ARNALDO AMADO FERREIRA NETO
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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- Locking intramedullary nails compared with locking plates for two- and three-part proximal humeral surgical neck fractures: a randomized controlled trial(2016) GRACITELLI, Mauro E. C.; MALAVOLTA, Eduardo A.; ASSUNCAO, Jorge H.; KOJIMA, Kodi E.; REIS, Paulo R. dos; SILVA, Jorge S.; FERREIRA NETO, Arnaldo A.; HERNANDEZ, Arnaldo J.Background: Previous studies have shown good clinical results in patients with proximal humeral fractures (PHFs) treated with locking intramedullary nails or locking plates. Our study compared the clinical and radiographic outcomes in patients with 2- and 3-part surgical neck fractures. Methods: In this prospective, randomized controlled trial, 72 patients with 2- or 3-part surgical neck PHFs were randomly assigned to receive fixation with locking intramedullary nails (nail group) or locking plates (plate group). The primary outcome was the 12-month Constant-Murley score. The secondary outcomes included the Disabilities of the Arm, Shoulder and Hand score, the visual analog scale pain score, the shoulder passive range of motion, the neck-shaft angle, and complication rates. Results: There was no significant mean treatment group difference in the Constant-Murley score at 12 months (70.3 points for the nail group vs. 71.5 points for the plate group; P=.750) or at individual follow-up assessments. There were no differences in the 3-, 6- and 12-month Disabilities of the Arm, Shoulder and Hand scores, visual analog scale scores, and range of motion, except for the medial rotation at 6 months. The neck-shaft angle was equivalent between the groups at 12 months. There were significant differences over 12 months in total complication rates (P=.002) and reoperation rates (P=.041). There were no significant differences for the rotator cuff tear rate (P=.672). Conclusion: Fixation of PHFs with locking plates or locking intramedullary nails produces similar clinical and radiologic results. Nevertheless, the complication and reoperation rates were higher in the nail group. Level of evidence: Level I; Randomized controlled trial; Treatment study (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees.
- Intraobserver and interobserver agreement in the classification and treatment of proximal humeral fractures(2017) GRACITELLI, Mauro E. C.; DOTTA, Thiago A. G.; ASSUNCAO, Jorge H.; MALAVOLTA, Eduardo A.; ANDRADE-SILVA, Fernando B.; KOJIMA, Kodi E.; FERREIRA NETO, Arnaldo A.Background: There is controversy surrounding the reliability of radiographic measurements and existing classifications for proximal humeral fractures. Methods: Ten orthopedists, divided into 2 groups by length of experience, evaluated radiographs in 3 views from 40 proximal humeral fractures. We evaluated 11 radiographic criteria (including the Neer and pathomorphologic classifications, head-shaft angle, displacement of the humeral shaft, and lesser and greater tuberosities) and treatment indication. We also analyzed the criteria that most influenced the choice of treatment. Results: Interobserver reliability was substantial for the presence of fracture of the greater tuberosity (kappa = 0.749) and medial metaphyseal comminution (kappa = 0.627) and moderate for the pathomorphologic classification (kappa = 0.504), displacement of the greater tuberosity (kappa = 0.422), and treatment decision (kappa = 0.565). Intraobserver reliability was substantial for treatment indication (kappa = 0.620) and presence of displacement of the fracture of the greater tuberosity (kappa = 0.627 and 0.611) and moderate for the Neer (kappa = 0.490) and pathomorphologic (kappa = 0.607) classifications. The results were influenced by the observer's experience. The surgical indication was influenced by the pathomorphologic classification in 50% of the evaluators (odds ratio, 4.85; range, 3.30-8.65). Conclusion: The pathomorphologic classification has higher reliability than the Neer classification and was the factor that most influenced the surgical decision. The determination of the presence of fracture and displacement of the greater tuberosity and medial metaphyseal comminution is reliable with the use of simple radiographs, and the results were influenced by the observer's experience. Level of evidence: Basic Science Study; Validation of Classification System (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.
- Ultrasound evaluation of the rotator cuff after osteosynthesis of proximal humeral fractures with locking intramedullary nail(2017) GRACITELLI, Mauro Emilio Conforto; MALAVOLTA, Eduardo Angeli; ASSUNÇÃO, Jorge Henrique; MATSUMURA, Bruno Akio; KOJIMA, Kodi Edson; FERREIRA NETO, Arnaldo AmadoABSTRACT Objective: To evaluate supraspinatus tendon integrity with ultrasound (US) in patients submitted to proximal humeral fracture (PHF) fixation with a locking intramedullary nail., Methods: Thirty-one patients with PHF treated with curvilinear locking intramedullary nail, aged between 50 and 85 years, were assessed by US at six months postoperatively and clinically at six and 12 months postoperatively. The primary aim was supraspinatus tendon integrity, evaluated by US at six months postoperatively. Secondary aims included the Constant-Murley, DASH score, and visual analog pain scores, as well as complications and reoperation rates. Results: Full-thickness rotator cuff ruptures were observed in four patients (13%), supraspinatus ruptures in three cases (10%), and subscapularis ruptures in one case (3%). Partial ruptures were diagnosed in 10 cases (32%). The results using the Constant-Murley score at 12 months were 71.3 ± 15.2 points for the entire series, with 73.2 ± 16.1 points for patients without rotator cuff ruptures and 68.7 ± 14.1 points for those with partial or complete ruptures, without a statistically significant difference (p= 0.336). Complications, exclusively for rotator cuff ruptures, were observed in nine patients (29%). Conclusion: A high rate of rotator cuff ruptures was demonstrated, with partial ruptures in 32% of cases and full-thickness ruptures in 13%. However, clinical results are satisfactory, and are not influenced by the presence of rotator cuff ruptures.
- Outcomes evaluation of locking plate osteosynthesis in displaced fractures of the proximal humerus(2013) GRACITELL, Mauro Emilio Conforto; LOBO, Frederico Lafraia; FERREIRA, Gustavo Maximiano Aliperti; PALMA, Marcos Vianna da; MALAVOLTA, Eduardo Angeli; BENEGAS, Eduardo; KOJIMA, Kodi Edson; FERREIRA NETO, Arnaldo Amado; SILVA, Jorge dos SantosObjective: To evaluate functional outcomes, radiographic findings and complications of proximal humeral fractures treated with locking plates and to determine prognostic factors for successful clinical outcomes. Methods: Forty patients undergoing internal fixation of fractures of the proximal humerus with the Philos(r) plate were included in the study. The surgeries were performed between 2004 and 2011 and the patients underwent radiographic and clinical evaluation, by Constant -Murley and Dash score. Outcomes were analyzed by use of multivariate regression with several different variables. Results: Patients were on average of 61.8 ± 16.28 years, and most were female (70%). The Constant -Murley score was 72.03 ± 14.01 and Dash score was 24.96 ± 19.99. The postoperative radiographs showed a head-shaft angle of 135.43º± 11.82. Regression analysis showed that the patient's age and the Hertel classification influenced the Constant -Murley scale (p = 0.0049 and 0.012, respectively). Other prognostic criteria such as Neer and AO classification, head-shaft angle, the presence of metaphyseal comminution and extension of the humeral metaphyseal fragment showed no effect on prognosis. Complications occurred in four patients (10%). Conclusion: The fixation with the Philos(r) plate provided good clinical and radiographic results in fractures of the proximal humerus, with a low complication rate. Patient's age and Hertel classification were defined as prognostic factors that led to worse functional outcomes.
- Nonoperative Treatment for Displaced Proximal Humeral Fractures in Elderly Patients: Correlation Between Deviations and Clinical Outcomes(2022) GRACITELLI, Mauro Emilio Conforto; YAMAMOTO, Gustavo Jum; MALAVOLTA, Eduardo Angeli; ANDRADE-SILVA, Fernando Brandão; KOJIMA, Kodi Edson; FERREIRA NETO, Arnaldo AmadoAbstract Objectives To describe the functional result of the conservative treatment of displaced proximal humerus fractures (PHF) using the American Shoulder and Elbow Surgeons (ASES) score after 12 months and assess whether the different initial classifications and radiographic measurements are related to clinical results. Methods Forty patients > 60 years old, with displaced PHUs submitted to conservative treatment were evaluated at standardized times (3, 6, and 12 months). The American Society of Shoulder and Elbow Surgeons (ASES), Constant-Murley and Single Assessment Numeric Evaluation (SANE) scales were used as clinical outcomes. Radiographic variables included the Neer and Resch classifications, the presence and displacement of tuberosity fracture, metaphyseal comminution, medial periosteal lesion, and angular and translational deviations of the head in the coronal and sagittal plane. Results The result of the ASES score was 77.7 23.2 for the whole sample, the mean absolute values of the Constant-Murley score were 68.7 16 and 82.6% for the scale relative to the contralateral side. The SANE scale at 12 months was 84.8 19. We observed that the severity of the Neer classification and the coronal plane angular deviation (measured by the head-shaft angle) and the presence of fractures in both tuberosities negatively influenced the ASES score after 12 months of treatment. Conclusion Nonoperative treatment of displaced proximal humerus fractures in elderly patients results in good clinical results. Clinical results are negatively influenced by the angular deviation of the humeral head and the presence of fractures of the greater and lesser tubercles, as well as by the Neer classification.