AUTORS:KODI E. KOJIMA, GILBERTO H. OHARA, WALTER H.C. TARGA The authors discuss the indications of the wrist arthroscopic exam and suggest a guide to its use. They present the routine employed in their Service and comment on the anatomical structures that must be analysed. Download PDF   View Article in Portuguese

AUTORS:SÉRGIO L. CHECCHIA, PEDRO DONEUX S. Results obtained with 40 patients (44 shoulders) surgically treated of the impingement syndrome between July 1987 and July 1991, with a minimum follow-up of 2 years, are discussed and analyzed. These patients underwent an open acromioplasty plus resection of the distal end of the clavicle, when painful at preoperative examination. Final results did not compare favorably with those obtained with a group of patients who had been submitted to open acromioplasty without A/C resection (p < 0.05). A postoperative residual instability of the A/C joint, accompanied by a "dropped shoulder", leading to an often incapacitating muscular fatigue and pain, was believed to be the main cause for the results obtained. Clinical findings and a specific maneuver to access the residual instability of the acromioclavicular joint, and also the anatomic basis which might lead to such instability, are described. The authors propose a slight modification of the operative technique to avoid or minimize this complication, and a surgical technique to restore the lost stability, obtained by transposing a flap of the conjoined tendon to the stump of the resection, combined with a cerclage between the clavicle and the coracoid process. Download PDF   View Article in Portuguese

AUTORS:AFRÂNIO DONATO DE FREITAS, ARLINDO G. PARDINI JÚNIOR, PAULO CEZAR V. FONSECA MONTEIRO The surgical treatment of metacarpal fractures has been used since a long time ago. There are several techniques described in the medical literature, all of them presenting good results. The major challenge in metacarpal fractures is to offer a stable fixation rigid enough to allow early mobilization in order to prevent frequent complications, such as edema, fibrosis, adherence and stiffness. In this paper, the authors present the results of 21 metacarpal fractures treated by multiple intramedullary Kirschner's wires technique. This technique is safe for early mobilization, promote quick healing of the bone with good results and low costs. Download PDF   View Article in Portuguese

AUTORS:EDUARDO DA FROTA CARRERA, MARCO MARTINS AMATUZZI The authors describe a surgical technique by arthroscopic approach, for the reconstruction of the articular capsule and glenoidal labrum lesion, in the anterior aspect of the shoulder (Bankart lesion). The technique consists of a suture in "U" shape, with a straight needle, involving all the articular capsule and glenoidal labrum lesion and passing through the glenoidal border, from the anterior to the posterior aspect of the shoulder. The articular capsule and the glenoidal labrum are fixed, under tension, in the anterior border of the glenoid, using a non-absorbable suture. Twenty-eight shoulders were operated on. Follow-up varied from nine months to six years (average of 29.4 months). Download PDF   View Article in Portuguese

AUTORS:NILSON ROBERTO SEVERINO, OSMAR PEDRO ARBIX DE CAMARGO, TATSUO AIHARA, RICARDO DE PAULA LEITE CURY, EVALDO HIRASHIMA The authors present a 49-year-old female patient who complained of pain in her left knee due to a discoid medial and lateral menisci. As it is a very rare finding, a literature review was realized concerning mainly its incidence, etiology, radiographic and arthroscopic aspects, and the possible treatment. The discoid medial menisci is a unusual finding, and it is even rarer when both menisci are affected in the same knee. Download PDF   View Article in Portuguese

AUTORS:JOSÉ MARCIO GONÇALVES DE SOUZA The author presents an anatomic and arthroscopic description of the popliteus tendon and its correlated structures situated in the popliteus hiatus space. He presents a functional and clinical evaluation. After reviewing 100 videotapes of arthroscopic surgeries of the popliteus hiatus, he describes the lesions found and comments on the value of the popliteus system as a postero-lateral restrainer of the knee. Download PDF   View Article in Portuguese

AUTORS:CAIO AUGUSTO DE SOUZA NERY, MÁRIO CARNEIRO FILHO A retrospective review of 18 patients seen at the Federal University of São Paulo with osteochondral lesions of the talus was undertook. Ninety-four per cent of the patients had had a history of severe ankle sprain and 88.9% had had chronic symptoms before the definitive diagnosis was made. The lesions were classified by fracture type (Berndt-Harty) and distributed as: 3 patients with type I (16.7%), 3 type II (16.7%), 11 type III (61.1%) and 1 type IV (5.5%). The treatment of choice to type I fractures was the conservative one with restriction of weight-bearing. For the others, it was suggested arthroscopic treatment (excision of fragments, curettage and drilling of the remaining crater) but only 12 were treated by this method. In two instances, it was done the transmaleolar arthrotomy to find and treat the lesions. One patient refused to be treated. After an average follow-up period of 2 years and 10 months (minimum of 3 months and maximum of 8 years), the authors found 8 excellent results (44.4%), 8 good results (44.4%), 1 fair result (5.6%) and 1 poor result (5.6%). The poor result is the one who refused the treatment. Considering the patients who undertook arthroscopic treatment, it was obtained 50.0% (6 patients) of excellent results and 50.0% (6 patients) of good results. This indicates the arthroscopic treatment as the best choice because it is quicker, less morbid, with few complications and offers very good results. Download PDF   View Article in Portuguese

AUTORS:JOÃO LUIZ ELLERA GOMES, ALEX EICKHOFF, LUIZ ROBERTO S. MARCZYK A prospective study comparing subchondral bone perforation and abrasion arthroplasty to treat knee chondral lesion was performed in 2 groups of 10 patients each. Both techniques were performed by videoarthroscopic vision. Seven patients were submitted to a second look after the first procedure. Comparative results were based on the remaining symptoms after the treatment. Both techniques presented similar results, with equal incidence of bad results in each group. Download PDF   View Article in Portuguese

AUTORS:MARCELO HIDE MATSUMOTO, ANTONIO ALTENOR BESSA DE QUEIROZ, SÉRGIO JOSÉ NICOLLETI, JOÃO EDUARDO PATO The authors present a preliminary communication about elbow arthroscopy, with special attention for local anatomy. The main indications are discussed. Download PDF   View Article in Portuguese

AUTORS:LAFAYETTE AZEVEDO LAGE, ROBERTO CAVALIERI COSTA Hip arthroscopy is a minimally invasive procedure, which allows early discharge from hospital and short rehabilitation time. The authors recommend the use of hip arthroscopy in the diagnosis of hip pain in which non-invasive investigations have failed, for the diagnosis and treatment of septic arthritis and torn acetabular labrum, and for the removal of loose bodies and the debridement of mild to moderate osteoarthritis in young patients. Download PDF   View Article in Portuguese

AUTORS:RENE JORGE ABDALLA, MOISÉS COHEN, CARLOS GORIOS The authors present a study performed in 23 patients with partial anterior cruciate ligament lesions, diagnosed through arthroscopic and anatomic criteria. They analysed 18 male patients (78.2%), and 5 (21.7%) females, with an average age of 25.3 years old. Follow-up ranged from 30 to 83 months (average of 55.8). The integrity or rupture of the synovial membrane that involves the ligament classified the lesions as closed or open sheath. The closed sheath type ruptures allowed results classified as normal and nearly normal in 90.91%, and abnormal and severily abnormal in 9.09%, during the follow-up. The open sheath type presented normal and nearly normal evolution in 33.33%, and abnormal and severily abnormal in 66.67%. The authors conclude that those partial lesions of the anterior cruciate ligament which maintain the synovial membrane integrity showed better prognosis. Download PDF   View Article in Portuguese

AUTORS:GLAYDSON GOMES GODINHO, JOSÉ MÁRCIO GONÇALVES DE SOUZA, ALEXANDRE CASSINI DE OLIVEIRA, JOSÉ MÁRCIO DE FREITAS The authors present their experience with arthroscopic surgery for subacromial decompression, after 100 consecutive surgeries in patients with impingement syndrome, staged according to Neer's classification in grades II and III. In this revision, patients with SLAP lesions (11 patients) and those with a follow-up of less than 6 months postoperatively (9 patients) were excluded. Sixty-five patients were reviewed (5 patients did not return for revision) with an average age of 46.5 years and medium follow-up of 21.7 months. The results were analyzed in subjective, objective and functional manners using the UCLA protocol, obtaining 90.8% excellent and good results, 7.7% fair results and 1.5% poor results. Among the advantages of this technique, it is emphasized the good results achieved, the possibility of detecting associated intra-articular lesions (43.1% of the patients) and the low morbidity offered by arthroscopic surgery. The authors conclude that subacromial decompression by arthroscopy in the impingement syndrome is a modern surgical technique and has advantages in relation to open subacromial decompression. Download PDF   View Article in Portuguese

AUTORS:RENE JORGE ABDALLA, MOISES COHEN, THOMAS P. LEIVAS, HEVERTON C. OLIVEIRA, LUIZ RENATO NAKASHIMA, WALTER FERRARESI The authors present a study of the vasculature of anterior cruciate ligament, with and without synovial sheath, in 15 knees of 10 human cadavers. Radiographic study was performed using mamographic machine to analyse the blood supply and its possible damage after biomechanical test (pure axial traction) in 10 knees in which the synovial sheath was maintained. The main nourishment of the anterior cruciate ligament is provided for the synovial sheath, mainly from its proximal third. In partial ligament lesion (experimental study), the authors found 90% of vascular damage, mainly in the distal segment. Download PDF   View Article in Portuguese

AUTORS:CARLOS ROBERTO SCHWARTSMANN, IVO SCHMIEDT, LUÍS FERNANDO CARVALHO, LUCIANO C. RAMIRES, PAULO CÉSAR NERY, GUSTAVO H. SILVA, GUSTAVO K. DE OLIVEIRA The authors present two cases of unstable fractures of the pelvic ring during pregnancy. Both patients were treated at the Serviço de Ortopedia e Traumatologia da Santa Casa de Porto Alegre. It was not found any similar report in the literature. Download PDF   View Article in Portuguese

AUTORS:MOISÉS COHEN1, RENE J. ABDALLA, BRUNO LOMBARDI JR., MARCELO S. FILARDI, BENNO EJNISMAN, JOICEMAR T. AMARO The authors present an indication of hip arthroscopy technique with diagnosis of chrondroma confirmed by histological exam. The indication of arthroscopic procedure was realized after serial exams and the result of MRI (abnormal intra-articular image near the fovea). The main objective was the biopsy and, if possible, arthroscopic resection in order to avoid open arthrotomy and promote a quick rehabilitation and less traumatic surgery. After one year follow-up, the patient is asymptomatic. Download PDF   View Article in Portuguese

AUTORS:MUNIR MARCUS BESSA, JOSÉ WAGNER DE BARROS, CLAUDIO HENRIQUE BARBIERI Aiming at studying and quantifying the fracture healing process, fifteen patients with closed tibial shaft fracture, treated by conservative method, were submitted to scintigraphic evaluation using 99mTc-MDP, at 45, 90 and 180 postoperative days. An "activity index" (AI, quotient between the mean counting on the fracture site and on the corresponding region on the contralateral leg) was calculated for each patient, in all periods of evolution. Results showed that the AIs varied significantly from one patient to another and from one period to another in the same patient, without correlation with type of fracture or any other parameter. Therefore, the lack of homogeneity made it impossible to establish a consistent pattern of behaviour of the metabolic activity of the healing of closed diaphysial tibial fractures. Download PDF   View Article in Portuguese

AUTORS:ALBERTO HAMRA, JOSÉ B. VOLPON A method allowing quantitative evaluation of the medial plantar arch was developed using the moiré topography. The study was conducted in positive plaster molds obtained from the right foot of thirty normal adult individuals. Such molds, after being drawn with referential lines on the plantar surfaces, were placed behind a screen manufactured with nylon threads. A properly placed light source gave rise to a pattern of moiré fringes on the mold surface that was photographed. The analysis was carried out in the pictures. Applying an equation, it was possible to calculate the plantar arch high. Such figures were compared with the results obtained from the direct measurement. Objective evaluation of the results was performed with regression analysis, and subjective evaluation was done with the comparison of the Cartesian lines obtained with both methods. A high coefficient of correlation was found between the two methods, and the visual comparison of the graphs showed very similar curves. It was concluded that the moiré topography was as an adequate and sensitive method to evaluate the plantar arch, but strict placement of the object and observation of the referential parameters are of the utmost importance. Download PDF   View Article in Portuguese

AUTORS:HELTON L.A. DEFINO, ANDRÉS EDGAR RODRIGUEZ FUENTES The authors present their experience with the osteosynthesis of the odontoid process by means of two screws. They discuss some technical aspects of the operation and the result obtained in three patients, being two men and one woman with ages ranging from 22 to 72 years (average: 40.6 years). Fractures were classified according to Anderson-D'Alonzo classification: two cases as type II and one as type III. One patient presented a stable fracture of the C1 arch;another one was a psychiatric patient with an associated wrist fracture. All fractures were significantly displaced and were fixed with two 4.0 mm spongiosa AO screws. All patients wore a cervical collar for 12 months postoperatively. All fractures healed uneventfully and all patients resumed their previous professional occupation with a variable period of time but not longer than 3 months. Download PDF   View Article in Portuguese