Orthopaedic SPOT is the official journal of the Portuguese Society of Orthopedics and Traumatology (SPOT). The main scope of the journal encompasses musculoskeletal pathology and trauma, as well as clinical research. Published articles are “peer-reviewed” and vary between original articles, clinical case reports, review articles or technical videos. The magazine is bilingual (Portuguese/English) and is available free of charge on its website.
Bilateral Avulsion Fracture of the TibialTuberosity: A Case Report of a Rare Injury
Avulsion fractures of the anterior tibial tuberosity are rare, predominantly occurring in adolescent males. This article reports a bilateral case in a 15-year-old boy with obesity, which occurred during running. The fractures, diagnosed by imaging as Watson-Jones type III, were treated with open reduction and internal fixation with screws bilaterally in the same surgical procedure. The postoperative period included immobilization for 4 weeks, with weight-bearing allowed at 8 weeks. At 6 months, the patient showed complete consolidation, a return to activities without limitations, and maximum functional scores. The discussion highlights the vulnerability of the growth plate and the disproportion between muscle strength and bone resistance. Surgical treatment proved effective, with a low complication rate, ensuring excellent functional outcomes with early diagnosis and appropriate management.
Copyright (c) 2026 Tiago P. Barbosa, João Castro Mendes, Luís Fabião, Luís Miguel Silva, Tiago Frada https://creativecommons.org/licenses/by/4.0
Predictive Value of DeltoidTuberosity Index in PlateOsteosynthesis of ProximalFractures: Is it Better than Age?
Introduction: Proximal humerus fractures (PHF) are considered fragility fractures, with increasing incidence in the elderly. Several risk factors negatively influence osteosynthesis outcomes, including age, bone density and medial hinge comminution. Age ≥65 is often considered a decision threshold in treatment algorithms. The deltoid tuberosity index (DTI) is a simple, reproducible method to evaluate local bone density. This study aimed to assess whether DTI is a better predictor than age for complications and re-interventions in PHF treated with locking plates. Methods: This retrospective study included 40 patients with PHF treated with open reduction and internal fixation with locking plates between 2021 and 2024. DTI was measured on pre-operative AP Grasey views by two independent shoulder specialists. Calcar screw-calcar distance and calcar reduction were also evaluated. Early complications (<12 weeks), late complications (>12 weeks), and the type of re-intervention were recorded. Results: Early complications occurred in 15% (n = 6), late complications in 27.5% (n = 11), and re-intervention was required in 25% (n = 10). DTI had good accuracy for predicting complications (AUC = 0.809), with an optimal cut-off of ≤1.64 (100% sensitivity, 92% specificity; Youden Index = 0.92). DTI was significantly lower in patients with late complications (1.34 vs 1.46; p = 0.001) and re-intervention (1.31 vs 1.45; p = 0.002), but not with early complications (p = 0.309). Age was not associated with early (p = 0.668), late complications (p = 0.148), or re-intervention (p = 0.889). There was no correlation between age and DTI (r = 0.232; p = 0.150). Calcar screw-calcar distance was significantly higher in early complications (11.23 vs 7.84 mm; p = 0.018) and re-intervention (10.77 vs 7.92 mm; p = 0.036). Calcar deviation had no significant associations. Conclusion: DTI is a valuable tool in the management of PHF, predicting complications and re-intervention more reliably than patient age.
Copyright (c) 2026 Pedro Seabra, Daniel Gonçalves, Miguel Pimentel, Pedro Lourenço, Miguel Frias, André Sarmento https://creativecommons.org/licenses/by/4.0
Regenerative Therapies inTendinopathies and PartialRotator Cuff Tears
Rotator cuff tendinopathies and partial‑thickness tears are common causes of shoulder pain, particularly in adults over 40, with a significant impact on quality of life and work capacity. While conservative treatment remains the first‑line approach, a substantial proportion of patients experience suboptimal outcomes. In recent years, regenerative therapies have emerged as promising alternatives or adjuncts to traditional treatment, aiming to promote tendon healing, reduce pain, and delay or avoid surgical intervention. This review critically evaluates the current evidence on regenerative interventions, including corticosteroid injections, hyaluronic acid, prolotherapy, platelet‑rich plasma (PRP), and cell‑based therapies such as bone marrow aspirate (BMA) and adipose‑derived mesenchymal stem cells (AD‑MSCs). Among these, leukocyte‑poor PRP (LP‑PRP) demonstrates the most consistent results in pain relief and functional improvement, with sustained effects observed for up to 12 months. Prolotherapy and hyaluronic acid, particularly in high‑molecular‑weight formulations, also show favorable short‑term results. Conversely, corticosteroids provide only transient analgesia and may negatively affect tendon healing if administered postoperatively. Cell‑based therapies have shown encouraging preliminary findings, including structural tendon improvement and reduction in lesion size. However, current studies are limited by methodological heterogeneity, small sample sizes, and short follow‑up periods, precluding definitive conclusions. This article emphasizes the need for individualized treatment selection based on patient profile, clinical severity, and access to therapy. Although some regenerative strategies are becoming more accessible, many remain experimental and should be restricted to research protocols until further high‑quality evidence becomes available. Therapeutic decisions should involve shared decision‑making, clearly addressing benefits, limitations, costs, and safety profiles of each modality.
Copyright (c) 2025 Rodrigo Alves Beraldo, Leonardo Zanesco, Jorge Henrique Assunção, Eduardo Angeli Malavolta https://creativecommons.org/licenses/by/4.0
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
A Tribute to the Past and a Look to the Future of Orthopaedic SPOT
Copyright (c) 2025 Nuno Sevivas https://creativecommons.org/licenses/by/4.0
Cubital Tunnel Syndrome After Insertion of a Subdermal Contraceptive Implant
Subdermal contraceptive implants, such as Implanon®, are an effective and reversible option for hormonal contraception. Although generally safe, complications related to their insertion may occur. This case report describes a 39‑year‑old woman who developed cubital tunnel syndrome following implant placement. Imaging studies (ultrasound and computed tomography) revealed incorrect positioning of the device, which was in contact with the ulnar nerve. Surgical intervention was performed to remove the implant and decompress the nerve. The postoperative course was uneventful, and no symptom recurrence was observed after one year. This case highlights the importance of adhering to proper guidelines for implant insertion to prevent neurological injury and underscores the need for qualified healthcare professionals to be aware of the potential complications associated with the procedure. Early detection and appropriate management are essential to prevent permanent damage.
Contraceptive Agents, Female/adverse effects
Copyright (c) 2025 Pedro Balau, Manuel Magalhães Godinho, Tânia Alegre Veigas, Vera Resende, Artur Costa Neto https://creativecommons.org/licenses/by/4.0
Advantages of a MultidisciplinaryTeam in the Treatment of Boneand Joint Infections
Bone and joint infections represent a significant source of morbidity and mortality, often termed a “silent epidemic.” While native infections, such as septic arthritis and osteomyelitis, still persist, surgical site infections related to orthopedic implants have gained particular prominence due to their growing prevalence and complexity. These infections not only lead to substantial patient morbidity and mortality but also create a significant burden on healthcare resources through prolonged hospital stays, multiple surgeries and extended antibiotic therapy. We advocate for the adoption of a multidisciplinary approach in treating bone and joint infections, drawing on the experiences of an existing multidisciplinary team. The integration of orthopedic surgeons, infectious disease specialists, internal medicine professionals and microbiologists enables a more comprehensive diagnostic and therapeutic approach, offering tailored surgical and antibiotic strategies based on the specific infection and the patient’s overall circumstances. Based on existing international examples and the experience of the authors, this paper proposes the establishment of a structured multidisciplinary approach in the Portuguese setting to optimize patient care and healthcare resources use.
Copyright (c) 2025 Ricardo Sousa, Miguel Araújo Abreu https://creativecommons.org/licenses/by/4.0
Translation and Cross‑Cultural Adaptation of the International Hip Outcome Tool 12 and 33 into European Portuguese
Introduction: Hip pathologies in young adults have a significant impact on quality of life, affecting physical activities, professional performance and general well‑being. Cultural adaptation of the iHOT‑12 and iHOT‑33 into Portuguese is essential to ensure the accuracy and relevance of these instruments in the Portuguese population. We aimed to translate and culturally adapt the iHOT‑12 and iHOT‑33 questionnaires into European Portuguese, ensuring their validity and reliability. Methods: A rigorous approach to translation and cultural adaptation was followed, including initial translation, back‑translation, review by a committee of experts, pre‑testing with 32 Portuguese patients and final adjustments based on feedback from participants. Results: The final Portuguese versions of the iHOT‑12 and iHOT‑33 demonstrated excellent internal consistency (Cronbach’s alpha of 0.90 and 0.96, respectively) and test‑retest reliability (ICC of 0.88 and 0.90). The questionnaires were well accepted, with culturally adapted items. Conclusion: The Portuguese versions of the iHOT‑12 and iHOT‑33 are valid and reliable tools for assessing the quality of life of Portuguese patients with hip pathologies, contributing to improvements in the assessment and treatment of these patients.
Copyright (c) 2025 Manuel Godinho, Filipe Maçães, João Magalhães, Frederico Magalhães, Carlos Branco, Filipa Pires, Sílvio Dias, Helena Gonçalves, Firmino Silva, André Sarmento https://creativecommons.org/licenses/by/4.0
Copyright (c) 2024 https://creativecommons.org/licenses/by/4.0
Mechanical Expandable Tumoral Prosthesis Lengthening Mechanism Collapse: Salvage with Magnetic Expandable Prosthesis
We describe a clinical case of a patient with osteosarcoma, who underwent resection and reconstruction with an expandable prosthesis, mechanical failure of the lengthening device and sudden dysmetria. Girl, 8 years old, with distal metadiaphyseal osteosarcoma of the left femur. She underwent a 14cm resection and reconstruction with an expandable prosthesis. Mechanical lengthening without complications, totaling 4.4 cm. Clinical dysmetria of 2 cm at maturity. At 16, she suffered a fall which damaged the mechanical system of the prosthesis and caused the lengthening to collapse. She opted for revision with an electromagnetic lengthening prosthesis (4.6 cm over 2 months). At the age of 18, it was replaced with a definitive modular prosthesis. At 6 months post‑surgery, he had no pain and radiological dysmetria of 2 cm, with no need for compensation. We describe an unusual case in which we used an electromagnetic lengthening prosthesis to solve a complication of a mechanical expandable prosthesis.
Copyright (c) 2025 Sónia Rodrigues, Inês Balacó, Cristina Alves, Gabriel Matos (Author) https://creativecommons.org/licenses/by/4.0
Introduction: Compartment syndrome (CS) is an orthopedic emergency. Diagnosis is particularly difficult in children because of the challenges inherent to communication and clinical examination. This paper aims to present a pediatric case series of CS and to analyze its etiology, diagnosis, treatment and complications as well as to assess the quality of life of the patients at least 1 year after the event. Methods: Retrospective study of children with CS treated at our institution between 2009-2020. Demographic characteristics and data on etiology, diagnosis, treatment and complications were analyzed. Quality of life was assessed using the Kidscreen 10 scale. Results: Nine patients with CS were identified 8 male, median age 10 years. The most frequent etiologies were traumatic (n=5), postoperative (n=2), viper bite (n=1) and infectious (n=1). The lower limb was involved in 5 cases, the upper limb in 3 and the lower and upper limb bilaterally in one. In 6 patients there was an associated fracture. Median follow up was 8 months. Complete functional recovery was seen in 5 patients. Complications occurred in 4: two patients with decreased joint mobility, one patient with sensory motor deficit and one patient requiring amputation. The median Kidscreen 10 score was 49. Conclusion: Adequate and well timed treatment of CS allows complete functional recovery in most patients and a good quality of life, although a high complication rate is expected.
Copyright (c) 2025 Rui Viegas, Marcos Carvalho, João Cabral, Pedro Sá Cardoso, Oliana Tarquini, Inês Balacó, Tah Pu Ling, Cristina Alves (Author) https://creativecommons.org/licenses/by/4.0
Machine Versus Man: Artificial Intelligence Diagnostic Accuracy in Fracture Diagnosis
Introduction: Yearly around 21 thousand adult patients visit our tertiary hospital’s emergency department after suffering from high or low energy trauma. Skeletal radiographs, being inexpensive and widely available, are the first‐line imaging mo‐ dality. Recent studies are showing encouraging results of the use of artificial intelligence in the detection of bone fractures. The main objective of this study is to compare the diagnostic accuracy between a medical‐grade artificial intelligence (AI) software (BoneView®, Gleamer) and orthopaedic surgeons of various levels of expertise for the detection of bone fractures in a tertiary hospital’s emergency department. Methods: Retrospective analysis of a series of posttraumatic radiographic examinations, including only adult patients with plain radiographs of limbs or pelvis obtained after a recent trauma. Exclusion criteria were patients with cast control radiographs, images with inadequate radiographic quality, and examinations showing only obvious fractures. The diagnostic performance of the AI software and six orthopaedic surgeons was measured by sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Results: The AI software had 91.3% sensitivity (95% CI: 82.03‐96.74) and 97.3% specificity (95% CI: 93.22‐99.26), with 0.95 AUC (95% CI: 91.3‐98.8; p <0.001). All six readers had inferior results in every measure obtained, with slight differences between them. Conclusion: Our study demonstrated that the BoneView® software has a high diagnostic capacity for fractures and, in this regard, can be considered a useful tool in the emergency department.
Copyright (c) 2024 Fábia Silva, Diogo Tomaz, Micaela Gonçalves, Jorge Lopes, Miguel Relvas Silva, Vítor Vidinha, António Sousa (Author) https://creativecommons.org/licenses/by/4.0
Carpal Tunnel Release with Regional Block of the Wrist: An Effective Anesthesia
Introduction: Carpal tunnel syndrome is the most common form of nerve compression, and its treatment is almost always surgical with the release of the median nerve. However, there is still no consensus on the type of anesthesia used for this procedure. This study aimed to evaluate whether wrist block represents a valid alternative to local anesthesia. Methods: To that end, 40 patients indicated for surgical release of the carpal tunnel were selected and divided into two groups (Group 1 ‐ underwent carpal tunnel release with local anesthesia; Group 2 ‐ locoregional block). They were assessed for pain at the surgical incision site ‐ intraoperatively, in the postoperative period, and after one month of follow‐up ‐ as well as for functional evaluation and occurrence of complications. In terms of local pain, it was significantly greater (p<0.05) in patients from Group 1. Results: Regarding functional assessment, Group 2 showed better results with respect to the Quick Dash score (p<0.05). Complications occurred only in Group 1 (p<0.05). Conclusion: With this study, we were able to demonstrate that wrist anesthetic block is a valid alternative method to local anesthesia.
Copyright (c) 2024 Ana Esteves, Nuno Silva, Pedro Ribeiro, Sara Lima, João das Dores Carvalho (Author) https://creativecommons.org/licenses/by/4.0
Arthroscopic Foveal Reattachment of the Triangular Fibrocartilage Complex (TFCC) with Transosseous Sutures and Anchor Fixation
Injuries to the triangular fibrocartilage (triangular fibrocartilage complex or TFCC) are common, and they can manifest with ulnar‐sided pain and a decrease in muscle strength, particularly under load during pronation‐supination move‐ ments. For diagnosis, the most reliable clinical signs are the fovea sign and ballottement. Among the most commonly used classifications for TFCC injuries are those by Palmer, Atzei, and Schmitt. In cases of injuries with persistent symptoms after conservative treatment or injuries with associated instability of the distal radioulnar joint (DRUJ), sur‐ gical treatment should be considered, with arthroscopic techniques being preferred for their less invasive nature. The transosseous suture technique, favored by the authors, is presented in the surgical technique video attached to this article. Current arthroscopic techniques yield good results in treating these injuries, and the surgeon’s preference and technical expertise influence their choice.
Copyright (c) 2024 Filipa Santos Silva, Alexei Buruian (Author) https://creativecommons.org/licenses/by/4.0
Identification of Risk Factors for Lower Limb Injuries in Athletes
Introduction: Proper physical activity and sport for everyone are one of the main cornerstones for a healthy lifestyle. However, regular sport activity is not without risk, with the correlation between participation in sport activities and the emergence of injuries being well documented. One of the most common injuries is the anterior cruciate ligament rup‐ ture which brings negative consequences for both the athlete and the team. Therefore, there is a high priority need to find standardized methods to identify which athletes are in greater risk of injury and what are the problems responsible for that risk with the goal of correcting them with customized training programs. The aim of this project is to identify the athletes who have a higher injury risk through their biomechanical profile and the recognition of neuromuscular deficits of the inferior limbs in kinematic patterns. Methods: Video analysis of three jumps (countermovement vertical jump without arm swing) performed by 27 basket‐ ball athletes. We recorded the flexion and varus/valgus knee angles. Anthropometric data, training hours per week and the presence or not of hypermobility in the Beighton scale were also collected. Results: The presence of a higher body mass index was correlated with personal history of ankle sprain (BMI=21.64 ± 2.28 kg/m2 versus BMI=19.80 ± 2.21 kg/m2). It was found that athletes who land in a valgus collapse also land with less knee flexion (57.60o ± 9.29o vs 62.80o ± 10,62o). Considering as an asymmetry a difference of at least 10o, we marked 6 athletes with considerable variance between the two legs. Conclusion: We concluded that it is possible to characterize the studied population and split some of the athletes in two risk groups according to the neuromuscular deficits. One of the groups is the leg dominance one and the other is put together in the same group quadriceps dominance and ligament dominance.
Copyright (c) 2024 Pedro Ribeiro, Ana Ribau, Tiago Amorim-Barbosa, João Esteves, Pedro Fonseca, Adélio Vilaça (Author) https://creativecommons.org/licenses/by/4.0
Arthroscopic Repair of a Bucket-Handle Tear of a Discoid Lateral Meniscus in a 14-Year-Old Child: Case Report
A discoid meniscus is a rare congenital anatomic variation with an estimated incidence of 1% to 3% in children. Due to their abnormal shape, discoid meniscus are associated with reduced tissue quality, less vascularization and looser peripheral attachments when compared to normal ones. Individuals with this abnormality are more predisposed to sustain meniscal injuries. Although meniscal injuries are less prevalent in children, they are associated with a higher healing potential when comparing to adult population. Currently, treatment options are either partial meniscectomy or meniscal repair. However, meniscectomy in children is associated with a faster progression to osteoarthritis than in adults. It is of great importance to identify and repair these injuries when possible, to achieve favorable long-term outcomes. The authors report the pre-operative evaluation, arthroscopic findings, repair technique, and post-operative outcome of a 14-year-old basketball player who sustained a displaced bucket handle tear of a discoid lateral meniscus. This is a rare injury pattern in pediatric population with sparse reports being found in literature. The meniscus reduced well and was found to be stable after repair. The patient regained full range of motion and returned to full unimpeded activity at three months post-operatively. At six months she returned to play without limitations. This report presents a rare meniscal injury in a pediatric patient who underwent surgical repair with successful recovery to date. It highlights a technique for meniscus repair which is of particular benefit when comparing to partial meniscectomy, especially in pediatric population.
Copyright (c) 2024 Catarina Silva Souto, Duarte Sousa, Tiago Carvalho, José Mesquita Montes, Nuno Tavares (Author) https://creativecommons.org/licenses/by/4.0
Anterior Cruciate Ligament Reconstruction: Flowchart of Technical Options and Relationship with the Instrument Sets
The anterior cruciate ligament (ACL) reconstruction is one of the most frequently performed orthopedic surgeries. Despite the extensive literature available, it is difficult to find a pragmatic description of the different technical variants that can guide multiple surgical decisions. In this review article, the technical variants of ACL reconstruction are systematically described, namely in the collection and preparation of the graft, in the creation of tunnels and in the fixation of the graft. The hypothesis of supplementing the reconstruction with an anterolateral reconstruction or tenodesis is described. This review includes a discussion on potential intraoperative difficulties and their respective solutions, such as graft contamination, sub‐optimal positioning of the tunnels and insufficient fixation of the graft. It is the opinion of the authors that the ACL reconstruction can become more complex due to the surgeon’s attempt to adapt his technique to the available commercial set. As so, we suggest a simplified surgical technique with an algorithm which is independent from the specificities of each set.
Anterior Cruciate Ligament Injuries/surgery
Anterior Cruciate Ligament Reconstruction/methods
Copyright (c) 2024 Francisco Guerra Pinto, Rita Alçada, Jácome Pacheco, Gonçalo Moraes Sarmento, Carlos Martinho, António Martins (Author) https://creativecommons.org/licenses/by/4.0
Is Joint Aspiration to Rule Out Prosthetic Joint Infection Required Before every Revision Joint Arthroplasty? Validation of Institutional Criteria using the New European Bone and Joint Infection Society definition
Introduction: Synovial fluid investigation is the best alternative to diagnose prosthetic joint infection (PJI) before ade‐ quate microbiological/histology sampling during revision surgery. Although accurate preoperative diagnosis is certainly recommended, puncturing every patient before revision arthroplasty raises concerns about safety and feasibility issues especially in difficult to access joint (e.g., hip). Currently, there is no clear guidelines regarding optimal indications to per‐ form preoperative joint aspiration to diagnose PJI before revision surgery. We hypothesize that our institutional criteria are appropriate to identify potentially infected joints before surgery while saving an unnecessary number of procedures. The main goal of this study is to determine the accuracy of our institutional criteria in picking up potentially infected joints using the new New European Bone and Joint Infection Society (EBJIS) PJI definition as the standard. Methods: We performed a retrospective review including all patients that underwent total hip or knee arthroplasty single or first‐stage revision surgery (regardless of preoperative diagnosis) between January 2013 and December 2019. We applied the new EBJIS PJI definition criteria and we studied patients whose institutional criteria were applied to perform preoperative joint aspiration. Results: After applying the EBJIS definition 38 (35.8%) were classified as confirmed infections, 10 (9.4%) as likely infected and 58 (54.7%) as infection unlikely. Of those, 37 confirmed infection cases, 9 likely infected cases and 32 infection unlikely cases did have indication for preoperative synovial fluid collection before surgery. Conclusion: Our proposed institutional criteria identify the majority of infected or likely infected patients, while saving a significant number of unlikely infected cases from unnecessary and potentially risky procedures.
Copyright (c) 2024 Sara Elisa Diniz, André Vinha, Ana Ribau, Daniel Soares, Miguel Araújo Abreu, Ricardo Sousa (Author) https://creativecommons.org/licenses/by/4.0
Charting a New Horizon: The Launch of SPOT Orthopaedics Journal
Copyright (c) 2024 Helena Donato, João Torres (Autor) https://creativecommons.org/licenses/by/4.0
Revision Arthroplasty in Vancouver B1 Periprosthetic Hip Fractures
Introduction: Periprosthetic hip fractures (PHF) represent an important complication after hip arthroplasty. The management of Vancouver B1 fractures remains elusive. While most stems may present radiographically as stable, stem fixation may in fact be compromised. Choosing plate osteosynthesis as a treatment in this type of fractures, trusting radiographic studies alone may lead to implant failure. Methods: We reviewed 10 years of our institution ́s clinical records (2011­2021) and found a total of 161 PHF. Twenty five cases of B1 periprosthetic fractures were included in our study, after their presenting radiographs were blindly reviewed. All PHFs were submitted to arthrotomy, dislocation and stability assessment. Stable implants were submitted to plate osteosynthesis, and unstable implants were submitted to revision arthroplasty. Demographic information, duration of surgery, blood loss, inpatient complications, functional outcomes, and outpatient outcomes and complications were recorded. Mean time of follow­up was 47 months. Results: Seventy­two percent of of initially classified B1 type fractures presented with a loose stem and required revision arthroplasty. Time until supported ambulation was lower in the revision arthroplasty group (p= 0.01) while surgical time, blood loss after surgery, and inpatient complications presented similar results in both groups. Negative outpatient outcomes showed similar rates in both groups. Conclusion: Most radiographically well­fixed implants were in fact unstable. Stability assessment using radiographic studies alone proves insufficient and may lead to inadequate osteosynthesis treatment. As such, in­operative stability testing in all B1 type fractures is paramount. Revision arthroplasty permitted early ambulation and showed no greater complications when comparing with osteosynthesis.
Copyright (c) 2024 João C. Pereira, André Moreira, André Costa, Guilherme Correia, João B. Tinoco, Pedro Varanda, Eurico B. Rodrigues (Author) https://creativecommons.org/licenses/by/4.0
Conflicts Around the Shoulderand the Importance of DynamicBalances: Current Concepts
Copyright (c) 2024 Manuel Gutierres (Autor) https://creativecommons.org/licenses/by/4.0
Arthroscopic Repair of Supraspinous Tendon Rupture
In this video, the author presents his technique for arthroscopic repair of a ruptured supraspinatus. The patient is positioned in a “beach chair”. Arthroscopy begins through a posterior port about 2 cm below and into the posterior external angle of the acromion. After systematized intra‐articular inspection and once the articular surface of the rupture has been observed, tenotomy of the long portion of the biceps is performed through the external port, passing the scissors through the rupture. Still with an intra‐articular view, the rupture is debrided and the trochanter prepared. Moving on to the subacromial space through the same posterior port and after bursectomy, the rupture is mobilized with visualization through the external port and using the superior and posterior anteroposterior ports. Once the size, geometry and reducibility of the rupture have been determined, a bridge repair is carried out, with a system without medial knots and using tapes bunched over the tendon and 4 anchors, two more medial and two more external. Finally, the quality of the repair is checked on the bursal and articular surfaces.
Copyright (c) 2024 António Cartucho (Autor) https://creativecommons.org/licenses/by/4.0
Osteoma Osteoid Radiofrequency Ablation: Outcomes of a Referral Pediatric Hospital
Introduction: Computed tomography‐guided radiofrequency ablation remains the gold‐standard for the treatment of osteoid osteoma, however, treatment failures continue to be reported. This study intends to describe the results of using this technique in a pediatric age to treat osteoid osteoma, thus pro‐ moting its development. Methods: This retrospective study included 18 patients diagnosed with symptomatic osteoid osteoma treated with radiofrequency ablation between December 2013 and March 2022. To assess the results, time required for pain reso‐ lution, complications and treatment failure of the procedure were recorded. Results: The mean age was 11 years (3‐17) and the mean follow‐up time was 67 months (9.6‐101.3). The most fre‐ quently affected location was the femur (11 patients, 7 in the proximal region and 4 in the diaphysis). The mean size of the nidus was 7.4 mm (1‐15 mm) and the mean eccentricity index was 1.6 (1‐2.6). Using the visual analogue pain scale, 3 patients had moderate pain and 15 had severe to very severe pain before the procedure. After the procedure, only 1 patient maintained pain although with less intensity, representing a 5.6% rate of treatment failure (incomplete resolution). No recurrence was recorded. In terms of complications, a case of skin burn of about 2.5 cm was reported. Conclusion: In this study, there was a high rate of treatment success (94.4%), however the sample was small. The use of radiofrequency ablation in the treatment of osteoid osteoma is a less invasive method than excision and with a high level of patient satisfaction.
Copyright (c) 2024 Eduardo R. Silva, Ana Forjaco, Joana Arcângelo, Delfin Tavares (Author) https://creativecommons.org/licenses/by/4.0
Natural Distribution of the Femoral Mechanical Anatomical Angle in a Portuguese Population with Advanced Knee Osteoarthritis and it’s Implication in Total Knee Arthroplasty Surgical Planning
Introduction: Total knee arthroplasty is one of the most successful interventions in medicine. Mechanical alignment remains the gold standard in obtaining a proper coronal prosthetic alignment. There is controversy regarding the use of a fixed cutting angle of the distal femur, with a value between 4o‐7° of valgus that is frequently used intraoperatively. The aim of this study was to describe the distribution of the valgus cut angle in the Portuguese population and to assess the safety of using a fixed valgus cut angle. Methods: From 13.3.2021 to 14.12.2021, 100 pangonograms of patients on the waiting list to undergo total knee arthroplasty, with advanced gonarthrosis, refractory to conservative treatment, were analysed retrospectively and consecutively. Results: The preoperative full length weight bearing radiography of one hundred patients submitted total knee replacement were evaluated, with a mean valgus cut angle of 7.0o± 1.3o (range 3.7o‐10.3o). Conclusion: The use of a fixed resection angle results in a percentage of mechanical axis deviation greater than acceptable (± 3o) in 8%‐68% of cases, as such we conclude that, in order to obtain a proper mechanical alignment, pre‐operative full length weight bearing evaluation is required for proper valgus cut angle measurement.
Copyright (c) 2024 Alexei Buruian, Emanuel Homem, Gonçalo Modesto, João Mendes , Carlos Alegre, Fernando Fonseca (Autor) https://creativecommons.org/licenses/by/4.0
Functional Outcomes of Basilar Thumb Arthritis Treatment with Tendon Suspension‐Interposition Arthroplasty: Retrospective Analysis with Mean Follow‐Up of 10 Years
Introduction: Thumb arthritis is a common condition. Its prevalence increases with age and predominantly affects females. Methods: In the period from January 2009 to December 2014, 105 patients were submitted to trapezectomy, ligament reconstruction and tendon interposition for basilar thumb arthritis grades III and IV, of which 40 patients (42 hands) were included in the study. The majority, 92.5%, were females, with an average age of 59.6 ± 7.18 years, 52.5% were operated with an abductor pollicis longus tendon technique as described by Mathoulin and 47.5% with flexor carpi radialis tendon as described by Burton‐Pellegrini. The mean follow‐up time was 122.15 ± 25.3 months. Results: The mean DASH score was 20.38±19.63, mean VAS score 2.3±302, Kapandji score 8.29±2.11, grip strength 19.5 ±10.91 kg, pulp pinch force 3.9±2.39 kg and lateral pinch force 4.77±2.33 kg. In terms of satisfaction 59.52% referred to maximum satisfaction with the surgery (5/5), 23.80% (4/5), 4.76% (3/5), 4.76% (2/5) and 7.14% minimum satisfaction (1/5). Analytically, males presented a greater grasp strength and lateral pinch and basilar thumb arthritis grade IV had worse outcomes. There are no significant differences in the results obtained with the different surgical techniques. Conclusion: Trapezectomy and ligament reconstruction and tendon interposition present good medium‐long‐term func‐ tional results for the treatment of basilar thumb arthritis without statistically significant differences between Burton Pellegrini and Mathoulin techniques.
Copyright (c) 2024 Alexei Buruian, Vítor Hugo Pinheiro , António Néri , Pedro Matos , Alexandre Marques, Fernando Fonseca (Author) https://creativecommons.org/licenses/by/4.0
Stemless Humeral Prosthesisin Shoulder Arthroplasty:Systematic Review
Introduction: Stemless shoulder prostheses were introduced as a new shoulder replacement system designed to reduce the potential risks associated with the humeral component and achieve better functional results by lowering the surgical complication rates. This systematic review aims to assess the latest available published findings regarding stemless shoulder replacement. Methods: A search in PubMed, Scopus, and Clarivate Web of Science databases was performed, selecting publications that reported the constant score for functional assessment in patients submitted to shoulder arthroplasty with a stem­ less prosthesis. Results: Three types of shoulder arthroplasties were identified, with a constant score average between 63.4% and 73.3% and with a revision rate average between 2.8% and 3.4%. These results were similar among studies with differ­ ent follow­up duration: 6 months to 9 years. Conclusion: Shoulder arthroplasty with stemless prosthesis is very promising with favourable results in the short and medium­terms regarding improvement in the shoulder function, pain relief and patient satisfaction and low rates of complications.
Copyright (c) 2024 Rómulo Silva, Gabriela Almeida, Filomena Ferreira, António Barros, Manuel Gutierres (Author) https://creativecommons.org/licenses/by/4.0
Transepiphyseal Fracture­‐Dislocation of the Hip inan Adolescent: A Rare Clinical Case
Hip fracture‐dislocations in children and adolescents are rare and severe injuries. Surgical treatment is urgent and, even with adequate and timely treatment, the complication rate is high. The most common complication is osteonecrosis of the femoral head and the main risk factors include fracture type and displacement. A 13‐year‐old boy presented after a high‐energy trauma, having sustained a fracture‐dislocation of the left hip, with complete separation of the proximal femoral epiphysis, incarcerated in a fracture of the acetabulum. He underwent surgery with open reduction of the femoral epiphysis and fixation with two Kirschener wires, hip joint reduction, open reduction of the acetabulum fracture and internal fixation with a reconstruction plate. The immediate postoperative evolution was favorable, but at 10 months radiological signs of osteonecrosis of the femoral head were already visible. Clinically, 5 years after the accident, he maintains good function, with a Non Arthritic Hip Score of 80/100. Pediatric hip fracture‐dislocation is a therapeutic challenge and has a poor prognosis. In addition to timely and appropriate treatment, it is essential to manage the expectations of patients and their families.
Copyright (c) 2023 Andreia G. Moreira, Inês Balacó, João Cabral, Cristina Alves (Autor) https://creativecommons.org/licenses/by/4.0
Deferred surgical treatment of upper limb trauma in a pandemic context
Introduction: In order to manage the high number of patients with upper limb fractures that require surgical treatment, it is essential to have a well‐defined structure, in order to promote an adequate response to each type of orthopedic pathology and to fit the reality of all other pathologies. In order to reduce hospital stays and promote better treatment of patients, our service promoted the deferred treatment of numerous pathologies in the area of traumatology. The aim of the study was to assess the type of pathologies, patient characteristics, degree of satisfaction and pain control of patients with upper limb fractures, treated in a deferred manner in our hospital, in 2020, a severely marked year by the global pandemic context by COVID‐19. Methods: We developed a retrospective observational study with the evaluation of 71 patients treated in a deferred manner and who waited at their home for a call for surgical treatment. Results: We recorded an average age of 49 years (14‐71), with 40 males (56.3%). The most frequent diagnoses were distal radius fracture (36.6%; n=26), metacarpal fracture (19.7%, n=14) and phalangeal fractures (11.3%, n=8). The average time from coming to the emergency department until definitive surgical treatment was 7 days and the most frequent anesthetic risk was ASA 2 (in 64.6%). After a telephone call made in May 2021, it was possible to assess 36 of the 65 patients operated, with 89% reporting satisfaction with the possibility of waiting for surgical treatment at home and 92% reporting recommending this type of strategy. About pain control at home, while waiting for surgery, applying the VAS score: the mean was 1.94 (0 – 9). We applied the score (QuickDASH) to all patients with distal radius fractures included in the group, with a mean of 18.2 points (0 – 65.9; SD 18.65). Conclusion: Deferred treatment of upper limb traumatic pathology was satisfactory for patients, who recommended the treatment and allowed pain control throughout the clinical course. The surgical results are comparable to the current literature, allowing the validation of this type of therapeutic strategy, namely in a phase in which health services are going through an additional pressure explained by the pandemic. These results are applied to typically young patients with few medical comorbidities, so they should not be extrapolated to all populations.
Copyright (c) 2025 Nuno Telo Ramos, Miguel Relvas, Joana Almeida, João Duarte Silva, Vitorino Veludo, António Nogueira de Sousa, Vitor Vidinha https://creativecommons.org/licenses/by/4.0
Iliopsoas Grade 2 Myotendinous Junction Injury in an Elite Football Player: Return to Play Process
Groin pain is a common injury in professional footbal and widely acknowledged as a complex medical issue. Iliopsoas pathology stands as the second‐most common cause of athletic groin injury, yet iliopsoas traumatic muscle injuries are infrequent and inadequately documented in the literature. This case report outlines a grade 2 myotendinous junction injury of the iliopsoas in a football player competing in the Portuguese First League, combining an early rehabilitation protocol with ultrasound‐guided hematoma evacuation and LP‐PRP injection, enabling return to play 23 days after injury with no reported re‐injury over a period exceeding 12 months.
Copyright (c) 2023 Alexandre Fernandes, Pedro Cunha, Júlio Silva, Carlos Duarte, Alexandre Estaca, Mónica Bettencourt, Miguel Reis e Siva (Autor) https://creativecommons.org/licenses/by/4.0
Deltopectoral or Anterosuperior Approachin Total Reverse Shoulder Arthroplasty:Differences in Metaglene Positioning
Introduction: Our purpose was to evaluate the differences in metaglene positioning in deltopectoral and anterosuperior approach in total reverse shoulder arthroplasty. Methods: Patients who underwent total reverse shoulder arthroplasty for degenerative or traumatic pathology within a 10‐year period were selected. Two groups were created: group 1, deltopectoral approach; group 2, anterosuperior approach. The metaglene positioning was evaluated through anteroposterior radiography by the methods of Lévigne et al and Maurer et al. Statistical study was performed by Mann‐Whitney U‐test. Results: A total of 145 patients were admitted, 33 submited to deltopectoral approach and 112 anterosuperior. Surgery for degenerative pathology occurred in 106, for trauma in 39. The overall median age was 70 years (64‐75), in degenerative pathology 68 years (62‐72), in trauma 76 years (69‐81). Overhang showed no significant difference (p=0.882), 5.1±2.2 mm group 1 and 5.4±2 mm group 2. The tilt showed significant difference (p=0.005), 103.2±11o group 1 and 96.8±9.7o group 2. The beta angle showed significant difference (p=0.001), 81.4±7.3o group 1 and 74.6±8.6o group 2. When comparing traumatic and degenerative pathology, the overhang did not show significant difference (p=0.06), 5.8±1.6 mm traumatic pathology and 5.1±2.2 mm degenerative pathology. The tilt was signifi‐ cantly different (p<0.001), 104.8±10° traumatic pathology and 95.8±9.4o degenerative pathology. The beta angle was significantly different (zc wq <0.001), 82.5±6.6o traumatic pathology and 73.8±8.4o degenerative pathology. Conclusion: The approaches did not differ in the craniocaudal positioning of the metaglene, but tilt was lower in the anterosuperior approach and may correlate with future complications. Patients who had surgery for traumatic pathology showed greater inferior tilt of the metaglene.
Copyright (c) 2023 Carla Olim Castro, Carlos Freitas, Ana Rita Cavaca, João Marques, Ana Catarina Quintas, Paulo Lourenço, Ana Inês (Autor) https://creativecommons.org/licenses/by/4.0