Scielo RSS <![CDATA[Acta Ortopédica Brasileira]]> vol. 24 num. 2 lang. en <![CDATA[SciELO Logo]]> <![CDATA[PROPRIOCEPTION, BODY BALANCE AND FUNCTIONALITY IN INDIVIDUALS WITH ACL RECONSTRUCTION]]> Objective : To evaluate and compare proprioception, body balance and knee functionality of individuals with or without unilateral anterior cruciate ligament (ACL) reconstruction. Methods : Forty individuals were divided in two groups: Experimental group, 20 individuals with ACL reconstruction at six months postoperative, and control group, 20 individuals with no history of lower limb pathologies. In the experimental group, we assessed lower limbs with reconstructed ACL and contralateral limb; in the control group the dominant and the non-dominant lower limbs were assessed. All subjects were submitted to joint position sense test to evaluate proprioception, postural control measure in single-limb, and step up and down (SUD) test for functional assessment. Results : There were no deficits in proprioception and postural control. In the SUD test, a 5% decrease in lift up force was found in reconstructed ACL lower limbs, however, a statistically not significant difference. The impact and step down force during the course of test were 30% greater in anatomic ACL than in control lower limbs. Conclusion : The individuals with ACL reconstruction at six months postoperative did not show changes in proprioception and postural control, but showed motor control changes, influencing knee functionality. Level of Evidence IV, Prognostic Studies. <![CDATA[USE OF SPATIOTEMPORAL GAIT PARAMETERS TO DETERMINE RETURN TO SPORTS AFTER ACL RECONSTRUCTION]]> Objective : To compare gait spatiotemporal parameters of healthy and ACL reconstructed subjects in order to classify the status of gait normality. Methods : Fourteen healthy subjects and eight patients submitted to ACL reconstruction walked along a walkway while the lower limbs movement was captured by an infrared camera system. The frames where the initial contact and toe-off took place were determined and the following dependent variables, which were compared between groups through the Mann-Whitney test (a=0.05) were calculated: percentage of time in initial double stance, percentage of time in single stance, percentage of time in terminal double stance, stride length and gait velocity. Initially, all variables were compared between groups using a Mann-Whitney test. A logistic regression was applied, including all dependent variables, to create a model that could differentiate healthy and ACL reconstructed subjects. Results : ACL reconstructed group showed no differences in any spatiotemporal parameter of gait (p &gt; 0.05) in relation to the control group, although the angular kinematic differences of the knee remained altered, as evidenced in a study with a similar sample. Conclusion : The regression classified all subjects as healthy, including the ACL reconstructed group, suggesting the spatiotemporal variables should not be used as the sole criterion of return to sports activities at the same level as prior to injury. Level of Evidence III, Case Control Study. <![CDATA[CLINICAL AND RADIOGRAPHIC EVALUATION OF ELBOWS FROM SPINAL CORD INJURIED PATIENTS]]> Objectives : To evaluate clinically and radiologically the elbows of spinal cord injured patients and compare them to the control group. Methods : Twenty patients (10 paraplegics and 10 tetraplegics) were clinically evaluated through assessment of pain scale, measurement of active and passive range of motion, degree of muscle strength and MEPS score. They were also submitted to bilateral plain radiography of the elbows. Both groups were compared to the control group. Results : Four paraplegic and three tetraplegic patients referred mild to moderate, sporadic and motion related pain. The control group was asymptomatic. No statistic significant difference was found in passive range of motion among the three groups. The tetraplegic group showed a lower active range of motion as well as lower MEPS score as compared to the control group. Equal number of patients in the spinal cord injured patients had radiological abnormalities, but those were more severe in the tetraplegic group. Conclusion : Spinal cord injured patients presented clinical and radiological elbow abnormalities, which were more evident on tetraplegics. Level of Evidence III, Case Control. <![CDATA[EVALUATION OF CHILDREN WITH RADIAL NECK FRACTURES TREATED WITH FLEXIBLE INTRAMEDULLARY NAIL]]> Objective : To evaluate the results of displaced radial neck fractures in children trated surgically with flexible titanium intramedullary nails. Method : This is a retrospective study of five cases of radial neck fractures with displacement greater than 30° fixed with flexible intramedullary nails. Patients were evaluated regarding functional outcome through range of motion and the Mayo Elbow Performance Score (MEPS), as well as radiographic exams. Results : Five patients, with a mean age of 8.4 years were assessed, during a mean post-operative follow up of 12.2 months. Open reduction was necessary in three cases with major displacement. At the end of the follow up, 80% of the patients had excellent results, 20% good results, and all fractures healed. As complications we observed: heterotopic ossification, superficial infection and radial head necrosis. Conclusions : In spite of the small sample, our results with flexible titanium intramedullary nails were similar to the current literature, with good functional outcomes. Level of Evidence III, Retrospective Study. <![CDATA[MANAGEMENT OF INFANTILE BLOUNT'S DISEASE WITH MOLDED ORTHOSES: A NEW PERSPECTIVE]]> Objective : This retrospective study evaluated treatment with individually contoured molded bracing at early stages of the disease. Methods : We evaluated the medical records of patients undergoing treatment of Blount's disease with molded orthoses for medial decompression between 2010 and 2014. The deformity angle (Drennan's metaphyseal-diaphyseal angle) and Langenskiöld classification were measured before and after treatment by a pediatric orthopedic surgeon with over 5 years of practice, blinded for the study and patients. Results : The mean age was 2.57 years old. Four patients were female and six male. Half of the total sample had bilateral disease. The average deformity angle showed a statistically significant reduction after treatment (p &lt;0.001). Gender and laterality did not statistically influence the change of the deformity angle after treatment (p&gt; 0.05). Conclusion : The nightly use of molded orthoses for medial decompression was effective in reducing the metaphyseal-diaphyseal angle in Blount's disease in children under 3 years of age, regardless of gender and bilateral disease. Patients over 3 years old did not benefit from bracing. Level of Evidence IV, Case Series. <![CDATA[ASSESSMENT OF REPRODUCIBILITY OF SANDERS CLASSIFICATION FOR CALCANEAL FRACTURES]]> Objective : To assess intra- and interobserver reproducibility of Sanders Classification System of calcaneal fractures among experienced and less experienced observers. Methods : Forty-six CT scans of intra-articular calcaneal fractures were reviewed. Four observers, two with ten years of experience in foot and ankle surgery and two third-year residents in Orthopedics and Traumatology classified the fractures on two separate occasions three weeks apart from each other. The intra and inter-observer reliability was analyzed using the Kappa index. Results : There was good intraobserver reliability for the two experienced observers and one less experienced observer (Kappa values 0.640, 0.632 and 0.629, respectively). The interobserver reliability was fair between the experienced observers (Kappa = 0.289) and moderate among the less experienced observers (Kappa = 0.527). Conclusions : The Sanders Classification System showed good intraobserver reliability, but interobserver reproducibility below the ideal level, both among experienced and less experienced observers. Level of Evidence III, Diagnostic Studies. <![CDATA[INTRAMUSCULAR MARTIN-GRUBER ANASTOMOSIS]]> Objective : This paper reports the incidence, origin, course and anatomical relationships of intramuscular Martin-Gruber anastomosis. Methods : Anatomical dissection of 100 limbs from 50 adults cadavers was performed. The intramuscular Martin-Gruber anastomosis was found in five forearms, three in the right and two in the left side, one was bilateral. All communication were located between the anterior interosseous nerve and the ulnar nerve. Conclusion : The purpose of intramuscular Martin-Gruber anastomosis, which we found in 5% of dissected limbs, is to supply the flexor digitorum profundus muscle and it is unlikely to have any influence on the innervation of the intrinsic muscles of the hand. Level of Evidence IV, Cases Series. <![CDATA[GLYCOSAMINOGLYCANS AND PROTEOGLYCANS IN PALMAR FASCIA OF PATIENTS WITH DUPUYTREN]]> Objective : To evaluate and compare the behavior of glycosaminoglycans (GAGs) in Dupuytren disease (DD). Methods : This is an experimental study with 23 patients diagnosed with DD. Tissue collected through fasciectomy with incision type Brunner or McCash were evaluated by electrophoresis for identification of GAGs. The quantification was carried out by immunofluorescence and dosage of proteins for different types of glycosaminoglycans. The results were expressed in percentage and statistically evaluated. Results : A significant increase was observed through eletrophoresis in GAGs, as compared to the control (p&lt;0.05). Immunofluorescence of hyaluronic acid was reduced (23 times) when compared to the control (p&lt;0.0001). Conclusion : An increase of sulfated GAGs in Dupuytren's disease, mainly dermatan sulfate, was evident from our results, as well as a pronounced decrease of hyaluronic acid in the palmar aponeurosis from the same patients. Level of Evidence III, Case-Control Study. <![CDATA[CADAVERIC STUDY ON THE LEARNING CURVE OF THE TWO-APPROACH GANZ PERIACETABULAR OSTEOTOMY]]> Objective : The Bernese periacetabular osteotomy (PAO) is a widely used technique for the treatment of non-arthritic, dysplastic, painful hips. It is considered a highly complex procedure with a steep learning curve. In an attempt to minimize complications, a double anterior-posterior approach has been described. We report on our experience while performing this technique on cadaveric hips followed by meticulous dissection to verify possible complications. Methods : We operated on 15 fresh cadaveric hips using a combined posterior Kocher-Langenbeck and an anterior Smith-Petersen approach, without fluoroscopic control. The PAO cuts were performed and the acetabular fragment was mobilized. A meticulous dissection was carried out to verify the precision of the cuts. Results : Complications were observed in seven specimens (46%). They included a posterior column fracture, and posterior and anterior articular fractures. The incidence of complications decreased over time, from 60% in the first five procedures to 20% in the last five procedures. Conclusions : We concluded that PAO using a combined anterior-posterior approach is a reproducible technique that allows all cuts to be done under direct visualization. The steep learning curve described in the classic single incision approach was also observed when using two approaches. Evidence Level: IV, Cadaveric Study. <![CDATA[PERPENDICULAR DOUBLE-PLATE FIXATION WITH LOCKING SYSTEM FOR ACROMION PEDICLE FRACTURE]]> Objective : To describe the surgical technique and preliminary clinical outcomes in a series of open reduction internal fixation of basal acromion process fractures applying a double-plating technique. Methods : Nine consecutive patients, mean age 33.4 years old (range, 23-61 years old) with unilateral acromion fracture (Type 3 AO/OTA) with more than 1cm displacement who underwent fixation utilizing a locked double-plating technique, were evaluated on average at 7.8 months (range, 3-15 months) for outcomes related to pain, shoulder function, and surgical complications. Results : Eight patients recovered with complete radiographic union and favorable shoulder function. One case failed to be fully evaluated for more than 3 months follow-up. The overall scores of Constant, Shoulder Pain and Disability Index (SPADI) and DASH for the eight patients reviewed were 91.9± 6.31, 3.11± 3.79 and 5.2± 6.35, respectively. No post-operative infection or surgical hardware irritation was identified at final follow-up of these eight patients. Conclusion : While more evidence is needed to justify its advantages over traditional implants, perpendicular double-plate with a locking system may be indicated for acromion pedicle fracture treatment, since it performed well for fracture healing and joint function rehabilitation. Level of Evidence IV, Therapeutic Study.