HB - Ortopedia
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- Corticoterapia em altas doses no traumatizado medular – benefício ou prejuízo?Publication . Bandeira-Rodrigues, E; Duarte, R; Maia, J; Vaz, H; Pereira, ESequelae of the traumatic injuries to the spinal cord represent a high personal, family and social damage. Since 1984, it has been investigated and considered that the treatment with sodium succinate methylprednisolone in high doses was a solution to revert or to prevent the aggravation of such injuries. We present a revision of literature on this subject. It is well established that this therapeutic has a high rate of complications, but concerning its advantages and real effectiveness, there is no agreement between paper authors. While some defend it, others state that this is a total contraindication in this pathology. There are already some medical centers worldwide that do not use it. In Portugal, the practice of its administration is generalized. Not to do it could be difficult to defend in a litigation situation. But are we really helping our patients with it?
- Metacarpal solitary osteochondroma—case report of a rare conditionPublication . Duarte, RM; Ferreira, NV; Silva, LM; Rodrigues, LF; Ribeiro, JM; Vieira da Silva, M
- Granuloma eosinofílico na clavícula. Apresentação atípica de uma patologia raraPublication . Gomes, M; Tavares, N; Leal, F; Resende, V; Varanda, P; Silva, BO granuloma eosinofílico de localização óssea é uma lesão benigna e apresenta geralmente um curso indolente. Esta entidade foi descrita em 1940 por Lichtenstein e Jaffe e a sua etiologia permanece desconhecida, sendo sugerida a sua associação a outros síndromes. A sua localização mais comum é a nível do crânio, fémur e coluna vertebral e pode apresentar-se como uma lesão simples ou lesões múltiplas. Tem geralmente bom prognóstico, não havendo contudo um consenso quanto ao seu tratamento. Os autores presentam o caso de um homem de 36 anos que apresentava um granuloma eosinofílico de localização atípica – a clavícula – complicado com fratura patológica. Foi submetido a tratamento cirúrgico com excisão da massa tumoral e estabilização com placa e enxerto de ilíaco tricortical autólogo. Foi conseguido um excelente resultado funcional que se mantinha no follow-up a três anos. Não existe na literatura, ao conhecimento dos autores, qualquer descrição de um caso de fratura patológica na apresentação de um granuloma eosinofílico.
- Osteochondral transplantation using autografts from the upper tibio-fibular joint for the treatment of knee cartilage lesionsPublication . Espregueira-Mendes, J; Pereira, H; Sevivas, N; Varanda, P; Vieira da Silva, M; Monteiro, A; Oliveira, JM; Reis, RLPURPOSE: Treatment of large cartilage lesions of the knee in weight-bearing areas is still a controversy and challenging topic. Autologous osteochondral mosaicplasty has proven to be a valid option for treatment but donor site morbidity with most frequently used autografts remains a source of concern. This study aims to assess clinical results and safety profile of autologous osteochondral graft from the upper tibio-fibular joint applied to reconstruct symptomatic osteochondral lesions of the knee. METHODS: Thirty-one patients (22 men and 9 women) with grade 4 cartilage lesions in the knee were operated by mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint, between 1998 and 2006. Clinical assessment included visual analog scale (VAS) for pain and Lysholm score. All patients were evaluated by MRI pre- and post-operatively regarding joint congruency as good, fair (inferior to 1 mm incongruence), and poor (incongruence higher than 1 mm registered in any frame). Donor zone status was evaluated according to specific protocol considering upper tibio-fibular joint instability, pain, neurological complications, lateral collateral ligament insufficiency, or ankle complaints. RESULTS: Mean age at surgery was 30.1 years (SD 12.2). In respect to lesion sites, 22 were located in weight-bearing area of medial femoral condyle, 7 in lateral femoral condyle, 1 in trochlea, and 1 in patella. Mean follow-up was 110.1 months (SD 23.2). Mean area of lesion was 3.3 cm2 (SD 1.7), and a variable number of cylinders were used, mean 2.5 (SD 1.3). Mean VAS score improved from 47.1 (SD 10.1) to 20.0 (SD 11.5); p = 0.00. Similarly, mean Lysholm score increased from 45.7 (SD 4.5) to 85.3 (SD 7.0); p = 0.00. The level of patient satisfaction was evaluated, and 28 patients declared to be satisfied/very satisfied and would do surgery again, while 3 declared as unsatisfied with the procedure and would not submit to surgery again. These three patients had lower clinical scores and kept complaints related to the original problem but unrelated to donor zone. MRI score significantly improved at 18-24 months comparing with pre-operative (p = 0.004). No radiographic or clinical complications related to donor zone with implication in activity were registered. CONCLUSIONS: This work corroborates that mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint is effective to treat osteochondral defects in the knee joint. No relevant complications related to donor zone were registered.
- Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device.Publication . Espregueira-Mendes, J; Pereira, H; Sevivas, N; Passos, C; Vasconcelos, JC; Monteiro, A; Oliveira, JM; Reis, RLPURPOSE: Objective evaluation of both antero-posterior translation and rotatory laxity of the knee remains a target to be accomplished. This is true for both preoperative planning and postoperative assessment of different ACL reconstruction emerging techniques. The ideal measurement tool should be simple, accurate and reproducible, while enabling to assess both ‘‘anatomy’’ and ‘‘function’’ during the same examination. The purpose of this study is to evaluate the clinical effectiveness of a new in-house developed testing device, the so-called Porto-knee testing device (PKTD). The PKTD is aimed to be used on the evaluation of both antero-posterior and rotatory laxity of the knee during MRI exams. METHODS: Between 2008 and 2010, 33 patients with ACLdeficient knees were enrolled for the purpose of this study. All patients were evaluated in the office and under anesthesia with Lachman test, lateral pivot-shift test and anterior drawer test. All cases were studied preoperatively with KT-1000 and MRI with PKTD, and examinations performed by independent observers blinded for clinical evaluation. During MRI, we have used a PKTD that applies antero-posterior translation and permits free tibial rotation through a standardized pressure (46.7 kPa) in the proximal posterior region of the leg. Measurements were taken for both knees and comparing side-to-side. Five patients with partial ruptures were excluded from the group of 33. RESULTS: For the 28 remaining patients, 3 women and 25 men, with mean age of 33.4 ± 9.4 years, 13 left and 15 right knees were tested. No significant correlation was noticed for Lachman test and PKTD results (n.s.). Pivot-shift had a strong positive correlation with the difference in anterior translation registered in lateral and medial tibia plateaus of injured knees (cor. coefficient = 0.80; p\0.05), and with the difference in this parameter as compared to side-to-side (cor. coefficient = 0.83; p\0.05). Considering the KT-1000 difference between injured and healthy knees, a very strong positive correlation was found for side-to-side difference in medial (cor. coefficient = 0.73; p\0.05) and lateral (cor. coefficient = 0.5; p\0.05) tibial plateau displacement using PKTD. CONCLUSION: The PKTD proved to be a reliable tool in assessment of antero-posterior translation (comparing with KT-1000) and rotatory laxity (compared with lateral pivotshift under anesthesia) of the ACL-deficient knee during MRI examination.
- Spinal infection: state of the art and management algorithmPublication . Duarte, RM; Vaccaro, ARINTRODUCTION: Spinal infection is a rare pathology although a concerning rising incidence has been observed in recent years. This increase might reflect a progressively more susceptible population but also the availability of increased diagnostic accuracy. Yet, even with improved diagnosis tools and procedures, the delay in diagnosis remains an important issue. This review aims to highlight the importance of a methodological attitude towards accurate and prompt diagnosis using an algorithm to aid on spinal infection management. METHODS: Appropriate literature on spinal infection was selected using databases from the US National Library of Medicine and the National Institutes of Health. RESULTS: Literature reveals that histopathological analysis of infected tissues is a paramount for diagnosis and must be performed routinely. Antibiotic therapy is transversal to both conservative and surgical approaches and must be initiated after etiological diagnosis. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and upon failure of conservative treatment. CONCLUSIONS: A methodological assessment could lead to diagnosis effectiveness of spinal infection. Towards this, we present a management algorithm based on literature findings
- Giant knee “ganglion”—a case reportPublication . Ferreira, NV; Carriço, FL; Pereira, B; Duarte, R; Maia, R; Sevivas, N; Fidalgo, R; Vieira da Silva, M
- Neuropatia compressiva do nervo supraescapularPublication . Vieira-Ferreira, N; Sevivas, N; Vieira da Silva, MIntrodução: a neuropatia compressiva do nervo supraescapular foi descrita pela primeira vez em 1952 mas só recentemente tem sido mais compreendida e diagnosticada. A sua etiologia nem sempre é clara e o seu diagnóstico ainda não está bem estabelecido. O tratamento é controverso, especialmente a opção pela libertação artroscópica. Esta técnica tem sido cada vez mais utilizada mas, apesar dos bons resultados relatados, não encontramos na literatura qualquer análise sistematizada dos resultados clínicos desta técnica. Pretendeu-se com este trabalho efetuar uma revisão teórica do tema e uma análise detalhada dos resultados do tratamento artroscópico, procurando as indicações mais apropriadas para esta técnica. Material e Métodos: pesquisa efetuada em 6 bases de dados disponíveis na Internet utilizando as expressões: “suprascapular nerve”, “arthroscopic”, “release” e “decompression”. Efetuada revisão sistemática da literatura encontrada e uma síntese narrativa. Síntese de dados e conclusão. A neuropatia compressiva do nervo supraescapular é atualmente uma entidade nosológica bem estabelecida e cada vez melhor compreendida. Integra o diagnóstico diferencial da patologia da cintura escapular, sobretudo em doentes jovens, atletas ou no contexto de roturas da coifa. O tratamento cirúrgico está indicado na falência do tratamento conservador sendo a libertação artroscópica do nervo uma técnica em expansão. Está indicada em doentes com omalgia posterior, diminuição da força do supraespinhoso e infraespinhoso ou apenas do infraespinhoso, com ou sem alterações electromiográficas. O resultado das pequenas series publicadas até ao momento é encorajador pois parece proporcionar resultados clínicos positivos consistentes, constituindo um tratamento válido para a neuropatia compressiva do nervo supraescapular
- Benefits of radial distortion correction in arthroscopic surgery: a first experimental study on a knee modelPublication . Duarte, RM; Ferre, NV; Oliveira, AM; Fonseca, FP; Vieira da Silva, M; Correia-Pinto, JBACKGROUND: Lens probes used in arthroscopy typically have a small diameter and wide field-of-view. This introduces strong radial distortion (RD) into the image, ultimately affecting the surgeon's hand-eye coordination. This study evaluates potential benefits of using distortion-free images in arthroscopic surgery. METHODS: Distortion-free images were obtained using RDFixer™ software (Perceive3D, SA) to remove RD in the input video stream. Twelve orthopedic residents performed an arthroscopic task (loose body removal) in a dry-knee model using video with and without distortion. Residents were questioned about image quality, and surgical performance was rated using an adapted Global Rating Scale. RESULTS: A statistically significant improvement of all parameters was observed with distortion-free images. Residents perceived distortion-free images as providing a wider field-of-view and a better notion of relative depth and distance. CONCLUSION: RD correction improved the surgical performance of residents, potentially decreasing their learning curve. Future work will study whether the benefits are observable in experienced surgeons.
- Eczema de contacto alérgico a artroplastias – uma raridade ou uma entidade subdiagosticada?Publication . Resende, C; Santos, R; Pereira, T; Araújo, C; Tavares, N; Brito, CIntrodução: O eczema de contacto alérgico aos constituintes das próteses ocorre em 1-5% dos doentes e pode ser a causa de falência das artroplastias. Os metais sensibilizantes mais comuns são o níquel, o cobalto e o crómio. Métodos: Estudo retrospectivo dos doentes com artroplastias, submetidos a testes epicutâneos nos últimos 2 anos, com suspeita clinica de eczema de contacto alérgico. Efectuaram-se testes com a bateria padrão do Grupo Português de Estudo das Dermites de Contacto e as baterias complementares de metais, acrilatos/metacrilatos e antibióticos tópicos. Resultados: Foram testados 14 doentes: 10 submetidos a artroplastias do joelho, 3 da anca e 1 do tornozelo. A média de idades foi de 61,6 anos, sendo que 12 eram do sexo feminino. Todos os doentes apresentavam limitação funcional das articulações. A sintomatologia apareceu em média 14,4 meses após a cirurgia. Nove doentes obtiveram positividade ao níquel, 5 ao cobalto, 1 ao crómio, 1 à gentamicina e neomicina. Nesses casos, optou-se pela cirurgia de revisão com substituição por componentes em oxinium e/ou titânio, com melhoria dos sinais inflamatórios. Discussão: Esta revisão mostrou a importância da realização de testes epicutâneos nos doentes com sinais clínicos de falência das artroplastias. Observou-se melhoria das queixas e dos sinais inflamatórios em todos os doentes com sensibilização aos constituintes das artroplastias após a sua substituição. Permanece controverso se os doentes com suspeita de eczema de contacto alérgico a artroplastias deverão ser testados apenas com os seus constituintes ou com uma bateria alargada de alergénios