Revista Brasileira de Ortopedia (English Edition)最新文献

Objective

This study sought to analyze the relationship between the components and aggravations of body composition (obesity, sarcopenia, and sarcopenic obesity) and bone mineral density in elderly subjects aged ≥80 years.

Methods

A cross-sectional study design was utilized to assess 128 subjects aged between 80 and 95 years. Body composition and bone mineral density were measured by dual energy X-ray absorptiometry. Gait speed was assessment by walking test. The statistical analyses included Spearman's correlation, one-way analysis of variance, the chi-squared test, and binary logistic regression analysis.

Results

The elderly subjects with sarcopenia had lower bone mineral density compared to the obesity group, with higher risk for presence of osteopenia/osteoporosis in the spine (OR: 2.81; CI: 1.11–7.11) and femur (OR: 2.75; CI: 1.02–7.44). Obesity was shown to be a protective factor for osteopenia/osteoporosis in the spine (OR: 0.43; CI: 0.20–0.93) and femur (OR: 0.27; CI: 0.12–0.62).

Conclusion

It was found that lean mass is more directly related to bone mineral density (total, femur, and spine) and sarcopenia is associated with osteopenia/osteoporosis. Obesity represents a possible protective factor for osteopenia/osteoporosis in elderly subjects aged 80 years and over.

Objective

This study aimed to investigate drain use in a controlled population of patients with hip osteoarthritis undergoing primary total hip arthroplasty.

Methods

This prospective controlled trial evaluated 93 patients randomized into two groups: a group that received drains and a group that did not. The patients who were randomized to the drain group used a 3.2 mm drain placed under the fascia that was kept in place for 24 h. Postoperative evaluations were performed after 24 h and then three, six, and 12 weeks after total hip arthroplasty. The primary outcome was perioperative blood loss in both groups 24 h after total hip arthroplasty. The other parameters that were evaluated included mid-thigh circumference, the rate of blood transfusion, hematocrit, inflammatory serum levels, and the Harris Hip Score.

Results

The clinical and laboratory data revealed no differences between the study groups with respect to blood loss and need for blood transfusion, duration of hospital stay, reoperation rate, complications, inflammatory serum markers, and the Harris Hip Score. Patients without closed suction drainage reported higher pain levels after 24 h (VAS score 1 vs. 2, p < 0.01).

Conclusion

Similar clinical and laboratory outcomes were found in both cohorts.

Objective

To translate and adapt culturally to Brazilian Portuguese the Forgotten Joint Score (FJS) patient-reported outcome questionnaire.

Methods

Forty-five patients in the postoperative period (3–12 months) of total knee and hip arthroplasty were asked to answer the Br FJS questionnaire, translated into Portuguese based on the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Results

Twenty-three patients completed the questionnaire correctly, suggesting changes when pertinent. In the first round of answers, it was observed that 20% had difficulty in understanding the expression “joint awareness.” In further harmonization of the questionnaire, it was decided to change the term “awareness” for “remember.” After this change no difficulty was observed in understanding for more than 85% of patients.

Conclusion

The FJS questionnaire was translated and culturally adapted to Brazilian Portuguese. Additional studies are underway to compare the reproducibility and validity of the Brazilian translation to other questionnaires already established for the same outcome.

Tibiofemoral unilateral knee dislocations are uncommon, making bilateral dislocations even rarer injuries. Knee dislocation is considered one of the most serious injuries that can affect this joint. Associated complications such as popliteal artery injury are responsible for the important morbidity in these patients. The authors report the case of a 52-year-old man with a traumatic bilateral knee dislocation with associated bilateral popliteal arterial injury. His clinical presentation along with radiographic and angiographic findings are described. Surgical and non-surgical treatment and functional outcomes are also reported.

Objective

The objective of this study is to analyze the surgical results of humeral shaft fracture treatment and describe its epidemiology.

Methods

Retrospective study that identified all patients treated with surgical fixation of humeral shaft fractures between December of 2014 and June of 2016 in a trauma reference center. All medical records were reviewed in search of epidemiological data referent to the trauma and post-operative results, including radiographic healing of the fracture and related complications.

Results

Fifty-one patients were included, mostly male (78.4%), with an average age of 35.02 years. The most common trauma mechanism was a traffic accident (56.9%) followed by same-level falls (17.6%). No statistically significant difference was found between healing time comparing surgical fixation techniques, including open reduction and internal fixation, minimally invasive technique, intramedullary nailing, and external fixation.

Conclusion

Although each technique has inherent advantages and disadvantages, all fixation methods proved to be adequate options for the surgical treatment of humeral shaft fractures with high rates of healing and low rates of post-operative complications.

Objective

To evaluate the usefulness of an application when planning total knee arthroplasties (TKA), besides the accuracy when measuring the anatomical-mechanical femoral angle (AMFA), comparing, also, the time spent during planning a TKA manually and by using the application.

Methods

An interdisciplinary team involving health and computer science areas established activities in order to develop the application. After development, 24 physicians underwent an application usability test. Each one planned a primary total knee arthroplasty (TKA) initially, in a conventional manner and then by using the application. Data concerning AMFA measurement and time spent during planning were collected, in both manners. The Mann–Whitney and Wilcoxon tests were used to evaluate statistical significance related to angle and time.

Results

Users considered it important checking AMFA and drawing the bone cut lines orthogonal to the mechanical axis, when planning TKAs. They also assessed that the application could be useful for training surgeons and for specialists. There was no statistically significant difference between the AMFA, as measured by the application and by the conventional manner. The planning time was shorter when the application was used (39% of the time spent manually).

Conclusions

The application has proved to be useful in planning TKAs and has revealed accuracy when measuring the AMFA when it was compared to the manual form of preoperative planning. The application was able to reduce planning time by more than half and it demonstrated reliability in measuring the AMFA.

Objective

Compare the maximal isokinetic muscle strength of knee extensor and flexor muscles between patients with knee osteoarthritis and patients submitted to total knee arthroplasty.

Methods

Volunteers were divided into five groups (n = 20): Control; Ahlbäck I and II; Ahlbäck IV; six months after total knee arthroplasty; 12 months after total knee arthroplasty. An isokinetic knee strength evaluation was conducted for the quadriceps and hamstrings at 60°/s.

Results

Significant differences in the peak torque of the quadriceps and hamstrings were found among the groups (p < 0.001). The Ahlbäck IV, six-month, and 12-month postoperative groups demonstrated lower values when compared to the Control and Ahlbäck I and II groups. When percentage values were compared to the Control group, mean differences ranged from 7% to 41%.

Conclusion

Patients with healthy knees or early stage osteoarthritis have higher quadriceps and hamstrings strengths than those with a more advanced stage of the disease, even after knee replacement. These findings suggest that the traditional rehabilitation programs do not recover strength to levels observed in individuals without knee osteoarthritis.

Objective

This study is aimed at determining, through a cross-sectional study, the preferred therapeutic method in Brazil considering the approach to Gartland type II and III supracondylar humerus fractures during childhood.

Methods

The research project was approved by the Research Ethics Committee of Plataforma Brasil and the material was collected during the 46th Brazilian Orthopedics and Traumatology Congress. A questionnaire was developed to analyze two clinical scenarios about Gartland type II and III fractures.

Results

The sample consisted of 301 questionnaires obtained from 5500 participants of the Congress who met the inclusion and non-inclusion criteria. In case 1, the following was observed: 140 (46.5%) of physicians opted for closed reduction with immobilization and 116 (38.5%) selected closed reduction and osteosynthesis, of whom 82 (70.7%) preferred two crossed Kirschner wires. In case 2, 294 (97.7%) considered that the treatment is urgent, and 225 (74.8%) of the interviewed orthopedists answered that they perform osteosynthesis with two crossed Kirschner wires.

Conclusions

The opinion of orthopedic surgeons in Brazil varies for Gartland type II fractures. Type III fractures have a uniform conduct and they are treated urgently (97.7%). When osteosynthesis is necessary, it was observed that 82 (70.7%) and 225 (74.8%) of the interviewed surgeons opted for fixation with two crossed Kirschner wires.

Objective

To present the indications, technical aspects, and initial results of the first cases using Endo-Model™ implants in Brazil.

Methods

A prospective study was conducted. It included nine patients submitted to a total knee arthroplasty, of which six were primary and three were revisions, using exclusively the Endo-Model™ implant. These patients were followed for an average of 12 months and evaluated with functional scores, such as the Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), and visual analog pain scale (VAS).

Results

There were statistically significant improvements in all scores evaluated in every patient. Only one complication occurred postoperatively (apraxia of the peroneal nerve) and did not require surgery revision.

Conclusion

The use of a rotating-hinge implant for knee arthroplasty is a new option for complex cases with severe instability in Brazil; the initial results are satisfactory.

Objectives

To measure the quality of life and clinical outcomes of patients treated with interosseous membrane (IOM) ligament reconstruction of the forearm, using the brachioradialis (BR), and describe a new surgical technique for the treatment of joint instability of the distal radioulnar joint (DRUJ).

Methods

From January 2013 to September 2016, 24 patients with longitudinal injury of the distal radioulnar joint DRUJ were submitted to surgical treatment with a reconstruction procedure of the distal portion of the interosseous membrane or distal oblique band (DOB). The clinical-functional and radiographic parameters were analyzed and complications and time of return to work were described.

Results

The follow-up time was 20 months (6–36). The ROM averaged 167.92° (93.29% of the normal side). VAS was 2/10 (1–6). DASH was 5.63/100 (1–18). The time to return to work was 7.37 months (3–12). As to complications, one patient had an unstable DRUJ, and was submitted to a new reconstruction by the Brian-Adams technique months. Currently, he has evolved with improved function, and has returned to his professional activities. Three other patients developed problems around the transverse K-wire and were treated with its removal, all of whom are doing well.

Conclusion

The new approach presented in this study is safe and effective in the treatment of longitudinal instability of the DRUJ, since it has low rate of complications, as well as satisfactory radiographic, clinical, and functional results. It allows return to social and professional activities, and increases the quality of life of these patients.