ALEXANDRE LEME GODOY DOS SANTOS
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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- EPIDEMIOLOGICAL STUDY ON LISFRANC INJURIES(2017) SOBRADO, Marcel Faraco; SAITO, Guilherme Honda; SAKAKI, Marcos Hideyo; PONTIN, Pedro Augusto; SANTOS, Alexandre Leme Godoy dos; FERNANDES, Tulio DinizObjective: To analyze the characteristics of patients with Lisfranc injuries and their associated fractures. Methods: This is a retrospective analysis on 42 patients with Lisfranc injuries hospitalized at Instituto de Ortopedia e Traumatologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, between 2006 and 2010. Parameters on patient profile, risk factors, fracture characteristics, data on treatment and acute complications were analyzed. Results: Analysis of 42 cases showed that in our sample, men were more affected than women, with a ratio of 4.25:1. The most frequent trauma mechanism was car accident, followed by motorcycle accident. The most frequent type of injury was isolated lesion type B of Quenu and Kuss classification, representing 50% of cases. The most common fracture on the sample was the second metatarsal bone, with 16 cases, followed by cuboid bone fracture. Among the 42 cases, 17% had exposed fractures and 33 patients presented other associated fractures. The mean time elapsed between the trauma and definitive treatment was 6.7 days, while the mean length of hospital stay was 13.8 days. Six patients presented acute postoperative complications. Conclusion: Lisfranc injuries are more common in men undergoing automobile trauma. The prevalence of associated fractures is a frequent finding and the hospital stay may be longstanding.
article 3 Citação(ões) na Scopus Minimally invasive posteromedial percutaneous plate osteosynthesis for diaphyseal tibial fractures: technique description(2017) WAJNSZTEJN, Andre; PIRES, Robinson Esteves Santos; SANTOS, Alexandre Leme Godoy dos; LABRONICI, Pedro Jose; FERNANDES, Helio Jorge Alvachian; FERRETTI, MarioPurpose: The aim of this study was to evaluate the feasibility of performing minimally-invasive plate osteosynthesis (MIPO) in tibial fractures using two posteromedial incisions, and to measure the distance between the plate and neurovascular structures. Materials and methods: We performed nine dissections of specimens that were submitted to tibial MIPO with two posteromedial incisions. One locking compression plate (LCP) of 14 to 16 holes was inserted into the submuscular tunnel in a retrograde manner. Incisions were linked to evaluate the distance between neurovascular structures and the plate. Results: During the proximal incision, a blunt dissection between semitendinosus and medial gastrocnemius tendons, as well as their lateral shift, helped to protect the main local neurovascular structures. In its distal portion, the submuscular plate tunnel insertion and its direction to the proximal incision prevented direct contact and possible damage to neurovascular structures. Moreover, we obtained successful results from a patient submitted to this procedure. Conclusion: Posteromedial MIPO represents a safe and attractive alternative for tibial fractures, particularly if there are damaged soft tissues in the anterior and medial side, or when access to intramedullary osteosynthesis is blocked.- Diabetic limb salvage procedure with bone allograft and free flap transfer: A case report(2017) GODOY-SANTOS, A. L.; AMODIO, D. T.; PIRES, A.; LIMA, A. L. M.; WEI, T. H.; CESAR-NETTO, C. D.; ARMSTRONG, D. G.The aim of this case report was to describe a successful diabetic limb salvage procedure in the treatment of an infected diabetic foot ulcer through a multidisciplinary team approach and complex surgical reconstruction involving a femoral head bone allograft and musculocutaneous latissimus dorsi free flap. The decision to proceed with aggressive staged efforts at diabetic limb salvage should be made only after careful consultation with the patient, his or her family, and the rest of the multidisciplinary healthcare team. © 2017 The Author(s).
bookPart Pé diabético - fisiopatologia, diagnóstico e tratamento(2017) ORTIZ, Rafael Trevisan; SPOSETO, Rafael Barban; SANTOS, Alexandre Leme Godoy dos; SAKAKI, Marcos Hideyo; CORSATO, Marcos Andrade; FERNANDES, Túlio Diniz; LIMA, Ana Lúcia Lei Munhoz; OLIVEIRA, Priscila Rosalba Domingos de; MELLO, Henry; PARISI, Maria Cândida Ribeiro- ROLE OF BONE GRAFTS AND BONE GRAFT SUBSTITUTES IN ISOLATED SUBTALAR JOINT ARTHRODESIS(2017) SHAH, Ashish; NARANJE, Sameer; ARAOYE, Ibukunoluwa; ELATTAR, Osama; GODOY-SANTOS, Alexandre Leme; NETTO, Cesar de CesarObjectives: The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 +/- 14 months. The standard approach was used for all surgeries. Graft materials included beta-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 +/- 0.73 months and 3 +/- 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis.
- Matrix Metalloproteases 1 and 3 Promoter Gene Polymorphism Is Associated With Rotator Cuff Tear(2017) ASSUNCAO, Jorge H.; GODOY-SANTOS, Alexandre L.; SANTOS, Maria Cristina L. G. dos; MALAVOLTA, Eduardo A.; GRACITELLI, Mauro E. C.; FERREIRA NETO, Arnaldo A.Background Studies suggest that the collagen degeneration and disordered arrangement of collagen fibers in rotator cuff tears are associated with an increase in activity of matrix metalloproteases 1 and 3 (MMP-1 and MMP-3), and that MMP activity may be in part genetically mediated. The degree to which this might be clinically relevant in patients with rotator cuff tears has not been well characterized. Questions/purposes (1) Is genetic polymorphism of MMP-1 and MMP-3 associated with rotator cuff tears? (2) Are there haplotypes of MMP-1 and MMP-3 correlated with rotator cuff tears? (3) Compared with control subjects, do patients with rotator cuff tears have a higher proportion of relatives with the same disease? Methods We evaluated 64 patients with full-thickness rotator cuff tears and 64 asymptomatic control subjects. Patients younger 65 years, with nontraumatic tears, were included. The tear or integrity of the rotator cuff tear was evaluated by MRI or ultrasonography in all individuals. The patients and control subjects were paired by age. MMP-1 and MMP-3 genotypes were determined using the PCR-restriction fragment length polymorphism assays. Results Genetic polymorphisms in MMP-1 and MMP-3 are associated with rotator cuff tear, in which individuals with rotator cuff tears have associated genotypes 1G/2G (patients, 32 of 64 [50%], control subjects, 16 of 64 [25%]; odds ratio [OR], 4.8; 95% CI, 2.1-11.0; p < 0.001) and 2G/2G were at great risk (patients, 15 of 64 [23%], control subjects, seven of 64 [11%]; OR, 5.2; 95% CI, 1.8-14.9; p < 0.001), and patients with rotator cuff tears were associated with a higher proportion of 2G allele distribution (62 of 128 [48%] versus 30 of 128 [23%]; p < 0.001). Patients with the 5A/5A genotype are at greater risk of rotator cuff tear (patients, 15 of 64 [23%]; control subjects, four of 64 [6%]; OR, 5.5; 95% CI, 1.4-20.9; p = 0.021), and there was higher 5A allele distribution in patients with rotator cuff tears (patients, 68 of 128 [53%]; control subjects, 52 of 128 [41%]; p = 0.045). Individuals with the haplotype 2G/5A were more likely to have rotator cuff tears develop (patients, 42 of 64 [66%]; control subjects, 17 of 64 [27%]; OR, 5.3; 95% CI, 2.5-11.3; p < 0.001). Patients with rotator cuff tears reported, in higher number, the existence of relatives who previously had treatment for rotator cuff tears (19 of 64 [30%] versus four of 64 [6%]; OR, 6.3; 95% CI, 2.0-19.9; p = 0.001). Conclusions The genetic polymorphism of MMP-1 and MMP-3 is associated with rotator cuff tear. Individuals with haplotype 2G/5A were more susceptible to rotator cuff tears in the population studied. .
- Finite element analysis of the equivalent stress distribution in Schanz screws during the use of a femoral fracture distractor(2017) GIORDANO, Vincenzo; GODOY-SANTOS, Alexandre Leme; BELANGERO, William Dias; PIRES, Robinson Esteves Santos; LABRONICI, Pedro José; KOCH, Hilton AugustoABSTRACT To evaluate the mechanical stress and elastic deformation exercised in the thread/shaft transition of Schanz screws in assemblies with different screw anchorage distances in the entrance to the bone cortex, through the distribution and location of tension in the samples. An analysis of 3D finite elements was performed to evaluate the distribution of the equivalent stress (triple stress state) in a Schanz screw fixed bicortically and orthogonally to a tubular bone, using two mounting patterns: (1) thread/shaft transition located 20 mm from the anchorage of the Schanz screws in the entrance to the bone cortex and (2) thread/shaft transition located 3 mm from the anchorage of the Schanz screws in entrance to the bone cortex. The simulations were performed maintaining the same direction of loading and the same distance from the force vector in relation to the center of the hypothetical bone. The load applied, its direction, and the distance to the center of the bone were constant during the simulations in order to maintain the moment of flexion equally constant. The present calculations demonstrated linear behavior during the experiment. It was found that the model with a distance of 20 mm between the Schanz screws anchorage in the entrance to the bone cortex and the thread/shaft transition reduces the risk of breakage or fatigue of the material during the application of constant static loads; in this model, the maximum forces observed were higher (350 MPa). The distance between the Schanz screws anchorage at the entrance to the bone cortex and the smooth thread/shaft transition of the screws used in a femoral distractor during acute distraction of a fracture must be farther from the entrance to the bone cortex, allowing greater degree of elastic deformation of the material, lower mechanical stress in the thread/shaft transition, and minimized breakage or fatigue. The suggested distance is 20 mm.
- Increased cytokine levels and histological changes in cartilage, synovial cells and synovial fluid after malleolar fractures(2017) GODOY-SANTOS, Alexandre L.; RANZONI, Lucas; TEODORO, Walcy R.; CAPELOZZI, Vera; GIGLIO, Pedro; DINIZ-FERNANDES, Tulio; RAMMELT, StefanBackground: Malleolar fractures are among the most common fractures in the human skeleton with a high risk of later development of post-traumatic osteoarthritis (OA). The acute ankle injury initiates a sequence of events potentially leading to progressive articular surface damage resulting from inflammatory changes in cartilage, synovial tissue and synovial fluid. We hypothesised that in the acute phase of ankle fracture, these changes occur at the same time in the different tissues. Methods: Specimens of chondral tissue, synovial tissue and synovial fluid were collected from 16 patients with acute articular ankle fracture (study group). Additional samples were obtained from five male fresh cadavers within 12 hours of death (control group). Chondral tissue was assessed for cellularity, irregularities and chondrocyte disarray. Synovial tissue was assessed for synovitis, proteoglycans and collagen deposition. Synovial fluid was assessed for cytokines IL-2, IL-6, IL-10, IL-17, IFN-7 and TGF-beta 1. Results: Chondral tissue showed discontinuity in the tidemark between cartilage and subchondral bone, chondrocyte disarray, increased cellularity (both at the cartilage surface and subchondral bone), articular surface irregularities and increased deposition of proteoglycans and collagen fibres. Synovial tissue showed a statistically significant difference between the study and control groups in the concentration per tissue area of both thin collagen fibres (p=0.0274) and thick collagen fibres (p<0.0001). Cytokine concentrations in synovial fluid samples were significantly higher in ankle fracture tissue compared with controls for IL-2 (p=0.0002), IL-6 (p< 0.0001), IL-10 (p=0.002) and IL-17 (p< 0.0001). No statistically significant differences were observed for IFN-gamma, (p= 0.06303) and TGF-beta 1 (p= 0.8832). Conclusion: We observed a pattern of simultaneous and interrelated pathological changes in cartilage, subchondral bone, synovial tissue and synovial fluid after acute malleolar fracture. As the observed inflammatory changes could lead to the development of OA, a more thorough knowledge of these early processes could be helpful to find strategies for prevention or delay of this common complication.