AUTORS:EGON ERICH HENNING, ALI JUMA ABDALLA ABDEL HAMID, ODON LUIZ SILVEIRA Fº, CARLO HENNING In a retrospective study, the authors compare the results of 70 feet with hallux valgus after a mean follow-up of 58 months. The feet were treated by the following techniques: Hohmann, Chevron, Lelièvre-Viladot and osteotomy at the base of the first metatarsal. The authors compare the variation of pre and post-operative data obtained by subjective and objective assessment. Variations in pre and post-opera-tive values of the intermetatarsal angle, of the valgus angle of the hallux, of the relative protrusion of the first metatarsal bone were found to be fundamental factors to obtain good results with different surgical techniques, and that it is also extremely important to analyze each particular situation to determine the ideal method to be used. Download PDF   View Article in Portuguese

AUTORS:JOSÉ AUGUSTO CALIL, LYDIA MASAKO FERREIRA, JOSÉ LAREDO FILHO A study was done of the anatomy of the fascio-cutaneous branches of the inferior gluteal artery, first and second perforators, in order to help in the preparation of a flap for the reconstruction of the gluteal and perineal regions. After dissecting 40 thighs in fresh cadavers, the inferior gluteal artery was found to be medial and posterior to the sciatic nerve; the descending fascio-cutaneous branch was medial to the posterior cutaneous nerve of the thigh (87.5%), its average diameter of 0.61 mm, standing to the side of the ischial tuberosity at an average distance of 3.66 cm. The fascio-cuta-neous branches of the first and second perforator arteries were also examined, that were 1.21 mm and 1.01 mm in diameter. The distances from the first and second perforator arteries to the greater trochanter of the femur were 6.23 cm and 12.19 cm, respectively. The cutaneous area nourished by each one of the arteries was evaluated through the injection of dye. The inferior gluteal artery colored the upper medial and lateral regions. The first perforator artery colored the mid-lateral region, the proximal portion of the mid-medial region and the distal portion of the upper medial and lateral regions. The second perforator artery nourished the distal portion of the mid-medial and lateral regions and the proximal portion of the lower lateral region. Download PDF   View Article in Portuguese

AUTORS: JOÃO MAURÍCIO BARRETTO, FERNANDO JOSÉ DE PINA CABRAL, MARCIO CARPI MALTA, CLAUDIO PENA GONÇALVES   Download PDF   View Article in Portuguese

AUTORS:JOSÉ CARLOS BONGIOVANNI, EMÍLIO PALAZZO NETO, HILÁRIO BOATTO, RENATO AMORIM The authors performed a retrospective review, evaluating 42 patients (44 knees) with knee flexion deformity, ages ranging from 6 to 63 years, treated by the Ilizarov method. They report the disability caused by this deformity concerning weight bearing and walking, and the limitations of conventional treatment methods. Details of the method are presented, emphasizing the placement of hinges, which are the main element for the correction of this deformity. The major complication was bony ankylosis during distraction in 6 cases that had previous chondral lesions. These cases show the importance of ligamentotaxis to achieve range of motion as well as proper rehabilitation after the removal of the external fixator. Download PDF   View Article in Portuguese

AUTORS:ANDERSON AMARAL DE OLIVEIRA, WAGNER NOGUEIRA DA SILVA, EDUARDO RAMOS MARQUES PINA The authors present the results obtained in 10 patients with congenital short femur. 11 elongations were treated with Ilizarov external fixation between February 1990 and June 1995. The authors analyze patients type IX of Pappas classification in whom there is only shortening without bone deformity. Complications are discussed: wire infections, joint contractures, early osteotomy consolidation, and posterior subluxation of the knee. Download PDF   View Article in Portuguese

AUTORS:ARNALDO LUIZ LEON BLUM, JOÃO DE SOUZA GASPAR, LEO DALTO DOS SANTOS, MARCOS VINICIUS P. BARBOSA, JORGE DA SILVA REZENDE, ANTONIO CARLOS B. FAUSTINI, CARLOS ALBERTO F. RODRIGUES, JOSÉ MAURÍCIO DA SILVA The authors show an infected pseudoarthrosis jaw case, treated by external fixator and a variant of the Papineau technique. They chose this association after having failed when the patient was submitted to bone curettage and rigid fixation with mini-plates. Download PDF   View Article in Portuguese

AUTORS:GERALDO JOSÉ TUFFI, NÉLSON FRANCO FILHO, FRANCISCO CARLOS SBRUZZI The authors studied 44 cases in 43 patients sustaining osseous infections of various etiologies treated by the Ilizarov method in the period from May 1988 to February 1995, at the University Hospital in Taubaté. Ample cleaning of the infected site followed by bone transport was done in 19 (43.1%) patients, namely 18 (94.7%) tibiae and 1 (5.2%) forearm. Monofocal osteosynthesis (compression alone or compression followed by distraction) without cleaning the infectious focus was performed in 25 (56.8%) patients: on the tibia in 15 (60%), on the femur in 9 (36%), and on the forearm in 1 (4%). In 9 (36%) of the patients showing bone cavity images at simple X-ray, an oblique osteotomy was performed on the infection focus, followed by compression drainage. The antibiotic therapy was used in all patients submitted to bone transport, after identification of the infectious agent by culture of materials collected during surgery. Fol-low-up of the 44 patients went from 1 year and 8 months to 6 years and 9 months, with a mean of 4 years, 2 months, and 15 days. In 19 patients (43.1%) submitted to bone transport, consolidation with no relapses occurred in 11 (57.9%). Infection remained inactive in 13 (68.4%) patients. Consolidation occurred in 14 (73.7%), and 8 (42.1%) had unsatisfactory results, as follows: 3 (15.7%) achieved consolidation but with persistence of the infection; 2 (10.5%) stayed in non-union with no clinical signs of infection; 2 other (10.5%) had to be submitted to amputation due to vascular complications, and 1 (5.2%) patient remained with infected non-union. In 25 (56.8%) patients, monofocal osteosynthesis was utilized. 23 (92%) achieved consolidation without relapse of infection. Consolidation occurred in 24 (96%) patients and, among them, just 1 (4%) kept an active infection. The other patient in this group (4%) remained with infected non-union. In the eventual assessment of the 43 patients studied, 34 (77.3%) achieved consolidation with inactive infectious focus, which is considered a good outcome. Download PDF   View Article in Portuguese

AUTORS:MAURIZIO A. CATAGNI, J. TEJAN, J.V.N. FELICI, J.C. BONGIOVANNI Massive tibial bone loss after trauma or tumor resection presents a formidable problem. Existing reconstructive techniques are associated to significant limb and donor site morbidity, and frequently result in amputation. The authors present another technique which uses the fibula and the Ilizarov apparatus. Ilizarov device was attached to the remaining tibia, occasionally extending to the distal femur and/or foot. Complete proximal and distal fibula corticotomy was performed followed by transverse distraction of the ipsilateral fibula across into the tibial defect. Cancellous bone graft was added to the docking sites. After union, the frame was replaced by a cast which, in turn, was replaced with an orthosis. This procedure was used to treat five male patients, ages ranging from 13 to 53 years, with massive tibial bone loss. One patient was submitted to resection of the proximal two thirds of the tibia because of a tumor, three patients had reconstruction of the tibia after acute trauma, and one patient had the tibia resected because of chronic infection. Four patients achieved good to excellent results. These patients returned to their normal activities, including sports. Treatment is considered to have failed for one patient. Ipsilateral fibular transfer and skeletal stabilization with the Ilizarov apparatus have several advantages over traditional methods of treatment for massive tibial bone loss after fractures and tumor resection. The Ilizarov construct is a stable external fixator that allows early weight bearing. The horizontal transfer is carried out with minimal surgical exposure. There is no donor site morbidity and the patient can bear an uninterrupted weight on the good lower limb. Download PDF   View Article in Portuguese

AUTORS:MARCELO TOMANIK MERCADANTE, ROBERTO A.L. SANTIN The Ilizarov method is well established to treat non-union bone loss because of its principle of permanent tension to Download PDF   View Article in Portuguese

AUTORS:TOMAZ PUGA LEIVAS, EDUARDO CÁRDENAS ARENAS, WALTER HAMILTON DE CASTRO TARGA, NATALINO LEOPIZZI, AURO M. OKAMOTO, JOÃO D.M.B.A. ROSSI, JOSÉ A.B. BAPTISTÃO A comparison is made of the axial rigidity and the radial stability of the external circular fixator in the "classical" assembly preconized by Ilizarov using only tensioned fine wires, to the variations proposed by the Lecco school, using tensioned fine wires and Schanz screws, and by Green (Rancho de Los Amigos - USA), using only Schanz screws, in flexo-compression assays (eccentric compression). All assemblies used for circular stainless steel 150 mm rings, two to each side of the space that simulated bone loss (situation of instability). 1.8 mm diameter Kirschner wires, and 4.8 mm diameter Schanz screws were used. At the center of abutting extremities of the tubes, going through the assembly axis, metal pointers were placed as points of reference. The model adopted simulates a high energy fracture at the diaphyseal region of the medium third of the tibia with 2 cm of bone substance loss. The assemblies were installed in a universal mechanical assay machine equipped with an electronic load cell and graphic recorder. The load was applied through and eccentric pin with a polished spherical tip located 25 mm from the system axis, in a position that was assumed to be dorsal, in order to generate moments similar to that of the human tibia during the support phase of gait (calcaneus touch). Conclusion is that, axially, the "classical" assembly is the most elastic of the three, whereas the North-American assembly (Rancho) is more rigid, and that the three assemblies have equal rigidity in the radial direction of the focus of the fracture. Download PDF   View Article in Portuguese

AUTORS:JOSÉ ANTONIO BADDO BAPTISTÃO, WALTER HAMILTON DE CASTRO TARGA, ROBERTO SANDOVAL CATENA, RAUL BOLLIGER NETO, PAULO ROBERTO DOS REIS Twenty-five patients aged 17 to 74 years (mean age 43.9) were treated for humerus non-unions (10 infected, 15 noninfected) by the Ilizarov technique. Union was achieved in all but one case. Mean time to union was 9.08 months. The authors discuss the indications, surgical planning, surgical technique, and the post-operative methods. Results were classified as good, fair, and poor, although they were, for the purposes of strict statistical analysis, grouped into 18 satisfactory (good), and 7 unsatisfactory (fair and poor) cases. Prior surgery and the presence of infection are factors that altered the final result. The good results achieved with the Ilizarov technique established this procedure as a good option of treatment. Download PDF   View Article in Portuguese

AUTORS:ALCIDES DURIGAN JUNIOR, LÉLIO CARLI BATISTA The use of osteotomies, a frequent practice in orthopedic surgery, is essential for deformities correction and bone lengthenings. After the announcement of Ilizarov's concepts about corticotomy, with preservation of osteogenetic elements, different articles were published with modifications of the technique. The authors present a review of the literature and discuss the different techniques now in use of a correct execution of the corticotomy, with the objective of decreasing complications caused by lesion of osteogenic elements, such as delayed union, non-union, and failures in bone regeneration. Download PDF   View Article in Portuguese

AUTORS:WALTER HAMILTON DE CASTRO TARGA, ROBERTO SANDOVAL CATENA The Ilizarov method is a very interesting option to treat fractures. The use of a fast, bloodless treatment with satisfactory reduction, free joints, early walking, and early hospital release is very attractive and tending to the choice of this technique. The obstacle found, however, is the difficult access to Russian literature. The authors standardize a method to assemble and apply the apparatus for the treatment of diaphyseal fractures of the tibia. Download PDF   View Article in Portuguese

AUTORS:JULIO CESAR GALI, GILBERTO LUÍS CAMANHO The authors study the results attained in the surgical treatment of 37 patients with anterior cruciate ligament lesions that were submitted to intra-articular reconstruction with bone-patellar tendon-bone graft in a single surgical approach. The authors attempt to establish the advantages and disadvantages of this technique. The results are analyzed based on the International Knee Documentation Committee protocol. In the final evaluation, they verify that 5.4% of patients' knees were graded as normal, 72.9% as nearly normal and 21.6% as abnormal. They correlate the data and conclude that the procedure improves the preoperative symptoms and the joint stability without causing significant limitation to the mobility of the knee. The authors observe an association between chronic anterior cruciate ligament lesions and medial meniscus lesions. However, no association between patellofemoral crepitus and pain was noted. Download PDF   View Article in Portuguese

AUTORS:ANDERSON VIEIRA MONTEIRO, JOSÉ RAUL CHICONELLI The authors present six cases of congenital ulnar deficiency, classified as type II according to Dobyns, Wood and Bay-ne's radiological classification. The procedure is reliable and includes resection of the proximal third of the radium with the dislocated head, and resection of the distal ulna, creating a one-bone forearm. Besides providing deformity correction, this technique increases the joint movements in the arc and prevents further deformity caused by growth. Download PDF   View Article in Portuguese

AUTORS:CLAUDE CHAMBRIARD, PAULO COUTO, LUIZ OSÓRIO, ZARTUR MENEGASSI The authors report a case of ulnar nerve compression by the posterior branch of the medial antebrachial cutaneous nerve, close to the elbow joint. It is a rare case and they have found no similar report. A historical review is made regarding the etiology of ulnar nerve compression and the anatomic description of the medial antebrachial cutaneous nerve. Download PDF   View Article in Portuguese