MARCOS DE CAMARGO LEONHARDT
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
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- Isolated open tibial shaft fracture: a seven-hospital, prospective observational study in two Latin America countries(2022) BELANGERO, WILLIAM DIAS; FOGAGNOLO, FABRICIO; KOJIMA, KODI EDSON; MIGUEL, GUILHERME CHOHFI DE; BIDOLEGUI, FERNANDO; BERTUNE, ALEJANDRO DANIEL; LOMBARDO, ERNESTO; DIAS, ADÉLIO DE LIMA; TORRES, JOÃO BATISTA MANZOLI; COUTINHO, BRUNO PARILHA; SILVA, JORGE DOS SANTOS; LEONHARDT, MARCOS DE CAMARGO; PEREIRA, PABLO SEBASTIÁN; MARIOLANI, JOSÉ RICARDO LENZI; GIORDANO, VINCENZOABSTRACT Introduction: open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR). Methods: patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status. Results: Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score. Conclusions: Isolated open tibial shaft fractures are potentially harmful to the patient’s quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.
- Intramedullary Steinmann pin nailing of the ulna: an option for the damage control orthopedics treatment of forearm fractures in open injuries in polytraumatized patients - A description of the technique and presentation of a case series(2021) KOLLNBERGER, Karin Veronica; SILVA, Fernando Brandao de Andrade e; CAIERO, Marcelo Tadeu; LEONHARDT, Marcos de Camargo; REIS, Paulo Roberto dos; SILVA, Jorge dos Santos; KOJIMA, Kodi EdsonIntroduction: Forearm shaft fracture is common in young adult patients and associated with soft tissue and organ injuries. In open fractures in polytrauma patients, damage control orthopaedics (DCO) is well indicated. The aim of this study is to describe intramedullary Steinmann pin fixation of the ulna as a DCO procedure for the forearm and present a case series. Description of the technique: A 3.0 mm Steinmann pin is inserted retrograde in the ulna proximal fragment through the fracture site using the open wound as the approach. With direct visualization of the reduction, the pin is advanced into the distal fragment. The reduction of the longitudinal axis and shortening is thus achieved. Patients and methods: This method was used for all open fractures of forearm both-bone fractures in polytrauma patients undergoing DCO from 2014 to 2019. The alignment and length of the ulna were evaluated radiographically after pin fixation and before and after definitive fixation. Differences in the need for secondary procedures and infection rate between DCO and definitive fixation were also evaluated. Results: There were 30 males (85.7%) with an average age of 32.9 +/- 12.0 years and a mean ISS (Injury Severity Score) of 29.4 (range, 18.0-41.0). The most common associated injuries were thoracic trauma (62.8%) and head trauma (45.7%). In the radius and ulna, 51.4% and 60.0% of fractures, respectively, were multifragmentary (types B and C). Gustilo type IIIA represented 77.1% of the injuries. Pin fixation achieved good alignment and length in all cases. The mean time between DCO and definitive fixation was 12.0 days, and no secondary procedure was needed, nor any case developed either superficial or deep infection. The conversion from DCO to definitive fixation was considered easy in all cases. Conclusion: Intramedullary Steinmann pin fixation of the ulna is a viable option for DCO for forearm both-bone fractures in open fractures in polytrauma patients. (C) 2021 Published by Elsevier Ltd.
- Proposal for a new clinical test for diagnosing lateral hip snapping,(2014) CABRITAA AMORIM, Henrique Antonio Berwanger de; GURGELA, Henrique Melo de Campos; MARQUES, Ricardo; SANTOS, Leandro Emilio Nascimento; VICENTEA, José Ricardo Negreiros; LEONHARDTA, Marcos de Camargo; EJNISMANA, Leandro; CROCI, Alberto TesconiLateral hip snapping is a nosological entity that is often unknown to many orthopedists and even to some hip surgery specialists. It comprises palpable and/or audible snapping on the lateral face of the hip that is sometimes painful, caused by muscle-tendon friction on the greater trochanter during flexion and extension of the coxofemoral joint. In the following, we describe a new test for diagnosing lateral hip snapping, which is eminently clinical.
- Acetabular Component Positioning in Total Hip Arthroplasty With and Without a Computer-Assisted System: A Prospective, Randomized and Controlled Study(2014) GURGEL, Henrique M. C.; CROCI, Alberto T.; CABRITA, Henrique A. B. A.; VICENTE, Jose Ricardo N.; LEONHARDT, Marcos C.; RODRIGUES, Joao CarlosIn a study of the acetabular component in total hip arthroplasty, 20 hips were operated on using imageless navigation and 20 hips were operated on using the conventional method. The correct position of the acetabular component was evaluated with computed tomography, measuring the operative anteversion and the operative inclination and determining the cases inside Lewinnek's safe zone. The results were similar in all the analyses: a mean anteversion of 17.4 degrees in the navigated group and 14.5 degrees in the control group (P = .215); a mean inclination of 41.7 degrees and 42.2 degrees (P = .633); a mean deviation from the desired anteversion (15 degrees) of 5.5 degrees and 6.6 degrees (P = .429); a mean deviation from the desired inclination of 3 degrees and 3.2 degrees = .783); and location inside the safe zone of 90% and 80% (P = .661). The acetabular component position's tomography analyses were similar whether using the imageless navigation or performing it conventionally.
- Factors associated with one year mortality in ill patients with proximal femoral fractures treated non operatively(2021) MIRANDA, Maria Adelaide de; PONTON, Andres Paliz; GUERRA, Leonardo Mousinho; ANDRADE-SILVA, Fernando Brandao; LEONHARDT, Marcos de Camargo; REIS, Paulo Roberto dos; SILVA, Jorge dos Santos; KOJIMA, Kodi EdsonY Introduction: Non-operative treatment is an exceptional indication for the treatment of proximal femur fracture. The aim of the study was to analyze the mortality rate in one year and associated factors in severely ill patients submitted to non-operative treatment. Methods: It was included 28 patients treated from August 2014 to September 2019. Eighteen (64.3%) patients were female and 10 (35.7%) were male. The mean age was 78.7 +/- 11.9 years old. The main outcome evaluated was the mortality rate in one year. It was also evaluated the correlation with gender, age, personal habits, number of comorbidities and Charlson Comorbidity Index (CCI). Results: The functional result was assessed with WOMAC score via telephone call. The mortality rate in one year was 42.8% without statistical positive correlation with any of the studied parameters. Patients with three or more comorbidities didn't have a higher mortality rate comparing to survived patients (83.3% vs 81.3%). The CCI also didn't show any correlation with high mortality (6.9 vs 7.1). The functional result of the survived patients was poor (78.2 points WOMAC). Conclusion: The conclusion is that the mortality rate in one year of ill patients with hip fractures treated non-operatively is 42.8% without correlation with age, gender of number of comorbidities, and the functional result of the survived patients is poor. (C) 2021 Published by Elsevier Ltd.
- Infection after intramedullary nailing of femoral and tibial diaphyseal fractures(2023) OLIVEIRA, Priscila R.; LEONHARDT, Marcos C.; PANICO, Caroline T.; SILVA, Julia B.; CARVALHO, Vladimir C.; KOJIMA, Kodi E.; SILVA, Jorge S.; LIMA, Ana Lucia L.Purpose: Management of fracture-related infection (FRI) after intramedullary fixation (IF) is a challenge. The aim of the present study is to describe a series of 26 patients with FRI after IF and to evaluate factors possibly related to the outcome. Methods: Baseline variables were obtained at the time of IF: age, sex, body mass index, affected bone, open fracture, substance abuse, use of an external fixator, type of nail, reaming, soft-tissue reconstruction and surveillance culture result. After diagnosis of the infection, information was obtained about the time interval between IF and diagnosis and classification according to both the Willeneger and Roth and Makridis systems. Treatment modalities were grouped and analysed according to: use of antimicrobials, surgical debridement, nail removal or retention and spacer use. Cultures of bone or deep soft tissues were performed. Patients were followed up for 12 months, and outcomes (remission, relapse, death and loss of follow-up) were evaluated, as well as fracture consolidation. Results: Remission was observed in 42.3% of patients. There was no significant association between any baseline variable and outcome. There was a significant association between Makridis stage 2 classification and recurrence or death. Treatment strategy was not significantly associated with outcome, and 65.4% of cases had positive culture results, with Enterobacter cloacae as the predominant agent. Consolidation was observed in 81.8% of patients and was not significantly related to the outcome. Conclusion: There was a significant association between Makridis classification and the outcome. Consolidation rate was not associated with the outcome regarding the treatment of the infection.
- DISTAL FEMORAL FRACTURES FROM HIGH-ENERGY TRAUMA center dot center dot A RETROSPECTIVE REVIEW OF COMPLICATION RATE AND RISK FACTORS(2022) PAIVA, Micael De Mesquita; LEAL, Daniel Peixoto; KUROKI, Paulo Ken; BARROSO, Barbara Garcia; REYNA, Marco Antonio Avalos; LEONHARDT, Marcos De Camargo; SILVA, Jorge Dos Santos; KOJIMA, Kodi EdsonObjective: Determine complications' incidence and risk factors in high-energy distal femur fractures fixed with a lateral locked plate. Methods: Forty-seven patients were included; 87.2% were male, and the average age was 38.9. The main radiographic parameters collected were distal lateral femoral angle (DFA), distal posterior femoral angle (DPLF), comminution length, plate length, screw working length, bone loss, and medial contact after reduction and plate-bone contact, location of callus formation, and implant failure. The complications recorded were nonunion, implant failure, and infection. Results: Complex C2 and C3 fractures accounted for 85.1% of cases. Open fractures accounted for 63.8% of cases. The mean AFDL and AFDP were 79.8 4.0 and 79.3 6.0, respectively. The average total proximal and distal working lengths were 133.3 42.7, 60.4 33.4, and 29.5 21.8 mm, respectively. The infection rate was 29.8%, and the only risk factor was open fracture (p = 0.005). The nonunion rate was 19.1%, with longer working length (p = 0.035) and higher PDFA (p = 0.001) as risk factors. The site of callus formation also influenced pseudoarthrosis (p = 0.034). Conclusion: High-energy distal femoral fractures have a higher incidence of pseudoarthrosis and infection. Nonunion has greater working length, greater AFDL, and absence of callus formation on the medial and posterior sides as risk factors. The risk factor for infection was an open fracture.
- WEDGE FRAGMENT VARIATIONS OF TIBIAL SHAFT FRACTURES WITH INTRAMEDULLARY NAILING(2023) BOFF, Mario Sergio; PAOLUCCI, Pedro Henrique De Oliveira; OLIVEIRA, Gabriel Machado De; ZANESCO, Leonardo; ANDRADE-SILVA, Fernando Brandao; LEONHARDT, Marcos De Camargo; REIS, Paulo Roberto Dos; SILVA, Jorge Dos Santos; KOJIMA, Kodi EdsonIntroduction: Tibial shaft fracture is the most common long-bone fracture, and the standard treatment is intramedullary (IM) nail fixation. Regardless of the development of this technique pseudoarthrosis remains prevalent.Objectives: Evaluate the correlation between wedge fragment size and displacement, displacement of the main fragments of the 42B2 type, and pseudoarthrosis incidence.Methods: We retrospectively assessed all patients with 42B2 type fracture treated with IM nailing between January, 2015 and December, 2019. Six radiographic parameters were defined for preoperative radiographs in the anteroposterior (AP) and lateral views. Another six parameters were defined for postoperative radiographs at three, six, and 12 months. The Radiographic Union Score for Tibial Fractures score was used to assess bone healing.Results: Of 355 patients with tibial shaft fractures, 51 were included in the study. There were 41 (82.0%) male patients, with a mean age of 36.7 years, 37 (72.5%) had open fractures, and 28 (54.9%) had associated injuries. After statistical analysis, the factors that correlated significantly with nonunion were wedge height > 18 mm, preoperative translational displacement of the fracture in the AP view > 18 mm, and final distance of the wedge in relation to its original anatomical position after IM nailing > 5 mm.Conclusion: Risk factors for nonunion related to the wedge and42B2 fracture are wedge height > 18 mm, initial translation in the AP view of the fracture > 18 mm, and distance > 5 mm of the wedge from its anatomical position after IM nailing. Evidence level III; Retrospective comparative study .
- RADIOGRAPHIC EVALUATION OF IMMEDIATE LOADING SAFETY AFTER SURGICAL REDUCTION IN ACETABULAR FRACTURES center dot center dot A COMPARATIVE-RETROSPECTIVE STUDY(2022) KOJIMA, Kodi Edson; MUNARI, Bruno Mendes; KUBOTA, Bruno Seiki; ZANESCO, Leonardo; PROENCA, Daniel Sonnewend; LEONHARDT, Marcos de Camargo; SILVA, Jorge Dos SantosObjective: Radiographically evaluate the quality of reduction over six weeks of follow-up in patients with surgically treated deviated acetabular fractures who underwent rehabilitation with immediate loading as tolerated and compare this with the results of the unloaded protocol. Methods: We retrospectively evaluated the records of 137 patients with deviated acetabular fractures treated with open reduction and internal fixation. Sixty-six (48.2%) patients underwent postoperative rehabilitation with immediate loading as tolerated, while 71 (51.8%) patients completed rehabilitation using a no-load protocol. The quality of the reduction was assessed radiographically by measuring the fracturing step and gap on radiographs taken immediately after surgery and three and six weeks after surgery. Results: Comparing the joint step, group 1 had an average of 0.44 +/- 1.4 mm, 0.47 +/- 1.5 mm, and 0.51 +/- 1.6 mm immediately, three and six weeks after surgery, respectively. Group 2 had a mean step of 0.24 +/- 0.8 mm, 0.27 +/- 0.9 mm, and 0.37 +/- 1.2 mm immediately, three, and six weeks after surgery. No statistically significant differences were observed between the groups. With a joint gap, group 1 had a mean of 1.89 +/- 1.7 mm, 2.12 +/- 1.8 mm, and 2.36 +/- 2.1 mm; and group 2 had a mean of 2.16 +/- 2.4 mm, 2.47 +/- 2.6 mm, and 2.67 +/- 2.8 mm in the immediate postoperative period, three, and six weeks, respectively. There was also no statistical difference between groups in these measurements. Conclusion: Immediate loading after surgical treatment of deviated acetabular fracture had no negative impact on radiographic reduction parameters and had similar results to the protocol without weight bearing. Level of evidence III; Therapeutic Retrospective Cohort Study.
- VALIDITY AND RELIABILITY OF THE MANCHESTER SCALE USED IN THE ORTHOPEDIC EMERGENCY DEPARTMENT(2019) ANDRADE-SILVA, Fernando Brandao; TAKEMURA, Renan Lyuji; BELLATO, Renato Tavares; LEONHARDT, Marcos de Camargo; KOJIMA, Kodi Edson; SILVA, Jorge dos SantosObjectives: To describe the clinical utility of the Manchester triage scale adapted for orthopedic emergency departments and to evaluate its validity in identifying patients with the need for hospital care and its reliability when reproduced by different professionals. Methods: Five triage flowcharts were developed based on the Manchester scale for the following orthopedic disorders: traumatic injuries, joint pain, vertebral pain, postoperative disorders, and musculoskeletal infections. A series of patients triaged by two orthopedists was analyzed to assess the concordance between the evaluators (reliability) and the validity of the Manchester scale as predictive of severity. Results: The reliability analysis included 231 patients, with an inter-observer agreement of 84% (Kappa = 0.77, p <0.001). The validity analysis included 138 patients. The risk category had a strong association with the need for hospital care in patients with trauma (OR = 6.57, p = 0.001) and was not significant for non-traumatic disorders (OR = 2.42; p = 0.208). The overall sensitivity and specificity were 64% and 76%, respectively. Conclusion: The evaluated system presented high reliability. Its validity was adequate, with good sensitivity for identifying patients requiring hospital care among those with traumatic lesions. However, the sensitivity was low for patients with non-traumatic lesions.