Total ruptures of the extensor apparatus of the knee

This was a retrospective case-control study on total ruptures of the extensor apparatus of the knee, aimed to compare patella fractures with tendinous ruptures.info:eu-repo/semantics/publishedVersio

Hip disarticulation - case series analysis and literature review

OBJECTIVE: To present a retrospective study of 16 patients submitted to hip disarticulation. METHODS: During the period of 16 years, 16 patients who underwent hip disarticulation were identified. All of them were studied based on clinical records regarding the gender, age at surgery, disarticulation cause, postoperative complications, mortality rates and functional status after hip disarticulation. RESULTS: Hip disarticulation was performed electively in most cases and urgently in only three cases. The indications had the following origins: infection (n = 6), tumor (n = 6), trauma (n = 3), and ischemia (n = 2). The mean post-surgery survival was 200.5 days. The survival rates were 6875% after six months, 5625% after one year, and 50% after three years. The mortality rates were higher in disarticulations with traumatic (66.7%) and tumoral (60%) causes. Regarding the eight patients who survived, half of them ambulate with crutches and without prosthesis, 25% walk with limb prosthesis, and 25% are bedridden. Complications and mortality were higher in the cases of urgent surgery, and in those with traumatic and tumoral causes. CONCLUSION: Hip disarticulation is a major ablative surgery with obvious implications for limb functionality, as well as high rates of complications and mortality. However, when performed at the correct time and with proper indication, this procedure can be life-saving and can ensure the return to the home environment with a certain degree of quality of life.info:eu-repo/semantics/publishedVersio

Sports activity and hip, knee, shoulder and intervertebral disc arthroplasties

The success of joint replacement surgery has been responsible for raising patients' expectations regarding the procedure. Many of these procedures are currently designed not only to relive the pain caused by arthrosis, but also to enable patients to achieve functional recovery and to engage in some degree of physical activity and sports. However, as physical exercise causes an increase in forces exercised through the articular prosthesis, it can be an important risk factor for its early failure. Scientific literature on sports after arthroplasty is limited to small-scale retrospective studies with short-term follow-up, which are mostly insufficient to evaluate articular prosthesis durability. This article presents a review of the literature on sports in the context of hip, knee, shoulder and intervertebral disc arthroplasty, and puts forward general recommendations based on the current scientific evidence. Systematic Review, Level of Evidence III.info:eu-repo/semantics/publishedVersio

Intravertebral expandable implants in thoracolumbar vertebral compression fractures

Current scientific evidence enhances the importance of the anatomic restauration of vertebral bodies with compression fractures aiming, as with other human body joints, to obtain a biomechanic and functional spine as close as the one prior to the fracture as possible. We consider that anatomic reduction of these fractures is only completely possible using intravertebral expandable implants, restoring vertebral endplate morphology, and enabling a more adequate intervertebral disc healing. This enables avoiding disc and osteodegenerative changes to that vertebral segment and its adjacent levels, as well as the anterior overload of adjacent vertebral bodies in older adults - a consequence of post-traumatic vertebral flattening - thus minimizing the risk of adjacent vertebral fractures. The ability of vertebral body fracture reduction and height maintenance over time and its percutaneous transpedicular application make the intra-vertebral expandable implants a very attractive option for treating these fractures. The authors show the direct and indirect reduction concepts of vertebral fractures, review the biomechanics, characteristics and indications of intravertebral expandable implants and present a suggestion for updating the algorithm for the surgical treatment of vertebral compression fractures which includes the use of intravertebral expandable implants. Level of Evidence V, Expert Opinion.info:eu-repo/semantics/publishedVersio

High congenital hip dislocation in adults - arthroplasty and functional results

Objective: Retrospective case-control study on the authors' experience regarding arthroplasty in high congenital dislocations of the hip in adults. Methods: Sample with 11 high congenital hip dislocations (Hartofilakidis type C) that occurred in seven patients, who were submitted to hip arthroplasty by the same surgeon and with the same surgical technique. Mean follow-up period was 4.32 ± 2.67 years (minimum one year) and all patients were evaluated by the same examiner. Results: All the arthroplasties had cementless fixation, with application of screwed acetabular cups, conical femoral stems, and a metal-polyethylene articular pars. In every patient, shortening femoral osteotomies were performed at subtrochanteric or supracondylar locations. The mean Harris Hip Score at the last evaluation was 88.55 ± 4.50 (range 81-94). The mean time with high dislocation of the hip (42.91 ± 14.59 years, range 19-68) showed a significant inverse correlation with Harris Hip Score (r = 0.80; p = 0.003). All patients reported important relief of pain complaints and are capable of ambulation without any external support. In the unilateral dislocations, leg length discrepancies were fully corrected; in the bilateral cases, isometric limbs were achieved in all patients. All osteotomies consolidated, with a mean interval of 3.27 ± 0.47 months. There were complications in 18.18% of the sample: one iatrogenic intraoperative fracture of the greater trochanter and a transitory sciatic neurapraxia. Conclusion: Despite being a demanding surgery with a reportedly high complication rate, total hip arthroplasty in high congenital dislocations, when properly indicated and technically correctly performed, allows an improvement in function and quality of life.info:eu-repo/semantics/publishedVersio

Cúpulas Acetabulares De Dupla Mobilidade Em Artroplastias Primária E De Revisão Da Anca

As resseções peri-acetabulares e reconstrução subsequente estão entre os procedimentos mais desafiantes na Ortopedia Oncológica. Os autores apresentam 2 casos em que foram aplicadas endopróteses modulares tripolares de reconstrução peri-acetabular com pedestal do ilíaco e os seus resultados clínico-funcionais. Apresenta-se uma mulher de 70 anos com metastização óssea única ao nível do acetábulo esquerdo, com origem primária num tumor papilar do urotélio vesical de alto grau. Entretanto sofreu queda da própria altura, da qual resultou fratura-luxação central patológica da anca esquerda, com lesão lítica acetabular na zona de carga. Foi então submetida a cirurgia de resseção tumoral, com resseção total da zona II (peri-acetábulo) e resseção parcial da zona III (púbis) de Enneking. Aplicou-se uma prótese LUMiC® com pedestal no ilíaco, componente acetabular com rebordo anti-luxante e cúpula de dupla mobilidade. A nível femoral, foi aplicada uma haste de Wagner, com utilização de manga de Trevira para reinserções musculares. Apresenta-se uma jovem do sexo feminino de 26 anos referenciada ao nosso centro por cordoma coccígeo recidivado, com envolvimento de várias estruturas, entre as quais pilar posterior do acetábulo, vértebras sagradas, músculos pélvicos incluindo os glúteos e parede retal. Através de abordagem multi-disciplinar foi submetida a resseção tumoral, com necessidade de osteotomia superior a nível da 2ª vértebra sagrada e de resseção do canal anal e ânus, com realização da respetiva colostomia. Depois da remoção tumoral, foi realizada osteotomia da zona II do acetábulo e reconstrução com prótese de pedestal no ilíaco com componente acetabular com rebordo anti-luxante e cúpula de dupla mobilidade, com haste cimentada a nível femoral. Para encerramento posterior, foi realizada passagem transabdominal de retalho músculo-cutâneo do reto anterior do abdómen. O pós-operatório imediato de ambas as pacientes consistiu inicialmente em repouso no leito em decúbito dorsal, com almofada entre as pernas e tornozelos imobilizados, sendo apenas permitidas semi-lateralizações. Após 4 semanas, a primeira paciente iniciou levante com ortótese anti-abdutora da anca e às 16 semanas fazia marcha autónoma com apoio de canadianas. Na segunda paciente foi constatada uma dismetria de 3,5cm, pelo que foi necessária osteotomia femoral homolateral de encurtamento para correção. Teve episódios de deiscências de suturas e ao fim de 8 semanas foi realizada a osteotomia. Às 10 semanas iniciou levante e deambulação com andarilho/canadianas, sem queixas dolorosas relevantes. A resseção e reconstrução acetabular são das cirurgias mais desafiantes a nível da Ortopedia Oncológica. A anatomia complexa, dimensão tumoral e proximidade a estruturas neuro-vascular major leva a que muitas vezes seja difícil de conseguir margens de resseção adequadas. Em segundo lugar, a reconstrução de um membro funcional e indolor é cirurgicamente exigente devido à extensão da resseção e à biomecânica complexa a restaurar. Por outro lado, as reconstruções deste calibre estão associadas a risco elevado de infeção, chegando a 40% em alguns relatos. Os autores apresentam 2 casos clínicos em que a reconstrução peri-acetabular com recurso a endoprótese com pedestal no ilíaco permitiu excelentes resultados clínico-funcionais, apesar de extensa resseção (zonas II e III). Como complicações apenas se verificou dismetria acentuada do membro. Esta complicação foi verificada intra-operatoriamente, no entanto, preferiu-se garantir estabilidade da prótese a nível do ilíaco e posteriormente corrigir a dismetria. As reconstruções acetabulares são cirurgias complexas de elevado risco. O aparecimento de próteses de reconstrução acetabular para grandes defeitos ósseos pós-resseções tumorais, tais como as próteses modulares tripolares com pedestal no ilíaco, e a sua correta aplicação e indicação, permitem obter resultados promissores no tratamento e recuperação funcional capaz destes pacientes

Surgical Treatment of Multiple Osteoporotic Fractures of the Dorsolumbar Spine: Case Report

Osteoporotic vertebral fractures are a common type of fracture and affect a significant number of subjects with osteoporosis. Despite the high fracture risk, the concomitant occurrence of vertebral fractures at non-contiguous levels is very rare. We report the case of a patient with three burst dorsolumbar spine fractures at non-contiguous levels who was treated with percutaneous kyphoplasty and transpedicular posterior fixation. Six months after the surgery, the patient walks autonomously and without pain; in addition, there is no radiological evidence of fracture reduction loss.info:eu-repo/semantics/publishedVersio

Stent-armed kyphoplasty in osteoporotic thoracolumbar fractures—clinical and functional results and a center experience over 10 years

Background: The optimal treatment of osteoporotic vertebral fractures is still a controversial and under discussion topic. Armed kyphoplasty with expansive intravertebral implants is an emerging procedure, which, in theory, it not only makes it possible to achieve instant analgesia, and to get stabilization gains of benefits of kyphoplasty and vertebroplasty, but also, allows for a more effective maintenance of the restored vertebral height. Methods: A retrospective observational study is presented, in which 30 patients participated, including a total of 33 osteoporotic thoracolumbar compression burst vertebral fractures with involvement of one or both vertebral platforms and of more than one fifth of the posterior wall. These individuals underwent armed kyphoplasty with VBS® stents (or stentoplasty) filled with bone cement over 10 years (between 2012 and 2022) at the same center. Clinical (visual analogue scale, Oswestry Disability Index and Patient Global Impression of Change) and imaging results (restoration and maintenance of vertebral body heights) achieved were investigated. The mean follow-up time was 4.5 years (range, 1-10 years). Results: There was a statistically significant improvement in all clinical and functional parameters evaluated, as well as a statistically significant difference in the various vertebral body heights between preoperative and end of follow-up time [increase of 10.7-15.2-5.0 mm (anterior-median-posterior) in the sagittal plane and 6.7-11.6-9.7 mm (right-median-left) in the coronal plane]. There was a statistically significant direct correlation between vertebral heights in the coronal plane, and between the Beck index assessed at the end of the follow-up period and the improvement in functional disability. Conclusions: The percutaneous transpedicular posterior approach, the ability to anatomically restore the fractured vertebra and to maintain it in the medium-long term, as well as the reduced risk of adverse effects, make stent-armed kyphoplasty a very attractive treatment option for osteoporotic compressive thoracolumbar fractures. A clinical-morphological correlation was demonstrated regarding the surgical treatment of these fractures, it was found that a more effective morphological restoration of vertebral heights in both the sagittal and coronal planes is associated with superior satisfactory clinical functional parameters.info:eu-repo/semantics/publishedVersio

Why are Diverticula of the Rectum Uncommon? Angiomorphological Hypothesis

info:eu-repo/semantics/publishedVersio

Intrapelvic trauma by metallic wire: Surgical challenges faced

Introduction: Penetrating pelvic trauma is rare and presents as one of the most difficult challenges to trauma surgeons. Case Report: We present an unusual case of a 23-year-old male suffering a penetrating pelvic trauma by a projected metal wire. The wire was found in intrapelvic location, caused no internal organs injury and was safelyremoved using a Pfannenstiel extended approach. Conclusion: Preoperative assessment of foreign body position is mandatory to set-up an efficient surgical procedure. The surgeon must have a profound knowledge of pelvic anatomy in order to choose the best option for the foreign body removal without any iatrogenic lesions.info:eu-repo/semantics/publishedVersio