RAFAEL BARBAN SPOSETO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
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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- SOFT-TISSUE INJURY TO THE FOOT AND ANKLE: LITERATURE REVIEW AND STAGED MANAGEMENT PROTOCOL(2019) GODOY-SANTOS, Alexandre Leme; SCHEPERS, Tim; RAMMELT, Stefan; SAKAKI, Marcos Hideyo; MATELUNA, Cristian Ortiz; SPOSETO, Rafael Barban; SYMEONIDIS, Panagiotis; BITAR, Rogerio; DARWISH, Husam; ZWIPP, HansComplex trauma of the foot and ankle is characterized by fractures with severe soft tissue damage associated with neurovascular injury and joint involvement. These injuries are frequently present in the polytraumatized patient and are a predictor of unfavorable clinical outcome. In the initial approach to a patient with complex foot and ankle trauma, the decision between amputation and reconstruction is crucial. The various existing classification systems are of limited effectiveness and should serve as tools to assist and support a clinical decision rather than as determinants of conduct. In the emergency department, one of two treatment options must be adopted: early complete treatment or staged treatment. The former consists of definitive fixation and immediate skin coverage, using either primary closure (suturing) or flaps, and is usually reserved for less complex cases. Staged treatment is divided into initial and definitive. The objectives in the first phase are: prevention of the progression of ischemia, necrosis and infection. The principles of definitive treatment are: proximal-to-distal bone reconstruction, anatomic foot alignment, fusions in severe cartilage lesions or gross instabilities, stable internal fixation and adequate skin coverage.
- Diabetic Foot(2022) GODOY-SANTOS, A. L.; SPOSETO, R. B.Diabetic foot syndrome is among the most serious complications of diabetes mellitus; it is increasing in worldwide prevalence despite advances in the clinical and metabolic control of diabetes mellitus. It represents great suffering for patients, their families, professionals, and health institutions and for society in general. It is a clinical situation associated with a high financial impact on health systems around the world. Treatment strategies are based on prevention, patient education, a multidisciplinary approach, and the principles of appropriate surgical and non-surgical treatment. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
bookPart Prevenção e abordagem cirúrgica das infecções(2013) FERNANDES, Tulio Diniz; SPOSETO, Rafael Barban; ORTIZ, Rafael Trevisan; SANTOS, Alexandre Leme Godoy dos; SAKAKI, Marcos Hideyo; CORSATO, Marcos de Andrade- Talar Body Reconstruction for Nonunions and Malunions(2018) SAKAKI, Marcos Hideyo; MACEDO, Rodrigo Sousa; SANTOS, Alexandre Leme Godoy Dos; ORTIZ, Rafael Trevisan; SPOSETO, Rafael Barban; FERNANDES, Tulio DinizBackground: Talar body and neck nonunions and malunions may undergo a reconstructive surgery when joint cartilage is still viable, and no talar collapse or infection has occurred. This is a rare condition and the studies supporting the procedure have small number of cases. The objective of the present study is to report a case series of six patients who underwent talar reconstructions. Materials and Methods: Six patients with talar malunions or nonunions who underwent surgical treatment were reviewed in this retrospective study. There were three nonunions and two malunions of the talar body and one malunion of the talar neck. Clinical evaluation included all the parameters used in the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale. Arthritic degeneration of the ankle joint was assessed according to a modified Bargon scale. Results: The mean followup was 86 months (range 24-282 months). There were no cases of postoperative avascular necrosis of the talus. Four of the six patients in our series required a subtalar fusion as part of the reconstruction procedure. The average preoperative AOFAS hindfoot score was 34, and at the time of the last evaluation, it was 74. The mean preoperative score on the modified Bargon scale for the tibiotalar joint was 1.17. At the last followup, it rose to 1.33. Three different deformities of the talus were identified (a) flattening of the talus (b) extra-articular step and (c) intraarticular step. Conclusion: Reconstruction of talar nonunions and malunions improved function in selected patients with a low risk of complications. Three different anatomical patterns of talar nonunions and malunions were identified.
- Arthrodesis in the Deformed Charcot Foot(2022) ROSEMBERG, Dov Lagus; SPOSETO, Rafael Barban; GODOY-SANTOS, Alexandre Leme
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- Tibiotalocalcaneal Arthrodesis: A Retrospective Comparison Between Nails and Lateral Locking Plate Complications(2023) ROSEMBERG, D. L.; MACEDO, R. S.; SPOSETO, R. B.; SAKAKI, M. H.; GODOY-SANTOS, A. L.; FERNANDES, T. D.Background: Tibiotalocalcaneal arthrodesis is a well-established procedure to treat some hindfoot diseases. Currently, the most used implants are retrograde intramedullary nails and locking plates combined with lag screws, but there are few articles comparing differences regarding the complications. Methods: We have retrospectively analyzed the medical records and the radiographs of patients older than 18 years who underwent this procedure in our service between 2005 and 2019 through retrograde intramedullary nails or lateral locking plates and compression screws with at least 12 months of follow-up and with no history of osteomyelitis in these bones. Results: We evaluated a total of 67 patients; of these, 48 received retrograde intramedullary nail implants and 19 received locking plates and compression screws. The overall mean age was 48 years; the median follow-up time was 64.3 months. The complication rate was 60.4% for the intramedullary nail procedure and 52.6% for the locking plate combined with compression screws procedure. Conclusion: No significant differences were found in the complication rates between the 2 implants. Level of Evidence: Level V, Case series
- Weightbearing Forefoot Axial Radiography - Technical Description and Reproducibility Evaluation(2020) SPOSETO, Rafael Barban; SAKAKI, Marcos Hideyo; GODOY-SANTOS, Alexandre Leme; ORTIZ, Rafael Trevisan; MACEDO, Rodrigo Sousa; FERNANDES, Tulio DinizAbstract Objective The present study aims to describe a new weightbearing radiographic method to visualize the heads of the five metatarsals on the coronal plane, evaluating their accuracy through intraclass correlation coefficients. Methods The subjects were evaluated, with weightbearing, with the ankle at 20 degrees of plantar flexion and the metatarsophalangeal joints at 10 degrees of extension, positioned on a wooden device. Two independent foot and ankle surgeons evaluated the radiography, with one of them doing it twice, at different moments, achieving an inter and intraobserver correlation, with intraclass correlation coefficients. Results We radiographed 63 feet, achieving an interobserver correlation coefficient of the radiographic method for the metatarsal heads heights in the coronal plane of the 1st, 2nd, 3rd, 4th, and 5th metatarsals of, respectively, 0.90, 0.85, 0.86, 0.83, 0.89. The intraobserver correlation coefficient were, respectively, 0.95, 0.93, 0.93, 0.86, 0.92. Conclusion Those correlations demonstrate that the method is accurate and can be used to investigate metatarsal head misalignments in this plane.
- Charcot Neuroarthropathy(2022) SPOSETO, R. B.; GODOY-SANTOS, A. L.Charcot’s Neuroarthropathy (CN) is a serious pathology, with devastating impact on mobility and quality of life of the patient. Although its pathophysiology is not completely clear, it is related to sensory neuropathy, repetitive trauma, and increased expression of pro-inflammatory cytokines. Currently, Diabetes Mellitus (DM) is the disease most related to this pathology. The pathology begins with intense inflammation, associated with fractures and cumulative and progressive dislocations, mainly in the foot and ankle. At the end of the inflammatory phase, bone healing occurs, and the residual deformity is established. The objective of the treatment is to obtain a functional plantigrade foot at the end of the four clinical phases. The initial approach is to protect the foot in the inflammatory phase to avoid progression of the fractures and deformity. After the consolidation phase in case the patient does not adapt to the modification of footwear and orthotics, the surgical treatment for foot realignment should be indicated. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
- The Flatfoot in Collapse Needs Stability and That is Why I Fuse It(2019) SPOSETO, Rafael B.; SAKAKI, Marcos H.; FERNANDES, Tulio D.; GODOY-SANTOS, Alexandre L.The pathophysiology and treatment of the adult-acquired flatfoot is still quite controversial. Soft tissue reconstruction and tendon transfer surgery combined with corrective osteotomy for flexible deformities are well established in the literature. However, patients with signs of hindfoot osteoarthritis, rheumatological or neurological diseases, and obesity can benefit from surgical correction with arthrodesis because of greater outcome predictability. Various types of arthrodesis, including isolated, triple, double, or segmental procedures, have been described to treat this deformity. We will discuss the events leading to the progressive collapse of the medial arch and distinguish between patients who could benefit from reconstruction with arthrodesis from those who cannot, as well as the indications for these technical options. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.