bluuebunny/crossref_metadata_2025 huggingface dataset:
PO 18146 - The efficacy of a diabetic educational program and predictors of compliance of patients with non-insulin dependent diabetes mellitus (type 2)
Authors: Cristina Stéfani Kelly , Barbachan Rodrigues Aldo , Quadros Borges Vinicius , Ferraz Ferreira Gabriel , De Matos Moraes Leonardo Vinícius
Published: November 2019

Introduction: Diabetes mellitus (DM) has become a global public health problem. The concept of detection and management of diabetes mellitus in primary care centers is widely practiced in Brazil by the general practitioner. The aim of this study was to evaluate the efficacy of our educational program for diabetics for patients with diabetes mellitus and to determine the predictors of compliance. Methods: A cross-sectional prospective study was performed in a quaternary hospital where patients with diabetes were referred to the outpatient clinic of the diabetic foot group so that they were part of a multidisciplinary group (medical orthopedists specialists in foot and ankle, medical endocrinologists, physiotherapist and nurse) with a specific protocol for guidelines for foot care. Specialist orthopedic doctors of the foot and ankle completed the protocol and performed the specific physical examination. Results: Of the 578 diabetic patients, the mean age was 67 years, 69% were female, 53% used insulin to control the disease and the disease duration was 14 years. Obesity was diagnosed by calculation of the body mass index (BMI), and 85% patients were overweight. Evaluation of protective sensibility showed that 68% were significantly decreased, with sensation from the 4.0 g monofilament. One hundred and twenty seven patients required surgery resulting from clinical complications of the disease: 64 ulcers (Wagner classification 57% ulcers had a degree 1 Wagner classification, 63% affected forefoots), 54 Charcot arthropathies (52% Eichenholz in phase 3, 61% located in the mid-foot), and 9 cases of osteomyelitis. Fifty-three patients had one or more prior amputations at the time of their first appointment, mostly of the toes (66%). Conclusion: The costs related to the disease increased greatly with the appearance of complications, especially if there was a need for hospitalization and surgical treatment. The prevention of injuries with adequate glycemic control and the provision of protective shoes is essential.
PO 18150 - Comparison between the open and minimally invasive repair techniques in acute Achilles tendon injuries
Authors: Primo de Araujo João Paulo , Mota Garcia Moreno Marcus Vinicius , De Souza Guimarães Janice , Torres Gomes Marilton Jorge , Marçal Vieira Túlio Eduardo , Souza Jalil Vitor
Published: November 2019

Objective: Our study compares the functional outcomes of patients who underwent open repair of the Achilles tendon with those of patients treated with the minimally invasive technique using the percutaneous Achilles repair system (PARS) over a 1-year minimum follow-up period and presents the complication rates for the 2 techniques. Methods: Between 2011 and 2016, 31 patients were reviewed; of these, 20 were included in the study (10 PARS X 10 open repair technique). Patients with chronic Achilles tendon rupture, insertional or bilateral, and patients with a history of surgery or previous ankle pathology that could mask functional outcomes were excluded from the study. The open repair technique was performed via a posteromedial incision to the ankle to repair the tendon and was combined with myotendinous transfer of the flexor hallucis longus tendon, which was fixed with a Biotenodesis screw. The minimally invasive technique was performed using the PARS of the company Arthrex through a small transverse incision at the site of the Achilles tendon rupture. Functional outcomes and complications were collected after at least 1 year of follow-up. Results: Both groups had similar American Orthopedic Foot and Ankle Society (AOFAS) scores (PARS: 95.3±5.1, open: 96.5±5.1; p=0.604), demonstrating similar functional outcomes. The PARS group had a higher number of complications than the open repair group (PARS: 20% x open: 10%), but the difference was not significant (p=0.383). Conclusion: For the treatment of acute Achilles tendon injuries, the PARS and open repair techniques had similar functional outcomes after 1 year of follow-up.
PO 18194 - Functional and quality of life assessment of patients with ankle ulcers treated with complete Achilles tendon resection
Authors: Godinho Bordone Pires Wrgelles , De Almeida Pinto Roberto Zambelli , Carvalho Maia Philipe Eduardo , Simões Castilho Rodrigo , Vasconcelos de Carvalho Felipe Daniel , Araújo Silva Lopes Fernando
Published: November 2019

Objective: The objective of this study is to perform a functional and quality of life assessment of patients subjected to debridement of ulcers in the posterior region of the ankle, which progressed to complete Achilles tendon resection without any type of tendon reconstruction or transfer. Methods: This is a case series of 4 patients, mostly diabetic, who underwent complete resection of an exposed and degenerated Achilles tendon due to ulcer in the posterior region of the ankle that precluded preservation given the need to control the infectious process considering the diagnosis of calcaneal osteomyelitis. This diagnosis was compatible with changes observed in the magnetic resonance imaging evaluation and was confirmed in cultures of bone tissue removed during debridement. The patients filled out the Brazilian Portuguese version of the Achilles Tendon Total Rupture Score (ATRS-BR) and 36-Item Short Form Survey (SF-36) during the postoperative period, and follow-up ranged from 6 to 24 months. The ATRS score ranges from 0 to 100, and the higher the scores are, the fewer symptoms and limitations the patients have. The SF-36 consists of 36 questions covering 8 domains: physical role functioning, physical functioning, bodily pain, general health perceptions, social role functioning, vitality, mental health and emotional role functioning. The items are independently assessed, and the total possible score is 100 points, which is indicative of the best health status. Results: All 4 Achilles tendons were approached. The mean age of the patients was 69.8 years. The mean score on the physical functioning section of the SF-36 was 63.8 points. When comparing the outcome with literature data, we observed that when patients with ulcers were compared with individuals of a similar age group, our study showed better results than previous studies. The mean score of the ATRS-BR was 46.3 points, which suggests a poor outcome. However, the patients had few complaints about their physical functioning, as shown in the SF-36 analysis. The decision not to perform Achilles tendon reconstruction was made jointly by the medical team and the patients and their families. Conclusion: Not reconstructing the Achilles tendon in patients, mostly elderly diabetic patients with posterior ankle ulcers, led to encouraging functional scores. The present study suggests that this type of ulcer treatment is a viable option for such populations.
PO 18205 - Case report
Authors: Dos Santos Barroco Rui , Candido de Paula Neto Antonio , Hideki Ikeuti Douglas , Prates de Oliveira Letícia Zaccaria , De Miranda Bruno Rodrigues , Beerens Abdul Ghani Abdul Ghani Mahmoud
Published: November 2019

Introduction: Anterior tibial tendon ruptures are quite rare. All studies found in the literature refer to the adult population, with no reports of this injury in the pediatric population. The literature on the treatment of this injury is scarce. Objective: To report the case of a child subjected to peroneus brevis tendon transfer for the sequela of a severe anterior tibial and extensor hallucis longus tendon injury. Methods: Male patient, 8 years of age, was run over by a car and sustained an exposed tibial fracture and major soft-tissue injury of the foot. Anterior tibial, posterior tibial and extensor hallucis longus tendon rupture were detected. Damage control, soft-tissue cover and conservative treatment of the anterior tibial and extensor hallucis longus tendons were initially performed; however, the conservative treatment failed, and valgus deformity and pronation developed. Subsequently, tenoplasty (posterior tibial tendon), the Strayer procedure (gastrocnemius recession of the Achilles tendon) and elongation of the peroneus longus and brevis tendons were also performed, but the patient experienced deformity recurrence. Subcutaneous peroneus brevis tendon transfer to the navicular was then chosen, with postoperative use of an ankle-foot orthosis (AFO) and physical therapy. Results: The deformity was improved. The patient progressed with satisfactory gait and strength. He currently walks without support using an AFO. Both the patient and his family were satisfied with the functional outcome of the tendon transfer. Conclusion: Reconstruction of anterior tibial and extensor hallucis longus tendon rupture through peroneus brevis tendon transfer is a viable and reliable treatment option. No complications such as adhesions or correction failure were observed, thus corroborating the viability of this method.
TL 18077 - Synthetic neoligamentplasty with FiberTape has the same rigidity as transarticular screws in Lisfranc subtle lesions
Authors: De Souza Nery Caio Augusto , Baumfeld Daniel Soares , Baumfeld Tiago Soares , Prado Marcelo Pires , Wagner Pablo , Wagner Emilio
Published: November 2019

Introduction: Lisfranc joint injuries occur due to direct or indirect trauma. Recently, new treatment options are being sought to use methods that allow more physiologic fixation of this joint. The purpose of this study was to analyze the stability of a cadaveric Lisfranc injury model fixed with a synthetic neoligamentplasty in comparison to traditional trans-articular screw fixation.

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). The groups were further divided by fixation with screws (G1 Screws and G2 Screws) and with Tape (G1 Tape and G2 Tape). The tape fixation group underwent the fixation technique using FiberTape (Arthrex, Inc.). After ligament lesion and fixation, the construct rigidity was measured with the help of a 3D Digitizer arm during a stress condition (pronation and supination of the forefoot). Results: The C1-C2 distance 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. Rigidity between C1-C2, C1- M1 and C2-M2 did not differ between the fixation with screws and tape. The fixation with screws presented more rigidity in the C1-M2 distance (p=0,03), but only during pronation stress. Conclusion: Tape and Screws can produce the same rigidity after repair of Lisfrac Ligament injuries, excluding the C1-M2 distance during pronation stress.
TL 18088 - Subluxation of the middle facet of the subtalar joint as a marker of adult acquired flatfoot deformity peritalar subluxation
Authors: Godoy-Santos Alexandre Leme , Cesar Netto Cesar , Ellis Scott , O'Malley Martin , Lintz Francois , Deland Jonathan
Published: November 2019

Introduction: Progressive peritalar subluxation (PTS) occurs in patients with adult acquired flatfoot deformity (AAFD) and is usually assessed in coronal plane images of the subtalar joint (SJ) posterior facet (PF). In this case control study, we investigated the use of the middle facet (MF) as an indicator of PTS using weightbearing computed tomography (WBCT). We hypothesized that significantly increased joint uncoverage and incongruence would be noted in patients with AAFD. Objective: To assess the amount of subluxation of the middle facet of the subtalar joint as a marker of PTS in patients with symptomatic AAFD when compared to controls using coronal plane WBCT images. Methods: We included 30 patients with stage II AAFD (20 females/10 males), aged 57.4 (range, 24 to 78) years, and 30 matched-pair controls (20 females/10 males), with a mean age of 51.8 (range, 19 to 81) years, who underwent WBCT. Two independent and blinded fellowship-trained foot and ankle surgeons measured the amount of subluxation (percentage of uncoverage) and the incongruence angle of the MF at the midpoint of its longitudinal length, using coronal WB CBCT images. Intra- and interobserver reliability were assessed by the intraclass correlation coefficient (ICC). A comparison was performed using the paired Student’s T-test or for each pair the Wilcoxon test. P-values lower than 0.05 were considered significant. Results: Substantial to almost perfect intra- and interobserver reliability was observed for both measurements. The MF demonstrated significantly increased PTS in patients with AAFD, with a mean value for joint uncoverage of 45.3% (95% CI, 40.5% to 50.1%), as compared to 4.8% (95% CI, 0% to 9.6%) in controls (p<0.0001). Significant differences were also found for the incongruence angle, with a mean value of 17.3 degrees (95% CI, 15.5 to 19.1) in AAFD patients and 0.3 degrees (95% CI, -1.5 to 2.1) in controls (p<0.0001). A joint incongruence angle of more than 8.4 degrees was found to be diagnostic for symptomatic stage II AAFD. Conclusion: We described the use of the subtalar joint middle facet as a marker for PTS in patients with AAFD. Significant differences in the percentage of joint uncoverage and incongruence were found compared with the controls.
PO 18219 - Treatment of malleolar ankle fractures
Authors: Fernandes Araujo Caio Augustus , Kenzo Arie Eduardo , Mizusaki Danilo , Stella Peccin Maria , De Almeida Estevam Jhony , Souza de Barros Brenison
Published: November 2019

Objective: Given the epidemiological importance of malleolar fractures and differences in treatment choices, this study provides an update on the multiprofessional treatment of these fractures by mapping systematic reviews available in the scientific literature. Methods: The search was performed in the electronic databases Cochrane Database of Systematic Reviews (CDSR), Medline and Lilacs and in the PROSPERO international prospective register of systematic reviews, with no language or publication date restriction. The most recent search was performed on June 1, 2018. The term “ankle fracture” was used in those databases. Pubmed was also searched, using the [Mesh] term. The inclusion criteria were systematic reviews on the treatment of malleolar ankle fractures in adults. Results: Twenty-two systematic reviews were identified in the searched databases. Systematic reviews on the multiprofessional treatment of patients with malleolar fractures addressed the selection of metallic syndesmotic screw rather than absorbable screw without indicating its removal in the absence of symptoms. Furthermore, the Adelaide Fracture in the Diabetic Ankle (AFDA) algorithm was established for the diagnosis and treatment of diabetic patients. There is still no evidence that arthroscopically assisted open reduction and internal fixation (ORIF) is the best therapeutic method, nor is there biomechanical evidence that the locking plate is better than the conventional plate for treating lateral malleolar fracture in elderly people. There is strong evidence that mobility and early weight-bearing directly affect the functional prognosis of patients. Conclusion: This study was extremely important for identifying and selecting the most recent systematic reviews on the topic, thereby guiding practices regarding the best therapeutic regimen for patients with malleolar fractures.
PO 18220 - Talocalcaneal tibio arthrodesis with percutaneous retrograde intramedullary nail
Authors: De Schoucair Jambeiro Jorge Eduardo , Cordeiro Neto Tavares , Delmonte Moreira Fernando , De Oliveira José Augusto , Fernande Leão Felipe
Published: November 2019

Introduction: Primary osteoarthritis, post-traumatic lesions, Charcot arthropathy and rheumatoid arthritis are some of the causes of ankle and hind foot osteoarthritis that result in pain and sometimes functional limitations in patients affected by such pathology. The therapeutic options vary from conservative treatment (painkillers, bracing and nonsteroidal anti-inflammatory drugs) and surgical treatment. The objective of this present study is to report three cases of patients with ankle osteoarthritis who had undergone minimally invasive surgery (MIS) for tibio-talocalcaneal arthrodesis with an intramedullary nail, with the use of a retrograde blocked intramedullary nail and screws as fixation. Methods: Clinical and radiographic evaluations were conducted of three cases treated using this technique at our institution in 2017, who were allowed full weight bearing postoperatively The AOFAS questionnaire and radiographic evaluation were employed in two orthogonal incidences of the ankle, evaluated after one year postoperatively. Results: We obtained AOFAS scores between 68 and 86 after one year postoperatively with this study technique, and the radiographic consolidation index was observed in 100% of cases (between 6 and 12 weeks) postoperatively. There were no complications.

Conclusion: We obtained good results with minimally invasive surgery (MIS) for tibio-talocalcaneal arthrodesis, with satisfactory consolidation presenting no complications. However, there are an insufficient number of studies in the literature demonstrating superiority of the percutaneous tibio-talocalcaneal arthrodesis technique over the open technique. We believe that the percutaneous technique is a recent method fir study that may be added to the therapeutic arsenal.
PO 18236 - Assessment of hallux valgus reduction using a modified version of the McBride test
Authors: Rodrigues de Miranda Bruno , Dos Santos Barroco Rui , Prates de Oliveira Leticia Zaccaria , Beerens Abdul Ghani Abdul Ghani Mahmoud , Candido de Paula Neto Antonio , Hideki Ikeuti Douglas
Published: November 2019

Introduction: The McBride test was created to assess hallux valgus reduction and is also used to assess capsular and lateral soft-tissue tension indicating the need for lateral capsular release after the bone procedure in the first metatarsal bone. The flowcharts for lateral soft-tissue release remain unclear and lack consensus among surgeons. Objective: To propose a modified version of the test for the complementary preoperative assessment of hallux valgus reduction. Methods: We describe a method in which the examiner supinates the first metatarsal head medially to manually correct the pronation of the first metatarsal and then applies varus force to the hallux to test the lateral capsular tension of the metatarsophalangeal joint. Results: A significant reduction in lateral capsular tension was observed in the metatarsal head lifting and rotating maneuver compared with the conventional McBride test. Discussion: Hallux valgus reduction is greater with manual correction of the deformity than with the classic McBride test, most likely because of the resulting rotational bone repositioning and soft-tissue balancing. These changes seem to decrease the lateral tension that limits the correction of the deformity in the metatarsophalangeal angular plane. Conclusion: We believe that this modified version of the McBride test can be used as a more reliable predictor of the need for lateral metatarsophalangeal release after the metatarsal position is corrected through osteotomy or cuneometatarsal arthrodesis.
TL 18094 - Fluorquinolones and the risk of Achilles tendon disorders
Authors: Godoy-Santos Alexandre Leme , Srougi Miguel , Bruschini Homero , Netto Cesar de Cesar , Furtado Lucas , Maffulli Nicola
Published: November 2019

Introduction: Achilles FQ-associated tendinopathy was first reported by Bailey et al. in 1983. Since then, nearly 200 case reports related to FQ-associated tendon injury have been published, as well as some case control and cohort studies. Today, drug-induced tendinopathy is accepted as a class effect of FQ. The Achilles tendon is affected in 90% of cases of FQ-related tendinopathy and rupture. Objective: To evaluate current evidence for the association between fluoroquinolones and Achilles tendinopathy and to identify associated risk factors that increase the incidence of this complication. Methods: We conducted a computerized search of the relevant scientific literature from 1988 to 2018 using electronic databases, including PubMed, Medline and Scopus. The search terms were fluoroquinolone-related tendinopathy. Eligible studies were any available reports of fluoroquinolone-related tendinopathy (tendinitis, tendon pain, or rupture); animal and human histologic studies were included. Data collected included any cases of fluoroquinolone-related tendinopathy, the particular tendon affected, type of FQ, dosage, and concomitant risk factors. Results: The references selected were reviewed by all authors and judged based on their contribution to the body of knowledge on this topic. The conduct and validity of any clinical studies were carefully considered, and the outcomes of management protocols were carefully scrutinized. Case reports mentioning a specific association with the condition that were thought to be relevant to the discussion were included. Only papers that made a significant contribution to understanding of this condition were included in the review. Thus, a total of 560 abstracts were screened, 79 of which were directly related to FQ-associated Achilles tendinopathy or tendon rupture. Conclusion: The association between the use of fluoroquinolone antibiotics and Achilles tendon disorders is well-established in the medical literature. We found that male gender, advanced age, normal BMI, chronic renal failure and concurrent use of corticosteroids increases the risk of Achilles tendon pathology. Caution should be exercised during the utilization of this antibiotic class in patients with these characteristics
TL 18165 - Relationship between lower limb dysmetria and plantar fasciitis
Authors: Mansur Henrique , Gonçalves Feijó Carvalho Guilherme , Moreira de Castro Júnior Isnar
Published: November 2019

Introduction: Plantar fasciitis is an inflammatory process of multifactorial etiology that affects the origin of the plantar fascia and surrounding structures. A difference in length between lower limbs is relatively common within the population and can sometimes cause changes in biomechanics and symptoms. The objective of this study is to evaluate the relationship between lower limb dysmetria and plantar fasciitis. Methods: A cross-sectional study was performed to measure the length of the lower limbs by scanometry in patients diagnosed with plantar fasciitis. Other risk factors, such as body mass index, foot shape and the presence of plantar calcaneal spur, were also assessed in foot radiographs. Results: Of the 54 patients included in the study, 44.4% were men, and the mean age was 50.38 (23-73 years); 81.5% had pain in one foot, and 53.7% had feet that were considered plantigrade. We observed dysmetria in 88.9% of the sample, with a mean of 0.749 cm (SD ±0.63). In addition, 46.3% feet with pain showed calcaneal spurs on the radiographs. Conclusion: Approximately 90% of patients showed lower-limb dysmetria and, in most cases, the side with the shorter limb was affected by plantar fasciitis
TL 18166 - Evaluation of quality of life and radiological parameters after hallux valgus correction
Authors: Mansur Henrique , Trindade Cardoso Vinicius , Moreira de Castro Júnior Isnar
Published: November 2019

Introduction: The outcome of hallux valgus correction surgery is usually evaluated based on parameters of interest to the surgeon; however, the outcomes considered important by patients differ from those analyzed by physicians. Our objective is to evaluate the quality of life of patients undergoing hallux valgus correction and to assess the maintenance of radiographic parameters over time. Methods: The study included 38 patients who underwent hallux valgus correction surgery using different osteotomy techniques (scarf, chevron, arciform, proximal chevron and chevron-Akin) from January 2010 to December 2012. The patients were evaluated radiographically at 3 different times (preoperatively and 1 and 5 years postoperatively) and filled out the 36-Item Short Form Survey (SF-36) for the assessment of quality of life. Statistical analysis was performed using the paired Student’s t-test and the nonparametric Wilcoxon signed-rank and Friedman tests, with a maximum significance level of 5%. Results: Among the main findings of the SF-36 questionnaire, the sections on which the patients reported the best results were emotional role functioning, physical functioning and social role functioning, and the final mean score was 74.9. The metatarsophalangeal and intermetatarsal angles and medial eminence showed significant decreases during the postoperative period (p<0.05), and only 1 patient presented loss of joint congruence. Conclusion: Different surgical osteotomy techniques used to correct moderate and severe hallux valgus improved the patients’ radiological parameters and quality of life.
TL 18168 - Effect of obesity on the functional outcome of flexor hallucis longus tendon transfer surgery in patients with Achilles tendinopathy
Authors: Mansur Henrique , Almeida de Sousa Nogueira Thomás , Benitez Juan , Moreira de Castro Júnior Isnar
Published: November 2019

Introduction: Several factors, including diabetes and smoking, increase the risk of and predisposition for complications of foot and ankle surgeries; however, studies assessing the effects of obesity remain scarce. The objective of this study is to assess the effects of obesity on functional outcomes of flexor hallucis longus (FLH) tendon transfer surgery in patients with chronic Achilles tendinopathy. Methods: A retrospective study was performed with patients aged 18 years or older who underwent FHL tendon transfer between March 2010 and May 2015. The characteristics recorded were sex, age, body mass index (BMI), American Orthopedic Foot and Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS) and ankle plantar flexion and dorsiflexion strength, assessed using an isokinetic dynamometer. Results: The sample had 24 participants (13 women and 11 men) with a mean age of 55.7 years; among them, 13 were obese (BMI>=30), and 11 were nonobese (BMI<30). After a mean follow-up time of 66 months, the FAOS of the sample increased from 28 to 91 points (p=0.000). No significant difference in the postoperative AOFAS score or FAOS was found between the subgroups (p>0.05), with values of 83 and 86.7 points (AOFAS) and 92.72 and 90 points (FAOS) for obese and nonobese patients, respectively. The comparison of the strength of each motion revealed no significant difference (p>0.05) between subgroups. There was no association between BMI and postoperative functional outcomes (AOFAS score and FAOS) (p>0.05) or correlation between BMI and the strength of the operated ankles. Conclusion: Our findings indicate that flexor hallucis longus tendon transfer surgery in Achilles tendinopathy is effective for obese and nonobese patients based on the AOFAS and FAOS scores and dynamometry results.
TL 18177 - Epidemiological profile of sesamoid disorders of the first metatarsophalangeal joint
Authors: Rassweiler Hardt Marcelo , Bergamaschi Demore André , Kim Antônio , Marcantonio Camargo Leandro , Claudino Barbosa Carolina , Machado Samuel
Published: November 2019

Introduction: The sesamoid bones are part of the hallux metatarsophalangeal (MTTF) joint complex and are an important factor in the normal biomechanics of gait. Abnormalities of the sesamoid bones are not rare but are often underestimated and include acute fractures, osteochondral lesions, bipartite sesamoids, recurrent traumatic sesamoiditis or infection, in addition to osteoarthritis. Given the lack of recent studies on the epidemiological profile of sesamoid-related diseases, the objective of this study is to identify the epidemiological characteristics of patients with these disorders. Methods: The study was approved by the research ethics committee and registered in the Brazil Platform (Plataforma Brazil). This retrospective study was performed by reviewing the electronic charts of foot and ankle outpatients diagnosed with sesamoiditis and acute or stress fractures between February 1, 2013 and January 31, 2018. The exclusion criterion used was the presence of incomplete records in the electronic chart. The following variables were analyzed: sex, age, occupation, participation in sports, laterality and affected sesamoid bone (medial or lateral). The data collected were tabulated and saved in an Excel spreadsheet and analyzed using descriptive statistics. Results: Data on 108 patients were collected after reviewing the charts. Based on these data, we report the epidemiological characteristics of patients with sesamoid disorders in a sample of orthopedic patients from a reference hospital of the Unified Health System (Sistema Único de Saúde – SUS) in a city in southern Brazil. Among the various occupations reported, the 3 most common were cleaner (29), student (23) and salesperson (16). Among the subjects who participated in sports, only 22 were involved in competitive sports (professional or amateur).
TL 18193 - Efficacy of triple surgery for the treatment of pes cavus in Charcot-Marie-Tooth disease
Authors: Marchi Neto Noé De , Moré Luciene , Ferreira Ricardo Cardenuto , Costa Marco Tulio , Bergamasco Jordanna Maria Pereira , Chakkour Marcelo Marcucci
Published: November 2019

Introduction: Pes cavus is a deformity characterized by a high longitudinal medial arch. It is classically associated with neurological conditions, among which Charcot-Marie-Tooth (CMT) disease is the most common. Treatment options depend on the flexibility of the deformity. Various procedures are available to correct flexible pes cavus; these procedures can be performed in combination, and there is no standardized technique. There is limited information in the literature on the long-term outcome of treatment, and thus far, there is no consensus on the ideal surgery. The objective of the present study was to assess the efficacy of triple surgery (TS) (plantar fasciotomy, valgising calcaneal osteotomy and first metatarsal extension osteotomy) in the long-term treatment of pes cavus of patients with CMT. Methods: Between 2000 and 2015, 15 patients with CMT and pes cavus who underwent TS were treated at our department, including a total of 18 feet from 8 women and 7 men. The mean age of the patients at the time of the surgery was 21 years (9 to 60 years), and the mean follow-up time was 11 years (4 to 19 years). Of the 18 feet that underwent TS, 14 required an additional procedure. To analyze the outcomes of TS, criteria were stipulated and divided into 3 categories: pain (A), deformity (B) and function (C). The following criteria were analyzed: category A: AOFAS pain subscale, pain visual analog scale; category B: clinical and radiographic pes cavus, clinical and radiographic hindfoot varus; category C: gait, flexibility and AOFAS-function subscale. Each analyzed subitem was scored (total score: 10 points) to determine whether correction was achieved and maintained until the final assessment according to different objective criteria. The outcome was considered good when the score was 8 points or more, fair when the score ranged from 5 to 7 points, and poor when it was 4 points or less. Results: When pre-established criteria were objectively applied, 10 feet had a good outcome, 5 feet had a fair outcome, and 3 feet had a poor outcome; thus, a total of 15 feet (83%) had a satisfactory long-term outcome. Conclusion: Triple surgery was effective for treating patients with CMT, providing good deformity correction of pes cavus in addition to long-term clinical and functional improvement.
TL 18200 - Percutaneous metatarsophalangeal arthrodesis for the treatment of hallux rigidus
Authors: Viana Pereira Filho Miguel , Baltazar Nogueira Vitor , Mattos e Dinato Mauro Cesar , De Farias Freitas Marcio
Published: November 2019

Introduction: Arthrodesis is considered the gold standard treatment for the final stages of hallux rigidus, promoting long-term symptom improvement. Arthrodesis is traditionally performed as open surgery. However, in recent years, the prevalence of minimally invasive surgery has increased due to its decreased aggression to soft tissue, shorter surgical time and association with a more comfortable postoperative period with reduced pain intensity. The objective of the study is to describe the percutaneous metatarsophalangeal arthrodesis technique with a single medial portal and to evaluate postoperative outcomes regarding union time, the presence of residual pain and the degree of satisfaction in a series of 22 patients. Methods: This is a series of 22 patients (23 feet) who underwent surgery between January 2017 and July 2018. The union time was assessed, and the patients reported their pre- and postoperative pain levels using the pain visual analog scale (VAS) and their degree of satisfaction. Surgical wound dehiscence, superficial and deep infection and need for orthopedic hardware removal were considered complications. Results: All patients underwent clinical evaluation. In 3 patients, union could not be assessed due to the lack of postoperative radiographs. Twenty patients were women, and 2 were men. Their mean age was 67.8 years. The mean time between the date of surgery and the evaluation was 51 weeks. The follow-up time ranged from 6 to 24 months, with a mean union time of 9 weeks. The union rate was 80%. Five cases showed no radiographic union, although the patients had stable and asymptomatic arthrodesis that required no revision. There were no cases of postoperative infection. In 3 patients, orthopedic hardware was removed. The mean preoperative pain intensity was 8.73, and the mean postoperative pain intensity was 1.26 (p<0.001). All patients were satisfied with the surgery. Conclusion: Percutaneous arthrodesis of the metatarsophalangeal joint of the hallux potentially provides outcomes similar to those of the conventional method reported in the literature and tends to produce a more comfortable postoperative period and better cosmetic results because it uses smaller incisions.
TL 18167 - Reproducibility assessment of the Lauge-Hansen, Danis-Weber and AO classifications of ankle fractures
Authors: Mansur Henrique , Ramos Lucas Sacramento , Freitas Anderson
Published: November 2019

Introduction: Although there are some studies on the reproducibility of various classifications of ankle fractures, they are controversial and lack consensus on which classification is the most appropriate. Thus, the objective of this study is to identify which of the 3 main ankle fracture classifications has the highest intra- and interobserver reproducibility and to assess whether the medical training stage of the participants affects the evaluation. Methods: Radiographs of 30 patients with ankle fracture in anteroposterior (AP), profile and true AP views were selected. All images were evaluated by 11 participants at different stages of their medical training (5 residents and 6 orthopedic surgeons) and at 2 different times. Intra- and interobserver agreement was analyzed using the weighted Cohen's kappa coefficient. Paired Student's t-tests were performed to assess whether the degree of interobserver agreement significantly differed between classification methods. Results: The results showed significant agreement in all classifications when analyzing intraobserver agreement alone. The Danis-Weber classification showed a highly significant (p<0.0001) moderate-to-excellent interobserver agreement. The Danis-Weber classification had, on average, a significantly higher degree of agreement than the other classification methods (p<0.0001). Conclusion: The Danis-Weber classification had the highest reproducibility among the classification methods evaluated in this study.
PO 18115 - Percutaneous hallux valgus correction using the Reverdin-Isham osteotomy
Authors: Lemos Rodrigues Fábio , Ribeiro Lara Luiz Carlos , Grajales Juan Antonio , Torres Lucio Carlos
Published: November 2019

Objective: To analyze the outcomes of percutaneous hallux valgus correction using the Reverdin-Isham osteotomy through clinical and radiographic studies. Methods: We retrospectively evaluated 43 feet in 38 patients with mild or moderate hallux valgus from June 2009 to July 2018. The mean age at surgery was 59 years; the mean postoperative follow-up time was 79 months. All patients treated with the Reverdin technique modified by Isham were evaluated in the pre- and postoperative periods using the American Association Orthopedic Foot and Ankle Society (AOFAS) score; we radiographically measured the hallux valgus angle (HVA), the intermetatarsal angle (IMA) and the first distal metatarsal articular angle (DMAA). Results: The AOFAS score increased by an average of 55 points. On average, the HVA decreased by 14°, the IMA by 3° and the DMAA by 9°. The mean reduction in the length of the first metatarsal bone was 0.3 cm. Conclusion: This surgical technique was effective for hallux valgus correction, demonstrating good angle correction and a marked increase in the AOFAS score.
PO 18116 - Reproducibility assessment of the Lauge-Hansen classification for ankle fractures
Authors: Christovan Ribeiro Evandro Junior , Farias Fábio , Damião Prata S´érgio , Rizzo Marco Antônio
Published: November 2019

Objective: This study evaluated the reproducibility of the Lauge-Hansen classification among orthopedic residents and more experienced orthopedists. Methods: The inclusion criteria were ankle fractures with adequate radiographs taken in anteroposterior (AP), true AP and P (profile) views, which were individually analyzed by physicians. The analysis was performed based on the Lauge-Hansen classification. The raters were 5 orthopedic professionals from our department: 3 residents and 2 board-certified orthopedists (one with less than 10 years of experience, and the other with more 10 years of experience in the field). The professionals first analyzed and classified 30 ankle fracture radiographs; then, after 1 week, they were asked to perform a new evaluation. The radiographs were shown without names or other identifying information. The classifications were subsequently examined based on the analysis of the supporting material that had been previously provided for each individual. A consensus decision regarding the classification was made among all professionals at the end of the study. Results: The professionals were asked to analyze radiographs from 30 patients with ankle fracture, among whom supination-external rotation was the most common diagnosis. The results were outlined in tables and plotted in graphs; in a second evaluation performed after 1 week, there were 66% hits and 34% errors, whereas the percentage of hits in the first evaluation was 61.33%. Conclusion: The routine use of management classifications by physicians facilitates the understanding of these classifications by other professionals in the field while increasing interobserver agreement.
PO 18120 - Eccrine poroma associated with a poroid hidradenoma in a large single lesion over the foot
Authors: Ryuko Cândido Nishikawa Danilo , Leite da Silva Ana Caroline , Aires Duarte Fernando , Honda Saito Guilherme , Monteiro Augusto César , Pires Prado Marcelo
Published: November 2019

Introduction: Eccrine poroma (EP) and poroid hidradenoma (PH) are rare benign neoplasms derived from eccrine sweat glands of the epithelium. Both are variants of poroid neoplasms and rarely become malignant. This report describes the clinical presentation, radiographic and pathological features as well as the treatment of a rare association of EP and PH in a large single lesion over the foot.  Case Report: We present a 55-year-old male patient with a large soft tissue mass over the midfoot (approximately 7 cm in length and 4 cm width). It started as a hyperchromic black spot on the skin and has slowly grown over the last eight years. One year prior, pain increased significantly. There was no history of trauma, infection or other tumor in this part of the foot. In the physical exam, the tumor had well-defined edges, fibroelastic consistency and was not adherent to the surrounding soft tissue. Preoperative planning included radiographic exams: X-ray and magnetic resonance imaging (MRI). On the MRI, the tumor showed a low signal intensity on T1-weighted images, with heterogeneous high and low signal intensities on T2-weighted images. Strong contrast enhancement was observed after intravenous gadolinium administration in the base portion. The peripheral portion showed a low signal intensity without enhancement. We decided on total resection, and the procedure was performed in January of 2017. The surgical approach was a longitudinal dorsomedial incision over the first ray starting from the ankle joint to the distal third of the first metatarsal. The entire tumor was excised with clean margins and sent for anatomopathological analysis and histopathological examination. Histopathologic examination showed that the tumor was a poroid neoplasm consisting of both dermis (poroid hidradenoma) and epidermis (eccrine poroma) components. There were no features of malignancy. After 20 months of surgery, patient remains asymptomatic with no signs of recurrence of the tumor. Conclusion: Skin tumors must be born in mind in the differential diagnosis of a chronic mass in the foot. Surgical treatment for this type of tumor is curative and prevents recurrence and malignant change.
PO 18121 - Reconstruction of peroneus brevis tendon tears by semitendinosus tendon autograft
Authors: Ryuko Cândido Nishikawa Danilo , Aires Duarte Fernando , Honda Saito Guilherme , Monteiro Augusto César , Corrêa Paiva Fonseca Fábio , Pires Prado Marcelo
Published: November 2019

Introduction: Reconstruction for irreparable tears of the peroneal brevis tendon (PBT) using tendon allograft has provided satisfactory clinical results. The aim of this study is to present the surgical technique for reconstruction of PBT tears using semitendinosus tendon autograft (SA) as an alternative to allograft and its early results. Methods: We describe the surgical technique for the reconstruction of irreparable tears of the PBT using SA performed in 3 patients, from December 2016 to May 2017, and early results. Two patients were male and one female, with a mean age of 46.6 years and a mean follow-up of 21 months. The indication for reconstruction was the presence of degenerative tissue that involved more than 50% of the cross-sectional area of the PBT. Preoperative planning included a clinical and imaging evaluation to search for conditions such as ankle instability, cavovarus foot, low-lying muscle belly of the PBT and peroneus quartus tendon. In the pre and postoperative period, they were prospectively assessed using visual analog scale (VAS) scores for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. At 6 months, they were submitted to an isokinetic evaluation of the strength of both feet. Results: At the final follow-up, the mean VAS score was 8,7 preoperatively and 0 postoperatively. The mean AOFAS score was 43 preoperatively and 98,7 postoperatively. The 3 patients had different conditions associated with the lesions: a peroneus quartus tendon, a low-lying muscle belly and a cavovarus foot. They were addressed with resection of the peroneus quartus, resection of the low-lying muscle belly and with a lateral sliding calcaneal osteotomy. At 3 months, they were pain free and able to resume labor activities. At 6 months, they were able to return to sports. The isokinetic evaluation showed no eversion strength deficits compared with the contralateral side. At a mean follow-up of 21 months, they remain asymptomatic and fully active. Conclusion: Reconstruction of PBT tears with SA may be an effective alternative to allograft tissues. It can decrease pain and restore PBT function.
COMPARAÇÃO DE DESEMPENHO ENTRE NOC E WINOCS USANDO TOPOLOGIA MESH
Authors: Oliveira Samuel Da Silva , Kreutz Márcio Eduardo
Published: November 2019

As Redes-em-Chip contribuem muito para o desempenho nas comunicações intra-chip. Alguns fatores, como reutilização e escalabilidade são algumas das razões que levam ao uso desse tipo de arquitetura de comunicação no lugar do barramento. No entanto, as formas de uso desse tipo de comunicação também evoluíram e se adaptaram a vários cenários e desafios. As redes sem fio começaram a ser consideradas, obtendo melhorias em vários aspectos. Nesse artigo serão analisados e comparados o desempenho entre redes-em-chip convencionais e redes que se utilizam de comunicação sem fio. As comparações foram realizadas para latência média dos pacotes, vazão, número de pacotes recebidos e consumo energético. Pode-se verificar que na maioria das métricas usadas, as redes convencionais obtiveram valores mais otimizados.
PROPOSTA DE UM JOGO SÉRIO E DESPLUGADO PARA O ENSINO DE ALGORITMOS
Authors: Bastiani Ederson , Majolo Roman Laura , Botelho Victoria
Published: November 2019

Algoritmos é considerada uma disciplina base em cursos de informática porém, a maioria dos alunos apresenta grandes dificuldades na disciplina, o que causa altos índices de reprovações e, consequentemente, evasão nos cursos de informática. Diante disso, os Jogos Sérios têm se apresentado como uma ferramenta de apoio no processo de ensino-aprendizagem dessa disciplina pois tratam-se de jogos que conciliam a educação com o entretenimento dos jogos. Neste trabalho, foi realizado um estudo sobre a disciplina de algoritmos, suas dificuldades e sobre os jogos sérios. Também foi aplicado um questionário à turma de algoritmos de um curso superior de Tecnologia em Sistemas para Internet de uma instituição pública de ensino para identificar suas dificuldades na matéria e foram analisados dados de aprovações e reprovações de turmas anteriores deste curso. Por último, foi feita a proposta de um jogo sério desplugado como ferramenta de apoio à aprendizagem de algoritmos, a fim de diminuir as dificuldades na matéria, desenvolver habilidades da área de computação, motivar alunos e despertar seu interesse pela área.
The analysis of causes of waterlogging and salt destruction of Bandinelli Palace building constructions in Lviv
Authors: Voloshyn Petro
Published: November 2019

In the article, presenting results of geological environment a complex study and status of structural elements of monument. By the research works on building stones of deepened rooms detecting a number of man-made minerals thenardite, gypsum, leveyit, vanthofit, mirabilite. Thenardite plays a leading role among them.
It was established that the development of minerals due conducive to technological accumulation of water geological conditions, the specificity of which is occurrence at depth laying the foundations waterproof marl clay and unsatisfactory functioning of drainage and water supply systems, leading to waterlogging soil thickness adjacent to foundation and formation of technogenic aquifer layer.
Under favourable physical and chemical conditions from water enriched with ions of sodium, calcium and sulfate taking place a crystallization of containing sodium man-made minerals. To the possibility of their crystallization affects not only, the presence of an aqueous solution of enriched sodium sulphate, and temperature and humidity. Changes of micro-climatic conditions in the basement of the palace closely related to seasonal variations in town climate and microclimate of lodging. During heating season indoor air temperature is quite high and the relative humidity is low. It promotes thenardite crystallization. Instead, in the spring-summer and summer-autumn period relative humidity increased and temperature decreased when salts formed.
Active development of technological processes leads to the destruction of mineral building stone in Palace walling constructions and should take actions. Main among these is the placement of vertical waterproofing or drainage ring.
Key words: architectural monument, technogenic flooding, technogenic minerals, building stone.