição articular com hemiartroplastia / Hállux Rígidus: prospective study of joint replacement with hemiarthroplasty

Objetivo: Relatar os resultados com médio prazo de seguimento após a implantação de Arthrosurface-HemiCap em pacientes com diagnóstico de hállux rígidus (HR). Método: Onze pacientes foram submetidos à artroplastia parcial da primeira metatarso-falangeana. Seis mulheres e cinco homens com idade média de 51,9 anos (46 a 58 anos) e média de seguimento pós-operatório de 3,73 anos (3-4 anos); foram classificados através do sistema de Kravitz e avaliados pelas escalas da american orthopaedic foot and ankle society (AOFAS) para hállux, visual analog scale (VAS) – analógico funcional de dor - e pela amplitude de movimento da primeira articulação metatarsofalangeana no periodo pré-operatório, pós-operatório de seis meses e pós-operatório atual. Resultados: Os resultados revelam melhora significativa dos três parâmetros analisados no estudo, tanto para análise global como para comparações pré e pós-operatórias individuais. A análise comparativa de cada variável nos períodos pós--operatórios de seis meses e atual não mostram diferença estatística o que indica manutenção dos parâmetros durante esse intervalo. Conclusão: A hemiartroplastia da primeira metatarsofalangeana é opção reprodutível e segura para o tratamento cirúrgico do hállux rígidus II e III, com significativa melhora dos parâmetros avaliados para a população estudada. Nível de Evidência IV, Série de casos.

Objective: To report the results of medium-term follow-up after deploying arthrosurface-Hemicap in patients with diagnosis of hállux rígidus (HR). method: eleven patients underwent partial arthroplasty of the first metatarsal-phalangeal joint. six women and five men with an average age 51.9 years (46 to 58 years) and average postoperative follow-up of 3.73 years (3-4 years); were classified through the Kravitz system and evaluated by the american orthopaedic foot and ankle society (aofas) scales for hallux, visual analogical scale (vas) – analog functional pain - and motion range in the first metatarsal joint in preoperative, postoperative after six months and present post-operative. Results: the results show significant improvement of the three analyzed parameters, both for overall analysis and for pre and post-operative comparisons individually. the comparative analysis of each variable in the six months and the current postoperative periods do not show statistically significant differences, indicating maintenance of parameters during this interval. conclusion: hemiarthroplasty of first metatarsophalangeal joint is a reproducible and safe option for the surgical treatment of hállux rígidus II and III, with significant improvement of the evaluated parameters for the studied population. Level of Evidence IV, Case Series.

Hállux Rígidus: prospective study of joint replacement with hemiarthroplasty.

OBJECTIVE: To report the results of medium-term follow-up after deploying Arthrosurface-HemiCap((r)) in patients with diagnosis of Hállux Rigidus (HR). METHOD: Eleven patients underwent partial Arthroplasty of the first metatarsal-phalangeal joint. Six women and five men with an average age 51.9 years (46 to 58 years) and average postoperative follow-up of 3.73 years (3-4 years); were classified through the Kravitz system and evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) scales for hállux, Visual Analogical Scale (VAS) - analog functional pain - and range of motion in the first metatarsal joint in preoperative, postoperative after six months and present post-operative. RESULTS: The results show significant improvement of the three analyzed parameters, both for overall analysis and for pre and post-operative comparisons individually. The comparative analysis of each variable in the six months and the current postoperative periods do not show statistically significant differences, indicating maintenance of parameters during this interval. CONCLUSION: hemiarthroplasty of first metatarsophalangeal joint is a reproducible and safe option for the surgical treatment of hállux rigidus II and III, with significant improvement of the evaluated parameters for the studied population. Level of Evidence IV, Case Series.

Charcot foot: skin temperature as a good clinical parameter for predicting disease outcome.

Twenty-eight diabetics presenting with acute Charcot foot were immobilized and the temperature difference between limbs measured at each month. All patients had monthly follow-up visits for a year and the relapse rate was zero. We found that skin temperature is a good parameter to ensure safe immobilization withdrawal.

Malignant Fibrohisticytoma of the Knee in a Patient with HIV.

This case report describes a patient presenting with anterior knee pain (extensor mechanism pain), a poorly studied complaint in the HIV population. The final diagnosis was malignant fibrohistiocytoma, a rare condition among knee pathologies, successfully treated with endoprosthesis after tumor resection. This article focuses on what the authors learned after treating this patient, particularly on the difficulty in making a correct diagnosis of this group of patients due to lack of adequate epidemiological characterization. By assuming that the pathology was related to long-term infection and treatment of HIV (knee hoffitis), the authors underestimated the gravity of the case, almost compromising the result of treatment.

Osteopenia and osteoporosis in people living with HIV: multiprofessional approach.

Increasing bone mineralization abnormalities observed among people living with HIV (PLWHIV) result from various factors relating to the host, the virus, and the antiretrovirals used. Today, HIV infection is considered to be a risk factor for bone mineralization disorders. The test most recommended for diagnosing osteoporosis is measurement of bone mineral density by means of dual energy X-ray absorptiometry at two sites. Osteoporosis treatment has the aims of bone mass improvement and fracture control. A combination of calcium and vitamin D supplementation may reduce the risk of fractures. Antiresorptive drugs act by blocking osteoclastic activity and reducing bone remodeling. On the other hand, bone-forming drugs stimulate osteoblastogenesis, thereby stimulating the formation of bone matrix. Mixed-action medications are those that are capable of both stimulating bone formation and inhibiting reabsorption. Antiresorptive drugs form the group of medications with the greatest quantity of scientific evidence confirming their efficacy in osteoporosis treatment. Physical activity is a health promotion strategy for the general population, but only preliminary data on its real value and benefit among PLWHIV are available, especially in relation to osteoporosis.