AUTORS:NELSON ELIAS1, DURVAL TERCIO N. LEAL, LUIZ ANTÔNIO M. SANTOS Eighteen patients with displaced malleolar fractures had open reduction and fixation of the fracture fragments using biodegradable screws. Mean follow-up time was 8 months (range 3 months - 1 year, 2 months) and mean age was 32 (21 - 55) years. A plaster cast below the knee was used for 6 weeks after surgery. Sinus formation as a sign of tissue reaction was observed in 2 patients, 8 and 10 weeks after the surgical procedure, but this did not influence the healing of the fracture or the functional recovery. The main benefit of using biodegradable implants in bone surgery is avoiding a removal procedure with its psychological and economic advantages. The results of this study showed that biodegradable screws can be used successfully in ankle fractures. Download PDF   View Article in Portuguese

AUTORS:ALUÍSIO JÚNIOR AGUIAR FIGUEIREDO, CELSO DIAS FERNANDES, DÉCIO JOSÉ DE OLIVEIRA, JOSÉ WAGNER DE BARROS From January 1995 to August 1996, ten patients with unstable fracture of the distal radius were submitted to surgical treatment with external fixation. They were evaluated by anatomic, radiographic, and functional final results. It was concluded that external fixation of unstable fracture of the distal radius is a useful method, and achieved 90% of excellent and good results. Download PDF   View Article in Portuguese

AUTORS:SÉRGIO JOSÉ NICOLETTI, BENNO EJNISMAN With the purpose of assessing the frequency of early glenohumeral arthrosis, in patients with the subacromial impingement syndrome, and of assessing the effectiveness of plain shoulder X-rays to detect such syndrome, the authors performed a retrospective study of plain X-rays and video arthroscopy tapes of 48 patients who were operated on, with a diagnosis of subacromial impingement syndrome, without total tear of the rotator cuff. X-rays of all patients were considered normal. Review of the video tapes, however, did show that 9 (19%) of the patients had a degenerating chondropathy of the humeral head compatible with the initial arthrosis diagnosis. The authors draw attention to a possible association between non-identified glenohumeral arthrosis and poor results in the treatment of the rotator cuff syndrome. Download PDF   View Article in Portuguese

AUTORS:GLAYDSON GOMES GODINHO, JOSÉ MÁRCIO GONÇALVES DE SOUZA, JOSÉ MÁRCIO ALVES FREITAS, FLÁVIO MÁRCIO LAGO SANTOS, AGNUS WELERSON VIEIRA5, FRANCISCO MATEUS JOÃO Based on the increasing knowledge of the anatomy and pathophysiology of the anteroinferior instability of the shoulder and with the increasing development of new techniques of arthroscopic surgery of the shoulder, treatment of dislocations has developed greatly. The advantages of this technique are indisputable, such as little agressiveness and, consequently, reduction of morbidity, hospitalization, reduction in the loss of range of motion and reduction of the risk of post operative infection and, at the same time, allowing for accurate diagnosis and treatment of intra-articular lesion. Indication for arthroscopic surgery was extended from traumatic unidirectional anterior recurrent dislocation to include spontaneous dislocations. The occurrence of 11 recurrences in 79 cases or 13.9% is situated within the average found in the literature. By modifying Morgan's technique, going from ex-tra-articular to intra-articular labrum suture in their 25 cases, the authors concluded that more satisfactory results can be achieved. Download PDF   View Article in Portuguese

AUTORS:AFRÂNIO DONATO DE FREITAS, ARLINDO G. PARDINI JÚNIOR, ANTÔNIO TUFI NEDER FILHO The authors present the results of the treatment of Du-puytren's contracture using the open palm technique. Fourteen patients were reviewed with an average follow-up of 3.5 years. They concluded the technique has a low rate of complications and offer the best conditions to achieve a good result. Download PDF   View Article in Portuguese

AUTORS:MÁRIO CARNEIRO FILHO, RICARDO DIZIOLI NAVARO, MARCOS JOSÉ CORTELAZO The authors report a technique of the arthroscopic anterior cruciate ligament reconstruction with patellar tendon autograft, in which they utilize two transverse anterior mini-incisions for harvesting the central third of the tendon with patellar and tibial bone blocks. In twenty patients that were submitted to this technique, better aesthetics results and less pain in the early post-operative period were observed. Download PDF   View Article in Portuguese

AUTORS:NILSON ROBERTO SEVERINO, OSMAR P.A. CAMARGO, TATSUO AIHARA, RICARDO DE P.L. CURY, VICTOR MARQUES DE OLIVEIRA4 CARLOS E.S. VAZ, ÁLVARO CHAMECK, ANTONIO TOMAZINI, JOÃO L. VIEIRA DA SILVA In attempt to study the role of magnetic resonance imaging (MRI) to evaluate knee lesions, a retrospective study of 100 patients submitted to MRI scanning before arthroscopy was performed. MRI had high accuracy in assessing meniscal and cruciate ligament tears and compares favorably with other reports in the recent literature. However, MRI was not useful to delineate chondral lesions, with many false negative results. MRI is a useful diagnostic tool in conjunction with clinical examination in patients who have a suspect meniscal or cruciate ligament tear. Download PDF   View Article in Portuguese

AUTORS:JOÃO MAURÍCIO BARRETTO, PAULO COUTO The objective of this paper is to evaluate the diagnostic and therapeutic possibilities of knee arthroscopy, using local intra-articular anesthesia associated to patient sedation. 320 arthroscopies were performed in 313 patients using this method. The technique used provided a satisfactory level of anesthesia for diagnostic and therapeutic arthroscopy, and proved to be economical and time saving, presenting very low morbidity. The complication rate was 1.25%. The authors conclude that this method of anesthesia is an excellent option for knee arthroscopy when the procedure consists solely in intra-articular surgical manipulation. Download PDF   View Article in Portuguese

AUTORS:JOSÉ MARCIO GONÇALVES DE SOUZA Arthroscopic ankle surgery provides many significant benefits including better direct visualization, and increases the ability to perform diagnosis. These benefits will allow the surgeon to perform ankle surgery more easily and with a reduced rate of complications. The author presents a preliminary work and show his own experience after 32 procedures in 19 patients submitted to arthroscopic ankle surgery during the period of 1992 to 1997. Download PDF   View Article in Portuguese

AUTORS:CAIO AUGUSTO DE SOUZA NERY, MÁRIO CARNEIRO FILHO, RUI DOS SANTOS BARRÔCO, ALEXANDRE CASSINI DE OLIVEIRA The systematization of diagnostic procedure of post-trau-matic disorders of the ankle in our service revealed an increasing incidence of cases of ligament lesions combined with talus osteochondral fractures. Since the optional treatment for such fractures is made through arthroscopy, the authors were stimulated to develop a technique whereby they could act on both the fracture and the lateral ankle instability at the same time and with the available resources. This paper presents the intra and extra-articular steps of the procedure developed to reach that goal. Based on the principles suggested by Broström (1966), they plicate the anterior-lateral portion of the articular capsule of the ankle, reattaching it to the anterior edge of the fibular malleolus. The intra-articu-lar procedure (made through two lateral portals) consists in the abrasion of the lateral malleolus edge and in making drill holes in which metallic anchors are introduced, the extremities of which are tied to #2, slowly-absorbable sutures, which exit through one of the portals. The extra-articular procedure consists in the passing of those same sutures in the articular capsule - region where ligament remnants and newly formed scar tissue are located. The closing of the knots of the sutures thus passed leads the capsule portion towards the anterior edge of the fibula, retightening it. The extra-articular step is completed by advancing the edge of the extensors retinaculum to reinforce the whole assembly. Patients treated with this method present satisfactory recovery concerning articular stability, without symptoms. Although only a few patients have been treated so far, with a short follow-up period, the authors feel encouraged to keep on applying this technique. Download PDF   View Article in Portuguese

AUTORS:CAIO AUGUSTO DE SOUZA NERY1, MÁRIO CARNEIRO FILHO, RUI DOS SANTOS BARRÔCO The authors describe one patient submitted to arthroscopy to assist in the reduction of a juvenile Tillaux fracture. They found that the anterolateral portion of the tibial periosteum acts as an obstacle for the arthroscopic reduction. Download PDF   View Article in Portuguese

AUTORS:PAULO SÉRGIO MENDES DE QUEIROZ The author presents two cases of Kienböck's disease in female teenagers, aged 11 and 14 years old, who did not have any response to the conservative treatment. They were operated by shortening of the radius, where a rapid revascularization of semilunar was achieved, and symptoms disappeared 6 months after surgery. Download PDF   View Article in Portuguese

AUTORS:CELSO T.S. GOMES, LUCIANO S. KEISERMAN, MARCO ANTONIO H. KROEFF The purpose of this study is to stablish: 1) the prevalence of intoeing gait, 2) the normal values of hip rotation and 3) the correlation between intoeing and rotation. The authors examined 286 healthy males ranging from 1 to 18 years of age. Nine (3.15%) showed intoeing during walk. No significant difference in this prevalence was found in different age groups. With regard to rotation, the lateral rotation showed an initial decrease up to 3 years of age. Thereafter, until 18 years, there was a stabilization with variations within 45º and 55º. The medial rotation did not vary significantly between 1 and 8 years, ranging within 45º and 55º. From 9 to 13 years, there was a progressive decrease of this rotation, with stabilization within 30º and 35º until 18 years. As to total rotation (medial + lateral), from 1 to 7 years it oscillated between 100º and 110º, from 8 to 12 years, within 90º and 100º, and from 13 to 18 years, between 80º and 90º. The authors did not find any significant correlation between in-toeing gait and rotation. Download PDF   View Article in Portuguese

AUTORS:ALESSANDRO JANSON ANGELINI, MARCELO FERREIRA VENTOSA, MICHAEL DAVITT, WILLIAM DIAS BELANGERO Fifty-four hips in 40 children were treated with the Pavlik harness for congenital hip dysplasia, diagnosed between 1 and 16 weeks of life, in a public hospital. The diagnoses were made through Ortolani's maneuver and/or by ultrasound assessment of the hip, using Graf 's classification. Reduction was achieved in 50 of the 54 hips (92%), the failures occurred in 3 cases with severe damage (Graf 's types IId, IIIb and IV) and in 1 case with mild damage (Graf 's type IIa). The favorable results were probably obtained due to the correct use of the Pavlik harness, and were facilitated by our support staff who helped manufacture the harnesses and on patient follow-up. Download PDF   View Article in Portuguese

AUTORS:RAMES MATTAR JÚNIOR, RONALDO J. AZZE, SERGIO Y. OKANE, REGINA STARCK, MARCELO R. REZENDE, LUIZ K. KIMURA, EMYGDIO J.L. PAULA, EDUARDO A. PEREIRA5, ANA CRISTINA CAMILLO The authors analyze the results obtained in the treatment of 14 patients with 54 flexor tendon lesions at zones II (8 patients), III (1 patient), IV (1 patient) and V (4 patients). All the patients were treated in the acute phase, 5 at 6 hours, 5 at the first week and 4 at the second week of the trauma. All the patients were submitted to the Indiana method of flexor tendon raphy with four passes of 4 zeros suture with a running lock peripheral epitendinous 6 zeros suture. The program of rehabilitation was based in early active motion with a splint control. The authors achieved good results in 13 patients (92.8%) and conclude that it is possible to improve the results with a more resistant tendon suture and early active motion. Download PDF   View Article in Portuguese

AUTORS:ISANIO VASCONCELOS MESQUITA, SAMUEL RIBAK, MARCELO ROSA DE REZENDE, ROBINSON DALAPRIA, RAMES MATTAR JÚNIOR4, ELIEZER CARVALHO DE NOVAES The case presented is a rare example of chronic subcutaneous emphysema isolated to an extremity. This is a benign condition and must not be confused with necrotizing gas-producing infections. In the described cases of subcutaneous emphysema, the condition rapidly resolves itself without treatment, but in this specific patient the problem persisted with high quantity of air in tissues of the upper limb for 8 months. The principles used for diagnosis and treatment are presented and discussed. Download PDF   View Article in Portuguese

AUTORS:ARNALDO V. ZUMIOTTI, CARLOS SANTIAGO MARIN POSTIGO, LUÍS FERNANDO MARTINS DE CASTRO MACHADO, MÁRCIO ISSAMU OIDE An anatomical study was performed in 5 fresh cadavers in order to evaluate the role of the circumflex scapular artery (CSA) in the vascularization of the scapular fascia. The CSA was identified at the lateral border of the scapula within the triangular space. Methylene blue was injected into the CSA and the fascial flap was harvested. The size of the free scapular fascial flap (FSFF) ranged from 20 x 16 cm to 24 x 22 cm with an average of 22.4 cm x 18.7 cm. The FSFF was performed in 8 patients to repair large skin defects on the upper or lower extremities. The FSFF was harvested based on the CSA with a little skin island that was used as a monitor of the microanastomoses. All flaps survived and the results showed that the FSFF is a good option to treat severe lesions of soft tissues of the extremities. Download PDF   View Article in Portuguese