EVALUATION OF PRESENTATION OF SIGNS AND SYMPTOMS OF FEMOROACETABULAR IMPINGEMENT AFTER EPIPHYSIOLYSIS OF THE PROXIMAL FEMUR

ABSTRACTThe long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical parameters and constant clinical monitoring. Once the diagnosis has been made, fasciotomy should be performed. It is always difficult to assess consolidation, but the RUST method may help in this. Radiography is assessed in two projections, and points are scored for the presence of the fracture line and a visible bone callus. Today, the dogma of six hours for cleaning the exposed fracture is under discussion. It is considered that an early start to intravenous antibiotic therapy and the lesion severity are very important. The question of early or late closure of the lesion in an exposed fracture has gone through several phases: sometimes early closure has been indicated and sometimes late closure. Currently, whenever possible, early closure of the lesion is recommended, since this diminishes the risk of infection. Milling of the canal when the intramedullary nail is introduced is still a controversial subject. Despite strong personal positions in favor of milling, studies have shown that there may be some advantage in relation to closed fractures, but not in exposed fractures

Tempo de radiação emitida por fluoroscopia em cirurgias ortopédicas

OBJETIVO: Averiguar o tempo médio de emissão de radiação por aparelho de fluoroscopia durante variadas cirurgias ortopédicas e quais necessitam maior uso de radiação. MÉTODOS: Foram contabilizados os tempos em 16 cirurgias diferentes, totalizando 80 procedimentos. Ao final de cada procedimento foi verificado o tempo de utilização de fluoroscopia diretamente do intensificador de imagem. RESULTADOS: Foram necessários em média 61 segundos de fluoroscopia por operação. Os procedimentos que demandaram mais uso de radiação em média foram epifisiodese femoral proximal bilateral (5,1 minutos) e osteossíntese diafisária de fêmur com haste intramedular bloqueada (3,33 minutos). CONCLUSÃO: O tempo médio de fluoroscopia em cirurgias ortopédicas foi de 61 segundos. Os procedimentos com uso de dispositivo intramedular são os que requerem maior emissão de radiação.OBJECTIVE: To ascertain the mean length of radiation emission from fluoroscopic devices during several types of orthopedic surgery and which of these required greater use of radiation. METHODS: The times taken to perform sixteen different types of surgery (total of 80 procedures) were measured. At the end of each procedure, the length of time for which fluoroscopy was used directly from the image intensifier was ascertained. RESULTS: The mean time required for fluoroscopy per operation was 61 seconds. The procedures that demanded greatest mean duration of radiation use were bilateral proximal femoral epiphysiodesis (5.1 minutes) and femoral shaft osteosynthesis using a locked intramedullary nail (3.33 min). CONCLUSION: The mean duration of fluoroscopy use in orthopedic operations was 61 seconds. The procedures using an intramedullary device were the ones that required greatest radiation emission

Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty

AbstractObjectivethis was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty.Methodssixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically.Resultsthere were 35 female patients (56.5%) and 27 male patients (43.5%), with a mean age of 65 years (±11). Trochanteric bursitis was conformed histologically in nine patients (14.5%), of whom six were female (66.7%) and three were male (33.3%).Conclusions14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients

Do patients lose weight after total hip arthroplasty?

AbstractObjectiveTo investigate the effect of total hip arthroplasty (THA) on body mass index (BMI), from before to after the operation.Methods100 patients who underwent THA were retrospectively analyzed. They were stratified according to BMI, as proposed by the World Health Organization (WHO).ResultsThere were 48 male patients and 52 female patients. Their mean age was 63.8±13.5 years. The mean follow-up was 24.6±0.6 months. The men had a mean preoperative BMI of 28.4±3.6kg/m2 and the women, 27.5±5.0kg/m2. The mean postoperative BMI was 28.9±0.7kg/m2 for the men and 27.8±0.7kg/m2 for the women. There was a general mean increase in BMI of 0.4kg/m2. The BMI increased both in patients with normal weight and in those who were overweight, but it decreased slightly in patients who were obese. BMI remained unchanged in the majority of the patients (73%).ConclusionThe improvement in mobility achieved through THA did not promote any reduction in anthropometric measurements in the majority of the patients

Paralisia nervosa na artroplastia total do quadril Nerve palsy in total hip replacement

A paralisia nervosa pós-prótese total do quadril é uma complicação incomum (0,17 a 1%). A presente revisão, após levantamento bibliográfico sobre o assunto, analisa 50 artigos relevantes sobre o tema. A revisão tem como objetivos analisar dados da fisiopatologia, prevalência, etiologia, fatores de risco, prognóstico e prevenção dessa complicação.<br>Nerve palsy after total hip replacement is a rare complication (0.17% to 1%). This review of the literature on this topic reviews 50 relevant papers on the issue. The purpose of the review is to analyze pathophysiology, prevalence, etiology, risk factors, prognosis, and prevention of this complication

Avaliação da função hepática em pacientes submetidos à artroplastia total do quadril em uso de enoxaparina Evaluation of hepatic function in patients undergoing total hip arthroplasty using enoxaparin

OBJETIVO: Avaliar as alterações hepáticas decorrentes do uso de enoxaparina para profilaxia da trombose venosa profunda em pacientes submetidos à artroplastia total do quadril. MÉTODOS: Trinta e dois pacientes submetidos à artroplastia total do quadril, em caráter eletivo, utilizando enoxaparina, foram acompanhados por 65 dias com dosagens seriadas das enzimas hepáticas. RESULTADOS: Foram encontradas alterações laboratoriais em até 75% dos pacientes durante o estudo, que normalizaram após a suspensão do tratamento. Não houve manifestação clínica de lesão hepática. CONCLUSÃO: As enzimas hepáticas elevam-se na maioria dos pacientes em uso de enoxaparina, sem correlação clínica, e normalizam após a suspensão do tratamento.<br>OBJECTIVE: To evaluate hepatic changes due to the use of enoxaparin for prophylaxis of deep vein thrombosis in patients submitted to total hip arthroplasty. METHODS: Thirty two patients submitted to elective total hip arthroplasty, using enoxaparin, were followed up for 65 days with serial doses of hepatic enzymes. RESULTS: Laboratory changes were found in up to 75% of patients during the study, which normalized after suspension of the treatment. No clinical evidence of hepatic lesion was found. CONCLUSION: Increase in hepatic enzymes levels occurs in most patients using enoxaparin, but without clinical relevance, and normalizes after suspension of the treatment

EVALUATION OF HEPATIC FUNCTION AMONG PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY USING ENOXAPARIN

ABSTRACTObjective: To evaluate hepatic changes resulting from the use of enoxaparin for prophylaxis of deep vein thrombosis among patients undergoing total hip arthroplasty. Methods: Thirty-two patients underwent elective total hip arthroplasty, using enoxaparin, and were followed up for 65 days with serial hepatic enzyme assays. Results: Changes in laboratory parameters were found in up to 75% of the patients during the study, but the parameters normalized after suspension of the treatment. No clinical evidence of hepatic lesions was found. Conclusion: The hepatic enzyme levels increase in most patients using enoxaparin, but without clinical correlation, and the levels normalize after suspension of the treatment