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- Extensive skin necrosis after periprosthetic knee infection: a case that highlights the possibility of complications induced by low-molecular-weight heparinPublication . Fonte, Hélder; Dias Carvalho, Andre; Rosa, João; Pereira, Cláudia; Pereira, Alexandre; Sousa, RicardoWe describe a case of a patient with atrial fibrillation, anticoagulated with dabigatran, that developed severe knee skin necrosis in the setting of an acute periprosthetic knee infection, after initiating low-molecular-weight heparin. A wide range of etiology hypotheses was discussed within a multidisciplinary team. The complex approach consisted of treating the underlying infection, multiple types of soft-tissue management, and stopping enoxaparin.
- Isolated traumatic posterior dislocation of the radial head in an adult, a rare injury: New case reportPublication . Fonte, Hélder; Rodrigues, Cláudia; Vale, João; Ramos, Joaquim; Costa e Castro, JoséIsolated radial head dislocations are rare in adults with only 23 cases published in 45 years. The diagnosis may be easily missed on radiographs and a CT-scan is often required. If managed promptly patient can restore normal range of motion and elbow function. Authors report a new case of a 67-year-old female presenting a posttraumatic isolated posterior dislocation of the radial head. Treatment consisted of closed reduction followed by immobilization for four weeks in a plaster cast with the elbow flexed at 90°, followed by active mobilization and physiotherapy. At 18 months of follow-up, functional outcome is excellent with no differences between both sides.
- Comparative clinical and radiologic evaluation between patients undergoing standard reversed shoulder arthroplasty or bony increased offsetPublication . Amorim-Barbosa, Tiago; Ribau, Ana; Fonte, Hélder; Henrique Barros, Luís; Claro, RuiBackground: Modifications of the medialized design of Grammont-type reverse shoulder arthroplasty (RSA) using a bony increased offset (BIO-RSA) has shown better clinical results and fewer complications. The aim of this study is to compare the clinical results, complications, and radiological outcomes between patients undergoing standard RSA and BIO-RSA. Methods: A retrospective review was performed of 42 RSA procedures (22 standard RSA and 20 BIO-RSA). With a minimum of 1 year of follow-up, range of motion (ROM), Constant shoulder score (CSS), visual analog scale (VAS), and subjective shoulder score (SSS) were compared. Radiographs and computed tomography (CT) scan were examined for scapular notching, glenoid and humeral fixation, and graft healing. Results: At a mean follow-up of 27.6 months (range, 12-48 months), a significant difference was found for active-internal rotation (P=0.038) and for passive-external rotation (P=0.013), with better results in BIO-RSA. No other differences were found in ROM, CSS (P=0.884), VAS score, and SSS. Graft healing and viability were verified in all patients with CT scan (n=34). The notching rate was 28% in the standard RSA group and 33% in the BIO-RSA group, but the standard RSA had more severe notching (grade 2) than BIO-RSA (P=0.039). No other significative differences were found in glenoid and humeral fixation. Conclusions: Bone-graft lateralization is associated with better internal and external rotation and with less severe scapular notching compared to the standard RSA. Integration of the bone graft occurs effectively, with no relevant changes observed on radiographic evaluation.