Alexandre Godoy-Santos - Academia.edu (original) (raw)
Papers by Alexandre Godoy-Santos
Foot & Ankle Orthopaedics, 2020
Category: Ankle Arthritis; Ankle; Hindfoot; Other Introduction/Purpose: Sinus tarsi and Subfibula... more Category: Ankle Arthritis; Ankle; Hindfoot; Other Introduction/Purpose: Sinus tarsi and Subfibular impingement are considered the main causes of lateral foot pain in patients with Adult Acquired Flatfoot Deformity (AAFD). They are considered important markers in the spectrum of progressive peritalar subluxation (PTS) in patients with AAFD. Recent literature has also highlighted the use of the Middle Facet of the subtalar joint as a more accurate indicator of PTS. The objective of this study was to assess the relationship between lateral impingement and middle facet PTS. Our hypotheses were that patients with sinus tarsi and subfibular impingement would demonstrate more severe PTS than patients with no impingement, and that subfibular impingement would represent a better indicator of pronounced deformity when compared to sinus tarsi impingement. Methods: In this retrospective comparative Cohort Study, we included 110 AAFD patients that underwent standing weightbearing CT (WBCT) as a ...
Foot & Ankle Orthopaedics, 2020
Category: Hindfoot; Ankle; Other Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) i... more Category: Hindfoot; Ankle; Other Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) is a three-dimensional (3D) and complex pathology that is characterized by peritalar subluxation (PTS) of the hindfoot. Measuring the amount of subluxation of the subtalar joint at the posterior facet was described and utilized for many years as a marker of PTS. The subluxation of the middle facet was recently proposed as possibly a more accurate and reliable early marker of pronounced deformity, with almost 100% sensitivity and specificity for symptomatic AAFD. The objective of this study was to compare the amount of subluxation of both the medial and posterior facets in patients with increased hindfoot valgus and controls. Methods: In this IRB-approved retrospective comparative study, we included a total of 91 patients with AAFD (108 feet) who underwent standing weightbearing CT (WBCT) as a standard baseline assessment of their foot deformity. One blinded Fellowship- Trained Orthopedic ...
Foot & Ankle Orthopaedics, 2020
Category: Ankle; Ankle Arthritis; Arthroscopy; Sports Introduction/Purpose: Chronic subtle distal... more Category: Ankle; Ankle Arthritis; Arthroscopy; Sports Introduction/Purpose: Chronic subtle distal tibiofibular syndesmotic instability (DTFSI) is relatively common, and consequences of undiagnosed injuries can be devastating. Diagnosing acute and chronic injuries is challenging, and the most commonly used diagnostic tools are physical exams, conventional radiographs and bilateral CT, and MRI. Arthroscopic assessment, an invasive method, is currently considered the gold standard. Weightbearing CT has just emerged as an excellent dynamic non-invasive diagnostic test. Recent literature highlighted the accuracy of syndesmotic incisura area measurements in diagnosing subtle DTFSI. The aim of our study was to develop and validate the use of a novel automatic 3D volumetric assessment of the incisura, and to compare the measurements between patients with surgically confirmed DTFSI and controls. Methods: In this IRB-approved case-control study, patients with suspected unilateral chronic subt...
Journal of the Foot & Ankle, 2020
The objective of this study is to evaluate the applicability of the finite element method to anal... more The objective of this study is to evaluate the applicability of the finite element method to analyze pressure distribution in the healthy human foot. Images of a foot were captured using computed tomography and converted into a three-dimensional model, which was adjusted with the aid of CAD software. The model was imported into Abaqus software for finite element analysis, considering the different regions of the foot. Observations of displacement, stresses, and pressure distribution demonstrated a biomechanical behavior of the foot consistent with that reported in the existing literature, regarding the regions of peak plantar pressure. These findings demonstrate the feasibility of evaluating the physical and mechanical behavior of the human foot using the finite element method, and can serve as a reference for the study and manufacture of orthotic appliances, prosthetic devices, and insoles. Level of Evidence V; Prognostic Studies; Expert Opinion.
Acta Ortopédica Brasileira, 2019
Complex trauma of the foot and ankle is characterized by fractures with severe soft tissue damage... more Complex trauma of the foot and ankle is characterized by fractures with severe soft tissue damage associated with neurovascular injury and joint involvement. These injuries are frequently present in the polytraumatized patient and are a predictor of unfavorable clinical outcome. In the initial approach to a patient with complex foot and ankle trauma, the decision between amputation and reconstruction is crucial. The various existing classification systems are of limited effectiveness and should serve as tools to assist and support a clinical decision rather than as determinants of conduct. In the emergency department, one of two treatment options must be adopted: early complete treatment or staged treatment. The former consists of definitive fixation and immediate skin coverage, using either primary closure (suturing) or flaps, and is usually reserved for less complex cases. Staged treatment is divided into initial and definitive. The objectives in the first phase are: prevention of...
Diabetic Foot & Ankle, 2017
The aim of this case report was to describe a successful diabetic limb salvage procedure in the t... more The aim of this case report was to describe a successful diabetic limb salvage procedure in the treatment of an infected diabetic foot ulcer through a multidisciplinary team approach and complex surgical reconstruction involving a femoral head bone allograft and musculocutaneous latissimus dorsi free flap. The decision to proceed with aggressive staged efforts at diabetic limb salvage should be made only after careful consultation with the patient, his or her family, and the rest of the multidisciplinary healthcare team.
Revista Dental Press de Ortodontia e Ortopedia Facial, 2007
OBJETIVO: este artigo visa informar e atualizar o profissional da área odontológica a respeito da... more OBJETIVO: este artigo visa informar e atualizar o profissional da área odontológica a respeito da tomografia computadorizada, incluindo informações concernentes à aquisição de imagens, dose de radiação e interpretação do exame tomográfico, com distinção entre a tomografia computadorizada tradicional e a tomografia computadorizada de feixe cônico. Adicionalmente, as possibilidades de aplicação deste método de diagnóstico por imagem na Ortodontia são discutidas. CONCLUSÕES: resultado de avanços tecnológicos, da redução da exposição à radiação e da ótima qualidade da imagem, as expectativas apontam para uma utilização mais abrangente da tomografia computadorizada de feixe cônico na Odontologia e na Ortodontia. Com a definição de novos conhecimentos gerados pela visão tridimensional do crânio e da face, o futuro reserva a renovação de conceitos e paradigmas, assim como a redefinição de metas e planos terapêuticos ortodônticos.
Acta Ortopédica Brasileira, 2013
OBJETIVO: Relatar os resultados com médio prazo de seguimento após a implantação de Arthrosurface... more OBJETIVO: Relatar os resultados com médio prazo de seguimento após a implantação de Arthrosurface-HemiCap® em pacientes com diagnóstico de hállux rígidus (HR). MÉTODO: Onze pacientes foram submetidos à artroplastia parcial da primeira metatarso-falangeana. Seis mulheres e cinco homens com idade média de 51,9 anos (46 a 58 anos) e média de seguimento pós-operatório de 3,73 anos (3-4 anos); foram classificados através do sistema de Kravitz e avaliados pelas escalas da american orthopaedic foot and ankle society (AOFAS) para hállux, visual analog scale (VAS) - analógico funcional de dor - e pela amplitude de movimento da primeira articulação metatarsofalangeana no periodo pré-operatório, pós-operatório de seis meses e pós-operatório atual. RESULTADOS: Os resultados revelam melhora significativa dos três parâmetros analisados no estudo, tanto para análise global como para comparações pré e pós-operatórias individuais. A análise comparativa de cada variável nos períodos pós-operatórios d...
Acta Ortopédica Brasileira, 2010
OBJETIVO: Analisar a amplitude de movimento do tornozelo e as forças de reação vertical do solo e... more OBJETIVO: Analisar a amplitude de movimento do tornozelo e as forças de reação vertical do solo envolvidas na marcha de pacientes portadores de diabetes com e sem neuropatia periférica. CASUÍSTICA E MÉTODO: 36 indivíduos divididos em três grupos: Controle - GC: 10 indivíduos sem diabetes, Diabetes - GD: 10 indivíduos portadores de diabetes sem neuropatia periférica e Neuropatia - GDN: 16 indivíduos portadores de diabetes e neuropatia diabética periférica. Foi realizada análise da marcha - AMTI® OR6/6, e da amplitude de movimento articular tíbio-társica - Sistema Vicom 640® - de todos os participantes. RESULTADOS: O primeiro e segundo pico de força vertical de reação do solo são maiores no grupo Neuropatia e a amplitude de movimento articular do tornozelo é menor nos grupos Diabetes e Neuropatia. CONCLUSÃO: A amplitude de movimento da articulação tíbio-társica está diminuida nos diabetéticos, independente da presença ou ausência de neuropatia periférica, e os diabéticos com neuropati...
Journal of Foot and Ankle Surgery (Asia Pacific), 2021
The tibiotalar joint is one of the most prevalent intra-articular fracture sites in the human bod... more The tibiotalar joint is one of the most prevalent intra-articular fracture sites in the human body, resulting in high rates of post-traumatic ankle osteoarthritis (PTOA). Studies have shown multifactorial causes for PTOA and highlight the importance of three determining factors for clinical outcomes after malleolar fracture: quality of joint reduction and fracture fixation, residual ligament instability, and initial damage to joint tissues-including chondral tissue, synovial tissue, and synovial fluid. This special article summarizes recent evidence of malleolar fractures treatment, with a main focus on important factors related to improve clinical outcomes in order to avoid posttraumatic ankle osteoarthritis (OA).
Foot & Ankle Orthopaedics, 2019
Category: Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Arthrodesis of the subtalar jo... more Category: Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Arthrodesis of the subtalar joint is performed for various arthritic and instability problems to correct alignment and relieve pain. For talocalcaneal pathologies, isolated subtalar arthrodesis has been advocated with the advantages of lower risk of adjacent joint arthritis and nonunion of the transverse tarsal joint. Internal fixation techniques have varied over time and use of compression screws is common. The screws may be oriented from dorsal to plantar or plantar to dorsal. Arguments favoring one approach over another are based more on “expert opinion” than hard data. The goal of this study was to compare the biomechanical stability of these two constructs to evaluate which creates a more stable construct. Methods: Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3-mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assi...
Acta ortopedica brasileira
The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and w... more The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all surgeries. Graft materials included b-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56). Graft use did not improve union rates for subtalar arthrodesis. Level of Evidence IV, Case Series.
Revista Brasileira de Ortopedia (English Edition), 2016
Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the mo... more Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, threedimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function. Therefore, the challenges in treating these injuries in children are to achieve adequate diagnosis and precise treatment, while avoiding complications. The objective of the treatment is to restore normal anatomy and the correct articular relationship between the bones in this region. Moreover, the treatment needs to be planned according to articular involvement, lower-limb alignment, ligament stability and age. This article provides a review on this topic and presents the scientific evidence for appropriate treatment of these lesions.
European Journal of Orthopaedic Surgery & Traumatology
Journal of the Foot & Ankle, 2021
Objective: To determine the microbiological profile and antimicrobial susceptibility patterns of ... more Objective: To determine the microbiological profile and antimicrobial susceptibility patterns of organisms isolated from chronic osteomyelitis secondary to neuropathic foot ulcers; secondarily, to describe the clinical outcomes of 52 patients admitted to a neuropathic foot referral center. Methods: Retrospectively chart review of 52 patients with clinically infected neuropathic foot ulcers admitted to our service for treatment between 2005 and 2013. Tissue samples were collected for culture at the operating room after extensive debridement in order to determine the infectious agents and their resistance profile using the disk-diffusion technique, following CLSI criteria. Results: A total of 52 patients were analyzed (40 males and 12 females). The mean age was 58 (37-72) years. Each patient presented with an average of 2.13 microorganisms, distributed as follows: 51% Gram-positive cocci, 43% Gram-negative bacilli. Among Staphylococcus aureus isolates, the prevalence of methicillin re...
Journal of the Foot & Ankle, 2020
Measurement of hindfoot malalignment and flexibility is essential for treatment decision-making i... more Measurement of hindfoot malalignment and flexibility is essential for treatment decision-making in cavovarus foot deformity. Weight-bearing computed tomography (WBCT) shows greater diagnostic accuracy and allows the study of osteoarticular alignment in the physiological upright position. The most commonly used method for measurements on WBCT scans is the foot and ankle offset (FAO), which is based on the structural tripod of the foot: the calcaneus and the first and fifth metatarsal heads. During the Coleman block test, the first metatarsal head is not resting on the ground and, therefore, does not represent the physiological support of the tripod. We describe a new measurement, the forefoot/hindfoot offset (FHO), for assessing hindfoot alignment on WBCT scans. Level of Evidence V; Diagnostic Studies; Expert Opinion.
Tarsal coalition is an abnormal connection between tarsal bones, caused by an embryogenic failure... more Tarsal coalition is an abnormal connection between tarsal bones, caused by an embryogenic failure. Its most common forms are calcaneonavicular and talocalcaneal coalition, which are present in 53% and 37% of the cases, respectively. The onset of symptoms is related to tarsal bone ossification, and mean age for this event is estimated at 16 years for calcaneonavicular coalition. Surgical treatment is indicated for patients who did not improve symptoms with conservative treatment. The aim of this study is to present a surgical technique as a treatment option for resection of calcaneonavicular coalition associated with abnormal cuboid-navicular joint. Level of Evidence V; Therapeutic Studies; Expert Opinion.
Journal of the Foot & Ankle, 2020
Syndesmotic instability is a fundamental question that guides treatment; despite the currently av... more Syndesmotic instability is a fundamental question that guides treatment; despite the currently available diagnostic imaging tests, its determination is still challenging. Knowledge of the instability degree assists the physician in the decision-making process regarding surgical or nonsurgical treatments. The authors are currently conducting a prospective diagnostic accuracy study by consecutively selecting individuals aged 18 years and older with an orthopaedic clinical examination indicating suspected acute syndesmotic injury. Magnetic resonance imaging is the reference standard used for evaluating the diagnostic accuracy of 3 computed tomography index tests. These tests include the neutral position and 2 ankle stress maneuvers: external rotation and dorsiflexion. Comparative measurements between the injured syndesmosis and the uninjured contralateral side of the same individual evaluate the tibiofibular relationship and investigate syndesmotic instability. This study aims to descr...
Archives of Orthopaedic and Trauma Surgery, 2021
Elevated first metatarsal, Metatarsus primus elevatus (MPE), has been a topic of controversy. Rec... more Elevated first metatarsal, Metatarsus primus elevatus (MPE), has been a topic of controversy. Recent studies have supported a significantly elevated first metatarsal in hallux rigidus on weight-bearing radiographs (WBR). However, conventional radiographs have limitations for accurate measurement. Our objective was to comparatively assess MPE and other variables which can affect the spatial relationship of the forefoot in the HR group compared to controls using weight-bearing CT (WBCT). In this single-center, retrospective, case–control study, 25 patients (30 feet) with symptomatic HR and 30 controls were selected. WBCT parameters were measured by two independent investigators. Inter-observer reliabilities were assessed using intra-class correlation coefficients (ICCs). MPE was evaluated by measuring the direct distance between 1st and 2nd metatarsals. Independent t tests were performed to compare the two groups. A threshold of MPE to diagnose HR was calculated using the Receiver Operating Characteristic (ROC) curve. HR groups had increased hallux valgus angle (HVA) (8.52° in control vs 11.98° in HR) and MPE (2.92 vs 5.09 mm), decreased 1st metatarsal declination angle (21.09° vs 19.07°) 1st/2nd metatarsal declination ratio (87.45 vs 79.71) indicating elevated first metatarsal compared to controls. Dorsal translation of the first metatarsal at the first tarsometatarsal joint was observed in 21 (70%) patients of the HR group when defined as a step-off or discontinuation of the curvature along the first TMT joint. The threshold of MPE for diagnosis of HR was 4.19 mm with 77% sensitivity and 77% specificity. Our results confirmed a significantly elevated first metatarsal in the HR group compared to controls on WBCT. A MPE greater than 4.19 mm was found to be diagnostic for symptomatic HR. Significant number of patients in the HR group (70%) had dorsal translation of the first metatarsal at the first TMT joint which can contribute to increased MPE. The present study demonstrated significantly increased MPE in HR on WBCT and MPE greater than 4.19 mm on WBCT can be used as a diagnostic threshold for HR.
Foot & Ankle Orthopaedics, 2020
Category: Ankle Arthritis; Ankle; Hindfoot; Other Introduction/Purpose: Sinus tarsi and Subfibula... more Category: Ankle Arthritis; Ankle; Hindfoot; Other Introduction/Purpose: Sinus tarsi and Subfibular impingement are considered the main causes of lateral foot pain in patients with Adult Acquired Flatfoot Deformity (AAFD). They are considered important markers in the spectrum of progressive peritalar subluxation (PTS) in patients with AAFD. Recent literature has also highlighted the use of the Middle Facet of the subtalar joint as a more accurate indicator of PTS. The objective of this study was to assess the relationship between lateral impingement and middle facet PTS. Our hypotheses were that patients with sinus tarsi and subfibular impingement would demonstrate more severe PTS than patients with no impingement, and that subfibular impingement would represent a better indicator of pronounced deformity when compared to sinus tarsi impingement. Methods: In this retrospective comparative Cohort Study, we included 110 AAFD patients that underwent standing weightbearing CT (WBCT) as a ...
Foot & Ankle Orthopaedics, 2020
Category: Hindfoot; Ankle; Other Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) i... more Category: Hindfoot; Ankle; Other Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) is a three-dimensional (3D) and complex pathology that is characterized by peritalar subluxation (PTS) of the hindfoot. Measuring the amount of subluxation of the subtalar joint at the posterior facet was described and utilized for many years as a marker of PTS. The subluxation of the middle facet was recently proposed as possibly a more accurate and reliable early marker of pronounced deformity, with almost 100% sensitivity and specificity for symptomatic AAFD. The objective of this study was to compare the amount of subluxation of both the medial and posterior facets in patients with increased hindfoot valgus and controls. Methods: In this IRB-approved retrospective comparative study, we included a total of 91 patients with AAFD (108 feet) who underwent standing weightbearing CT (WBCT) as a standard baseline assessment of their foot deformity. One blinded Fellowship- Trained Orthopedic ...
Foot & Ankle Orthopaedics, 2020
Category: Ankle; Ankle Arthritis; Arthroscopy; Sports Introduction/Purpose: Chronic subtle distal... more Category: Ankle; Ankle Arthritis; Arthroscopy; Sports Introduction/Purpose: Chronic subtle distal tibiofibular syndesmotic instability (DTFSI) is relatively common, and consequences of undiagnosed injuries can be devastating. Diagnosing acute and chronic injuries is challenging, and the most commonly used diagnostic tools are physical exams, conventional radiographs and bilateral CT, and MRI. Arthroscopic assessment, an invasive method, is currently considered the gold standard. Weightbearing CT has just emerged as an excellent dynamic non-invasive diagnostic test. Recent literature highlighted the accuracy of syndesmotic incisura area measurements in diagnosing subtle DTFSI. The aim of our study was to develop and validate the use of a novel automatic 3D volumetric assessment of the incisura, and to compare the measurements between patients with surgically confirmed DTFSI and controls. Methods: In this IRB-approved case-control study, patients with suspected unilateral chronic subt...
Journal of the Foot & Ankle, 2020
The objective of this study is to evaluate the applicability of the finite element method to anal... more The objective of this study is to evaluate the applicability of the finite element method to analyze pressure distribution in the healthy human foot. Images of a foot were captured using computed tomography and converted into a three-dimensional model, which was adjusted with the aid of CAD software. The model was imported into Abaqus software for finite element analysis, considering the different regions of the foot. Observations of displacement, stresses, and pressure distribution demonstrated a biomechanical behavior of the foot consistent with that reported in the existing literature, regarding the regions of peak plantar pressure. These findings demonstrate the feasibility of evaluating the physical and mechanical behavior of the human foot using the finite element method, and can serve as a reference for the study and manufacture of orthotic appliances, prosthetic devices, and insoles. Level of Evidence V; Prognostic Studies; Expert Opinion.
Acta Ortopédica Brasileira, 2019
Complex trauma of the foot and ankle is characterized by fractures with severe soft tissue damage... more Complex trauma of the foot and ankle is characterized by fractures with severe soft tissue damage associated with neurovascular injury and joint involvement. These injuries are frequently present in the polytraumatized patient and are a predictor of unfavorable clinical outcome. In the initial approach to a patient with complex foot and ankle trauma, the decision between amputation and reconstruction is crucial. The various existing classification systems are of limited effectiveness and should serve as tools to assist and support a clinical decision rather than as determinants of conduct. In the emergency department, one of two treatment options must be adopted: early complete treatment or staged treatment. The former consists of definitive fixation and immediate skin coverage, using either primary closure (suturing) or flaps, and is usually reserved for less complex cases. Staged treatment is divided into initial and definitive. The objectives in the first phase are: prevention of...
Diabetic Foot & Ankle, 2017
The aim of this case report was to describe a successful diabetic limb salvage procedure in the t... more The aim of this case report was to describe a successful diabetic limb salvage procedure in the treatment of an infected diabetic foot ulcer through a multidisciplinary team approach and complex surgical reconstruction involving a femoral head bone allograft and musculocutaneous latissimus dorsi free flap. The decision to proceed with aggressive staged efforts at diabetic limb salvage should be made only after careful consultation with the patient, his or her family, and the rest of the multidisciplinary healthcare team.
Revista Dental Press de Ortodontia e Ortopedia Facial, 2007
OBJETIVO: este artigo visa informar e atualizar o profissional da área odontológica a respeito da... more OBJETIVO: este artigo visa informar e atualizar o profissional da área odontológica a respeito da tomografia computadorizada, incluindo informações concernentes à aquisição de imagens, dose de radiação e interpretação do exame tomográfico, com distinção entre a tomografia computadorizada tradicional e a tomografia computadorizada de feixe cônico. Adicionalmente, as possibilidades de aplicação deste método de diagnóstico por imagem na Ortodontia são discutidas. CONCLUSÕES: resultado de avanços tecnológicos, da redução da exposição à radiação e da ótima qualidade da imagem, as expectativas apontam para uma utilização mais abrangente da tomografia computadorizada de feixe cônico na Odontologia e na Ortodontia. Com a definição de novos conhecimentos gerados pela visão tridimensional do crânio e da face, o futuro reserva a renovação de conceitos e paradigmas, assim como a redefinição de metas e planos terapêuticos ortodônticos.
Acta Ortopédica Brasileira, 2013
OBJETIVO: Relatar os resultados com médio prazo de seguimento após a implantação de Arthrosurface... more OBJETIVO: Relatar os resultados com médio prazo de seguimento após a implantação de Arthrosurface-HemiCap® em pacientes com diagnóstico de hállux rígidus (HR). MÉTODO: Onze pacientes foram submetidos à artroplastia parcial da primeira metatarso-falangeana. Seis mulheres e cinco homens com idade média de 51,9 anos (46 a 58 anos) e média de seguimento pós-operatório de 3,73 anos (3-4 anos); foram classificados através do sistema de Kravitz e avaliados pelas escalas da american orthopaedic foot and ankle society (AOFAS) para hállux, visual analog scale (VAS) - analógico funcional de dor - e pela amplitude de movimento da primeira articulação metatarsofalangeana no periodo pré-operatório, pós-operatório de seis meses e pós-operatório atual. RESULTADOS: Os resultados revelam melhora significativa dos três parâmetros analisados no estudo, tanto para análise global como para comparações pré e pós-operatórias individuais. A análise comparativa de cada variável nos períodos pós-operatórios d...
Acta Ortopédica Brasileira, 2010
OBJETIVO: Analisar a amplitude de movimento do tornozelo e as forças de reação vertical do solo e... more OBJETIVO: Analisar a amplitude de movimento do tornozelo e as forças de reação vertical do solo envolvidas na marcha de pacientes portadores de diabetes com e sem neuropatia periférica. CASUÍSTICA E MÉTODO: 36 indivíduos divididos em três grupos: Controle - GC: 10 indivíduos sem diabetes, Diabetes - GD: 10 indivíduos portadores de diabetes sem neuropatia periférica e Neuropatia - GDN: 16 indivíduos portadores de diabetes e neuropatia diabética periférica. Foi realizada análise da marcha - AMTI® OR6/6, e da amplitude de movimento articular tíbio-társica - Sistema Vicom 640® - de todos os participantes. RESULTADOS: O primeiro e segundo pico de força vertical de reação do solo são maiores no grupo Neuropatia e a amplitude de movimento articular do tornozelo é menor nos grupos Diabetes e Neuropatia. CONCLUSÃO: A amplitude de movimento da articulação tíbio-társica está diminuida nos diabetéticos, independente da presença ou ausência de neuropatia periférica, e os diabéticos com neuropati...
Journal of Foot and Ankle Surgery (Asia Pacific), 2021
The tibiotalar joint is one of the most prevalent intra-articular fracture sites in the human bod... more The tibiotalar joint is one of the most prevalent intra-articular fracture sites in the human body, resulting in high rates of post-traumatic ankle osteoarthritis (PTOA). Studies have shown multifactorial causes for PTOA and highlight the importance of three determining factors for clinical outcomes after malleolar fracture: quality of joint reduction and fracture fixation, residual ligament instability, and initial damage to joint tissues-including chondral tissue, synovial tissue, and synovial fluid. This special article summarizes recent evidence of malleolar fractures treatment, with a main focus on important factors related to improve clinical outcomes in order to avoid posttraumatic ankle osteoarthritis (OA).
Foot & Ankle Orthopaedics, 2019
Category: Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Arthrodesis of the subtalar jo... more Category: Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Arthrodesis of the subtalar joint is performed for various arthritic and instability problems to correct alignment and relieve pain. For talocalcaneal pathologies, isolated subtalar arthrodesis has been advocated with the advantages of lower risk of adjacent joint arthritis and nonunion of the transverse tarsal joint. Internal fixation techniques have varied over time and use of compression screws is common. The screws may be oriented from dorsal to plantar or plantar to dorsal. Arguments favoring one approach over another are based more on “expert opinion” than hard data. The goal of this study was to compare the biomechanical stability of these two constructs to evaluate which creates a more stable construct. Methods: Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3-mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assi...
Acta ortopedica brasileira
The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and w... more The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all surgeries. Graft materials included b-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56). Graft use did not improve union rates for subtalar arthrodesis. Level of Evidence IV, Case Series.
Revista Brasileira de Ortopedia (English Edition), 2016
Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the mo... more Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, threedimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function. Therefore, the challenges in treating these injuries in children are to achieve adequate diagnosis and precise treatment, while avoiding complications. The objective of the treatment is to restore normal anatomy and the correct articular relationship between the bones in this region. Moreover, the treatment needs to be planned according to articular involvement, lower-limb alignment, ligament stability and age. This article provides a review on this topic and presents the scientific evidence for appropriate treatment of these lesions.
European Journal of Orthopaedic Surgery & Traumatology
Journal of the Foot & Ankle, 2021
Objective: To determine the microbiological profile and antimicrobial susceptibility patterns of ... more Objective: To determine the microbiological profile and antimicrobial susceptibility patterns of organisms isolated from chronic osteomyelitis secondary to neuropathic foot ulcers; secondarily, to describe the clinical outcomes of 52 patients admitted to a neuropathic foot referral center. Methods: Retrospectively chart review of 52 patients with clinically infected neuropathic foot ulcers admitted to our service for treatment between 2005 and 2013. Tissue samples were collected for culture at the operating room after extensive debridement in order to determine the infectious agents and their resistance profile using the disk-diffusion technique, following CLSI criteria. Results: A total of 52 patients were analyzed (40 males and 12 females). The mean age was 58 (37-72) years. Each patient presented with an average of 2.13 microorganisms, distributed as follows: 51% Gram-positive cocci, 43% Gram-negative bacilli. Among Staphylococcus aureus isolates, the prevalence of methicillin re...
Journal of the Foot & Ankle, 2020
Measurement of hindfoot malalignment and flexibility is essential for treatment decision-making i... more Measurement of hindfoot malalignment and flexibility is essential for treatment decision-making in cavovarus foot deformity. Weight-bearing computed tomography (WBCT) shows greater diagnostic accuracy and allows the study of osteoarticular alignment in the physiological upright position. The most commonly used method for measurements on WBCT scans is the foot and ankle offset (FAO), which is based on the structural tripod of the foot: the calcaneus and the first and fifth metatarsal heads. During the Coleman block test, the first metatarsal head is not resting on the ground and, therefore, does not represent the physiological support of the tripod. We describe a new measurement, the forefoot/hindfoot offset (FHO), for assessing hindfoot alignment on WBCT scans. Level of Evidence V; Diagnostic Studies; Expert Opinion.
Tarsal coalition is an abnormal connection between tarsal bones, caused by an embryogenic failure... more Tarsal coalition is an abnormal connection between tarsal bones, caused by an embryogenic failure. Its most common forms are calcaneonavicular and talocalcaneal coalition, which are present in 53% and 37% of the cases, respectively. The onset of symptoms is related to tarsal bone ossification, and mean age for this event is estimated at 16 years for calcaneonavicular coalition. Surgical treatment is indicated for patients who did not improve symptoms with conservative treatment. The aim of this study is to present a surgical technique as a treatment option for resection of calcaneonavicular coalition associated with abnormal cuboid-navicular joint. Level of Evidence V; Therapeutic Studies; Expert Opinion.
Journal of the Foot & Ankle, 2020
Syndesmotic instability is a fundamental question that guides treatment; despite the currently av... more Syndesmotic instability is a fundamental question that guides treatment; despite the currently available diagnostic imaging tests, its determination is still challenging. Knowledge of the instability degree assists the physician in the decision-making process regarding surgical or nonsurgical treatments. The authors are currently conducting a prospective diagnostic accuracy study by consecutively selecting individuals aged 18 years and older with an orthopaedic clinical examination indicating suspected acute syndesmotic injury. Magnetic resonance imaging is the reference standard used for evaluating the diagnostic accuracy of 3 computed tomography index tests. These tests include the neutral position and 2 ankle stress maneuvers: external rotation and dorsiflexion. Comparative measurements between the injured syndesmosis and the uninjured contralateral side of the same individual evaluate the tibiofibular relationship and investigate syndesmotic instability. This study aims to descr...
Archives of Orthopaedic and Trauma Surgery, 2021
Elevated first metatarsal, Metatarsus primus elevatus (MPE), has been a topic of controversy. Rec... more Elevated first metatarsal, Metatarsus primus elevatus (MPE), has been a topic of controversy. Recent studies have supported a significantly elevated first metatarsal in hallux rigidus on weight-bearing radiographs (WBR). However, conventional radiographs have limitations for accurate measurement. Our objective was to comparatively assess MPE and other variables which can affect the spatial relationship of the forefoot in the HR group compared to controls using weight-bearing CT (WBCT). In this single-center, retrospective, case–control study, 25 patients (30 feet) with symptomatic HR and 30 controls were selected. WBCT parameters were measured by two independent investigators. Inter-observer reliabilities were assessed using intra-class correlation coefficients (ICCs). MPE was evaluated by measuring the direct distance between 1st and 2nd metatarsals. Independent t tests were performed to compare the two groups. A threshold of MPE to diagnose HR was calculated using the Receiver Operating Characteristic (ROC) curve. HR groups had increased hallux valgus angle (HVA) (8.52° in control vs 11.98° in HR) and MPE (2.92 vs 5.09 mm), decreased 1st metatarsal declination angle (21.09° vs 19.07°) 1st/2nd metatarsal declination ratio (87.45 vs 79.71) indicating elevated first metatarsal compared to controls. Dorsal translation of the first metatarsal at the first tarsometatarsal joint was observed in 21 (70%) patients of the HR group when defined as a step-off or discontinuation of the curvature along the first TMT joint. The threshold of MPE for diagnosis of HR was 4.19 mm with 77% sensitivity and 77% specificity. Our results confirmed a significantly elevated first metatarsal in the HR group compared to controls on WBCT. A MPE greater than 4.19 mm was found to be diagnostic for symptomatic HR. Significant number of patients in the HR group (70%) had dorsal translation of the first metatarsal at the first TMT joint which can contribute to increased MPE. The present study demonstrated significantly increased MPE in HR on WBCT and MPE greater than 4.19 mm on WBCT can be used as a diagnostic threshold for HR.