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.
- 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
- 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.
- 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.
- Common late complications of longitudinal forefoot amputations in neuropathic foot treatment(2021) MACEDO, Rodrigo Sousa; MACEDO, Lucas Sousa; SAKAKI, Marcos Hideyo; SPOSETO, Rafael Barban; ORTIZ, Rafael Trevisan; CORSATO, Marcos de Andrade; GODOY-SANTOS, Alexandre Leme; FERNANDES, Tulio DinizObjective: To describe and quantify the complications arising in consecutive neuropathic patients undergoing partial longitudinal amputations of the foot. Method: A retrospective study was conducted with data collected from the medical records of patients monitored at the Insensitive Foot Clinic of the Foot and Ankle Group of our institution who underwent partial amputation of foot rays from 2000 to 2016. Results: A total of 28 patients met the inclusion criteria, with a total of 31 amputated/partially amputated feet. Of these, 18 (58.1%) feet were amputated/partially amputated due to diabetes, seven (22.6%) due to leprosy, two (6.5%) due to alcoholic neuropathy, two (6.5%) secondary to traumatic peripheral nerve injury, and two (6.5%) due to other causes. Fifth ray amputation was the most frequent type (n=12). The cause of amputation was the presence of an infected ulcer in 93.6% of the samples. At a mean follow-up time of 60 months, 13 (41.9%) feet required new amputations-five (38.5%) transtibial, five (38.5%) transmetatarsal, two (15.4%) of the toes, and one (7.7%) at Chopart's joint. Patients with diabetes had a 50.0% reamputation rate. Patients who initially underwent amputation of the fifth ray had a 58.3% reamputation rate. Conclusion: Partial longitudinal amputation of the foot in neuropathic patients exhibited a high reoperation rate, especially in patients with diabetes or in patients with initial amputation of the peripheral rays.
- Histoarchitecture of the fibrillary matrix of human fetal posterior tibial tendons(2022) MACEDO, Rodrigo Sousa; TEODORO, Walcy Rosolia; CAPELLOZZI, Vera Luiza; ROSEMBERG, Dov Lagus; SPOSETO, Rafael Barban; NETTO, Cesar de Cesar; DELAND, Jonathan T.; MAFFULLI, Nicola; ELLIS, Scott J.; GODOY-SANTOS, Alexandre LemeAdult tendons are highly differentiated. In mature individuals, tendon healing after an injury occurs through fibrotic tissue formation. Understanding the intrinsic reparative properties of fetal tendons would help to understand the maturation tissue process and tendon tissue repair. The present study evaluated the evolution of histoarchitecture, cellularity and the distribution of collagens I, III and V in the posterior tibial tendon in human fetuses at different gestational ages. Morphological profiles were assessed in nine fresh spontaneously aborted fetuses (Group I: five fetuses aged between 22 and 28 weeks of gestation; Group II: four fetuses aged between 32 and 38 weeks of gestation), characterized by a combination of histology, fluorescence and immunohistochemistry. In Group I, the posterior tibial tendon showed statistically significant greater cellularity and presence of collagen III and V than in Group II tendon, which showed a predominance of collagenous I and a better organization of the extracellular matrix compared with Group I tendons. In addition, a statistically significant higher rate of CD90, a marker of mesenchymal cells, was found in Group I tendons. In fetuses with gestational age between 22 and 28 weeks, the posterior tibialis tendons showed a thin and disorganized fibrillar structure, with an increase in collagen III and V fibers and mesenchymal cells. In the posterior tibialis tendons of fetuses with gestational age between 32 and 38 weeks, the fibrillar structure was thicker with a statistically significant increase in type I collagen and decreased cellularity.
- Staged management of Lisfranc complex injury - Case report and literature review(2021) ROSEMBERG, D. L.; SPOSETO, R. B.; MACEDO, R. S.; FERNANDES, T. D.; GODOY-SANTOS, A. L.Background: There is an increase in the numbers of high energy tarsometatarsal / Lisfranc fracture dislocation. In this type of trauma, the specialist in orthopedics and traumatology cannot consider only the fracture as the challenge to be overcome, the injury to the soft tissues of the foot ends up being of equal or greater importance throughout the treatment. Our aim is to demonstrate, through a case report and literature review, that staged multidisciplinary surgical treatment is a good option for the treatment of these complex cases. Case: We report a case of a 28-year-old female victim of a motorcycle collision with a car. She was diagnosed with complex lesion of the right foot (fracture the medial cuneiform, fracture of the lateral cuneiform, cuboid fracture and loss of the intermediate cuneiform, detaching wound of dorsal skin, loss of the extensor hallux longus tendon, anterior tibial artery and deep peroneal nerve). In the emergency setting the patient was submitted to an initial debridement and gross reduction fixation with Kirschner wires. The further course was complicated with local infection and need for staged debridements, modification of the fixation and negative pressure wound dressing. She was later submitted to a flap coverage at the dorsum of the foot and in a last approach, arthrodesis of the medial tarsometatarsal and navicular joints. Conclusions: Lisfranc complex injuries continue to be an important source of pain and disability for patients worldwide. This case description show decision making challenges in a scenario without all resources available. The literature review demonstrates thar 2 phases of treatment principles must be respected: early damage control and definitive treatment. The key factors for improved outcomes are: early soft tissue coverage and restore axial, sagittal, and coronal alignment of the medial and lateral columns of the foot. © 2021