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- An unusual case of an isolated capitellar freacture of the right elbow in a child: a case reportPublication . Alves, Cristina; Ferreira, Fabiola; Pestana, José António; França, Ana Patrícia Macedo; Freitas, António Pedro Tomás Cunha; Jales, Bruno Tertuliano; Ramos, Manuel Correia; Pereira, MárioIntroduction: Although elbow fractures have a high incidence in the pediatric population, fractures of the capitellum are almost exclusively observed in individuals older than 12 years of age. Due to their rarity in children, reports with large numbers of cases are lacking in the literature and the surgical treatment options are poorly defined. Case presentation: We present the case of an 11-year-old Portuguese girl with a displaced fracture of the capitellum of the right elbow, a typical Hahn-Steinthal or Type 1 fracture, which was followed for one year. The treatment and outcome of this fracture are described. Our patient underwent an open reduction and internal fixation with two cannulated screws. There were no complications and normal elbow function was recovered. Conclusion: The authors believe that cannulated screw fixation is a reliable method of treatment for Type 1 capitellar fracture in children because it enables good terfragmentary compression, early mobilization, faster functional elbow recovery and implant removal is rarely necessary
- PÉ DIABÉTICO: O PODER DIAGNÓSTICO DA RADIOGRAFIA CONVENCIONALPublication . Campos Pereira, Eva; Ferreira, Joana; Carrilho, Celso; Braga, Sandrina; simóes, João Correia; Longras, Catarina; Brito, Diana; Mesquita, Amílcarpé diabético é uma complicação da Diabetes Mellitus (DM) responsável por 1250 amputações (705 minor e 545 major) em 2015 em Portugal1,2. É uma consequência da vasculopatia, imunopatia e neuropatia3,4, sendo esta última o mecanismo mais importante da Neuroartropatia de Charcot (NC)5. Ainda com a fisiopatologia exata por definir, defendem-se atualmente duas correntes — a neurotraumática e a neurovascular — ou mesmo uma terceira que combina ambas as teorias. Apesar do diagnóstico permanecer primariamente clínico, particularmente nos estadios iniciais da doença, é importante distingui-la de patologias com a mesma sintomatologia4. A radiografia convencional deverá ser o método de imagem inicial na avaliação do pé diabético. Realizando incidências em ambos os pés, preferencialmente em três projeções, podem-se comparar alterações subtis e identificar 25% dos pacientes que acabam por desenvolver alterações similares no pé contralateral3,4,7. Numa fase inicial a radiografia convencional poderá ser normal, sendo o achado mais precoce a desmineralização focal8,9. Uma vez que 50% do osso precisa de ser perdido para que se detete radiologicamente, demorando este processo entre 1 a 2semanas, realça-se a importância da repetição periódica deste exame de imagem. Eichenholtz classificou a progressão radiográfica da NC em três estadios: fragmentação/dissolução (Estadio I), coalescência (Estadio II) e reconstrução (Estadio III)5,. Na fase crónica crónica estável, este método de imagem é igualmente importante no follow-up, podendo sumariar-se a evolução pela regra dos “6 D’s”: Dense subchondral bones; Degeneration; Destruction; Deformity; Debris, Dislocation. Os achados radiológicos da forma severa da NC são patognomónicos. Deste modo, pretende-se relacionar os dados imagiológicos da radiografia simples do pé com a clínica e a fisiopatologia da entidade “Pé Diabético”, tendo como mote a descrição de um caso clínico.
- Difficult diagnosis of a neurogenic thoracic outlet syndrome and review of the current literaturePublication . Rosa, Joao Maia; Sousa, Arnaldo; Fonte, Helder; Campos Pereira, Eva; Sapage, Rita; Trigueiros, MiguelThoracic outlet syndrome (TOS) is an uncommon disorder, without a clear clinical presentation or a fully accepted definition. The patients usually present a set of symptoms arising from compression of the brachial plexus or subclavian vessels during their passage through the thorax, between the base of the cervical region and the axilla. The authors present a case of a 20 year old woman with sporadic paresthesia in the territory of C7-T1 nerve root. At the physical examination she had a positive Wright's test. The imaging studies revealed the presence of a right cervical rib. A partial rib resection was performed with exploration of the braquial plexus and at the current follow up; 24 months after the surgery, the patient is asymptomatic. Our objective is to present a case of TOS and to highlight the clinical-management and treatment challenges of this pathology.
- Reparação Cirúrgica de aneurisma inflamatório da aorta abdominalPublication . Campos Pereira, Eva; Ferreira, Joana; Braga, Sandrina; Carrilho, Celso
- Free Non-vascularized Toe Phalangeal Transfers in Symbrachydactyly: Outcome AnalysisPublication . Sapage, Rita; Rosa, João; Campos Pereira, Eva; Silva, Marta Santos; Pereira, Alexandre; Silva, CésarFree nonvascularized toe phalangeal transfer is an established surgical option for the reconstruction of hypoplastic digits. The purpose of the present study was to evaluate our experience with this procedure and to assess bone growth and digit function as well foot morbidity. Material and Methods We retrospectively evaluated the clinical records for all children with symbrachydactyly submitted to free nonvascularized toe phalangeal transfer between 2002 and 2017. A total of 8 patients were included. We summoned the patients to na appointment to clinically assess the range ofmotion, the stability, and the alignment of the neo-joint. We radiographically measured the final length and the expected percentage of growth of the transferred phalanx. We also evaluated the foot for comorbidities. Results The mean age at the time of the first surgery was 19 months (range: 8–42 months). A total of 20 phalanges were harvested: 16 total proximal phalanges, 2 middle phalanges, 1 subtotal proximal phalanx, and 1 accessory thumb phalanx. The distal part of one proximal phalanx was trimmed because the skin pocket was too tight. Two patients underwent a secondary procedure to release the syndactyly. One transfer required revision surgery due to distal tip necrosis and exposition of the transferred phalanx. In the present series, the overall clinical and radiographic outcomes were compatible to those reported in other studies. Discussion The main limitation of the nonvascularized toe phalanx transfer is the preexisting soft tissue envelope of the finger and the limited growth potential of the transferred bone. Conclusion Irrespective of the amount of growth achieved in the transferred phalanx, the actual transfer and growth attained should not be viewed as the end result, but rather as a means of providing a stable and functional joint.
- Pyrocarbon Humeral Head in a Shoulder Hemiarthroplasty: Preliminary Results at 3 Years Follow-Up and Review of the Current LiteraturePublication . Campos Pereira, Eva; Henrique-Barros, Luís; Claro, RuiShoulder hemiarthroplasty is a viable option in young patients with an intact rotator cuff in order to preserve the native glenoid. To avoid the dreaded and expected wear of the glenoid in very active shoulders, implants with humeral head coated with a high resistant and elastic material—pyrolytic carbon—are now an option. The authors present the first pyrocarbon coated arthroplasty performed at our Orthopedic Department in a patient with osteonecrosis of the humeral head. At three years of follow-up, the patient is pain free and without limitations in his daily work. The Constant score was applied preand postoperatively, and an improvement of 32 points was reported. Larger cohorts with long-term follow-up are required to confirm our promising results.
- The rare isolated adult Chaput-Tillaux fracture: two case reports and review of the literaturePublication . Campos Pereira, Eva; Rosa, João Maia; Diniz, Sara Elisa; Pereira, Filipa; Sapage, Rita; Soares, Daniel; Costa, LuisThe authors present two isolated chaput-tillaux fractures in an adult skeleton. A high level of suspicion is required to prevent diagnostic failure. Computerized tomography scan detects hidden fractures and enables a more detailed preoperative assessment of each case. Most of the cases reported in the literature are associated with other ankle lesions. This typical juvenile pattern is rare in the adults and ideal treatment is yet to be determined.
- Cross-leg flap after postraumatic osteomyelitis defect: A last resource for limb salvage Case Report. Open Acess, volume 2Publication . Campos Pereira, Eva; Diniz, Sara; Rodrigues, Filipe; Pereira, Alexandre; Sousa, RicardoWe report the case of a patient with a tibial shaft fracture occurring through a chronic posttraumatic osteomyelitis site with significant soft tissue defect. The bone and soft tissue reconstruction procedures are described with a cross-leg fasciocutaneous flap performed as a last resource after previous rotated muscle flap partial failure. Pre-operative CT angiography, to rule outaxial vessel damage and peripherical vessel diseases, and adequate stabilization of both legs are key for a successful limb salvage.
- Hind-Foot Synovial Sarcoma Treated With Wide Resection and Sural Fasciocutaneous Flap – A Case ReportPublication . Vale, João; Diniz, Sara; Campos Pereira, Eva; Cardoso, Pedro; Oliveira, VâniaSynovial sarcoma comprises about 5% to 10% of soft tissue sarcomas. Initial growth is often slow and a small circumscribed tumour may misleadingly appear to a benign lesion by clinical examination and imaging, occurring in up to 50% of cases. The modalities of treatment of foot malignant conditions depend on histological diagnosis and staging. A radical surgical procedure in the distal region of the lower limb is often difficult due to a limited soft-tissue situation and can result in soft-tissue defects. Plastic surgical techniques remain particularly indispensable in the treatment of such distal tumors.