ABSTRACT
We investigated the potential of exogenous hyaluronic acid (HA) associated with corticosteroid injections to improve pain and function for the treatment of post-traumatic subtalar osteoarthritis, in comparison with isolated intra-articular corticosteroid. Twenty-five symptomatic participants (50 ± 8 years) with a minimum follow-up of 1 year after surgery for calcaneus fractures were enrolled. Participants were randomly assigned into a therapeutic group that underwent isolated corticosteroid intra-articular subtalar injection (Corticosteroid Group, nâ¯=â¯12) or a combination of HA plus corticosteroid (HA+C Group, nâ¯=â¯13). All participants underwent three repeated injections with intervals of 1 week. We assessed the visual analog scale of pain (VAS) and the AOFAS scores at 4 moments: before treatment (pre), 4-, 12-, and 24-weeks following the last injection. HA+C Group showed lower VAS at the 12th (pâ¯=â¯.003) and 24th weeks (pâ¯=â¯.003) and greater AOFAS at the 4th (pâ¯=â¯0.040), 12th (pâ¯=â¯.014), and 24th weeks (pâ¯=â¯.021), in comparison to Corticosteroid Group. We observed a reduction in VAS in the Corticosteroid Group only at the 4th week (pâ¯=â¯.007), compared with pretreatment values. In the HA+C Group, VAS presented lower levels at the 4- (p < .001), 12- (p < .001), and 24 weeks (p < .001). In the Corticosteroid Group, participants presented higher AOFAS score only at the 4th week (p < .001), while in the HA+C Group, the AOFAS scores were greater at the 4th, 12th, and 24th weeks compared to baseline (p < .001). The combination of exogenous HA and corticosteroid showed greater and longer analgesic effects and function improvement in comparison with isolated intra-articular corticosteroids.
Subject(s)
Hyaluronic Acid , Osteoarthritis, Knee , Humans , Hyaluronic Acid/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Injections, Intra-Articular , Pain , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate the correlation between knee axis and hindfoot axis in patients with advanced gonarthrosis, and the association between ankle function and angular deformities. METHODS: 72 patients were enrolled in the study: 66% were women, and mean age was 58.7 years. The anatomical axis of the knee and hindfoot were measured by short knee radiographs and long axial view of the hindfoot. RESULTS: Among the study group, 79.2% presented varus knee (mean 15º ± 7.69º) and 20.8% valgus (mean 15.9º ± 7.7º). 63.9% had hindfoot varus (mean 8.5º ± 6.07º) and 36.1% valgus (mean 3.9º ± 3.92º) (p < 0.05). The mean value for the American Orthopaedic Foot and Ankle Society (AOFAS) score was 74.26 points, and values were significantly higher among patients with hindfoot varus (p < 0.05). We found no correlation between gender or AOFAS score and knee and hindfoot axes, nor between deformities in the knee and hindfoot axes (p > 0.05). The subgroup genu valgum - hindfoot varus presented a moderate correlation (r = 0.564; p < 0.05). CONCLUSION: We found no association between the anatomical axes of the knee and hindfoot. Patients with gonarthrosis and hindfoot varus presented a better ankle function. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
OBJETIVO: Avaliar a correlação entre o eixo do joelho e o eixo do retropé em pacientes com gonartrose avançada, e a relação da função do tornozelo com as deformidades angulares. MÉTODOS: 72 pacientes, sendo 66% mulheres, idade média 58,7 anos participaram do estudo. Mediu-se o eixo anatômico do joelho e do retropé por meio de radiografias curtas dos joelhos e a incidência axial longa do retropé. RESULTADOS: da amostra, 79,2% apresentavam eixo do joelho em varo (média 15º ± 7,69º) e 20,8% valgo (média 15,9º ± 7,7º). 63,9% retropé varo (média 8,5º ± 6,07º) e 36,1% valgo (média 3,9º ± 3,92º) (p < 0,05). O valor médio do escore AOFAS foi 74,26 pontos, com valores significativamente maiores nos pacientes com retropé varo (p < 0,05). Não houve correlação entre o sexo ou o escore AOFAS e os eixos do retropé e do joelho, ou entre desvios no eixo do joelho e os desvios no eixo do retropé (p > 0,05). Observou-se uma associação moderada no subgrupo genuvalgo - retropé varo (r = 0,564; p < 0,05). CONCLUSÃO: Não houve associação entre os eixos anatômicos do joelho e do retropé. Pacientes com gonartrose e retropé varo apresentaram melhor função do tornozelo. Nível de Evidência II, Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.
ABSTRACT
OBJECTIVE: To evaluate the correlation between postoperative quality of life and the severity of hallux valgus deformity. METHODS: A total of 23 patients underwent moderate (n = 14) and severe (n = 9) hallux valgus (HV) surgical correction with the Scarf technique between January 2010 and December 2012. The mean follow-up time was 60 months. Participants answered the SF-36 quality of life assessment questionnaire and their radiographs were evaluated at three different moments (preoperative, 1 and 5 years after surgery). Statistical analysis was performed with a maximum 5% significance level. RESULTS: The sample consisted of two men and 21 women, aged 58.7.SF-36 mean value was 75.73 and the metatarsophalangeal and interphalangeal angles improved significantly at the three moments (p < 0.05). SF-36 showed no statistical difference between patients with moderate or severe HV (p > 0.05). No correlations were found between quality of life and pre and postoperative radiographic angles. CONCLUSION: Patients with moderate and severe hallux valgus submitted to surgical correction had a very good quality of life and a significant improvement in radiographic parameters. However, these variables were not correlated. Level of Evidence II, Retrospective study.
OBJETIVO: Avaliar a correlação entre qualidade de vida pós-operatória e a gravidade da deformidade do hálux valgo. MÉTODOS: 23 pacientes foram submetidos à correção cirúrgica do hálux valgo (HV) moderado (n = 14) e grave (n = 9) pela técnica de Scarf, entre janeiro de 2010 e dezembro de 2012. O tempo mínimo de acompanhamento foi de 60 meses. Os participantes responderam ao questionário de avaliação de qualidade de vida SF-36 e foram avaliadas suas radiografias em três momentos distintos (pré-operatório, 1 e 5 anos de pós-operatório). A análise estatística foi realizada com nível de significância máximo de 5%. RESULTADOS: A amostra contou com 2 homens e 21 mulheres, com média de idade 58,7 anos. O valor médio do SF-36 foi 75,73 e os ângulos metatarsofalangiano e interfalangiano apresentaram melhora significativa nos momentos avaliados (p < 0,05). O SF-36 não mostrou diferença estatística entre os pacientes com HV moderado ou grave (p > 0,05). Não houve correlações entre a qualidade de vida e os ângulos radiográficos pré e pós-operatórios. CONCLUSÃO: Os pacientes com hálux valgo moderado e grave submetidos à correção cirúrgica apresentaram qualidade de vida considerada muito boa e tiveram significativa melhora dos parâmetros radiográficos. Contudo, não houve associação entre essas variáveis. Nível de Evidência II, Estudo retrospectivo.
ABSTRACT
ABSTRACT Objective: To evaluate the correlation between postoperative quality of life and the severity of hallux valgus deformity. Methods: A total of 23 patients underwent moderate (n = 14) and severe (n = 9) hallux valgus (HV) surgical correction with the Scarf technique between January 2010 and December 2012. The mean follow-up time was 60 months. Participants answered the SF-36 quality of life assessment questionnaire and their radiographs were evaluated at three different moments (preoperative, 1 and 5 years after surgery). Statistical analysis was performed with a maximum 5% significance level. Results: The sample consisted of two men and 21 women, aged 58.7.SF-36 mean value was 75.73 and the metatarsophalangeal and interphalangeal angles improved significantly at the three moments (p < 0.05). SF-36 showed no statistical difference between patients with moderate or severe HV (p > 0.05). No correlations were found between quality of life and pre and postoperative radiographic angles. Conclusion: Patients with moderate and severe hallux valgus submitted to surgical correction had a very good quality of life and a significant improvement in radiographic parameters. However, these variables were not correlated. Level of Evidence II, Retrospective study.
RESUMO Objetivo: Avaliar a correlação entre qualidade de vida pós-operatória e a gravidade da deformidade do hálux valgo. Métodos: 23 pacientes foram submetidos à correção cirúrgica do hálux valgo (HV) moderado (n = 14) e grave (n = 9) pela técnica de Scarf, entre janeiro de 2010 e dezembro de 2012. O tempo mínimo de acompanhamento foi de 60 meses. Os participantes responderam ao questionário de avaliação de qualidade de vida SF-36 e foram avaliadas suas radiografias em três momentos distintos (pré-operatório, 1 e 5 anos de pós-operatório). A análise estatística foi realizada com nível de significância máximo de 5%. Resultados: A amostra contou com 2 homens e 21 mulheres, com média de idade 58,7 anos. O valor médio do SF-36 foi 75,73 e os ângulos metatarsofalangiano e interfalangiano apresentaram melhora significativa nos momentos avaliados (p < 0,05). O SF-36 não mostrou diferença estatística entre os pacientes com HV moderado ou grave (p > 0,05). Não houve correlações entre a qualidade de vida e os ângulos radiográficos pré e pós-operatórios. Conclusão: Os pacientes com hálux valgo moderado e grave submetidos à correção cirúrgica apresentaram qualidade de vida considerada muito boa e tiveram significativa melhora dos parâmetros radiográficos. Contudo, não houve associação entre essas variáveis. Nível de Evidência II, Estudo retrospectivo.
ABSTRACT
Tillaux fracture is known to occur in adolescents once it happens during the transition period when the medial and central physis has finished closure, but the lateral physis is still opened. The trauma mechanism is typically external rotation ankle injury resulting in an avulsion fracture of the anterolateral tibial plafond. This fracture has rarely been reported in adults, especially associated with other injuries. We report a case of Tillaux fracture in an adult, associated with a Volkmann fracture and a Maisonneuve fracture, that were surgically treated with open reduction and internal fixation and had an excellent outcome. Recognizing and appropriately treating these injuries is key in the prevention of further degenerative arthritis and instability.
Subject(s)
Ankle Injuries/surgery , Fracture Fixation, Internal/methods , Ligaments, Articular/injuries , Tibial Fractures/surgery , Aged , Ankle Injuries/complications , Female , Humans , Radiography , Tibia/diagnostic imaging , Tibial Fractures/complications , Tibial Fractures/diagnostic imagingABSTRACT
BACKGROUND: It has been shown that total knee arthroplasty (TKA) can correct the alignment of the lower limb, not only correcting the knee axis, but also affecting the alignment of the hindfoot. However, there is still not a significant amount of work in the literature. METHODS: A prospective study was carried out in which 72 patients were radiographically (long axial view of the hindfoot) and clinically (American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale) evaluated before and 3 months after TKA. We investigated whether there were any significant associations between measurements of the axes, hindfoot angle, and AOFAS score with the type of deviation of the patient's axis. RESULTS: For the subgroups "hindfoot valgus-knee valgus," "hindfoot valgus-knee varus," and "hindfoot varus-knee valgus," a reduction in angle after surgery was observed; for the cases "hindfoot varus-knee varus," an increase in angle after surgery was observed. However, the Wilcoxon test showed that only the changes in the hindfoot axis of the "hindfoot varus-knee valgus" subgroup are statistically significant (P < .05). After surgery, the Wilcoxon test showed that the AOFAS score changes are statistically significant for all subgroups for which it was possible to perform the test (P < .05). CONCLUSION: TKA promotes changes in the postoperative hindfoot axis, significantly in patients with knee valgus and hindfoot varus. In addition, TKA provides significant improvement in the postoperative AOFAS score. LEVEL OF EVIDENCE: IIB.
Subject(s)
Arthroplasty, Replacement, Knee , Foot/physiopathology , Foot/surgery , Knee Joint/surgery , Osteoarthritis, Knee/surgery , Aged , Ankle Joint/surgery , Female , Humans , Lower Extremity/surgery , Male , Middle Aged , Postoperative Period , Prospective Studies , Walking , X-RaysABSTRACT
A lesão fechada simultânea por avulsão do tendão ï¬exor profundo e do tendão ï¬exor superï¬cial dos dedos é rara, tendo sido relatados somente nove casos na literatura desde 1984. Foram descritas diversas técnicas para o reparo cirúrgico da lesão dos tendões ï¬exores, todavia, sem um consenso sobre a melhor forma de reinserção do tendão. Relatamos o caso de um paciente que sofreu avulsão traumática do tendão ï¬exor superï¬cial e do tendão ï¬exor profundo do 5º dedo, que foi tratado cirurgicamente pela técnica de Pull-Out.
Simultaneous closed traumatic avulsion of both the deep flexor tendon and the superficial flexor tendon of the fingers is rare, and only nine cases have been reported in the literature since 1984. Several surgical procedures for repairing flexor tendon lesions have been described, but there is no consensus on the best approach to reinsert the tendon. We report the case of a patient who suffered a traumatic avulsion of the superficial flexor tendon and the deep flexor tendon of the fifth finger, which was surgically treated using the pull-out technique.
Subject(s)
Humans , Adult , Tendon Injuries/surgery , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Hand/surgery , RuptureABSTRACT
Introdução: a artrodese subtalar é uma técnica largamente utilizada na cirurgia de pé e
tornozelo. A artrose pós-traumática na fratura de calcâneo está entre as lesões mais comuns
que necessitam de artrodese em função da limitação funcional que essa gera. No entanto, há
um índice de pseudoartrose considerável nesse tipo de cirurgia. Objetivo: avaliar o índice
de pseudoartrose decorrente da artrodese subtalar em pacientes tabagistas. Método: foram
avaliados 149 pés de pacientes submetidos à artrodese por sequela de fratura de calcâneo no
INTO, de 2006 a 2009, com acompanhamento mínimo de 12 meses. Em função dos critérios
de inclusão e exclusão, 101 pacientes foram avaliados. Resultados: foi encontrado um índice
de pseudoartrose na amostra de 15,8%. A incidência de pseudoartrose entre os fumantes
foi de 26%, enquanto nos não fumantes foi de 9%. Conclusão: o risco de pseudoartrose na
artrodese subtalar entre os fumantes foi três vezes maior do que entre os não fumantes
Subject(s)
Humans , Pseudarthrosis , Tobacco Use DisorderABSTRACT
Os autores relatam um caso de duplicação do quinto metatarsiano com falanges normais
Subject(s)
Humans , Foot , Foot Bones/surgery , OrthopedicsABSTRACT
Os autores relatam um caso de duplicação do 5ºmetatarsiano com falanges normais
