Introduction: Two-stage revision is the gold standard for chronic periprosthetic joint infection (PJI). The removal of well-fixed implants, especially the femoral component, can be extremely difficult and additional osteotomies may be needed, which is time-consuming and results in bone stock loss. When the femoral stem is osseointegrated, there is no clear indication for the use of partial two-stage revision. The primary objective was to assess infection eradication after surgery. Methods: Retrospective study of specific case series. A total of eight patients with a chronic uncemented PJI, in the setting of complex revision surgeries, were treated with partial two-stage revision, which included selective retention of the well-fixed femoral component and complete acetabular removal. Stem retention was carried out regardless of the bacteria or associated comorbidities. Results: All patients were re-revision cases with at least two previous surgeries (range, 2–4). Complex revisions were performed in five cases (non-articulated spacer) and simple revisions in three cases (articulated spacer). The minimum follow-up time was 24 months (range, 24–132 months). The infection eradication rate at final follow-up was 100%. Conclusion: Partial two-stage reconstruction is a promising technique for the treatment of chronic PJI in patients with a well-fixed stem and complex re-revision acetabular procedures. Further prospective studies and prolonged follow-ups are required to confirm our results.

Background: The objective of this study is to detail the terminal distribution of the peroneal artery, which may be at risk in a number of surgical procedures. Five per cent of the population presents with a dominant peroneal artery (arteria peronea magna), which is responsible for the entire foot vascularization. Methods: Anatomic dissection of 54 specimens from 44 cadaveric donors was performed. Twenty belonged to women and 24 to men, whereas 10 lacked traceability data. Mean age of the donors was 75.01 ± 16.14 (range 38-101) years. Ten donors had bilateral extremities. Results: Six types on the terminal distribution of the peroneal artery were identified: type 1 (40.7%), terminal division into anterior perforating branch and posterior peroneal artery (bifurcation); type 2 (14.8%), proximal anterior perforating branch, distal bifurcation; type 3A (18.5%), terminal trifurcation into anastomosis, anterior perforating branch and posterior peroneal artery; type 3B (5.6%), terminal trifurcation where the anastomotic branch bows to join both posterior peroneal and posterior tibial arteries; type 3C (13%), proximal anterior perforating branch, distal trifurcation; type 3D (3.7%), proximal anterior perforating and anastomotic branches, distal trifurcation. Two specimens (3.7%) were nonclassifiable. The mean distance to the most distal anterior perforating branch was 69.37 ± 22.09 mm (from 35.69 to 146.40), whereas the mean diameter was 2.35 ± 0.71 mm (range 0.91-4.24). The most distal anastomosis branched off at 64.80 ± 21.49 mm (from 49.52 to 99.93). Horizontal distances from the fibula to the peroneal artery were, at 5 cm, 0.83 ± 1.21 mm (0-5.76); at 10 cm, 1.24 ± 1.16 mm (range 0-4.96); and at 15 cm, 1.63 ± 1.34 mm (0-5.2). No differences were found for side or gender. Three dominant peroneal arteries were found (5.56%), with a mean diameter of 3.78 ± 0.88 mm. These findings provide the most detailed classification to date and support incorporating peroneal artery mapping into preoperative planning for high-risk procedures. Conclusion: Narrow proximity to the fibula, variation in branching, and dominance patterns suggest that identifying the peroneal vascular bundle intraoperatively is critical to avoid vascular complications. When performing posterior approaches to the ankle, it may be helpful to identify the peroneal vascular bundle and perform the necessary dissections and implant placement as distal as possible to avoid its injury. Clinical Relevance: Understanding the anatomy of the peroneal artery, its branches and anatomical variations, with special mention of the dominant peroneal artery (arteria peronea magna), may help to avoid iatrogenic injury to the peroneal vascular bundle during the varied and increasing number of foot and ankle surgical procedures performed, such as posterior open reduction internal fixation of ankle fractures, ankle arthrodesis, or ankle arthroscopy.

O planejamento pré-operatório (PP) é fundamental para garantir um resultado bem-sucedido na cirurgia de trauma ortopédico. Desde que foi descrita pela primeira vez há trinta anos, não foram feitas modificações na técnica de planejamento pré-operatório original (PPO), que foi escrita à mão usando caneta e papel. Acreditamos que o uso de um software de apresentação (como o Microsoft PowerPoint, Microsoft Corp., Redmond, WA, EUA) pode facilitar, melhorar e atualizar o PPO e complementar o PP tridimensional. O objetivo deste artigo é apresentar nosso método de PP por meio de software de apresentação (SA). Alejandro Ordas-Bayon, David Cabrera, Karl Logan e Rodrigo Pesántez certificam que não têm conflito financeiro de interesses (por exemplo, consultorias, propriedade de ações, participação acionária, acordos de patente/licenciamento etc.) em relação a este artigo. ^* Trabalho desenvolvido no Departamento de Trauma e Cirurgia Ortopédica, Fundación Santa Fe, Bogotá, Colômbia. Received: 28 April 2020 Accepted: 16 September 2020 Publication Date: 15 April 2021 (online) © 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Resumo: Objetivos As fraturas do colo femoral em pacientes com mieloma múltiplo são geralmente tratadas com hemiartroplastia ou artroplastia total do quadril de acordo com a presença de infiltração acetabular. Devido à escassez de relatos nesta área, o objetivo deste estudo é revisar os desfechos clínicos da hemiartroplastia do quadril em pacientes com mieloma múltiplo e os resultados e a sobrevida neste subconjunto de pacientes. Métodos Um total de 15 pacientes (16 casos), com idade média de 71,7 anos e portadores de mieloma, foram submetidos à hemiartroplastia de quadril para tratamento de fraturas de colo femoral com luxação. Suas radiografias e dados clínicos foram avaliados. Destes casos, 13 passaram pela hemiartroplastia bipolar e três pela unipolar. Resultados Após um acompanhamento médio de 18,2 meses desde o momento da cirurgia, 3 casos sofreram fraturas periprotéticas (18,75%), 4 casos (25%) tiveram ossificação heterotópica e 1 caso (6,25%) apresentou erosão acetabular. A mortalidade dos pacientes em 1 e 5 anos foi de 53,3 e 73,3%, respectivamente. Conclusão A hemiartroplastia de quadril ainda é uma opção terapêutica viável em pacientes com mieloma. No entanto, a morbidade e a mortalidade podem ser altas nesses pacientes e devem ser compreendidas com sensatez antes da cirurgia para atingir bons resultados.