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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- 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.
- 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 .
- Pre-operative predictors of poor reduction in acetabular fractures submitted to surgical treatment(2022) KOJIMA, Kodi Edson; FULLER, Henrique; VIEIRA, Teofilo Josue A. C.; CLEMENTE, Henrique Rodrigues A.; ZANESCO, Leonardo; LEONHARDT, Marcos de Camargo; SILVA, Jorge dos SantosIntroduction: Acetabular fractures are among the most complex orthopedic injuries, and their treatment and understanding have evolved remarkably in the last 50 years. Several factors affect the reduction qual-ity of the surgically treated displaced acetabular fractures. Thus, this study aimed to identify these factors by analyzing patients' data. Patients and methods: Retrospective data from fractures operated in one center over 8 years were ana-lyzed. Patients with a mature skeleton who underwent open reduction and internal fixation and had a minimum follow-up period of 6 weeks were included. Non-displaced fractures were excluded from the study. Radiographic assessment of the reduction was performed before surgery and at follow-up using the method described by Borelli et al. The effects of age ( < 40 or > 40 years), sex, initial displacement (< 20 mm or > 20 mm), time to surgery ( < 14 days or > 14 days), fracture pattern (elementary or associ-ated), number of associated fractures (< 3 or > 3), and associated pelvic injury were analyzed Results: The study included 115 (83.9%) men and 22 (16.1%) women, with a mean age of 34.1 years (range 16-74 years). In the sixth week of follow-up, reductions were satisfactory in 96 (70.7%) patients and un-satisfactory in 41 (29.3%). The most prevalent patterns were the posterior wall (23.1%) and both column (15.7%). Linear regression showed that residual displacement was directly correlated with initial displace-ment ( p = 0.027) but without association with reduction quality. Age, sex, and initial displacement had no effect on reduction quality, which is in contrast with longer time to surgery ( p = 0.004), associated fracture pattern ( p = 0.002), three or more associated fractures ( p = 0.001), and presence of associated pelvic injury ( p = 0.021). Conclusion: Attempting to shorten the time to operate the fractures can lead to better results for patients because the other factors associated with poor reduction are inherent the trauma and cannot be modified by the surgeon.