Artrodese Tibio-talo-calcaneana com Placa de Compressão lateral

OBJECTIVE: The objective of this study was to evaluate the short-term clinical and radiographic results from a TTC fusion procedure using a lateral locking plate specifically designed for this purpose. METHODS: All the fourteen patients were evaluated using a variety of methods, including a visual analogue scale (VAS), the AOFAS hindfoot score and a subjective satisfaction scale. The average follow-up was 10 months. RESULTS: The average AOFAS score improved from 41 points preoperatively to 63 points postoperatively. The VAS pain score decreased from 7 to 3 points. Four patients reported excellent results, eight good, one fair and one poor. CONCLUSION: Our study provides support for using a specially designed plate for TTC fusion in hindfoot salvage surgery.OBJETIVO: O propósito deste estudo é avaliar os resultados clínicos e radiológicos a curto prazo do procedimento de fusão tíbio-talo-calcaneana (TTC) com o uso de uma placa lateral bloqueada especificamente concebida para este fim. MÉTODOS: Todos os 14 pacientes foram avaliados usando uma variedade de métodos, incluindo a escala analógico visual da dor (EAV), escore da AOFAS para o retropé e escala subjetiva de satisfação. O acompanhamento médio foi de 10 meses. RESULTADOS: O escore AOFAS médio melhorou de 41 pontos no período pré-operatório para 63 pontos no período pós-operatório. O escore da dor (EAV) caiu de 7 para 3 pontos. Quatro pacientes foram classificados como excelentes resultados, oito bons, um moderado e um ruim. CONCLUSÃO: Nosso estudo dá suporte ao uso da placa especialmente desenhada para a fusão tibio-talo-calcaneana (TTC) nas cirurgias de salvamento do retropé.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)UNIFESP, EPMSciEL

Trends in Severity of Illness on ICU Admission and Mortality among the Elderly

Background: There is an increase in admission rate for elderly patients to the ICU. Mortality rates are lower when more liberal ICU admission threshold are compared to more restrictive threshold. We sought to describe the temporal trends in elderly admissions and outcomes in a tertiary hospital before and after the addition of an 8-bed medical ICU. Methods: We conducted a retrospective analysis of a comprehensive longitudinal ICU database, from a large tertiary medical center, examining trends in patients’ characteristics, severity of illness, intensity of care and mortality rates over the years 2001–2008. The study population consisted of elderly patients and the primary endpoints were 28 day and one year mortality from ICU admission. Results: Between the years 2001 and 2008, 7,265 elderly patients had 8,916 admissions to ICU. The rate of admission to the ICU increased by 5.6% per year. After an eight bed MICU was added, the severity of disease on ICU admission dropped significantly and crude mortality rates decreased thereafter. Adjusting for severity of disease on presentation, there was a decreased mortality at 28- days but no improvement in one- year survival rates for elderly patient admitted to the ICU over the years of observation. Hospital mortality rates have been unchanged from 2001 through 2008. Conclusion: In a high capacity ICU bed hospital, there was a temporal decrease in severity of disease on ICU admission, more so after the addition of additional medical ICU beds. While crude mortality rates decreased over the study period, adjusted one-year survival in ICU survivors did not change with the addition of ICU beds. These findings suggest that outcome in critically ill elderly patients may not be influenced by ICU admission. Adding additional ICU beds to deal with the increasing age of the population may therefore not be effective

Trends in Severity of Illness on ICU Admission and Mortality among the Elderly

Background: There is an increase in admission rate for elderly patients to the ICU. Mortality rates are lower when more liberal ICU admission threshold are compared to more restrictive threshold. We sought to describe the temporal trends in elderly admissions and outcomes in a tertiary hospital before and after the addition of an 8-bed medical ICU. Methods: We conducted a retrospective analysis of a comprehensive longitudinal ICU database, from a large tertiary medical center, examining trends in patients’ characteristics, severity of illness, intensity of care and mortality rates over the years 2001–2008. The study population consisted of elderly patients and the primary endpoints were 28 day and one year mortality from ICU admission. Results: Between the years 2001 and 2008, 7,265 elderly patients had 8,916 admissions to ICU. The rate of admission to the ICU increased by 5.6% per year. After an eight bed MICU was added, the severity of disease on ICU admission dropped significantly and crude mortality rates decreased thereafter. Adjusting for severity of disease on presentation, there was a decreased mortality at 28- days but no improvement in one- year survival rates for elderly patient admitted to the ICU over the years of observation. Hospital mortality rates have been unchanged from 2001 through 2008. Conclusion: In a high capacity ICU bed hospital, there was a temporal decrease in severity of disease on ICU admission, more so after the addition of additional medical ICU beds. While crude mortality rates decreased over the study period, adjusted one-year survival in ICU survivors did not change with the addition of ICU beds. These findings suggest that outcome in critically ill elderly patients may not be influenced by ICU admission. Adding additional ICU beds to deal with the increasing age of the population may therefore not be effective

Peri-incisional dysesthesia following anterior cruciate ligament reconstruction using central third of patellar tendon

OBJECTIVE: To evaluate the prevalence and type of dysesthesia around the incision used to obtain the patellar tendon for anterior cruciate ligament (ACL) reconstruction surgery. METHODS: Out of a population of 1368 ACL reconstructions using the central third of the patellar tendon, 102 patients (111 knees) were evaluated by means of telephone interview. RESULTS: The mean follow-up was 52 months (ranging from 12 to 88 months). The patients' ages ranged from 16 to 58 years (mean: 34.7 years). There was some degree of peri-incisional dysesthesia in 66 knees (59.46%). In 40.54% of the knees, this condition was not found. In all the cases of dysesthesia, the type encountered was Highet's type II. CONCLUSION: Peri-incisional dysesthesia following ACL reconstruction using the central third of the patellar tendon is highly prevalent. It affected more than half of the cases in this series.OBJETIVO: Avaliar a prevalência e o tipo de disestesia em torno da incisão utilizada para obtenção desse tendão na cirurgia de reconstrução do LCA. MÉTODOS: De uma população de 1.368 reconstruções do LCA com o terço central do tendão patelar, foram avaliados, por entrevista telefônica, 102 pacientes, totalizando 111 joelhos. RESULTADOS: O seguimento médio foi de 52 meses, variando entre 12 e 88 meses. A idade dos pacientes variou entre 16 e 58 anos, com média de 34,7 anos. Em 66 joelhos (59,46%), houve algum grau de disestesia peri-incisional. Em 40,54% dos joelhos, essa condição não foi encontrada. Em todos os casos de disestesia, o tipo encontrado foi o tipo II de Highet. CONCLUSÃO: A disestesia peri-incisional após a reconstrução do LCA com terço central do tendão patelar é muito prevalente, acometendo mais da metade dos casos nessa série.UNIFESPUFMG Faculdade de Medicina Departamento do Aparelho LocomotorHospital Madre Teresa Grupo do JoelhoHospital Madre Teresa Serviço de OrtopediaUFMGUNIFESPSciEL

Planejamento pré-operatório de correção de deformidades supramaleolares através de impressão 3D

3D printed models have been explored deeply in the medical field, standing out as an important aid tool for surgical planning. The authors present a case report of a patient with post-traumatic arthrosis of the right ankle, who underwent supramaleolar osteotomy, using a medial closure wedge. This surgery was performed after operative planning by 3D printing, which can demonstrate the reproducibility of this method.Modelos impressos em 3D têm sido explorados profundamente no campo médico, destacando-se como importante ferramenta de auxílio para planejamento cirúrgico. Os autores apresentam relato de caso de um paciente, com artrose pós-traumática do tornozelo direito, submetido a osteotomia supramaleolar, em cunha de fechamento medial. Esta cirurgia foi realizada após planejamento operatório por impressão 3D, o que pode demonstrar reprodutibilidade deste método

All-arthroscopic AMIC® (AT-AMIC) for the treatment of talar osteochondral defects

Category: Arthroscopy Introduction/Purpose: Various operative procedures have been used to treat osteochondral lesions of the talus. Among the new alternatives to treat these lesions, Autologous Matrix-Induced Chondrogenesis (AMIC®) has proven to provide satisfactory results through medium-term follow-up. The aim of this study is to report early post-operative clinical results of patients submitted to the AT-AMIC® technique and autologous bone graft, when necessary, for OLT’s at a six-month minimum follow-up. Methods: This is case series of 17 consecutive patients that were submitted to AT-AMIC®, between january of 2016 and april of 2017. 9 men and 8 women, between 15 and 67 years were diagnosed with OLTs with the typical history of deep ankle pain and corresponding magnetic resonance imaging injury. Surgery was proposed only after failure of conservative treatment of at least 3 months. Surgeries were performed by three different surgeons, with high arthroscopic experience. Patients answered the AOFAS score preoperatively and at the last follow-up, ranging from 6 to 18 months Results: Average size of OLTs were 1,12 cm2, with Raikin 4 location being the most common (70,5%). Calcaneal osteotomy was the most common associated procedure, with 17,6%. Average follow-up was 10,76 months. Average AOFAS before surgery was 46,35, increasing to 89,53 at the last follow-up. This difference was statistically significant with a p-value of <0,001. No complications were observed and no changes in the post-operative protocol were needed. Conclusion: AT-AMIC® is a reliable and reproducible method of treatment for OLTs, reaching high clinical postoperative scores, with a very low rate of complications. Further comparative study is needed to prove its efficacy

Isokinetic functional outcomes of open versus percutaneous repair following Achilles tendon tears

Category: Sports Introduction/Purpose: Rupture of the Achilles Tendon (AT) is frequent in young recreational athletes. Conservative management, open surgery and percutaneous/minimally invasive approaches are all advocated, and conflicting data are available. This study compared functional and anthropometric outcomes of patients who underwent open or percutaneous repair. Methods: A retrospective comparative study, in which 38 patients underwent open and percutaneous techniques to manage AT ruptures. For functional assessment, the calf circumference of both injured and uninjured legs was evaluated. Isokinetic testing included total plantar flexion work, peak plantar flexion torque, total dorsiflexion work peak and dorsiflexion torque. The Achilles Tendon Rupture Score (ATRS) and the America Orthopedic Foot and Ankle Score (AOFAS) were evaluated at a final minimum follow-up of 12 months. Results: No major complications were observed. The average time to return to sport was 9 months. AOFAS and ATRS values did not differ statistically between groups. Isokinetic variables and circumference were similar in the operated and non-operated limb in both groups, and did not differ either when comparing open and percutaneous repair. Conclusion: Open and percutaneous repair of a torn Achilles tendon produced similar functional outcomes