Papers by Paulo Cesar Faiad Piluski
Arthroscopy: The Journal of Arthroscopic & Related Surgery, Oct 1, 2017
Management of significant glenoid bone loss in patients undergoing a Reverse Shoulder Arthroplast... more Management of significant glenoid bone loss in patients undergoing a Reverse Shoulder Arthroplasty (RSA) poses a significant treatment challenge. The long-term outcome of single stage RSA with glenoid bone grafting is unknown. This study assesses the indications, technique and outcome of RSA with glenoid bone grafting. Materials and Methods: Between 2001 and 2010, 1074 RSA were performed at our institution. Out of this cohort 94 patients had significant glenoid bone loss. These patients underwent a single or two-stage RSA with glenoid bone grafting. Intra operatively each patient was subcategorized on the basis of the size of the glenoid defect and managed in accordance with a standardized treatment protocol. The defects were sub classified as centric or eccentric and graded from 1-4 based upon their size. A retrospective analysis of the pre and post-operative clinical and radiological outcome was carried out. The mean follow up was 2.4 years, (0.52 years e 10.7 years). Results: Indication for RSA were as follows: 1) 29.3% Cuff tear arthropathy, 2) 27.2% failed prior arthroplasty, 3) 21% chronic dislocation, 4) 17.4% post traumatic cases. During the operation 17 % had a centric defect and 83 % of patients had an eccentric glenoid defect; the bone loss being anterior in the majority (51.1%). Composite glenoid grafts were required in 10 patients and 9 patients required a revision specific glenoid base plate. 92.5% (87/94) of the patients could be managed as
Revista de la Asociación Argentina de Ortopedia y Traumatología
Objetivo: Evaluar los resultados funcionales de tres protocolos distintos de tratamiento conserva... more Objetivo: Evaluar los resultados funcionales de tres protocolos distintos de tratamiento conservador en pacientes con capsulitis adhesiva del hombro. Materiales y Métodos: Se revisaron las historias clínicas de los pacientes tratados por capsulitis adhesivaen nuestra institución, entre enero de 2016 y enero de 2019. Se compararon tres protocolos diferentes de tratamiento: grupo 1, bloqueo del nervio supraescapular con un anestésico local y corticoide, analgésicos y fisioterapia después del alivio del dolor; grupo 2, bloqueo del nervio supraescapular con anestésico local sin corticoide, analgésicos y fisioterapia; grupo 3, analgésicos y fisioterapia, sin bloqueo del nervio supraescapular. Se determinaron los resultados funcionales con la escala ASES y el resultado subjetivo con el SSV. Resultados: Se dividió en tres grupos a 46 pacientes tratados por capsulitis adhesiva. Los pacientesdel grupo 3 tuvieron, en promedio, más sesiones de fisioterapia (30,31 ± 21,07). Los del grupo 2 reci...
Revista de la Asociación Argentina de Ortopedia y Traumatología
Objetivo: Evaluar los datos demográficos, como edad, sexo, profesión, lado afectado, lesión única... more Objetivo: Evaluar los datos demográficos, como edad, sexo, profesión, lado afectado, lesión única o múltiple, tipo de material utilizado, tiempo de cicatrización ósea y posibles complicaciones de los pacientes con fracturas diafisarias de húmero tratados mediante la técnica MIPO en tres centros hospitalarios de Ecuador, Paraguay y Brasil. Materiales y Métodos: Estudio retrospectivo, longitudinal, observacional de los datos de 133 pacientes recolectados en tres Servicios: de Quito (Ecuador), Asunción (Paraguay) y Passo Fundo (Brasil). Se compararon las distribuciones entre diferentes Servicios mediante la prueba x2 de Pearson. Resultados: La edad de los pacientes varió entre 17 y 76 años, con una media de 36 años. El tiempo promedio hasta la consolidación fue de 11 semanas (126 de 132 pacientes). Predominó el sexo masculino (70,45%), el lado derecho era el más afectado (55,3%), la mayoría de las fracturas eran únicas (85,61%), se logró la consolidación en el 95,45%. Solo el 9,09% tuv...
The sub-scapularis is the largest muscle in the entire rotator cuff and plays a critical role in ... more The sub-scapularis is the largest muscle in the entire rotator cuff and plays a critical role in the stability and function of the shoulder [1,2]. It is known, historically, that their lesions received little attention from the literature and were also under diagnosed [2-7]. The diagnosis is performed with a combination of physical examinations (Lift-off, Belly-Press and Bear-Hug) and imaging and the detection of sub-scapularis in reliable magnetic resonance imaging requires a high level of suspicion 3. With the advent of arthroscopy, more diagnoses of ruptures of this muscle have been made [5,8,9].
Bone Grafts [Working Title], 2020
The scaphoid fractures are the most common of the carpal bones, corresponding to 60; 10% of these... more The scaphoid fractures are the most common of the carpal bones, corresponding to 60; 10% of these progress to nonconsolidation, moreover, 3% can present necrosis of the proximal pole. There are various methods of treatment using vascularized (VBG) and nonvascularised bone grafts (NVBG). To evaluate and compare the rate of scaphoid consolidation with necrosis of the proximal pole using different surgical techniques. The authors conducted a systematic review of the literature using the following databases: PubMed and Bireme/Lilacs, where 13 case series were selected (10 with use of VBG and 3 of NVBG), according to inclusion and exclusion criteria. In most cases the vascularized bone grafts were used, especially those based on intercompartmental supraretinacular artery 1 and 2 due to greater reproducibility in performing the surgical technique.
MOJ Orthopedics & Rheumatology, 2017
Objective: to compare the functional results obtained from the arthroscopic and open techniques f... more Objective: to compare the functional results obtained from the arthroscopic and open techniques for the Bankart lesion in recurrent shoulder dislocation. Methods: a retrospective study comparing the results obtained with a minimum follow-up of two years in 76 patients (50 underwent arthroscopic repair and 26 had open repair performed). The results were obtained through ASES score (American Shoulder and Elbow Surgeons Score) and DASH score (Disabilities of the arm, shoulder and hand, and then analyzed using the Student's t-test. Results: 76 patients met the criteria for inclusion in the study, 65.8% (n = 50) had arthroscopic repair and 34.2% (n = 26) had open technique. 89% were men and 11% were women. The minimum follow-up time was 2 years. The mean age of the patients was 27.3 years. Among the patients, 31 were manual workers (39.2%) and 34 (43%) participate in recreational contact sports. The recurrence rate was 6% (3 patients) in the arthroscopic group and 3.8% (1 patient) in the open surgery group. The arthroscopic repair group achieved 94% of good and excellent results by ASES score and 92% of good and excellent results by DASH score. The open repair group achieved 92.3% of good and excellent results by ASES score and 96.1% by DASH score. Comparison between groups using DASH and ASES scores did not show a statistically significant difference, with p = 0.319 for DASH score and p > 0.05 for ASES score. Conclusion: The treatment of Bankart lesion in recurrent shoulder dislocation achieved good and excellent results in more than 90% of the cases using either arthroscopic or open techniques. Although arthroscopic surgery is the treatment of choice for most surgeons nowadays, the open repair remains an excellent option and should not be forgotten.
Journal of Reconstructive Microsurgery, 2006
Journal of Shoulder and Elbow Arthroplasty, 2017
Objective: To assess the prevalence of early minor and major complications (MMC) of reverse shoul... more Objective: To assess the prevalence of early minor and major complications (MMC) of reverse shoulder arthroplasty (RSA) according to the underlying pathology responsible for the surgical indication. Methods: Between August 2009 and September 2015, 75 shoulders were submitted to RSA. Revision surgeries and patients with less than 2 months of follow-up were excluded. We analyzed 72 shoulders. The cuff tear arthropathy (CTA) represented 56.9% of cases and proximal humeral 4-part fractures (4PF) represented 13.8%. The index of MMC was analyzed according to the indication of basic pathology and the presence of rheumatoid arthritis, diabetes mellitus, and obesity. Results: The evaluation was performed with a median of 11.5 months. Minor complications were found in 14 patients (19.4%) and major complications in 29 patients (40.3%). The statistical analysis was performed adding the contents of MMC-47.2%. In CTA patients, there were 43.9% (18/41) of MMC. In all other joint diseases, there were 51.6% (16/31) MMC. There was no statistical difference in the prevalence of MMC among the cases of CTA and the other diseases. There was a tendency, although not significant, of lower prevalence of MMC in cases of 4PF compared to CTA patients. Patients with rheumatoid arthritis and diabetes mellitus did not present with a higher prevalence of MMC, and obesity significantly increased the prevalence of MMC. Conclusion: It was not possible to demonstrate a higher prevalence of MMC according to the pathology being treated. The presence of obesity significantly increased the prevalence of MMC. Rheumatoid arthritis and diabetes mellitus did not increase the prevalence of MMC.
Rev Bras Ortop, May 1, 2007
Revista Brasileira De Ortopedia, Feb 1, 2006
Recebido em 28/3/05 (CET-SBOT). Aprovado para publicação em 22/11/05. Copyright RBO2005 ARTIGO OR... more Recebido em 28/3/05 (CET-SBOT). Aprovado para publicação em 22/11/05. Copyright RBO2005 ARTIGO ORIGINAL mia proximal e a artrodese dos quatro cantos são boas opções de tratamento cirúrgico para pacientes com colapso avançado escafo-semilunar. São procedimentos eficazes para o tratamento da dor e guardam mobilidade funcional do punho. Em nosso estudo, a perda da mobilidade foi maior nos pacientes submetidos à artrodese dos quatro cantos. Descritores-Ossos do carpo/cirurgia; Osteoartrite; Artrodese
Revista Brasileira de Ortopedia (English Edition), 2012
Osteoid osteoma is a benign osteoblastic tumor that is unusual in the hand. A location in the car... more Osteoid osteoma is a benign osteoblastic tumor that is unusual in the hand. A location in the carpal bones is infrequent, which leads to errors in diagnosing it because of polymorphism of the clinical symptoms. Reviewing the literature shows that nine cases of osteoid osteoma in the
Surgical Science, 2013
Objective: To clarify the indications and to describe the surgical technique and outcomes of surg... more Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients with multidirectional instability in the shoulder. Method: In 17 patients (mean age, 23 years) operated at São Vicente de Paulo Hospital and the Institute of Orthopedics and Traumatology of Passo Fundo, Brazil from 1999 to 2009, we performed trapezius transfer to the proximal humerus. In these patients, the mean interval between trauma and surgery was 8 months. Results: Functional improvement and resolution of multidirectional instability of the shoulder were observed in all the patients. No patient showed immediate postoperative complications. The mean active mobility was as follows: 95˚ flexion, 50˚ abduction, 45˚ external rotation, and internal rotation at the level of the first lumbar vertebra (L1). The trapezius muscle strength was classified as grade III, and the UCLA functional outcome was 22 points. The postoperative satisfaction was excellent, and occasional pain and weakness was reported by all the patients. Conclusions: Transfer of the trapezius muscle to the proximal humerus provides better results in patients with a more than 6-monthold lesion. This procedure also preserves passive mobility of the limb, confers shoulder stability, provides active mobility, and prevents osteoarthrosis.
Revista Brasileira de Ortopedia, 2009
Objetivo: Avaliar a integridade do músculo subescapular através da força, função e ressonância nu... more Objetivo: Avaliar a integridade do músculo subescapular através da força, função e ressonância nuclear magnética após acesso deltopeitoral para tratamento da luxação glenoumeral anterior recidivante. Métodos: Foram avaliados 20 pacientes com luxação recidivante do ombro. Todos os casos possuíam seguimento mínimo de 12 meses, com média de 40 meses. Os pacientes eram todos do sexo masculino, com média de idade de 29 anos (20-42 anos). Os pacientes foram submetidos a exame físico para avaliar mobilidade, força muscular, "Belly" Teste e teste de Gerber. A força isocinética em rotação interna e externa, em velocidades angulares de 60 0 /s e 180 0 /s, em ambos os ombros, foi medida utilizando-se um dinamômetro. Em 15 pacientes foi realizada ressonância nuclear magnética (RNM) em ambos os ombros para avaliação da espessura, área e possível hipotrofia do músculo subescapular. Resultados: Houve diferença significativa entre os picos de torque para a velocidade de 60 0 /s para as rotações interna (p = 0,036) e externa (p = 0,008). Porém, para a velocidade de 180 0 /s a situação se inverte (rotação interna: p = 0,133; rotação externa: p = 0,393). A espessura e a área do subescapular são significativamente menores que as do lado normal, com déficit de 19% e 23%, respectivamente. De acordo com os escores de Rowe e da UCLA, observamos excelentes e bons resultados na maioria dos pacientes, com média de 88 e 31,6 pontos, respectivamente. Conclusão: Apesar dos bons resultados funcionais, a cirurgia aberta pode restringir a força, bem como reduzir a espessura e a área da seção transversal do músculo subescapular. Os melhores resultados ocorreram no lado dominante.
Revista Brasileira de Ortopedia, 2012
Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology o... more Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6-strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15 th day and in 66.7% on the 30 th day, making the biological tissue stronger and more resistant (p=0.095). Conclusion: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques applied.
Rev Bras Ortop, 2005
* Trabalho realizado no Serviço de Cirurgia do Membro Superior do Institu-to de Ortopedia e Traum... more * Trabalho realizado no Serviço de Cirurgia do Membro Superior do Institu-to de Ortopedia e Traumatologia de Passo Fundo (IOT) Passo Fundo (RS) Brasil; Hospital São Vicente de Paulo HSVP Passo Fundo (RS) Brasil. 1. Chefe do Serviço de Residência Médica e ...
Rev Bras Ortop, 2003
Page 1. Rev Bras Ortop _ Vol. 38, Nº 8 Agosto, 2003 421 EPICONDILITE LATERAL DO COTOVELO Epicon... more Page 1. Rev Bras Ortop _ Vol. 38, Nº 8 Agosto, 2003 421 EPICONDILITE LATERAL DO COTOVELO Epicondilite lateral do cotovelo* Lateral elbow epicondylitis* OSVANDRÉ LECH1, PAULO CÉSAR FAIAD PILUSKI2, ANTÔNIO LOURENÇO SEVERO3 ...
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Papers by Paulo Cesar Faiad Piluski