Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital.

OBJECTIVE: To evaluate the clinical characteristics from patients submitted to osteogenic distraction to correct bone gap at a university hospital. METHODS: Retrospective transversal study, with a convenience sample, from 2000 to 2012, evaluating clinical aspects of patients treated, submitted to osteogenic distraction (bone transport) with Ilizarov's external fixation device. The chi-squared, Fisher's, and Mann-Whitney's U tests were used with a 5% level of significance (p < 0.05). RESULTS: 33 patients were studied, of whom 28 men (84.8%). The more frequent age was from 21 to 40 years. Most patients were from the metropolitan region of the capital (57.6%). The leg was the most affected limb (75.8%), and the left side was the most affected (66.7%). The most common cause was infected pseudoarthrosis (75.8%). The most common bone transportation type was bifocal (75.8%). Mean previous surgery at others institutions were 2.62 (1.93 standard deviation), and mean surgeries after treatment were 1.89 (1.29 standard deviation). Ilizarov's external fixation device was used for 1.94 years (1.34 mean deviation), from one to six years. The most common complications were pin infection (57.6%), equinus (30.3%), deep infection (24.2%), and shortening (21.2%). CONCLUSION: Osteogenic distraction for bone gaps were more frequent in young adults, men, in the leg, with bifocal transportation, after several previous surgeries, treated for a mean of two years, with many complications (infections were the most common).

OBJETIVO: Avaliar as características clínicas dos pacientes submetidos à distração osteogênica por falha óssea em hospital universitário. MÉTODOS: Estudo transversal, retrospectivo, com amostra de conveniência, de 2000 a 2012, das características clínicas de pacientes tratados e submetidos à distração osteogênica (transporte ósseo) com uso de fixador externo circular tipo Ilizarov. Foram usados os testes de qui-quadrado, exato de Fisher e U de Mann­Whitney, com nível de significância de 5% (p < 0,05). RESULTADOS: Foram 33 casos, 28 homens (84,8%). A idade mais frequente foi entre 21 e 40 anos. A maioria dos pacientes (57,6%) era da região metropolitana. O segmento mais afetado foi a perna (75,8%) e o lado foi o esquerdo (66,7%). A causa mais frequente foi a pseudoartrose infectada (75,8%). O tipo de transporte ósseo feito foi principalmente o bifocal (75,8% dos casos). A média de procedimentos prévios em outra instituição foi de 2,62 cirurgias (desvio padrão de 1,93) e a dos feitos após o início do tratamento foi de 1,89 cirurgia (desvio padrão de 1,29). O tempo de uso de fixador externo foi de 1,94 ano (desvio padrão de 1,34), com mínimo de um ano e máximo de seis. As quatro complicações mais encontradas foram infecção de base de pinos (57,6% dos casos), equino (30,3%), infecção profunda (24,2%) e encurtamento (21,2%). CONCLUSÃO: A necessidade de distração osteogênica por falhas ósseas foi mais frequente em adultos jovens, homens, na perna, com transporte bifocal, após múltiplas cirurgias prévias, com média de aproximadamente dois anos de tratamento e com várias complicações (as infecções foram as principais).

Intraosseous lipoma of the iliac: case report.

Lipomas are benign tumors that attack fat cells and most often affecting soft tissues in adulthood. On rare occasions, they may affect bones, preferentially the metaphyses of the long bone. They are generally asymptomatic and radiography shows radiolucent lesions with a thin sclerotic rim or radiodense lesions with a thick sclerotic rim. Malignant transformation of these tumors is rare, as is their recurrence, and there is no need for surgery in most cases. In this report, we present a rare case of intraosseous lipoma in the iliac bone.

Os lipomas são tumores benignos que acometem células adiposas, mais comumente afetam os tecidos moles na idade adulta. Raramente podem afetar os ossos, preferencialmente metáfises dos ossos longos. São geralmente assintomáticos, na radiografia verifica-se lesão radiotransparente, com uma fina borda esclerótica ou lesão radiodensa com uma espessa borda esclerótica. A transformação maligna do tumor é rara, assim como a recorrência, sem necessidade cirúrgica na maioria dos casos. Neste relato apresentamos um caso raro de lipoma intraósseo do ilíaco.

Clinical aspects of patients with traumatic lesions of the brachial plexus following surgical treatment.

OBJECTIVE: To evaluate sociodemographic and clinical aspects of patients undergoing operations due to traumatic lesions of the brachial plexus. METHOD: This was a retrospective study in which the medical files of a convenience sample of 48 patients operated between 2000 and 2010 were reviewed. The following were evaluated: (1) range of motion (ROM) of the shoulder, elbow and wrist/hand, in degrees; (2) grade of strength of the shoulder, elbow and wrist/hand; (3) sensitivity; and (4) visual analogue scale (VAS) (from 0 to 10). The Student's t, chi-square, Friedman, Wilcoxon and Kruskal-Wallis tests were used (p < 0.05). RESULTS: The patients' mean age was 30.6 years; 60.4% of them had suffered motorcycle accidents and 52.1%, multiple trauma. The mean length of time until surgery was 8.7 months (range: 2-48). Thirty-one patients (64.6%) presented complete rupture of the plexus. The frequent operation was neurosurgery in 39 cases (81.3%). The ROM achieved was ≥30° in 20 patients (41.6%), with a range from 30° to 90° and mean of 73° (p = 0.001). Thirteen (27.1%) already had shoulder strength ≥M3 (p = 0.001). Twenty-seven patients (56.2%) had elbow flexion ≥80°, with a range from 30° to 160° and mean of 80.6° (p < 0.001). Twenty-two had strength ≥M3 (p < 0.001). Twenty-two patients (45.8%) had wrist extension ≥30° starting from flexion of 45°, with a range from 30° to 90° and mean of 70° (p = 0.003). Twenty-seven (56.3%) presented wrist/hand extension strength ≥M3 (p = 0.002). Forty-five (93.8%) had hypoesthesia and three (6.2%) had anesthesia (p = 0.006). The initial VAS was 4.5 (range: 1.0-9.0) and the final VAS was 3.0 (range: 1.0-7.0) (p < 0.001). CONCLUSION: Traumatic lesions of the brachial plexus were more prevalent among young adults (21-40 years), men, people living in urban areas, manual workers and motorcycle accidents, with multiple trauma and total rupture of the plexus. Neurosurgery, with a second procedure consisting of muscle-tendon transfer, was the commonest operation. Surgery for traumatic lesions of the brachial plexus resulted in significant improvement in the ROM and strength of the shoulder, elbow and wrist/hand, improvement of the sensitivity of the limb affected and reduction of the final pain.

OBJETIVO: Avaliar aspectos sociodemográficos e clínicos de pacientes operados de lesão traumática do plexo braquial (LTPB). MÉTODO: Estudo retrospectivo, revisão de prontuários, amostra de conveniência, 48 pacientes operados entre 2000 e 2010. Avaliados: 1) ADM ­ em graus, do ombro, cotovelo e punho/mão; 2) grau de força do ombro, cotovelo e punho/mão; 3) sensibilidade; 4) EVA (0 a 10). Testes de t de Student, qui-quadrado, Friedman, Wilcoxon e Kruskal­Wallis (p < 0,05). RESULTADOS: Idade de 30,6 anos, 60,4% acidentes motociclísticos. Politraumatismo 52,1%. Tempo até a cirurgia de 8,7 meses (2 a 48). Trinta e um (64,6%) com lesão total do plexo. Cirurgias mais frequentes: neurais em 39 (81,3%). ADM ≥ 30° do ombro 20 pacientes (41,6%) de 30° a 90°, média 73° (p = 0,001); 13 (27,1%) já tinham força no ombro ≥ M3 (p = 0,001). Cotovelo ≥ 80° de flexão, 27 pacientes (56,2%) de 30° a 160°, com média de 80,6° (p < 0,001); 22 com força ≥ M3 (p < 0,001). Extensão do punho ≥ 30° partindo de 45° de flexão em 22 pacientes (45,8%), de 30° a 90°, média 70° (p = 0,003); 27 (56,3%) tinham força de extensão do punho/mão ≥ M3 (p = 0,002); 45 (93,8%) hipoestesia e três (6,2%) anestesia (p = 0,006). EVA inicial 4,5 (1 a 9) e EVA final 3 (1 a 7) (p < 0,001). CONCLUSÃO: As LTPB tem maior prevalência em jovens (21­40 anos), homens, urbanos, trabalhadores braçais, acidentes motociclísticos, com politrauma, lesão total do plexo. Cirurgias neurais, seguidas em segundo tempo, pelas transferências miotendíneas. A cirurgia para LTPB mostrou melhoria significativa de ADM e força em ombro, cotovelo e punho/mão, da sensibilidade do membro afetado e diminuição da dor final.

Use of risedronate for consolidation and callus formation in Colles fractures in postmenopausal women: SOLID study.

OBJECTIVE: This open, randomized and blinded parallel-group multicenter study evaluated the efficacy of Actonel(®) (35 mg) plus calcium/vitamin D versus calcium/vitamin D alone for preserving bone mineral density (BMD) in postmenopausal women with Colles fractures. METHODS: Patients with a Colles fracture for seven days were randomized to receive either Actonel(®) (35 mg) once a week plus calcium/vitamin D (ACD group) or calcium/vitamin D alone (CD group). The patients were evaluated after 90 and 180 days of treatment. RESULTS: 59 ACD patients and 56 CD patients completed all the evaluations. At the end of the study, the BMD of the radius at the fracture location showed a negative change in the CD group (32.8%). The loss of BMD in the ACD group (20.8%) was slightly less than that in the CD group. There was a difference in the proportions of patients with BMD losses at the end of the study period in the two treatment groups, in favor of the ACD group, although this was not statistically significant. There was no significant difference in radiological identification of callus formation between the treatment groups. In the majority of the patients, the callus could be radiologically identified after 90 days. CONCLUSION: Postmenopausal women with Colles fractures who received risedronate sodium plus calcium/vitamin D did not show any significant difference in BMD loss in forearm fractures, in comparison with those who received calcium/vitamin D alone. Risedronate presented a tendency toward a protective effect regarding BMD loss due to immobilization. The time taken for fracture consolidation to be achieved was unaffected.

OBJETIVO: Este estudo multicêntrico, randomizado, aberto, grupo paralelo avaliou a eficácia de Actonel® 35 mg mais cálcio/vitamina D versus cálcio/vitamina D isoladamente na preservação da densidade mineral óssea (DMO) em mulheres pós-menopausadas com fratura de Colles. MÉTODOS: Pacientes com fratura de Colles em sete dias foram aleatoriamente designadas para receber Actonel® 35 mg semanalmente mais cálcio/vitamina D (Grupo AO [GAO]) ou cálcio/vitamina D (grupo O [GO]) isoladamente. As pacientes foram avaliadas após 90 e 180 dias de tratamento. RESULTADOS: Completaram as avaliações 59 pacientes no GAO e 56 no OG. No fim do estudo, a DMO do rádio no local da fratura mostrou variação negativa no GO (32,8%) que foi discretamente menor no GAO (20,8%), assim como uma perda menor na DMO no GAO comparado com o OG. Houve diferença na proporção de paciente com perda da DMO no fim do estudo nos dois grupos de tratamento em favor do GAO, apesar de não estatisticamente significante. Não houve diferença significativa na identificação radiológica da formação do calo entre os grupos de tratamento. Na maioria das pacientes a identificação radiológica do calo ocorreu depois de 90 dias. CONCLUSÃO: Mulheres pós-menopausadas com fratura de Colles que receberam risedronato sódico, além do cálcio/vitamina D, comparado com cálcio/vitamina D não mostraram diferença significativa na perda da DMO na fratura do antebraço, com tendência de efeito protetor do risedronato na perda da DMO devido à imobilização. O tempo até a consolidação da fratura não foi afetado.

Evaluation of elbow flexion following free muscle transfer from the medial gastrocnemius or transfer from the latissimus dorsi, in cases of traumatic injury of the brachial plexus.

OBJECTIVE: To compare the gain in elbow flexion in patients with traumatic injury of the brachial plexus following muscle transfer from latissimus dorsi with the gain following free muscle transfer from the medial belly of the gastrocnemius. METHODS: This was a retrospective study in which the medical files of a convenience sample of 13 patients operated between 2000 and 2010 were reviewed. Group 1 comprised seven patients who underwent transfers from the gastrocnemius and group 2 (controls) comprised six patients who underwent transfers from the latissimus dorsi. The following functions were evaluated: (1) range of motion (ROM) of elbow flexion, in degrees, using manual goniometry and (2) grade of elbow flexion strength, using a muscle strength scale. Satisfactory results were defined as: (1) elbow flexion ROM ≥ 80° and (2) elbow flexion strength ≥ M3. The Fisher exact and Kruskal-Wallis tests were used (p < 0.05). RESULTS: The patients' mean age was 32 years (range: 17-56) and 72% had been involved in motorcycle accidents. Elbow flexion strength ≥ M3 was observed in seven patients (100%) in group 1 and in five patients (83.3%) in group 2 (p = 0.462). None of the patients presented M5, and one patient (16.7%) in group 2 had a poor result (M2). Elbow flexion ROM with a gain ≥ 80° (daily functions) was found in six patients (86%) in group 1 and in three patients (50%) in group 2 (p = 0.1). CONCLUSION: The patients in group 1 had greater gains in strength and ROM than did those in group 2, but without statistical significance. Thus, transfers from the gastrocnemius become a new surgical option, if other techniques cannot be used.

OBJETIVO: Comparar o ganho de flexão do cotovelo em pacientes com lesão traumática do plexo braquial após transferência muscular do latíssimo dorsal (TMLD) com a transferência muscular livre do ventre medial do gastrocnêmio (TMLGM). METÓDOS: Estudo retrospectivo, revisão de prontuários, amostra de conveniência, com 13 pacientes operados, entre 2000 e 2010. Grupo 1 (TMLGM) com sete pacientes e grupo 2 ou controle (TMLD) com seis. Função avaliada: 1) amplitude de movimento (ADM) em graus da flexão do cotovelo, goniometria manual; 2) grau de força de flexão do cotovelo, por escala de força muscular. Satisfatórios: 1) ADM: flexão do cotovelo ≥ 80°; 2) Força: flexão do cotovelo ≥ M3. Testes exato de Fisher e Kruskal­Wallis (p < 0,05). RESULTADOS: Média de idade foi de 32 anos (17 a 56). Acidente de moto em 72%. Força de flexão do cotovelo ≥ M3 no grupo 1 em sete pacientes (100%) e o grupo 2 em cinco (83,3%) (p = 0,462). Não tivemos M5 e o grupo 2 apresentou um paciente (16,7%) com resultado ruim M2. ADM na flexão do cotovelo com ganho ≥ 80° (funções diárias) foram encontrados no grupo 1 em seis pacientes (86%) e no grupo 2 em três (50%) (p = 0,1). CONCLUSÃO: Pacientes do grupo 1 tiveram um ganho maior de força e ADM, quando comparados com os do grupo 2, sem significado estatístico. Assim, TMLGM se torna uma nova opção cirúrgica, caso não possam ser aplicadas outras técnicas.

Clinical and radiographic medium-term evaluation on patients with developmental dysplasia of the hip, who were submitted to open reduction, capsuloplasty and Salter osteotomy.

OBJECTIVE: to evaluate the clinical and radiographic medium-term results from surgical treatment of developmental dysplasia through open reduction, Salter et al.'s osteotomy and capsuloplasty. METHODS: 13 patients were evaluated, 13 hips treated surgically by the proposed technique between 2004 and 2011. A clinical and radiographic evaluation was conducted by Dutoit et al. and Severin et al. criteria, respectively. RESULTS: the acetabular preoperative index for the 13 surgically treated hips ranged from 27° to 50° (average of 36), and after surgical correction to 18.5° (10-28°), so that the evaluations of preoperative and postoperative acetabular indexes showed up significant statistic reduction (p < 0.05). Regarding the postoperative clinical evaluation, it was found: nine excellent hips (69.2%), three good ones (23.1%), no fair hips (0%) and a poor one (7.7%). In radiographic evaluation, it was found: six excellent hips (46.1%), three good ones (23.1%), no fair hips (0%) and four poor ones (30.8%). Therefore, favorable results were obtained (92.3%), with grouped hips with excellent and good ratings as satisfactory and with fair and bad ratings as unsatisfactory. It is also important to notice that there was no significance among occurrence of complications, the patient's age, the time of surgery and the preoperative acetabular index (p > 0.05). As complications occurred, it was found that three subluxations and a subluxation associated with avascular necrosis of the femoral head. CONCLUSION: open reduction, Salter et al.'s osteotomy and capsuloplasty are seen to be a viable option for the treatment of developmental dysplasia of the hip, according to clinical and radiological medium-term evaluations.

OBJETIVO: avaliar o resultado clínico e radiológico do tratamento cirúrgico da displasia do desenvolvimento do quadril em médio prazo, por meio da redução aberta, da capsuloplastia e da osteotomia de Salter et al. MÉTODOS: foram avaliados 13 pacientes, 13 quadris, entre 2004 e 2011, tratados cirurgicamente pela técnica proposta. Uma avaliação clínica e radiológica foi feita pelos critérios de Dutoit et al. e Severin et al., respectivamente. RESULTADOS: nos 13 quadris acometidos o índice acetabular pré­operatório variou de 27° a 50° (média de 36) e, após correção cirúrgica, para 18,5° em média, com variação de 10° a 28°, de modo que as avaliações dos índices acetabulares pré e pós­operatórios apresentaram redução com significância estatística (p < 0,05). Quanto à avaliação clínica pós­operatória, foram encontrados: nove quadris ótimos (69,2%), três bons (23,1%), nenhum regular (0%) e um ruim (7,7%). Na avaliação radiológica, foram encontrados seis quadris ótimos (46,1%), três bons (23,1%), nenhum regular (0%) e quatro ruins (30,8%). Portanto, obtiveram­se resultados favoráveis em 92,3%, pois agrupam­se quadris com avaliação ótima e boa como satisfatórios e os com avaliação regular e ruim como insatisfatórios. Atente­se que não houve significância entre a ocorrência de complicações, a idade do paciente, o momento da cirurgia e o índice acetabular pré­operatório (p > 0,05). Como complicações ocorridas, têm­se três subluxações isoladas e uma subluxação associada à necrose avascular da cabeça femoral. CONCLUSÃO: a redução aberta, a capsuloplastia e a osteotomia de Salter et al. são consideradas uma opção viável do ponto de vista clínico e radiológico em médio prazo para o tratamento da displasia do desenvolvimento do quadril.

Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing: 29 patients' clinical and functional evaluation.

OBJECTIVE: To evaluate clinically and functionally the pos-operative results of patients submitted to tibiotalocalcaneal arthrodesis for the treatment of traumatic arthropathy and neuropathy. METHODS: Retrospective study of 29 patients undergoing ankle arthrodesis with intramedullary retrograde nail. All patients were evaluated for fusion time, AOFAS and VAS scores, satisfaction, and complications of surgery. The mean follow-up was 36 months (range 6-60 months). RESULTS: The union rate was 82%, and the consolidation occurred on average at 16 weeks (10-24 weeks). The pos-operative AOFAS score improved in 65.5% (average of 57.7 on neurological cases and 75.7 on cases pos-traumatic) and VAS score improved 94.1% (average of 2.3 on neurological cases and 4,2 on post-traumatic cases), and 86% of patients were satisfied with the procedure performed. Complications occurred in 11 patients (38%), including pseudoarthrosis (17.24%), infection (17.24%), material failure (13.8%) and fracture (13.8%). CONCLUSION: Tibiotalocalcaneal arthrodesis with retrograde intramedullary nail proved to be a good option for saving the ankle joint, with improvement of clinical and functional scores (AOFAS = 65.5% and VAS = 94.1%).

OBJETIVO: avaliar clínica e funcionalmente o pós-operatório de pacientes submetidos à artrodese tibiotalocalcaneana para o tratamento das artropatias traumáticas e neurológicas do tornozelo. MÉTODOS: estudo retrospectivo de 29 pacientes submetidos à artrodese do tornozelo com haste intramedular retrógrada. Todos os pacientes foram avaliados em relação ao tempo de consolidação, escores Aofas e EVA e grau de satisfação, além de complicações do ato cirúrgico. O tempo de seguimento médio foi de 36 meses (variação de 6­60). RESULTADOS: a taxa de união foi de 82% e o tempo médio de consolidação foi de 16 semanas (10-24). O critério Aofas melhorou no pós-operatório em 65,5% (média de 57,7 nos casos neurológicos e de 75,7 nos pós-traumáticos) e a EVA melhorou 94,1% (média de 2,3 nos casos neurológicos e de 4,2 nos pós-traumáticos) e 86% dos pacientes mostraram-se satisfeitos com o procedimento feito. As complicações ocorreram em 11 pacientes (38%), entre elas pseudartrose (17,24%), infecção (17,24%), falha do material (13,8%) e fratura (13,8%). CONCLUSÃO: a artrodese tibiotalocalcaneana com haste intramedular retrógrada mostrou ser uma boa opção para o salvamento da articulação do tornozelo, com melhoria dos critérios clínicos e funcionais (Aofas = 65,5% e EVA = 94,1%).

Total arthroplasty in displaced dysplastic hips with acetabular reconstruction and femoral shortening - technical note.

To describe a new procedure of total hip replacement in patient with severe developmental dysplasia of the left hip, using technique of acetabular reconstruction with autogenous bone grafts and subtrochanteric shortening femoral osteotomy. Total hip replacement done in January of 2003. The Eftekhar's classification was used and included type D, neglected dislocations. Bone graft incorporated in acetabular shelf and femoral osteotomy. Our contribution is the use of an Allis plate to better fix acetabular grafts, avoiding loosening, and cerclage around bone graft in femoral osteotomy site, which diminish pseudoarthrosis risk. This technique shows efficiency, allowing immediately resolution for this case with pain and range of motion of hip improvement. It also allows the acetabular dysplasia reconstruction, equalization of the limb length (without elevated risk of neurovascular lesion) and repairs the normal hip biomechanics due to the correction of the hip's center of rotation.

Descrever contribuições à técnica da cirurgia de artroplastia total em displasias do desenvolvimento do quadril grave, por meio da reconstrução acetabular com o uso de enxerto autólogo e encurtamento femoral feito com osteotomia subtrocantérica em V invertido. Paciente submetido a artroplastia total do quadril esquerdo em janeiro de 2003. Foi usada a classificação de Eftekhar e o paciente era do tipo D, luxação inveterada. Incorporação do enxerto no teto acetabular e osteotomia femoral. Acrescentamos a fixação do enxerto da cabeça femoral no acetábulo com placa do tipo Allis, que contribui para maior resistência do sistema, e a cerclagem com fio de aço no enxerto ósseo junto à osteotomia subtrocantérica, que diminui o risco de pseudoartrose. Essa técnica demonstrou eficácia e permitiu a resolução imediata do caso com melhoria da dor e da amplitude de movimento do quadril. Permitiu também a reconstrução do déficit ósseo acetabular, a recomposição do comprimento do membro (sem risco aumentado de lesão neurovascular) e a recuperação da biomecânica do quadril com a reparação do centro de rotação normal.

Patellar osteochondroma: case report.

The aim was to report on a rare case of patellar osteochondroma. A 60-year-old man presented a tumor on his left patella that had developed over a 10-year period, which is a rare occurrence, considering the patient's age and the site at which the tumor appeared. The clinical condition comprised mild pain and the presence of a mass, without limitation of flexion-extension or any neurovascular deficit. The tumor dimensions were 8 cm longitudinally × 6 cm transversally × 3 cm anteroposteriorly. It was hardened and was adhering to the patellar bone plane. On radiographs and tomographic scans, we observed areas of greater density corresponding to bone and other less dense areas that could correspond to slow-growing cartilage, with irregularities on the patellofemoral joint surface. Simple resection of the tumor was performed, and the anatomopathological examination confirmed that it was a patellar osteochondroma. Osteochondroma, or osteocartilaginous exostosis, includes a large proportion of the benign bone tumors. It results from cell alterations that trigger unregulated production of spongy bone. It is basically treated by means of surgical removal of the tumor mass. This is not essential, but is recommended in order to avoid lesions caused by contiguity and the risk of malignant transformation.

Relato de um caso raro de osteocondroma patelar. Homem de 60 anos apresentou tumor na patela esquerda que tem se desenvolvido por 10 anos, fato raro, considerando-se a idade do paciente e o local de surgimento do tumor. Dor leve e a presença da massa compunham o quadro clínico, sem limitação da flexoextensão ou déficit neurovascular. O tumor apresentava 8 cm longitudinal × 6 cm transversal × 3 cm anteroposterior, endurecido, aderido ao plano ósseo patelar. Nas radiografias e tomografias observamos áreas mais densas correspondentes de osso e outras menos densas, que podem corresponder à cartilagem, de crescimento lento, e irregularidades na superfície articular patelofemoral. Foi feita ressecção simples do tumor e o anatomopatológico confirmou osteocondroma da patela. Osteocondroma, ou exostose osteocartilaginosa, abrange uma grande parte dos tumores ósseos benignos. Ele resulta de alterações celulares que desencadeiam a produção desregulada de osso esponjoso. Seu tratamento é feito basicamente pela retirada cirúrgica da massa tumoral. Não é essencial, mas recomendada para evitar lesões por contiguidade e risco de malignização.

Ameloblastoma: a clinical and therapeutic analysis on six cases.

Ameloblastomas are odontogenic tumors that are locally invasive and slow-growing. Their etiology is still not well defined, but the forms of treatment have been widely discussed because of the possibility of tumor recurrence and postoperative complications. In this study, six patients who were diagnosed with ameloblastoma in the mandibular region and were treated in the Department of Orthopedics and Traumatology of Hospital das Clínicas, Federal University of Goiás, between 1958 and 1963, were evaluated. The radiological, clinical and therapeutic characteristics were evaluated. There was no predominance regarding gender in the sample studied. The symptoms most often presented by the patients were pain and tumor formation. The radiological characteristics with greatest incidence were multilocular lesions and the treatment used for all the patients was radical surgery. There was no recurrence over the minimum follow-up period of one year and six months.

Os ameloblastomas são tumores odontogênicos, localmente invasivos e de crescimento lento. Sua etiologia ainda não foi bem definida e as formas de tratamento são amplamente discutidas, por causa de possíveis recidivas do tumor e complicações pós-operatórias. Neste trabalho, foram avaliados seis pacientes diagnosticados com ameloblastoma na região mandibular e tratados no Departamento de Ortopedia e Traumatologia do HC-UFG, de 1958 a 1963. Foram avaliadas as características radiológicas, clínicas e terapêuticas. Não houve predomínio em relação ao gênero na amostra estudada. Os sintomas mais apresentados pelos pacientes foram dor e tumoração. As características radiológicas de maior incidência são de uma lesão multilocular e o tratamento usado em todos os pacientes foi o cirúrgico radical. A recidiva foi nula em um tempo mínimo de um ano e sete meses de seguimento.

Solitary ischial osteochondroma: an unusual cause of sciatic pain: case report.

The aim was to report on a rare case of osteochondroma of the left ischium, which evolved with compression of the sciatic nerve, thus causing sciatic pain in the homolateral lower limb. The patient was female and presented sciatic pain that was treated clinically for one year. However, the pain evolved with increasing intensity and worsened with hip movement. This was associated with diminished motor force and paresthesia of the homolateral lower limb. Radiological investigation of the region showed a bone lesion in the external portion of the left ischium, in the path of the sciatic nerve. Tomographic reconstruction showed cortical continuity with the bone of origin, i.e., a pattern characteristic of osteochondroma. En-bloc resection of the lesion was performed using the Kocher-Langerbeck route, and the anatomopathological analysis proved that it was an osteochondroma. The patient's neurological symptoms improved and, after two months of follow-up, she remained asymptomatic and without any signs of recurrence. Since osteochondroma is the commonest benign bone tumor, it should be taken into consideration in the diagnostic investigation of compressive tumor lesions that could affect the sciatic nerve.

Relatar um caso raro de osteocondroma do ísqueo esquerdo, que evoluiu com compressão no nervo ciático e provocou ciatalgia no membro inferior homolateral. Paciente do sexo feminino apresentou ciatalgia e foi feito tratamento clínico por um ano. Porém a dor evoluiu, aumentou de intensidade e piorou com a movimentação do quadril, associada a diminuição da força motora e a parestesia do membro inferior homolateral. A investigação radiológica da região mostrou uma lesão óssea na porção externa do ísqueo esquerdo e no trajeto do nervo ciático. A reconstrução tomográfica evidenciou continuidade cortical com o osso de origem, padrão característico de osteocondroma. Fez-se a ressecção em bloco da lesão pela via de Kocher-Langerbeck e o estudo anatomopatológico provou ser um osteocondroma. Os sintomas neurológicos da paciente melhoraram e, após dois anos de acompanhamento, ela permanece assintomática e sem sinais de recorrência. Por ser o tumor ósseo benigno mais comum, o osteocondroma deve ser considerado na investigação diagnóstica de lesões tumorais compressivas, que podem acometer o nervo ciático.

Correct use of safety belts and child restraint devices in cars among children in Goiânia.

OBJECTIVE: to conduct an observational study, by means of campaigns, regarding the use of child restraint devices in cars in Goiânia. METHODS: this was a cross-sectional study using a convenience sample built up as cases arose. The data were gathered into an Excel spreadsheet and were analyzed descriptively and statistically (SPSS 16.0), using chi-square and taking p < 0.05 as significant. RESULTS: in 2006, 410 cars were evaluated, and in 2010, 544 cars were evaluated. Around 85% of the occupants were using seat belts correctly at both times (p = 0.650). In 2006, it was observed that a total of 273 passengers were occupying the rear seats, while in 2010 there were 226. Among these, 178 and 170 were using seat belts, respectively, i.e. 65.2% and 75.22% (p = 0.001). In 2006, five children were occupying the front seat without using the seat belt, while in 2010, this number was 42 (p < 0.001). In 2010, it was observed that 458 vehicles were transporting children on the rear seats, and this was being done correctly in 214 vehicles, i.e. 46.72%. In 2006, of the 410 vehicles analyzed, only 90 of them (21.95%) were transporting children correctly (p < 0.001). In addition, there was a difference in the variables within the year evaluated, in which transportation done correctly in the front seat was much more frequent than transportation done correctly in the rear seats, in both years (p < 0.001). Cars transported one to four children, while vans transported one to nine children. In 2006, one van transporting children irregularly was observed, while in 2010 it was done correctly in all cases. CONCLUSION: comparing these two years (2006 and 2010) in which data were gathered, we can conclude that changes in behavior among drivers in Goiânia have begun, with regard to safety when transporting children in vehicles, with an improvement of 25% (p < 0.001). A large part of this has come through changes in knowledge among this segment of the population, through campaigns that have been carried out, including through the media, and because of legal obligations.

OBJETIVO: fazer um estudo observacional, por meio de campanhas, sobre o uso dos dispositivos de restrição infantil em automóveis de Goiânia. MÉTODOS: estudo transversal por amostra de conveniência conforme surgimento dos casos. Os dados foram coletados em uma tabela Excel, analisados de forma descritiva e estatística (SPSS 16.0), com o uso do qui-quadrado, com p < 0,05 como significativo. RESULTADOS: em 2006, foram avaliados 410 automóveis, enquanto que em 2010 foram avaliados 544, nos quais cerca de 85% das pessoas usavam o cinto de forma correta nos dois períodos (p = 0,650). Em 2006, foram observados 273 passageiros no banco dianteiro e em 2010, 226. Usavam cinto de segurança 178 e 170, respectivamente, ou 65,2 e 75,22% (p = 0,001). Em 2006, cinco crianças ocupavam o banco da frente sem o uso do cinto de segurança. Em 2010, esse número foi de 42 (p < 0,001). Em 2010, foram observados 458 veículos que transportavam crianças no banco traseiro, 214 de maneira correta, ou 46,72%. Em 2006, dos 410 veículos analisados, apenas 90 (21,95%) transportavam crianças de maneira correta (p < 0,001). Além disso, houve diferença entre as variáveis dentro do ano avaliado, no qual o transporte correto no banco da frente foi bem mais frequente do que o no banco de trás, nos dois anos (p < 0,001). Carros transportavam de uma a quatro crianças e as vans, de uma a nove crianças. Em 2006 foi observada uma van que transportava crianças de maneira irregular, enquanto que em 2010 todas estavam corretas. CONCLUSÃO: na comparação desses dois períodos, podemos avaliar que houve um início de mudança no comportamento do motorista goianiense no que tange à segurança no transporte de crianças em automóveis, com melhoria de 25% (p < 0,001). Grande parte disso decorreu da mudança de atitude da população após as campanhas feitas, até pela mídia, e da obrigatoriedade da lei.

Garré's sclerosing osteomyelitis: case report.

The aim of this study was to report on a rare case of Garré's sclerosing osteomyelitis. The patient was a 54-year-old woman with a history of treatment for lupus using corticoids for 20 years, and for osteoporosis using alendronate for five years. She presented edema and developed a limitation of left knee movement one year earlier, with mild effusion and pain on metaphyseal palpation, but without fever. She was in a good general state, without local secretion. Images of her knee showed trabecular osteolysis of the distal metaphysis of the femur and a periosteal reaction in both proximal tibias and both distal femurs, compatible with chronic osteomyelitis of low virulence and slow progression. Magnetic resonance imaging showed T2 hypersignal in the femur and tibia. Curettage was performed on the left distal femur, with release of secretion, but this was negative on culturing. A biopsy showed chronic infection and inflammation, fibrosis, xanthogranulomatous reaction and foci of suppuration. Antibiotic therapy was administered for six months. The etiology was not clarified: bacterial infection was suspected, but culturing was generally negative. The chronic process was maintained by low-virulence infection or even after treatment. The differential diagnoses were fibrous dysplasia, syphilis, pustulosis palmoplantaris, rectocolitis, Crohn's disease, SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) and Paget's disease. The unifocal diseases were osteoid osteoma, Ewing's disease, osteosarcoma and eosinophilic granuloma.

Relatar um caso raro de osteomielite esclerosante de Garrè. Paciente feminino, 54 anos, com história de tratamento de lúpus com corticoide havia 20 anos e osteoporose, em uso de alendronato havia cinco anos. Apresentava edema e limitação do joelho esquerdo havia um ano, derrame leve, dor à palpação metafisária, afebril, bom estado geral, sem secreção local. Imagens do joelho evidenciaram osteólise trabecular da metáfise distal do fêmur e reação periosteal nas duas tíbias proximais e nos dois fêmures distais, compatíveis com osteomielite crônica, de baixa virulência e progressão lenta. Hipersinal em T2 no fêmur e tíbia à ressonância. Curetagem do fêmur distal esquerdo, com saída de secreção, mas cultura negativa. Biópsia evidenciou infecção e inflamação crônica, fibrose, reação xantogranulomatosa e focos de supuração. Feita antibioticoterapia por seis meses. Etiologia não esclarecida, suspeita de infecção bacteriana, mas geralmente a cultura é negativa, processo crônico mantido por infecção de baixa virulência ou mesmo após o tratamento. Diagnósticos diferenciais: displasia fibrosa, sífilis, pustulose palmoplantar, retocolite, Crohn, Sapho (sinovite, acne, pustulose, hiperostose, osteíte) e Paget. Unifocais: osteoma osteoide, Ewing, osteossarcoma e granuloma eosinofílico.

Calcaneal chondrosarcoma: a case report.

The objective was to report on a rare case of chondrosarcoma of the bones of the foot, and specifically the calcaneus. The patient was a 30-year-old woman with a complaint of painless nodulation on the lateral face of the calcaneus, which she had had for around eight years, which then started to present significant pain. Radiography showed a tumor with imprecise limits, compromising the calcaneus, talus and lateral malleolus. The lesion had a destructive, aggressive and osteolytic appearance, with invasion of the surrounding soft tissues and the presence of points of calcification. Amputation was performed in the middle third of the right lower leg, with a histological diagnosis of chondrosarcoma. The case evolved with local recurrence of the tumor formation and subsequent amputation in the middle third of the right thigh. One year after the second amputation, the patient evolved with metastasis from the chondrosarcoma in soft tissues throughout the body and in the lungs, and she died one year and ten months after the diagnosis was made. Chondrosarcomas that involve the calcaneus are rare in young adults, with few reports in the literature. For this reason, the present report becomes important in that it shows that even though this is a rare condition, it is present in our environment. Early investigation is essential, especially by means of imaging examinations, with the aim of diminishing the chances of malignant transformation and consequent complications, so as to avoid death.

Relatar um caso raro de condrossarcoma dos ossos do pé, mais especificamente no calcâneo. Mulher de 30 anos, com queixa de nodulação indolor na face lateral do calcâneo havia cerca de oito anos, que iniciou com dor importante. A radiografia mostrou um tumor de limites imprecisos, que comprometeu o calcâneo, o tálus e o maléolo lateral. A lesão apresentou aspecto destrutivo, agressivo e osteolítico, com invasão de partes moles circunvizinhas e presença de pontos de calcificação. Foi feita amputação no terço médio da perna direita, com diagnóstico histológico de condrossarcoma. Evoluiu com recidiva local da tumoração e, posteriormente, amputação no terço médio da coxa direita. Após um ano da última amputação, a paciente evoluiu com metástase de condrossarcoma em partes moles pelo corpo e nos pulmões e faleceu um ano e dez meses após o diagnóstico. Os condrossarcomas que envolvem o calcâneo em adultos jovens são raros, com poucos relatos na literatura. Por esse motivo, o presente relato torna-se importante no sentido de mostrar que apesar de essa ser uma afecção rara, ainda assim ela está presente no nosso meio. É imprescindível sua investigação precoce, principalmente por exames de imagem, com o intuito de diminuir as chances de malignização e, consequentemente, de complicações e evitar o óbito.

Surgical features of Trevor's disease of the patella.

The aim of this study was to describe surgical features of resection of hemimelic epiphyseal dysplasia of the patella. We already described the clinical and imaging features in another article. The patient was a six-year-old boy with a tumor in his right knee measuring 12 cm longitudinally and 6 cm transversally, which was adhering to the patella and had been slowly growing for two years. Biopsy findings were suggestive of a benign osteochondromatous lesion, without a defined diagnosis. Imaging examinations such as radiography and tomography showed areas of bone formation and radiotransparent areas, while magnetic resonance imaging showed areas of hypo and hypersignal in T1 and T2, of estimated size 8.5 cm longitudinally and 6 cm transversally. The tumor growth was surgically resected and curettage was performed on the epiphyseal nucleus of ossification of the upper and medial centers of the patella, with good patellar remodeling and normal development. The patient did not present any recurrence of the lesion up to the time of reaching skeletal maturity.

Descrever aspectos cirúrgicos da ressecção de displasia epifisária hemimélica da patela. Os aspectos clínicos e de imagem já foram descritos em outro artigo. Paciente masculino, seis anos, com tumor de crescimento lento em joelho direito, por dois anos, com dimensões de 12 cm no eixo longitudinal e 6 cm no transversal, aderido à patela. Biópsia sugeriu lesão osteocondromatosa benigna, sem diagnóstico definido. Exames de imagem, como radiografias e tomografias, com áreas de formação óssea e áreas radiotransparentes e na ressonância magnética áreas de hipo e hiperssinal em T1 e T2, de tamanho estimado em 8,5 cm no eixo longitudinal e 6 cm no transversal. Foram feitas ressecção cirúrgica da tumoração e curetagem do núcleo de ossificação epifisário do polo superior e medial da patela, com boa remodelação patelar e desenvolvimento normal. Paciente não apresentou recidiva da lesão até o término da maturidade esquelética.

Evaluation of the quality of life after vertebroplasty to treat compressive osteoporotic fractures.

OBJECTIVE: with increasing life expectancy around the world, fractures due to osteoporosis have become more common and the expenditure for treating them has also increased. The aim here was to evaluate the improvement in pain and quality of life among patients with compressive osteoporotic vertebral fractures undergoing vertebroplasty. METHODS: eighteen patients with 27 fractured vertebrae underwent vertebroplasty and were evaluated using the Oswestry 2.0 limitations questionnaire before the operation and 24 h and six months after the operation. RESULTS: there was a 75% improvement in pain and quality of life, going from a mean preoperative Oswestry of 40% to 10% 24 h after the operation and 9% six months after the operation (p ≤ 0.05). CONCLUSION: vertebroplasty is effective in managing compressive osteoporotic vertebral fractures, with improvement in pain and quality of life in the immediate postoperative period and over the medium term.

OBJETIVO: com o aumento da expectativa de vida no mundo, as fraturas por osteoporose se tornaram mais frequentes e aumentaram também os gastos no tratamento. Avaliar a melhoria na dor e na qualidade de vida de pacientes com fraturas vertebrais osteoporóticas compressivas submetidos a vertebroplastia. MÉTODOS: foram submetidos à vertebroplastia 18 pacientes com 27 vértebras fraturadas e avaliados pelo questionário de limitações de Oswestry 2.0 de forma pré-operatória, 24 horas e seis meses no pós-operatório. RESULTADOS: melhoria de 75% da dor e na qualidade de vida, com Oswestry médio pré-operatório de 40%, em 24 horas de 10% e após seis meses da cirurgia, de 9%. (p ≤ 0,05). CONCLUSÃO: s vertebroplastia é efetiva no manejo das fraturas vertebrais osteoporóticas por compressão e melhora a dor e a qualidade de vida dos pacientes no pós-operatório imediato e médio prazo.

PROXIMAL FEMURAL VALGUS SUBTROCHANTERIC OSTEOTOMY FOR NON UNION OF TROCHANTERIC FRACTURES.

OBJECTIVES: To evaluate valgus subtrochanteric osteotomy for the treatment of trochanteric non-union. METHODS: A retrospective study of cases series. From 1998 September to 2009 January, seventeen (17) cases with a diagnosis of non-union of trochanteric fracture were re-operated by the hip group of the Ortophaedic And Traumatology service of the Hospital Geral de Goiania (HGG). The patients presented pain at the fracture site, a femoral varus angle of less than 120°, and non-union of the fracture in the 3(rd) months after the initial surgery. RESULTS: Patients with ages ranging from 30 to 73 years, with a maximum follow-up of 09 years and minimum of 09 years. The mean time from first surgery to osteotomy was six months. Bone union was observed in 16 patients, with a mean union time of 12 weeks after surgery. The mean hip varus angle was 105(0) (120(0) to 90(0)). After surgery, the mean hip valgus angle was 144(0) (155(0) to 135(0)). We had one unsuccessful case; a 78-year old patient who had osteogtomy, fixed with DHS of 150(0), with valgization to 154(0). After six months of follow-up without union of the fracture, it was decided to perform total cemented hip artroplasthy, without complications. CONCLUSION: Valgus subtrochanteric osteotomies can be indicated for the treatment of trochanteric treatment of pseudoarthroses, with good final results for bone union, avoiding the need for total hip artroplasthy and maintaining biological fixation, as well as reestablishing the mechanical and anatomical axis of the affected limb.

PRIMARY LIPOSARCOMA OF THE LUMBAR SPINE: CASE REPORT.

We report a rare case of primary bone liposarcoma of the lumbar spine, for which only one case has been reported. A female patient, 60 years of age, with lumbar pain and left sciatalgy for six months. In the imaging exams, a destructive tumor was found in the L4 vertebral body, and magnetic resonance imaging (MRI) revealed a tumoral lesion with T1 hiposignal and T2 hypersignal. Histological diagnosis was difficult, and immunohistochemistry confirmed the diagnosis. Surgical treatment was performed with wide ressection, spinal cord decompression, and anterior and posterior fusion of L3 to L5 complemented by radiotherapy and chemotherapy. After three years, a computed tomography (CT) scan evidenced an expansive injury in the lung. Despite its rarity, liposarcoma should be considered in the differential diagnosis of sciatica and primary tumors of the spine.

MYOSITIS OSSIFICANS PROGRESSIVA: CASE REPORT.

Myositis ossificans progressiva is a rare autosomal dominant disease with less than 1,000 case reports. Such patients present edema, caused by inflammatory processes that progressively calcify, and with loss of mobility in the region affected. The objective of this study was to describe a case of myositis ossificans progressiva, present its clinical manifestations and discuss the treatments available (oral ascorbic acid and intravenous bisphosphonate).

CLINICAL AND RADIOLOGICAL EVALUATION ON DEVELOPMENTAL HIP DYSPLASIA AFTER SALTER AND OMBRÉDANNE PROCEDURE.

OBJECTIVE: To evaluate the clinical and radiological medium-term results from surgical treatment of developmental hip dysplasia through Salter innominate bone osteotomy and Ombrédanne femoral shortening. METHODS: Fourteen patients were evaluated, with surgical treatment on 18 hips (seven right-side hips and eleven left-side hips) using the proposal technique, performed between 1998 and 2008. The Dutoit and Severin criteria were used respectively for clinical and radiographic evaluations. RESULTS: The average preoperative index for the seven right-side hips was 43.3° (40° to 50°), and this was corrected through surgery to an average of 31.57° (24° to 42°). The average preoperative index for the eleven left-side hips was 42.1° (36° to 56°), and this was corrected through surgery to an average of 30.36° (20° to 44°). There was a statistically significant difference between the preoperative and postoperative acetabular indexes, with P > 0.05. The clinical evaluation showed that there were seven excellent hips (38.9%), eight good ones (44.4%), three fair hips (16.7%) and no poor ones (0%). By grouping the hips rated good and excellent as satisfactory and those rated poor and fair as unsatisfactory, 83.3% of the results were seen to be favorable. There were no statistically significant correlations between occurrences of complications and patient age at the time of surgery or between complications and the preoperative acetabular index (p > 0.05). The complications observed consisted of one case each of subluxation, osteonecrosis and osteonecrosis together with subluxation. CONCLUSION: The combined procedure of Salter and Ombrédanne is a viable option for treating developmental hip dysplasia after patients have started to walk.