bluuebunny/crossref_metadata_2025 huggingface dataset:
ANÁLISE ECONÔMICA DA APLICAÇÃO DO FINALISMO MITIGADO PARA AFERIÇÃO DO CONCEITO DE EMPRESÁRIO
Authors: Goncalves Vitor Gabriel De Moura , Ribeiro Marcia Carla Pereira
Published: November 2019

O artigo trata da aplicação da teoria da finalista mitigada aos empresários para considera-los como consumidores em contratos empresariais. Procura-se demonstrar que as noções de consumidor e empresário são inconfundíveis e se subordinam a regimes jurídicos específicos, de modo que a noção de vulnerabilidade seria restrita ao âmbito consumeirista e incapaz de considerar os custos de transação e a barganha envolvida nos contratos empresariais. O método utilizado foi o dedutivo e a pesquisa bibliográfica se apoia na doutrina empresarial, consumeirista e econômica.
AS ALTERAÇÕES NA LINDB E O CONTROLE DA ADMINISTRAÇÃO PÚBLICA
Authors: Bellazzi de Oliveira Carvalho Morgana
Published: November 2019

Este artigo trata das alterações da Lei de Introdução às Normas do Direito Brasileiro (LINDB), decorrentes da Lei 13.655/2018, e da necessidade de adaptação das decisões da Administração Pública às novas disposições sobre segurança jurídica e eficiência. Para tanto, o trabalho analisa inicialmente o conteúdo e a função da LINDB; a opção político legislativa de inserir na LINDB diretrizes sobre a criação e a aplicação das normas de Direito Público; o cenário que norteou as alterações; os artigos inseridos na LINDB e seus efeitos na melhoria da qualidade do controle público, especialmente quanto à racionalidade e previsibilidade.
PRESCRIÇÃO EM MATÉRIA DISCIPLINAR
Authors: Viana Barbosa Ronaldo David , Viana Barbosa Reinaldo Denis
Published: November 2019

O presente artigo trata da prescrição no âmbito do Processo Administrativo Disciplinar. Para tanto, apresenta-se o tratamento dado à matéria pela Lei 8.112/90, destacando-se a problemática em torno do marco inicial para a contagem do prazo prescricional e da referência à utilização dos prazos prescricionais definidos pela lei penal. O problema da pesquisa consiste em identificar se a interpretação da CGU no sentido de que a contagem do prazo prescricional deve iniciar da ciência da autoridade competente para instauração do PAD conforma-se ao Estado de Direito. Utilizando-se método hermenêutico, verifica-se a hipótese inicialmente levantada que dá resposta negativa ao problema.
TRANSAÇÃO ADMINISTRATIVA: ENFRENTANDO O ARGUMENTO DA SUPREMACIA DO INTERESSE PÚBLICO
Authors: Arcanjo Carneiro Joao Lucas , Praxedes Rafael Da Nobrega Alves
Published: November 2019

O caráter de supremacia prima facie do interesse público frequentemente dificulta a solução satisfatória de conflitos administrativos. Este artigo pretende sugerir que, sem desconsiderar o interesse público, seja superada, em alguma medida, a resistência da Administração Pública ao encontro de saídas mais práticas e efetivas às demandas envolvendo particulares, o que ocorreria por meio do instrumento da transação administrativa. Propõe-se, portanto, com base em metodologia de exploração bibliográfica e com propósito descritivo e exploratório, que, para haver efetividade na solução de demandas administrativas – sem que menospreze a coisa pública –, deve-se institucionalizar, no ordenamento jurídico, a transação administrativa.
Administração Pública, princípio da eficiência e administração gerencial
Authors: Cordeiro rocha Manoel Ilson
Published: November 2019

O princípio da eficiência administrativa foi adotado pela ciência do direito, tem a sua dimensão jurídica, mas tem extensão e conexão com um amplo debate fora do Direito. Além das ciências jurídicas, ele é de interesse da administração, da sociologia, da economia, da política etc. Pretende-se conceituar e contextualizar a eficiência administrativa na perspectiva geral de eficiência; pretende-se demonstrar a ideia de eficiência como conceito da ciência econômica e da administração e como conceito emergente na administração pública moderna, suas causas e efeitos. São reflexões necessárias para compreender o princípio jurídico.
CONFLITOS NO CAMPO, JUDICIALIZAÇÃO E POLÍTICAS PÚBLICAS DE MEDIAÇÃO NO ESTADO DO MARANHÃO
Authors: Costa Amanda Cristina de Aquino , Chai Cássius Guimarães
Published: November 2019

Sustentado nos princípios norteadores do Direito Agrário, especialmente os princípios da garantia do direito de propriedade e da função social da propriedade, bem como na necessidade da aplicação de métodos de resolução pacífica de conflitos, o presente artigo busca verificar o funcionamento da Comissão Estadual de Prevenção e Combate à Violência no Campo e na Cidade (COECV), com atuação no Estado do Maranhão. Para esse propósito, além do levantamento bibliográfico acerca do tema, realiza-se pesquisa documental com análise da Lei nº 10.246/2015, responsável por criar a Comissão, relatórios e reportagens acerca da sua atuação na mediação de litígios coletivos rurais pela posse da terra.
Accidents features in construction
Authors: Pichugin Sergiy , Klochko Lina
Published: November 2019

This work aims to highlight the problem of accidents in the construction industry. On the basis of collected and processed informationthe accidents classification in the building is presented, depending on the building erection stage. The article givesa detailed description and analysis of such cases in the construction. The collection of information on accidents was carriedout using various information sources: Internet resources, literary sources, scientific works and information from world-widejournalistic services. The findings are presented over the last ten years and cover worldwide construction incidents.The material is systematized and presented in the table form. The study results are the created accidents classification withthe probability of their occurrence, which can be used later in the design of buildings and structures, in order to predict thevarious types of accidents in the construction.
Improvement of settlement calculations of building foundations by increasing the reliability of determining soil compressibility indices
Authors: Vynnykov Yuriy , Hajiyev Muhlis , Aniskin Aleksej , Miroshnychenko Irina
Published: November 2019

Ways to improve the methods of calculating the foundations bases’ settlements by increasing the reliability of determiningthe soil compressibility indices are substantiated. The complex approach to refinement of the buildings bases' settlements calculationby the layer summation method is investigated by accounting for the soil deformation modulus variability in the fullpressure range perceived by the base at loading; soil strength coefficient βZ; soil deformation anisotropy by elastic orthotropicmodel; tendencies to magnitude variation in the soil deformation modulus in depth of the body under the foundations andwithin the artificial bases built with the soil compaction. There was also proved the possibility of increasing the accuracy ofthe predicting method for the buildings' foundations base settling using the soil compression index and accounting for thepressure effect on the soil deformation parameters in depth of the compressible strata.
Modeling using the LIRA 9.6 software package of contact interaction of the retaining wall with the base
Authors: Timchenko Radomir , Krishko Dmytro , Savenko Volodymyr
Published: November 2019

The article analyzes the research of scientists who studied the work of retaining walls under different soil conditions, andtheir contact interaction with the base. Examples of recent designs of retaining walls and their use are given. It is stated thatthe goal is to study the stress-strain state of a retaining wall with a structural surface, considering its contact interaction withthe ground mass. The main stages and features of mathematical modeling of the retaining walls and soil foundation interactionin the conditions of a flat problem with the help of LIRA 9.6 software have been described. As a result, the nature of theretaining wall work has been analyzed under various conditions of interaction with the base and with different parameters ofthe retaining wall rigidity. The relationship between the retaining wall rigidity and the resulting equivalent stresses in the soilfoundation under various conditions of interaction has been established. It has been concluded that on the contact surface ofthe retaining wall with a structural surface, the effect of stresses redistribution is achieved and the carrying capacity of thefoundation soil is increased due to the formation of elastic cores and unloading arches.
Scientific basis of design structures plaster solutions
Authors: Paruta Valentyn , Gnyp Olha , Lavreniuk Leonid , Bachinsky Vyacheslav Bachinsky Vyacheslav , Grynyova Iryna
Published: November 2019

High-rise construction volume increase and new wall materials use require changing the approach to the design of plastermortar compositions. The analysis has showed that it is possible to reduce the number of cracks in the plaster coating by increasingthe water holding capacity of the mortar mixture. To optimize the prescription parameters of the mortar mixture, thefive-factor experiment with fine aggregate and the filler with a low modulus of elasticity, disperse polymeric powders andcellulose ethers, a polymer fiber for microdispersed reinforcement has been used. The obtained data indicate that the proposedapproach enables to obtain plaster mortars with physic mechanical characteristics that provide optimal working conditions“masonry - plaster coatings”.
The scientific and technical activity module development for the department of structures from metal, wood and plastics
Authors: Dmytrenko Tatyana , Dmytrenko Andriy , Derkach Tatyana , Klochko Lina
Published: November 2019

The problems of society informational support, which demand the creation of modern information management systems fordifferent objects were considered. Particular attention was paid to the detailed description and analysis of existing services forkeeping records of scientific activity in higher educational institutions. The necessity of module creating for management thescientific and technical activities, which will allow to optimize the procedure for conducting reports on scientific, technicaland innovative activities, to expand the possibilities for the results analysis, to ensure transparency and objectivity in the procedureof evaluating the teachers’ activities, was revealed and explained. The developed sections of the technical enquirywere given. On the basis of the conducted research the software implemented module for management the scientific andtechnical activity of the department.
Influence of molybdenum on corrosion and mechanical properties of carbon steel joint welds
Authors: Makarenko Valerii , Vynnykov Yuriy , Manhura Andrii
Published: November 2019

The results of experimental studies of the molybdenum impurity influence on corrosion and mechanical properties of carbonsteel (Grade 20) joint welds are presented in the article. In particular, it has been found that the highest and stable values ofthe impact strength and resistance properties of cracks (К1s and δs), as well as the resistance to sulfide corrosion cracking ofthe metal of tubular steel joints, are achieved at a concentration of molybdenum in it from 0,2 to 0,4%, which is realized byputting a molybdenum powder in the electrode coating in the amount of 0,5-1,0%. On the basis of the obtained results an optimalchemical composition of the weld metal was determined which is characterized by a fine-grained structure with a smallamount of non-metallic impurities of globular shape. Optimal content of the doping micro-additive - molybdenum should beselected, based on both the influence of molybdenum on the size of structural components, but, most importantly, on its effecton the corrosion and mechanical properties of metal joint weld.
Sealing materials effectiveness evaluation in the repair of bituminous-concrete surface with transversal cracks
Authors: Gustieliev Оleksandr
Published: November 2019

The method of sealing materials effectiveness evaluation in the repair of bituminous-concrete surface with transversal cracksis offered. Calculation schemes and mathematical models based on the application of the thermo-viscous-elasticity theory forthe prediction of temperature stresses in the sealing material at the contact with the bituminous-concrete surface, taking intoaccount the thermal-technical and thermorheological properties of the materials and the geometric parameters of the bituminous-concreteslabs and the transversal crack. The obtained analytical dependences allow to estimate the service life beforethe loss of sealant compound integrity or adhesive strength of their adhesion with bituminous-concrete surface taking intoaccount annual and daily temperature fluctuations according to the main provisions of the kinetic theory of solid bodiesstrength.
How can Complex Organizations Engage in a Successful Restructuring while Simultaneously Improving the Delivery of Products and Capabilities?
Authors: A Breckon Denise , LePage Patty , Oliver Jones Allyson , Onyeaku John , Bernadine Douglas Remedious
Published: November 2019

A large complex government organization is planning a restructure of their organization from a hybrid matrix or competency-aligned team structure to a more dominant mission-aligned structure. This restructure has the potential to spur organizational problems from employee churn, including a decrease in employee engagement as well as detract from product delivery. The purpose of this study is to systematically gather and review evidence on employee engagement and retention during organizational restructuring initiatives. Another purpose is to define how leadership style can impact the organization’s ability to successfully restructure while also improving the efficiency and effectiveness of the ongoing products. An analysis was carried out using four rapid evidence assessments and then a combined systematic review to analyze existing scholarly literature on the research question. The organizational problem was viewed through the lens of the contingency theory, which focuses on the structure best suited to the organization, contingent on its internal and external environments. With a complex reorganization, an organization can align with their internal mission, as well as their customers in the external environment. A thematic analysis of the literature revealed several themes; job resources, leadership styles, team innovation, training, external and internal environmental factors, employee engagement, open communication, and organizational diagnosis. This study supports the notion that a successful reorganization can be implemented through the support of an effective leadership style, training, and the implementation of job resources.
DEBATE SOBRE MASCULINIDADES EM GRUPO REFLEXIVO COM HOMENS: RELATO DE EXPERIÊNCIA
Authors: Santos Jemima Raquel Lopes , Cruz Moniky Araújo da , Estrela Fernanda Matheus , Silva Andrey Ferreira da , Gomes Profa. Dra. Nadirlene Pereira , Pereira Álvaro
Published: November 2019

INTRODUÇÃO: A masculinidade hegemônica legitima a dominação do homem sobre mulher mediante a afirmação dos preceitos patriarcais (SAFFIOTI, 2004). Tal realidade, encontra-se enraizada socialmente, de
PO 18124 - Large orthopedic surgery and its correlation with Cockett syndrome
Authors: Marum Bachir Raffael , Asaumi Inácio Diogo , Lo Turco Donato , Rodrigues Fernandes Clariana Casali , Luiz Kiyan Fábio
Published: November 2019

Introduction: Cockett syndrome (CS) is characterized by compression of the left common iliac vein by the right common iliac artery against the spinal wall, causing obstruction of left lower limb (LLL) blood flow. The clinical condition is mainly manifested by pain and edema of the LLL and, in more severe cases, even by left iliofemoral venous thrombosis. It is already well established in the literature that in cases such as Cockett syndrome, orthopedic surgeries also corroborate the occurrence of deep vein thrombosis (DVT), mainly by the positioning and manipulation of the limb during the intervention; by the continuous reaction secondary to the use of cement; by significant blood loss; by postoperative (PO) edema; and by the mobility limitations PO. Case report: A 42-year-old patient complained of left foot pain and repetitive sprains for 2 years. After a complete physical examination indicating a cavovarus foot and a pointed hindfoot, an AP and profile radiograph of the limb was requested, which revealed data compatible with a foot cavity. The nuclear magnetic resonance demonstrated the necessity for cavo foot correction surgery and reconstruction of the structure of the ankle. The patient was classified as ASA 1 and had no indication for prophylaxis for DVT according to the Hospital Protocol. The surgical procedure occurred without intercurrences, and the patient was discharged in good general condition in the 2nd PO with guidelines and prescriptions. The patient returned to the foot clinic on the 7th PO complaining of abrupt pain in the LLL, accompanied by edema, hyperemia and cyanosis of the limb. A Doppler ultrasonography was performed, which detected extensive thrombosis of the iliac vein and compression of the same by the contralateral iliac artery, raising the hypothesis of CS. In the present paper, the exam images, surgery, PO and evolution for the DVT will be presented and discussed, as well as the resolution of this condition through endovascular surgery with angioplasty and stent implantation. Conclusion: CS and orthopedic surgeries are, in isolation, important risk factors for the development of DVT and, above all, when overlapped, they increase this risk exponentially. Endovascular surgery with angioplasty and stent implantation is the main form of treatment, presenting excellent clinical results.
TL - 18033 - Proximal metatarsal osteotomy with fixation for the treatment of metatarsalgia
Authors: Tirico Sergio Rodrigues
Published: November 2019

Objective: To evaluate the outcomes of proximal metatarsal osteotomies for metatarsal head shortening and/or lifting, assessing pain and function, using the American Orthopedic Foot and Ankle Society (AOFAS) scale.  Methods: From November 2002 to November 2014, 29 feet (13 right feet and 16 left feet) of 22 patients (25 women and 4 men) aged 21 to 85 years, with a mean age of 52.8 years, underwent surgery, with a mean follow-up time of 73 months (7 to 150 months). The patients were treated with proximal end metatarsal osteotomies fixed with metallic wires, staples or compression plates with and without grading. Treated comorbidities included hallux valgus deformity, splayfoot, hallux rigidus, pes cavus, hammertoe, crossover toe and plantar plate repair. The patients were evaluated using the AOFAS lesser toes.  Results: The AOFAS score improved from 34.5 points (±12.5) preoperatively to 88.9 points (±7.9) postoperatively (p<0.0001). One patient developed a late infection in the foot that was controlled with antibiotics; although the correction of the second toe was partially lost, an acceptable transversal arch was maintained. In all cases except for the infection, no metatarsalgia recurrence or change in the deformity of the corresponding toes occurred.  Discussion: Surgical treatment aimed to improve the mechanical distribution of weight and to stabilize the transversal arch, thereby reducing metatarsalgia. The forefoot was stabilized by sufficient shortening and/or lifting to treat metatarsalgia, especially in the 2nd and 3rd rays. We also aimed to achieve complete flexibility of the metatarsophalangeal joints with good alignment. The favorable outcome of this method is comparable to that of the study by Aiello, who achieved good outcomes in 84.9% of 45 feet, whereas our study showed good outcomes in 96% of 29 feet.  Conclusion: Proximal metatarsal osteotomies with fixation with metal implants for metatarsalgia treatment showed satisfactory outcomes in 96% of operated cases. We believe that this procedure is effective and safe and has a high rate of patient satisfaction.
TL 18040 - Venous thromboembolism risk in foot and ankle surgical patients
Authors: Pinto Roberto Zambelli de Almeida , Nemeth Banne , Touw Carolina , Rezende Suely , Cannegieter Suzanne
Published: November 2019

Introduction: Venous thromboembolism (VTE) is the leading cause of preventable hospital death. There are several risk factors for VTE, of which orthopedic surgery is an important one. VTE risk is highest following major orthopedic surgery, and therefore, some form of prophylactic therapy is usually recommended. In contrast, the risk for VTE following foot and ankle surgery is less clear, as are guidelines on VTE prophylaxis in these patients.  Objective: To estimate the risk of VTE and the duration of the increased risk period after foot and ankle surgery.  Methods: Data from a large population-based case–control study (the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis [MEGA] study) on the etiology of venous thrombosis were used (4721 cases; 5638 controls). Odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex and body mass index (ORadj), were calculated for patients undergoing any foot or ankle intervention before the index date (VTE date or control date).  Results: The 263 cases and 94 controls underwent any orthopedic intervention in the year before the index date for an ORadj of 3,74 (95% CI 2,91-4,80) The ORadj in the first 90 days was 11,35 (95% CI 7,28-17,70). Fifty-five cases and 20 controls had a foot or ankle intervention in the year before the index date, resulting in a three-fold increased risk for VTE (OR 3,29, 95% CI 1,98-5,49). VTE risk was highest in the first 30 (ORadj 10,15 (95% CI 3,04-33,85)) and 90 days following surgery (ORadj 12,42, 95% CI 4,43-34,84). In 34 patients, the surgery was trauma-related, while 43 patients underwent elective surgery. Traumatic surgery was associated with a higher risk than elective surgery with an OR of 13,85 (95% CI 1,77-108,36) and 8,32 (95% CI 1,87-36,94), respectively, at 30 days. Conclusion: Foot and ankle procedures were associated with an increased VTE risk, which was highest in the first 90 days following surgery. Trauma-related surgery was associated with a higher VTE risk than elective surgery. These results are important for decisions regarding thromboprophylactic measures following foot and ankle surgery.
TL 18049 - Influence of tibial component position on altered kinematics following total ankle arthroplasty during simulated gait
Authors: Saito Guilherme Honda , Sturnick Daniel , Deland Jonathan , Ellis Scott
Published: November 2019

Introduction: Correct positioning of total ankle arthroplasty (TAA) implants has been associated with superior clinical outcomes. However, the correlation between implant position and ankle motion is unclear. The objective of this study was to assess the effect of tibial component position on ankle kinematics during simulated gait. Methods: The stance phase of gait was simulated pre and post-TAA with 8 mid-tibia cadaveric specimens using a six-degrees-of-freedom robotic platform. Ankle kinematics were measured based on reflective markers. A fixed-bearing total ankle system (Salto Talaris, Integra LifeSciences) was used. Using reconstructed CT data, the 3D tibial component position relative to a standard ankle joint reference was characterized (Fig 1A). The effect of the tibial component position on absolute differences in ankle kinematics (pre/post TAA) was assessed using linear regression with a level of significance set to p = 0.05. Results: Differences in ankle joint kinematics were only identified in the transverse plane, where internal talar rotation was significantly increased following TAA compared with the native condition (Fig 1B). The medial position of TAA tibial components was positively associated with increased internal talar rotation (Fig 1C; β = 1.861 degrees/mm, R2 = 0.72, p = 0.008). Conclusion: This study suggests that a medial-lateral position of the tibial implant affects ankle kinematics. During operative procedures, the tibial component is usually positioned to preserve the bone stock of the medial and lateral malleolus. However, little attention is given to the position of the implant in relation to the center of the tibial axis. This finding could have clinical implications for techniques.
TL 18051 - Accuracy of patient-specific instrumentation in total ankle arthroplasty
Authors: Saito Guilherme Honda , Sanders Austin , O'Malley Martin , Deland Jonathan , Ellis Scott , Demetracopoulos Constantine
Published: November 2019

Introduction: Correct positioning of implants in total ankle arthroplasty (TAA) is a key step to ensure the longevity of the prosthesis. Patient-specific instrumentation (PSI) via preoperative computed tomography for TAA was developed and made available through PROPHECY (Wright Medical, Memphis, TN). The purpose of this study was to compare the use of PSI with the standard referencing guide (SRG) in regard to the accuracy of tibial implant positioning, operative time, and fluoroscopy time. Methods: A retrospective analysis of 99 patients who underwent a primary TAA with the INFINITY prosthesis (Wright Medical, Memphis, TN) was performed. Patients were divided in two groups based on the type of instrumentation used during the TAA (75 in the PSI - PROPHECY group vs 24 in the SRG group). Results: Tibial implant positioning was similar between groups. In the coronal plane, the absolute deviation of the tibial implant was 1.7 ± 1.4 degrees for the SRG and 1.6 ± 1.2 degrees for PSI (P = 0.710). In the sagittal plane, the absolute alignment deviation of the tibial implant was 1.8 ± 1.4 degrees for the SRG and 1.9 ± 1.5 degrees for PSI (P = 0.675). Operative time (P = 0.040) and fluoroscopy time (P < 0.001) were significantly decreased in the PSI group. The PSI preoperative plan report correctly predicted the implant size in 73% of cases for the tibial component and in only 51% of cases for the talar component. Conclusions: PSI provided similar tibial component alignment to standard instrumentation while decreasing the operative and fluoroscopy time. However, PSI preoperative plan reports were poor predictors of implant sizing. Therefore, the final decision should always be based on the surgeon’s experience to prevent errors in implant sizing and positioning.
TL 18052 - Sagittal tibiotalar alignment in fixed-bearing total ankle replacement
Authors: Saito Guilherme Honda , Nielsen Natalie , Sanders Austin , Ellis Scott , Sofka Carolyn , Demetracopoulos Constantine
Published: November 2019

Introduction: Implant positioning is critical in total ankle replacement (TAR). However, the effect of sagittal tibiotalar alignment on functional outcomes in fixed-bearing TAR remains unclear. Furthermore, no studies comparing different fixed-bearing implants with respect to the anteroposterior position of the talar component have been performed to date. Methods: A retrospective analysis of 71 primary TARs in a single center was performed. Prostheses included were the INBONE II® (Wright Medical, Memphis, TN) and the Salto Talaris (Integra LifeSciences, Plainsboro, NJ). Radiographic measurements of the tibial-axis-to-talus ratio (T-T ratio) and the anteroposterior offset ratio (AP offset ratio) were performed preoperatively and postoperatively, respectively. Foot and Ankle Outcome Scores (FAOS) and SF-12 MCS and PCS scales were evaluated preoperatively and 2 years postoperatively. Results: Postoperative sagittal tibiotalar alignment was neutral in 39 ankles and anterior in 32 ankles. No significant differences were observed between groups with respect to clinical outcome scores. Patients with a Salto Talaris prosthesis had a greater AP offset ratio (0.12 ± 0.05) than patients with an INBONE II® implant (0.05 ± 0.04) (P < .01); however, this increased translation did not correlate with the outcome scores. Conclusion: At the 2-year follow-up, the INBONE II® TAA showed a more neutral sagittal alignment compared with the Salto Talaris prosthesis. However, no correlation between the postoperative AP offset ratio and functional outcome scores was observed with the use of the two fixed-bearing TAR. Further studies with longer follow-ups are needed to determine if the difference in sagittal alignment may have an effect on functional outcomes in the long-term.
TL 18075 - Subtalar arthroscopic debridement for treatment of sinus tarsi syndrome
Authors: Soares Baumfeld Tiago , Barbachan Mansur Nacime Salomão , Lemos André , Xavier da Silveira Juliana Doering , Furtado Fonseca Lucas , De Souza Nery Caio Augusto
Published: November 2019

Introduction: Sinus tarsi syndrome (SST) can be understood as a set of conditions that affect this anatomical region and manifest as common signs and symptoms. When the nonsurgical approach fails, subtalar arthroscopic debridement is a viable alternative with high rates of good outcomes. The objective of this study is to report the outcomes of subtalar arthroscopic debridement in 8 patients with SST refractory to conservative treatment. Methods: This is a retrospective study with 8 patients diagnosed with SST who underwent subtalar arthroscopic debridement of the sinus tarsi from January 2015 to January 2017, after 6 months of conservative treatment. All patients filled out an epidemiological questionnaire and underwent functional evaluation using the pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scale preoperatively and at the final evaluation, after an average of 12 months (6-24 months). Results: All patients presented with intense synovitis in the region. Seven patients had remnants of talocalcaneal ligaments, and 6 had remnants of cervical ligaments. The AOFAS score increased by a mean of 30 points (from 51.75 preoperatively to 82.62 at the final evaluation), and the VAS decreased by a mean of 5 points (from 7.37 preoperatively to 2.12 at the final evaluation); these differences were significant, at p=0.043 and p=0.032, respectively. Six patients described the outcome as excellent, and 2 described it as good. No complications were reported. All patients resumed sports activities after 6 months of follow-up.  Conclusion: Subtalar arthroscopic debridement is an effective and safe alternative in the treatment of SST refractory to conservative treatment. Further prospective studies are necessary to prove the outcome of this technique.
TL 18070 - Interobserver agreement of assessment methods for static footprint analysis in runners
Authors: Macedo Rafael Da Rocha , Mattos Gustavo Henrique Ramalho , Kanashiro Thiago Kazunori Neves , Alcaide Alexandre , Souza Eduardo Almeida Dias
Published: November 2019

Introduction: Running as a physical activity has gained considerable prominence in recent years. The diagnosis of footprint type has also been increasing in popularity, and several methods can be used for this purpose. However, we still lack effective mechanisms for accurate assessment. This study assesses the interobserver accuracy of diagnostic methods of footprint type in runners using 3 assessment methods: physical examination, podoscopy and baropodometry, in comparison with radiographic measurement of Meary’s and calcaneal pitch angles. Methods: A cross-sectional study of runners. In total, 40 patients were selected, namely, 29 men and 11 women, whose mean age was 39 years. Physical examination, podoscopy and baropodometry were performed and assessed by 4 raters; the results were compared with the radiographic classification of the footprint type identified by measuring Meary’s angle and the calcaneal pitch angle.  Results: The interrater agreement regarding these parameters was assessed using the weighted Cohen's kappa coefficient, which showed significant agreement regarding the physical examination, podoscopy and baropodometry. The kappa coefficient indicated that agreement was marginal when the results of the 3 methods were compared with the classification of radiographic angles. Conclusion: We obtained excellent agreement among observers when the physical examination, podoscopy and baropodometry were used for the diagnosis of the footprint type of runners. However, when the results of the physical examination, podoscopy and baropodometry were compared with radiographic measurements, agreement regarding the diagnosis of footprint type was low.
PO 18128 - Exposure area of the posterolateral approach to the distal region of the tibia
Authors: Farias Molina Wellington , Galizia Lourenço , Bottino Martins Guilherme , Martins Pimenta Luiz Sérgio
Published: November 2019

Introduction: The posterolateral approach was first described by Gatellier and Chastang in 1924 for assessing fragments of the posterior malleolar bone in ankle fractures. The correct posterior exposure of the distal tibia also makes it possible to treat osteochondritis dissecans of the talus, to excise benign tumors and to perform arthrodesis of the posterior facet of the subtalar joint. The objective of our study was to assess the exposure area of the posterior region of the distal tibia in the posterolateral approach and to determine its safety. Methods: The study was conducted on the fresh cadaver of a 54-year-old man without scars at the site. With the body positioned in dorsal decubitus, we marked the reference points. A 12-cm longitudinal incision was made halfway between the lateral malleolus and the Achilles tendon, extending distally along the posterior border of the fibula toward the fifth metatarsal. The sural nerve follows its course at a constant distance, on average 2.5 cm, posterior to the fibula. After the incision of the peroneal retinaculum sheath was made, the tendons were exposed and moved to the anterior. In the medial region, we moved the Achilles tendon and exposed the flexor hallucis longus tendon, moving it medially and exposing the posterior region of the tibia and syndesmosis. Using a digital caliper (Mitutoyu Kawasaki, Japan), we measured the exposed area. We respected a 40-mm safety area where the fibular artery arises from the bifurcation of the tibial-fibular trunk. We chose not to perform fibular osteotomy or a longitudinal section of the flexor hallucis longus tendon. Results: A 30.44-mm segment was exposed in the transverse plane of the distal tibial region that begins at the posterior distal tibiofibular syndesmosis. Conclusion: The posterolateral approach provides excellent exposure of the distal region of the tibia with great safety. The tibial nerve and the posterior tibial artery are safe after the flexor hallucis longus tendon is moved, and the sural nerve is contained in the region proximal to the approach. The exposed area stretches to the region near the medial malleolus, and the flexor retinaculum prevents a more medial approach. We conclude that the posterolateral approach is safe even for more medial lesions restricted to the flexor retinaculum.
PO 18133 - Internal fixation of displaced intra-articular fractures of the hallux through a dorsomedial approach
Authors: Ryuko Cândido Nishikawa Danilo , Aires Duarte Fernando , Monteiro Augusto César , Rodrigues de Miranda Bruno , Honda Saito Guilherme , Pires Prado Marcelo
Published: November 2019

Introduction: Intra-articular fractures of the hallux are usually treated nonoperatively, except when the fragments are displaced and the joint is incongruent. Displaced fractures treated nonoperatively can result in degenerative arthritis of the interphalangeal joint, causing pain and range of motion limitation. The aim of this study is to present the results of the surgical treatment of displaced interphalangeal joint (IPJ) fractures of the hallux using a dorsomedial approach. It is our understanding that this approach minimizes injury to the soft tissue envelope without the need to detach or create a tenotomy of the extensor hallucis longus tendon (EHL), allowing rigid fixation and early weight bearing and range of motion. Methods: A retrospective case series was performed of 5 patients with displaced IPJ fractures of the hallux treated with the dorsomedial approach from July 2013 to October 2017. Two patients were male and three female, with a mean age of 37,4 years and a mean follow-up of 36 months. The surgical indication for open reduction and internal fixation through a dorsomedial approach of the IPJ was displaced (>2 mm) bicondylar fractures of the proximal phalanx of the hallux. The incision was performed along the medial border of the EHL tendon without the need to detach or create a tenotomy of this tendon. In the postoperative period, follow-up included clinical evaluation and radiographic exams. All patients were assessed by visual analog scale (VAS) scores for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: All patients presented bone consolidation and returned to their previous activities without limitations. At the final follow-up, the mean VAS score was 0, and the mean AOFAS score was 92,6. Clinical evaluation revealed preservation of approximately 50% of the range of motion of the IPJ compared with the contralateral side. Conclusion: We concluded that a dorsomedial approach should be considered in the surgical management of displaced intra-articular fractures of the hallux. It preserves soft tissue and most of the IPJ motion, preventing postoperative joint pain and stiffness.
PO 18137 - Development of ankle arthrodesis based on 2D tomography with 3D reconstruction
Authors: Schroll Astolfi Rodrigo
Published: November 2019

Objective: To implement a method for analyzing the contour and alignment of the ankle bones in a normal population for a more accurate assessment of tibiotarsal arthrodesis. Methods: Tomographic scans of 20 ankles were subjected to 3D reconstruction. During the examinations, 7 anatomical points of interest for the 3-screw fixation technique were identified and marked with 3D position indicators. The mean locations of each point were calculated. The combination of these means made it possible to reconstruct a standard ankle for that population. In these standard ankles, the lengths and angles for the passage of the screws were studied. Results: Two ankles, one right and one left, were reconstructed. The best entry point in relation to the malleolus, the best entry points of the lateral, medial and posterior screws and the best entry angles in relation to the tibial axis were determined. Conclusion: This is the first study to present an accurate guide for performing ankle arthrodesis based on a population study.
PO 18162 - Clinical and functional outcomes of tibiotarsal arthrodesis in foot drop treatment
Authors: Christovan Ribeiro Evandro Junior , Dutra Ernesto Junior Gunther Geraldo , Damião Prata Sérgio , Rizzo Marco Antônio
Published: November 2019

Objective: To evaluate the clinical and functional outcomes of the treatment of foot drop with joint degeneration through tibiotarsal arthrodesis. Methods: Nine patients with foot drop were retrospectively evaluated, including 2 with lumbar disc disease, 4 with sequelae of poliomyelitis, and 3 with peroneal nerve injury. All patients underwent tibiotarsal arthrodesis (open surgery), and functional improvement of the limb was analyzed during the postoperative period. The mean age of the patients was 45 years and 10 months, and 6 patients were men. Results: The outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale translated into and adapted to Portuguese. In the postoperative assessment, 6 patients had mild or occasional pain, and 3 patients had no pain. The mean AOFAS ankle-hindfoot score was 36 points before surgery, ranging from 26 to 39, and 73 after surgery, ranging from 42 to 91. Conclusion: Tibiotarsal arthrodesis in patients with foot drop showed satisfactory outcomes, improvement in pain and gait and, consequently, improvement in quality of life.
PO 18188 - Ankle arthrodesis via a transfibular approach and circular external fixation
Authors: Yuzo Masuda Rodrigo , Felipe Pereira Vinícius , Barbachan Mansur Nacime Salomão , Boatto Hilário , Pereira da Cunha Neto Hélio , Figueiredo Fernandes Junior José Carlos
Published: November 2019

Objective: To present the radiographic and functional outcomes of a series of 11 cases of ankle arthrodesis operated on with a circular external fixator using the Ilizarov method and a transfibular approach from January 2017 to June 2018. Methods: The patients were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) scores. Anteroposterior and profile views of the ankle radiographs were evaluated. All patients underwent a similar procedure in terms of the surgical approach and assembly of the Ilizarov apparatus. Results: During the study period, 11 cases underwent surgery; the mean age was 44.81 years (28-70 years). The mean follow-up time was 50.81 weeks (13-90 weeks). The main indication for surgery was posttraumatic secondary arthritis. The mean functional AOFAS score was 55.72 (45-64) points. Soft-tissue evaluation revealed surgical wound healing of the transfibular approach in 9 patients (81%). All patients showed signs of superficial pin- or wire-tract infection. Union was reported in 10 patients (90.9%), and the radiographic varus deformities found in 2 patients did not exceed 7º. No additional surgical procedure was required during follow-up. Conclusion: Ankle arthrodesis using a transfibular approach and fixation using the Ilizarov method were efficient, promoted functional restoration considering the complexity of the cases, and resulted in a high union rate.
PO 18198 - Treatment of distal tibiofibular syndesmosis injury in ankle fractures with suture button
Authors: Honda Saito Guilherme , Pires Prado Marcelo , Abussamra Moreira Mendes Alberto , Ryuko Nishikawa Danilo , Devito Beatriz , Devito Leticia
Published: November 2019

Introduction: Distal tibiofibular syndesmosis (DTFS) injuries in ankle fractures are conventionally treated by DTFS fixation with stabilizing screws. However, screws may cause problems due to their inherent rigidity. Therefore, the popularity of fixation devices that allow DTFS mobility has increased. The objective of the present study is to describe the outcomes of the surgical treatment of ankle fractures with DTFS injury using suture button syndesmosis fixation. Methods: Forty-four patients surgically treated with a suture button for ankle fractures associated with DTFS injury were retrospectively analyzed. The mean follow-up time was 14.7 months. Patient functioning was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS), the rate of complications and the need for reoperation. Results: The mean AOFAS score at the last follow-up visit was 92 (35-100). The mean VAS was 0.8 (0-7). Eight patients (18%) developed complications, the most common of which were posttraumatic osteoarthrosis and peroneal tendinopathy. Reoperations were performed in 6 patients (13.5%) and included orthopedic hardware removal, peroneal tenoplasty, neurolysis or distal tibiofibular arthrodesis. Only one patient was unable to resume previous activities. Conclusion: Suture button is a reliable alternative for DTFS fixation in ankle fractures, providing excellent functional outcomes with a low rate of complications. This device has the theoretical advantage of allowing physiological mobility of the distal tibiofibular joint and generally requires no subsequent orthopedic hardware removal.
PO 18213 - Evaluation of hallux valgus treatment through percutaneous
Authors: De Schoucair Jambeiro Jorge Eduardo , Tavares Cordeiro Neto Antero , Delmonte Moreira Fernando , De Oliveira José Augusto , Miguelino Sousa Clara Cristiane , Fernande Leão Felipe
Published: November 2019

Introduction: Hallux valgus (HV) is characterized by the lateral deviation of the first finger, associated with pain and medial exostosis of the first metatarsus. The cause is usually multifactorial. The treatment varies with the degree of deformity and can be conservative or surgical. Percutaneous techniques have gained interest, offering less surgical trauma, fewer complications and faster recovery. The present study aims to evaluate the results of the surgical treatment of hallux valgus through percutaneous surgery.  Methods: A search was performed in PubMed / Medline and BVS, from 2013 to 2018, using as descriptors "hallux valgus" and "percutaneous surgery". Original articles in English, Portuguese and Spanish were included. We excluded systematic reviews, descriptions of surgical technique and publications older than 5 years. The quality of the methodology was evaluated with the help of the STROBE tool, with an emphasis on hallux valgus (HVA), intermetatarsal angle (IMA) and the AOFAS score.  Results: We found 185 references. After applying the inclusion and exclusion criteria, and STROBE tool, 5 articles were eligible, comprising a total of 290 percutaneous procedures. The follow-up time ranged from 6 months to 10 years. We found a reduction of IMA between 3.9º and 9.5º and a reduction of HVA between 12.5º and 26.8º. The AOFAS score ranged from 85 to 97.1 points in the evaluated works.  Discussion: In general, we found a good correction of HV deformity with improvement of HVA, IMA, DMAA and clinical improvement by the postoperative AOFAS score, with low complication rates. However, the heterogeneity of the studies, with variation of techniques and samples did not allow us to generalize the findings. Conclusion: It was possible to note that percutaneous surgery for HV treatment produces good outcomes with low complication rates, but few studies had a high level of evidence demonstrating the efficacy of these techniques, despite encouraging preliminary results.
TL 18078 - Biomechanical evaluation of a Lisfranc ligament Injury
Authors: Baumfeld Tiago Soares , Wagner Emilio , Wagner Pablo , Baumfeld Daniel Soare , Prado Marcelo Pires
Published: November 2019

Introduction: Lisfranc joint injuries occur due to direct or indirect trauma, where a twisting or axial force is transmitted to the foot. Cadaveric models are a useful way to evaluate injury patterns and models of fixation, but a frequent limitation is the amount of joint displacement after injury. Our hypothesis was that applying pronation and supination motion combined with ankle plantar flexion to a cadaveric model would produce reliable and measurable joint displacements. Methods: Twenty-four fresh frozen lower leg cadaveric specimens were utilized. The medial (C1) and intermediate (C2) cuneiforms and the first (M1) and second (M2) metatarsal bones were marked. A complete ligament injury was performed between C1-C2 and C1-M2 in 12 specimens (Group 1) and between C1-C2, C1-M2, C1-M1 and C2-M2 in 12 matched specimens (Group 2). Internal and external rotation was applied to the tibia with the ankle in 30 degrees of flexion, achieving pronation and supination motions, respectively, of the forefoot relative to the hindfoot. A 3D Digitizer was used to measure distances. Results: Distance C1- C2 increased 3 mm after ligament injury (23% increase) with supination motion. C1-M2 increased 4 mm after ligament injury (21% increase) with pronation motion. Distances between C1-M1 and C2-M2 only changed in Group 2, increasing 3 mm (14%) and 2 mm (16%), respectively. Conclusion: Pronation and supination motions of the forefoot relative to the hindfoot produce measurable joint displacements in a cadaveric Lisfranc injury model. Distances M1-M2 and C2-M1 are not reliable for the detection of injury in this model. The inclusion of axial rotation in Lisfranc injury models may allow better test repair or reconstruction techniques.