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.
- 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.
- 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.
- Functional results and isokinetic muscle strength in patients with Fraser type I floating knee treated with internal fixation(2017) ANDRADE-SILVA, Fernando Brandao; CARVALHO, Adriana; MANSANO, Caio; GIESE, Aline; LEONHARDT, Marcos de Camargo; BARBOSA, Dennis; KOJIMA, Kodi Edson; SILVA, Jorge SantosIntroduction: According to Fraser's description, ipsilateral femoral and tibial diaphyseal fractures are characterised as type I floating knee and have a better prognosis than fractures with joint involvement (type II). There are few reports of functional and muscle strength in these patients. The objective of this study was to evaluate the functional and isokinetic muscle strength of patients with type I floating knee undergoing femoral and tibial internal fixation. Methods: Patients with type I floating knee undergoing concomitant femoral and tibial internal fixation were invited for clinical evaluation. The parameters evaluated included the following: Karlstrom and Olerud score; Lysholm score; isokinetic thigh and hip muscle evaluation; knee range of motion; pain level; investigation of associated knee injuries by clinical evaluation and MRI; and types of complications. Results: Twenty-one patients were included in the study; 11 of these were clinically evaluated, with a mean follow-up of 23.9 months. Six patients had an acceptable result according to the Karlstrom criteria, whereas eight patients had a poor result based on the Lysholm scale. The peak torque deficit was 61% for knee extensors, 37% for flexors and -9% for hip abductors. The mean pain level was 5.9. Three patients had a partial anterior cruciate ligament (ACL) injury; one patient had a posterior cruciate ligament (PCL) injury; and three patients had a meniscal injury. There were four cases of tibial or femoral nonunion at one year and two cases of chronic osteomyelitis. Conclusion: Patients with type I floating knee had unsatisfactory functional results, significant knee extensor and flexor muscle strength deficits and a significant rate of complications at the two-year follow-up.
- Bioactive glass S53P4 to fill-up large cavitary bone defect after acute and chronic osteomyelitis treated with antibiotic-loaded cement beads: A prospective case series with a minimum 2-year follow-up(2021) KOJIMA, Kodi Edson; SILVA, Fernando Brandao de Andrade e; LEONHARDT, Marcos de Camargo; CARVALHO, Vladimir Cordeiro de; OLIVEIRA, Priscila Rosalba Domingos de; LIMA, Ana Lucia Lei Munhoz; REIS, Paulo Roberto dos; SILVA, Jorge dos SantosY Introduction: Bioactive glass S53P4 (BAG-S53P4) has been used in the treatment of osteomyelitis with excellent results. The aim of this study was to evaluate the clinical and radiographic results of patients treated with use of antibiotic-loaded cement beads, followed by bone defects filling using bioglass. Methods: We treated a prospective series of patients presenting with acute or chronic osteomyelitis of a long bone of the upper or lower limb. The first-stage procedure involved debridement and filling of cavitary defects with antibiotic-loaded polymethylmethacrylate (PMMA) beads. When signs of infection subsided, the defects were filled with BAG-S53P4. The main outcomes assessed were the reinfection rate, need for reoperation, radiographic and functional evaluations (DASH and Lysholm scores). Results: Ten patients were included, aged between 4 and 66 years (mean 25.4 years). The source of infection was hematogenic in five cases and post-traumatic in the other five. Hematogenic infections required two debridements before filling with bioglass, whereas post-traumatic cases required only one. The time between the first debridement and the application of bioglass varied from 1 to 63 weeks (average of 17 weeks). All patients showed a favorable evolution after bioglass procedure, with no need for reoperation or relevant wound problems. The radiographic evaluation showed partial incorporation of the material and adequate bone formation, and functional scores were satisfactory in all cases. Conclusion: The treatment of osteomyelitis with surgical debridement and PMMA beads, followed by filling of bone defect with BAG-S53P4, was effective in all patients evaluated, with adequate infectious control and bone regeneration. No cases required reoperation after bioglass implantation. Patients with hematogenous osteomyelitis required a greater number of debridements before filling with bioglass. (C) 2021 Published by Elsevier Ltd.
- A new low-cost negative-pressure wound therapy versus a commercially available therapy device widely used to treat complex traumatic injuries: a prospective, randomized, non-inferiority trial(2017) KAMAMOTO, Fabio; LIMA, Ana Lucia Munhoz; REZENDE, Marcelo Rosa de; MATTAR-JUNIOR, Rames; LEONHARDT, Marcos de Camargo; KOJIMA, Kodi Edson; SANTOS, Carla Chineze dosOBJECTIVES: Negative-pressure wound therapy has been widely adopted to reduce the complexity of treating a broad range of acute and chronic wounds. However, its cost is high. The objective of this study was to evaluate the following two different methods of negative-pressure wound therapy in terms of healing time: a low-cost method of negative-pressure wound therapy (a pressure stabilizer device connected to a hospital wall-vacuum system with a gauze-sealed dressing, USP) and the standard of care (vacuum-assisted closure, VAC). METHODS: This is a randomized, controlled, non-inferiority, unblinded trial. Patients admitted with complex injuries to a trauma center in a public referral hospital who were indicated for orthopedic surgery were randomized to a USP or VAC group. The primary outcome was the time required to achieve a ""ready for surgery condition'', which was defined as a wound bed with healthy granulation tissue and without necrosis or purulent secretion. Wound bed area contraction, granulation tissue growth and the direct costs of the dressings were secondary outcomes. RESULTS: Variation in area and granulation tissue growth were essentially the same between the systems, and healing time was equal between the groups (p= 0.379). In both systems, serial debridement increased wound area (p= 0.934), and granulation tissue was also increased (p= 0.408). The mean treatment cost was US$ 15.15 in the USP group and US$ 872.59 in the VAC group. CONCLUSIONS: For treating complex traumatic injuries, USP was non-inferior to and less expensive than VAC.
- Incidence and risk factors associated with infection after intramedullary nailing of femoral and tibial diaphyseal fractures: Prospective study(2018) OLIVEIRA, Priscila R.; LEONHARDT, Marcos C.; CARVALHO, Vladimir C.; KOJIMA, Kodi E.; SILVA, Jorge S.; ROSSI, Flavia; LIMA, Ana Lucia L.Background: Diaphyseal fractures of femur and tibia are prominent due to its high incidence and high economic and social impact. Intramedullary nailing (IN) is the surgical procedure of choice. Surgical site infection (SSI) related to this procedure is considered a difficult to treat complication. Aims: Determine the incidence of SSI after IN of femoral and tibial diaphyseal fractures and evaluate possible risk factors. METHODS: Prospective observational cohort study. SSI was defined according to CDC-NHSN criteria and surveillance period for the occurrence of infection was 12 months. Incidence of SSI was calculated as the ratio between the number of patients with SSI and total number of patients. Analysis of potential risk factors included patients-related factors (age, gender, body mass index, active foci of infection, immunosuppressive conditions, ASA score, alcohol or illicit drug abuse, smoking, polytrauma, etiology of fracture, type of fracture if closed or open, classification of fracture according to Muller AO, Tcherne classification for closed fractures, Gustilo-Anderson classification for open fractures, previous surgical manipulation, use of blood products); environmental and surgical-related factors (surgical wound classification, duration of surgery, hair removal, intraoperative contamination, antimicrobial use, presence of drains, hypothermia or hypoxia in the perioperative period, type of IN used, reaming, need for soft tissue reconstruction, use of negative pressure therapy) and microbiota-related factors (cultures of nasopharyngeal swabs for Staphylococcus aureus and axillary/inguinal/perineal swab for Acinetobacter baumannii). Results: 221 patients were included and completed the 12-month follow-up period. Incidence of SSI was 11.8%. In the initial analysis by unadjusted logistic regression, following factors were associated SSI: Muller AO classification of the fracture morphology groups 2 or 3, previous use of external fixator, presence of drains, use of negative pressure therapy and need for muscle or skin flap repair. In the multiple logistic regression-adjusted analysis, previous use of external fixator and need for muscle or skin flap repair remained associated with SSI. Conclusions: Incidence of SSI associated with IN for femoral and tibial diaphyseal fractures was 11.8%. Previous use of external fixators and need for muscle or skin flap repair were factors associated with occurrence of infection.