RAMES MATTAR JUNIOR

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Lattes
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Departamento de Ortopediae Traumatologia, Faculdade de Medicina - Docente
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 4 Citação(ões) na Scopus
    Comparative analysis of scaphoid nonunion treatment with screw fixation and angular stable plate
    (2023) NAKAMOTO, Joao Carlos; XAVIER, Renato Martins; BURGOS, Felipe Hellmeister; WATAYA, Erick Yoshio; IWASE, Fernanda do Carmo; NAKAMOTO, Hugo Alberto; MATTAR JUNIOR, Rames
    Introduction Scaphoid fractures represent 5-10% of nonunion rate and the treatment options consist of an open reduction with correction of deformity, restoration of the scaphoid length with autologous wedge grafting and fixation. However, there is still no consensus in the literature on the best fixation method. Therefore, the purpose of the study is to compare plate fixation and screw fixation in treating scaphoid nonunion with humpback deformity and carpal instability. Methods Prospective, non-randomised study comparing the treatment of two groups of patients with scaphoid nonunion. A total of 19 patients were included in the study, the first ten patients were included in group 1 (plate fixation), subsequently nine patients were included in group 2 (screw fixation). The nonunion duration was longer than 6 months and patients did not present type III Scaphoid Nonunion Advanced Collapse (SNAC). Clinical evaluations included pain intensity, range of motion, grip strength, pinch test and functional scales Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Wrist Score. Radiographic evaluations consisted of radiographs of both wrists in AP, AP with ulnar deviation, lateral and oblique views. Patients further underwent a tomography of the affected wrist for bone deformity, carpal collapse and later consolidation evaluation. Results According to post-operative measurements, group 1 showed a significant improvement in the scapholunate angle (p = 0.011) and in the intrascaphoid angle (p = 0.002). Group 2 only showed an improvement in the scapholunate angle (p = 0.011). All patients in group 1 achieved consolidation in 8 weeks, while group 2 patients had a slower consolidation, with a mean of 14 weeks and standard deviation (SD) of 4.2, with statistical significance (p = 0.006). Conclusion Our prospective study, despite the limitations, contributes to the literature for demonstrating a better fixation using plate, with a better correction of humpback deformity and Dorsal Intercalated Segment Instability (DISI) and a faster consolidation.
  • article 0 Citação(ões) na Scopus
    Functional and morphological evaluation of the trapezius muscle after spinal accessory nerve transfer to brachial plexus nerves
    (2024) SIMAO, Danielle Tiemi; HEISE, Carlos O.; RODRIGUES, Joao C.; YAMAUTI, Lucas S.; VILLEGAS, Robin I.; CHO, Alvaro B.; MATTAR JUNIOR, Rames
    IntroductionThe main innervation of the trapezius muscle is provided by the spinal accessory nerve. Several studies describe the contributions of cervical plexus roots to the trapezius muscle innervation, either directly or through connections with the spinal accessory nerve. There is no adequate understanding of how the trapezius muscle is affected after using the spinal accessory nerve in nerve transfer procedures with the usual technique, preserving at least 1 branch for the upper trapezius.MethodsWe evaluated 20 patients with sequelae of traumatic brachial plexus injury who underwent surgical procedures for brachial plexus repair or free muscle transfer, which included the spinal accessory nerve transfer technique and were followed for a minimum of 1 year. The three portions trapezius muscle were evaluated by physical examination, magnetic resonance imaging (analysis of fatty degeneration) and electromyography.ResultsIn all evaluation methods, the middle and lower portions of the trapezius muscle showed more significant morphological and/or functional impairment than the upper portion, in most cases. There was a statistically significant difference in all the complementary exams results, between the affected side (with sacrifice of the nerve) versus the normal side, in the middle and lower portions of the trapezius muscle.ConclusionsPhysical examination alone is not sufficient to determine the residual functionality of the trapezius muscle. Magnetic resonance imaging and electromyography are useful tools to assess both morphological involvement of the trapezius muscle and nerve conduction impairment of the trapezius muscle, respectively. The results suggest that the middle and lower portions of the trapezius muscle are affected by previous SAN transfer and should be considered with caution for further muscle transfer procedures.
  • article 4 Citação(ões) na Scopus
    Microsurgical Reconstruction in an Orthopedic Hospital: Indications and Outcomes in Adults
    (2022) IAMAGUCHI, Raquel Bernardelli; MACEDO, Lucas Sousa; CHO, Alvaro Baik; REZENDE, Marcelo Rosa de; MATTAR JÚNIOR, Rames; WEI, Teng Hsiang
    Abstract Objective Advances in reconstructive microsurgery in orthopedic surgery provided better functional and aesthetic results and avoided many indications for amputation. In high-volume trauma and orthopedic hospitals, microsurgical reconstruction is essential to reduce costs and complications for these complex orthopedic defects. We describe a microsurgical approach to traumatic wounds, tumor resection, bone defects, and free muscle transfer, performed by an orthopedic microsurgery unit. The objective of the present study was to evaluate predictor factors for outcomes of microsurgical flaps for limb reconstruction, and to provide a descriptive analysis of microsurgical flaps for orthopedic indications. Methods Cross-sectional prospective study that included all consecutive cases of microsurgical flaps for orthopedic indications from 2014 to 2020. Data were collected from personal medical history, intraoperative microsurgical procedure, and laboratory blood tests. Complications and free-flap outcomes were studied in a descriptive and statistical analysis. Results We evaluated 171 flaps in 168 patients; the indications were traumatic in 66% of the patients. Type III complications of the Clavien-Dindo Classification were observed in 51 flaps. The overall success rate of the microsurgical flaps was 88.3%. In the multivariate analysis, the risk factors for complications were ischemia time ≥ 2 hours (p= 0.032) and obesity (p= 0.007). Partial flap loss was more common in patients with thrombocytosis in the preoperative platelet count (p= 0.001). Conclusion The independent risk factors for complications of microsurgical flaps for limb reconstruction are obesity and flap ischemia time ≥ 2 hours, and presence of thrombocytosis is a risk factor for partial flap loss.
  • article 0 Citação(ões) na Scopus
    Atypical Cleft Hand: Surgical Technique for Grasping Improvement
    (2024) BISNETO, Edgard de Novaes Franca; FERNANDES, Laura Filippini Lorimier; PAULA, Emygdio Jose Leomil de; MATTAR JUNIOR, Rames
    Introduction:We present 6 cases of children with atypical cleft hand and discuss a surgical technique. Clinically, participants presented with a lack of pulp-to-pulp pinch due to metacarpophalangeal ligament insufficiency and difficulty grasping large objects because of the narrowed first web.Materials and Methods:Second metacarpal resection and Z-plasty, creating a wide first web. The second extensor digitorum communis tendon was transferred to improve the thumb metacarpophalangeal joint stability.Conclusions:The surgical technique presented in this paper did improve function in oligodactyly or type-IIA atypical cleft hand.
  • article 1 Citação(ões) na Scopus
    ARTHROSCOPIC AND MACROSCOPIC EVALUATION OF THE LUNATE MEDIAL FACET
    (2011) BISNETO, Edgard de Novaes Franca; SOUSA, Bruno de Biase Cabral de; PAULA, Emygdio Jose Leomil de; MATTAR JUNIOR, Rames; ZUMIOTTI, Arnaldo Valdir
    Objective: To evaluate the correlation between the presence of a lunate medial facet and the incidence of ligament lesions of the wrist and arthrosis of the proximal pole of the hamate. This study was carried out on cadavers. Methods: Arthroscopic evaluation and dissection were performed on cadaver wrists. Results: There was a clear, statistically significant correlation between arthrosis of the proximal pole of the hamate and the presence of a medial facet on the lunate. Conclusion: Arthrosis of the proximal pole of the hamate is correlated with the presence of a type II lunate. Level of Evidence III, Study of nonconsecutive patients; without consistently applied reference ""gold"" standard.
  • article 7 Citação(ões) na Scopus
    COMPARATIVE STUDY BETWEEN OSTEOSYNTHESIS IN CONVENTIONAL AND BIOABSORBABLE IMPLANTS IN ANKLE FRACTURES
    (2015) GAIARSA, Guilherme Pelosini; REIS, Paulo Roberto dos; MATTAR JUNIOR, Rames; SILVA, Jorge dos Santos; FERNANDEZ, Tlio Diniz
    Objective: To compare the functional results of ankle fractures treated with metallic and absorbable plates. Twenty patients were randomized into two groups (metallic and absorbable implant groups) and followed prospectively. In the immediate postoperative period, patients were immobilized with plaster casts for one week, which was replaced by a removable cast for another four weeks. Partial weight-bearing was allowed after three weeks, and full weight-bearing after six weeks. Functional recovery was similar in both groups. At six months, three patients in the metallic group complained of local pain, and had their implants removed. One patient in the absorbable group exhibited early dehiscence of the suture and underwent debridement and suturing with good evolution. The American Orthopaedic Foot and Ankle Society (AOFAS) score was similar between the two groups after six and nine months of follow-up. The absorbable implants showed clinical and functional results that were similar to those of metallic implants.
  • article 0 Citação(ões) na Scopus
    EFFECT OF HYPERBARIC OXYGEN THERAPY ON NERVE REGENERATION IN RATS
    (2022) BARROS, Thiago Felipe Dos Santos; PAULOS, Renata Gregorio; IWASE, Fernanda Do Carmo; SANTOS, Gustavo Bispo Dos; REZENDE, Marcelo Rosa De; MATTAR JUNIOR, Rames
    Objective: To evaluate histological changes in peripheral nerves of rats after sciatic nerve neurorrhaphy, according to the time of exposure to hyperbaric oxygen chamber treatment. Methods: Twenty-five Wistar rats were divided into 5 groups according to the amount of exposure to hyperbaric oxygen chamber treatment. Group 1 was the control and there was no use of hyperbaric oxygen chamber; group 2 received one week of therapy; group 3, two weeks; group 4, three weeks; and group 5, four weeks. After the fourth postoperative week, the animals were submitted to euthanasia and a sciatic nerve sample sent for histological analysis. Axons proximal and distal to the neurorrhaphy were counted with axonal regeneration index measurement. Results: We observed that the number of axons distal to neurorrhaphy increases with the amount of hyperbaric oxygen chamber exposure, the results were more expressive from the third week of treatment. However, the statistical analysis found no significant difference between the groups. Conclusion: The descriptive analysis suggests benefit of using hyperbaric oxygen chamber directly proportional to the time of therapy. The study, however, did not present statistically relevant results, probably due to the reduced sample size. Subsequent studies with more significant sampling would be of great value. Level of Evidence II, Prospective Comparative Study.
  • article 4 Citação(ões) na Scopus
    Avaliação do ganho funcional do cotovelo com a cirurgia de Steindler na lesão do plexo braquial
    (2011) REZENDE, Marcelo Rosa de; MASSA, Bruno Sergio Ferreira; FURLAN, Fernando Cesar; MATTAR JUNIOR, Rames; PAULA, Emygdio Jose Leomil de; SANTOS, Simone Silva e; FREITAS, Maura Cristina
    Objective: To evaluate the gain in strength and range of motion after modified Steindler surgery of the elbow in patients with lesions of the upper trunk of the brachial plexus. Method: From 1998 to 2007, eleven patients with traumatic closed upper trunk lesion of the brachial plexus were studied. All the patients had development of at least 1 year of injury and degree of strength of elbow flexion ranging from M1 to M3. The patients underwent Steindler surgery with at least 6 months of follow-up. Pre- and post-operative assessments were carried out to determine gain in muscle strength, range of motion of the elbow, and DASH scale score. Results: Of the eleven patients studied, nine (82%) achieved a level of strength equal to or greater than M3 (MRC) with good functional recovery. Two (18%) reached strength level M2 (MRC). We observed that the patients had an average postoperative gain in range of motion of the elbow of 43.45 degrees. The average elbow flexion after surgery was 88 degrees. There was an improvement in elbow function, as demonstrated in the DASH Scale, in 81% of the patients studied. Conclusion: Modified Steindler surgery was effective in the treatment of patients with injuries of the upper trunk of the brachial plexus, with statistically significant gains in range of motion. In all the cases studied, there was some degree of gain in strength and range of elbow flexion, the gain being correlated with the initial muscle strength. Level of Evidence: Level II, prospective clinical trial.
  • article 0 Citação(ões) na Scopus
    THE DESIGN OF THE ARTERIOVENOUS VASCULAR LOOP DOES NOT AFFECT ITS PATENCY: EXPERIMENTAL STUDY
    (2020) SAITO, Mateus; REZENDE, Marcelo Rosa de; SANTOS, Gustavo Bispo dos; BITTENCOURT, Thiago; NUNES, Maria do Carmo; MATTAR JUNIOR, Rames
    Objective: To evaluate the effect of the design of a femoral vascular loop with anastomosis in the femoral artery of rabbits on the presence of flow (patency) after seven days. Methods: A total of 39 rabbits underwent arteriovenous microanastomosis using the microsurgical technique. Two loop designs were used: one circular and the other angled. The parameters evaluated were presence or absence of flow, signs of hemolysis and hemodynamic changes. Results: After seven days, flow was present in 68% of the angled loops and 75% of the circular loops (p > 0.05). There was a significant intragroup decrease in pCO(2) and a significant increase in pH. For the other parameters evaluated, no significant differences between the two loop models were found. Conclusions: A reproducible vascular loop model was shown. There was no significant difference between the two vascular loop models about the presence of flow after seven days.
  • article 5 Citação(ões) na Scopus
    IS OBESITY A RISK FACTOR FOR FREE VASCULARIZED FIBULAR FLAP COMPLICATIONS?
    (2019) IAMAGUCHI, Raquel Bernardelli; MORAES, Marco Aurelio de; SILVA, Gustavo Bersani; CHO, Alvaro Baik; IWASE, Fernanda do Carmo; WEI, Teng Hsiang; REZENDE, Marcelo Rosa de; MATTAR JR., Rames
    Objective: Although our knowledge of bone reconstruction through microsurgery has increased, the vascularized fibula flap remains one of the most difficult free flap reconstructions to perform, and complications remain a challenge. The incidence of obesity is increasing and is associated with higher rates of free flap complications, which can lead to disastrous results. Since there is no consensus in literature regarding the influence of obesity on free flap outcomes in orthopedic surgeries that require segmental bone reconstruction, the objective of this study was to determine whether obesity increases the risk of post-operative complications (Clavien-Dindo grade III) after free vascularized fibular flap surgery. Methods: A cohort study was conducted in all patients undergoing free flap limb reconstructions between July 2014 and July 2018. Patients were separated in two groups based on their body mass index (BM I): non-obese and obese (BMI >= 30 kg/m(2)). Results: Twenty-three free vascularized fibular flaps were studied. The indications included trauma in 13, tumors in 7, and congenital pseudarthrosis of the tibia in 3. Obese patients were associated with an increase in surgical complications (p=0.038). During the final follow-up, consolidation was obtained in 17 patients (74%). Conclusion: Obesity is a risk factor for complications in free vascularized fibular flap surgery.