Browsing by Author "Barreira, M"
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- Anterior Slope Correction-Flexion Osteotomy in Traumatic Genu RecurvatumPublication . Ramos Marques, N; Morais, B; Barreira, M; Nóbrega, J; Ferrão, A; Torrinha Jorge, JA decreased posterior tibial slope has been associated with an increased risk of posterior cruciate ligament failure, anterior knee pain, and premature knee osteoarthritis. Trauma is a common cause of osseous genu recurvatum. Surgical management is recommended to correct the tibial slope and prevent knee pain and osteoarthritis progression. This article discusses our preferred treatment using a proximal tibial opening-wedge osteotomy for surgical management of genu recurvatum secondary to significant anterior tibial slope.
- A Giant Hand Lipoma As a Rare Cause of Secondary Carpal Tunnel Syndrome - a Case ReportPublication . Barreira, M; Marques, N; Campos, V; Marques, G; Gonçalves, S; Stefanova Alves, SIntroduction: Lipomas are a rare cause of compressive neuropathy and they lead to atypical clinical presentation that can mimic carpal tunnel syndrome. Case presentation: The authors describe a rare presentation of a carpal tunnel syndrome recurrence after a hand giant lipoma, presenting with rapidly compression neuropathy of the median nerve, 6 months after de primary surgery. Discussion: Lipomas are common benign soft tumours. Their occurrence in the hand remains rare and they rarely cause secondary entrapment neuropathies. Carpal tunnel syndrome is mostly idiopathic and bilateral. Local factors should be suspected when these neuropathies present with atypical symptomatology or even when they recur after primary conventional surgical release. Investigation should consider images studies as this correct preoperative assessment leads to successful diagnosis and treatment.
- Hip Arthroscopy With Initial Access to the Peripheral Compartment: a Detailed Step-by-Step Technique DescriptionPublication . Dantas, P; Gonçalves, S; Mascarenhas, V; Barreira, M; Marin-Peña, OHip arthroscopy with initial access to the peripheral compartment represents a specific technique to approach the hip that can be particularly useful. This technique is suitable for both the arthroscopic treatment of femoroacetabular impingement syndrome and other pathologies that can be addressed by classic arthroscopy with central compartment initial access. Minimal capsulotomies preserve the fluid pressure in the peripheral compartment, which allows the "ballooning" of the capsule and improved joint exposure with decreased risk of fluid extravasation. In the vast majority of cases, the hip joint can be accessed by any technique depending on the surgeon preference/expertise. Interestingly, access to the central compartment under direct arthroscopic visualization decreases the risk of iatrogenic labral and chondral damage. This is particularly important when access to the central compartment is technically challenging (e.g., acetabular overcoverage, labral hypertrophy, and limited joint distraction). Such a technique is also preferable if the pathology is mainly located in the peripheral compartment. Despite several advantages, hip arthroscopy with initial access to the peripheral compartment is not a commonly performed technique. Our purpose is to perform a step-by-step explanation of a previously described technique.
- Instabilidade Subtalar: uma Entidade Subdiagnosticada?Publication . Machado, M; Barreira, M; Pereira, B; Andrade, R; Espregueira-Mendes, JA instabilidade subtalar continua a ser um tópico controverso e a sua causa está ainda por conhecer. O mecanismo de lesão e os sintomas clínicos da instabilidade do tornozelo e da instabilidade subtalar sobrepõem-se, resultando muitas vezes em casos de instabilidade subtalar, isolada ou combinada, que não são corretamente diagnosticados. Negligenciar a instabilidade subtalar associada à instabilidade do tornozelo pode levar à falência do tratamento conservador e à evolução para instabilidade crónica com necessidade de tratamento cirúrgico. A compreensão da anatomia e da biomecânica da articulação subtalar é crucial para o diagnóstico correto desta patologia e posterior escolha do tratamento mais adequado. Esta revisão narrativa pretende percorrer à literatura mais recente, de forma a tornar percetível o estado de arte sobre esta entidade, desde a sua anatomia e biomecânica, aos métodos de diagnóstico e, finalmente, aos tipos de tratamentos existentes ao dia de hoje.
- Validation of the Ottawa Ankle Rules: Strategies for Increasing SpecificityPublication . Morais, B; Branquinho, A; Barreira, M; Correia, J; Machado, M; Marques, N; Ferrão, A; Nóbrega, J; Teixeira, F; Diogo, NIntroduction: The majority of patients with ankle injuries undergo radiological examinations of the foot, ankle or both. The objective of this study was in the first place to validate the Ottawa Ankle Rules (OARs) for the population of our centre. Secondly, an attempt was made to identify parameters that contribute to improve the specificity of the method, with a view to reduce the need for patients to be exposed to radiation as well as optimizing the expenses of the Emergency Ward (EW). Materials and methods: This was a prospective study conducted during a 9-month period. The study population included 148 patients, in 54 (36%) of the patients a fracture was present on the exams performed. Patients were submitted to a sequential protocol in the EW with a form completion, evaluation of OARs, application of the Visual Analog Pain Scale (VAS) and radiographic exams. Results: We found a sensitivity of OARs in ankle injuries of 100%, specificity of 26% and in midfoot injuries of 100% and 62% respectively. All patients with fractures had a VAS of 5 or more points in any of the tested sites. With the VAS criterium, we found a significant increase of global specificity (38% vs 15%), as well as when applied only to the ankle (26% to 47%) or to midfoot trauma (62% to 67%). In both, there would have been a 100% reduction of CT scans. Patients with a fracture or with fractures who required surgical treatment had a mean VAS significantly higher than patients with no fracture or fractures submitted to conservative treatment respectively. Although there was a lower percentage of fractures in the group of injuries in Work Accidents (31% vs 37% Sports Activity and 38% Leisure Activity), there was a statistically significant increase in the sum of average VAS in Accidents at Work vs Leisure Activities and vs Sports Activities. Conclusion: We seek to confirm the usefulness of OARs for our population and we investigated strategies to further reduce the need for unnecessary radiographs. The introduction of parameters for grading pain and adapting to the context of the accident seem promising